Efficacy, safety and tolerability of imeglimin in patients with type 2 diabetes mellitus: A meta‐analysis of randomized controlled trials

AIMS/INTRODUCTION: This meta‐analysis aimed to evaluate the efficacy and safety/tolerability of imeglimin, a novel oral antihyperglycemic agent, administered as monotherapy and adjunctive therapy in patients with type 2 diabetes mellitus. MATERIALS AND METHODS: Parallel‐group randomized controlled trials comparing imeglimin with placebo in adults with type 2 diabetes mellitus were included. Risk ratios or weighted mean differences (WMD) and 95% confidence intervals (CIs) were calculated using random effects models. The primary outcome for efficacy was the change in glycated hemoglobin (HbA1c). Secondary outcomes included other efficacy‐related outcomes, specific adverse events, and changes in body weight and lipid parameters. RESULTS: Nine randomized controlled trials (n = 1,655) were included. When analyzed by dose, there was a significant difference in glycated hemoglobin (%) between imeglimin monotherapy and placebo at doses >1,000 mg twice daily (1,000 mg: studies N = 3, patients n = 517, WMD = −0.714, P < 0.001; 1,500 mg: N = 5, n = 448, WMD = −0.531, P = 0.020; 2,000 mg: N = 1, n = 149, WMD = −0.450, P = 0.005). Imeglimin adjunctive therapy significantly improved glycated hemoglobin over placebo at doses of 1,000 mg (N = 1, n = 214, WMD = −0.600, P < 0.001) and 1,500 mg (N = 2, n = 324, WMD = −0.576, P < 0.001). Subgroup analysis of the primary outcome showed that imeglimin was effective regardless of chronic kidney disease category, with studies carried out in Japan and in patients with lower body mass index showing a trend toward improved imeglimin efficacy. There were no significant differences between imeglimin and placebo in the risk of all‐cause discontinuation and the proportion of patients who presented with at least one adverse event. CONCLUSIONS: Imeglimin is efficacious, safe, and well tolerated as monotherapy and adjunctive therapy.