Assessment of Saxagliptin Efficacy: Meta-Analysis of 14 Phase 2 and 3 Clinical Trials

INTRODUCTION: This meta-analysis of data from 14 phase 2 and 3, double-blind, randomized, controlled 12- and 24-week studies (N = 4632) summarizes saxagliptin efficacy in patients with type 2 diabetes (T2D) across treatment regimens. METHODS: Patients received saxagliptin 5 mg/d or control as either monotherapy (n = 1196 vs placebo), add-on therapy (n = 2139 vs placebo and n = 514 vs uptitrated sulfonylurea), or initial combination therapy (n = 619 vs control monotherapy). Patients with renal impairment received saxagliptin 2.5 mg/d or placebo (n = 164). RESULTS: Mean baseline glycated hemoglobin (A1C) ranged from 8.07% to 9.43% for the saxagliptin and control groups across treatment regimens. A1C reduction from baseline was greater with saxagliptin versus control for all studies combined (mean treatment difference [95% CI]: –0.55% [–0.63%, –0.47%]) and when used as monotherapy (–0.52% [–0.63, –0.40%]), add-on (–0.55% [–0.69%, –0.40%] vs placebo; –0.72% [–0.88%, –0.56%] vs uptitrated sulfonylurea), initial combination therapy (–0.54% [–0.73%, –0.35%] vs control monotherapy), and in patients with renal impairment (–0.42% [–0.75%, –0.09%]). Similar reductions in A1C versus control were noted for patients <65 years (–0.55% [–0.67%, –0.43%]) and ≥65 years (–0.54% [–0.69%, –0.38%]) and for men (–0.54% [–0.69%, –0.40%]) and women (–0.55% [–0.64%, –0.47%]) across treatment regimens. More patients achieved A1C <7% (39% vs 23%) and A1C ≤6.5% (24% vs 14%) with saxagliptin than with placebo or active-control treatment. Saxagliptin versus control was associated with a reduction in glucagon area under the curve (AUC) from baseline and increases in insulin AUC, C-peptide AUC, and the homeostasis model assessment of β-cell function. CONCLUSION: Results of this meta-analysis demonstrate the consistency of saxagliptin efficacy in different subgroups of patients with T2D across treatment regimens. FUNDING: AstraZeneca. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s13300-017-0261-8) contains supplementary material, which is available to authorized users.