A Phase 3 interventional study of Efpeglenatide (SAR439977) and Placebo in Type 2 Diabetes Mellitus, sponsored by Sanofi. Terminated at 353 sites in 28 countries. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2021-10-15.
Sponsored by Sanofi · Phase 3, Interventional, and Treatment
Primary Objective:
To demonstrate that efpeglenatide 4 and 6 mg was noninferior to placebo on 3-point major adverse cardiac events (MACE) in Type 2 diabetes mellitus (T2DM) participants at high cardiovascular (CV) risk.
Secondary Objectives:
To demonstrate that efpeglenatide 4 and 6 mg was superior to placebo in T2DM participants with high CV risk on the following parameters:
To assess the safety and tolerability of efpeglenatide 4 and 6 mg, both added to standard of care in T2DM participants at high CV risk.
The study duration per participant was up to approximately 36 months.
Exclusion criteria:
The above information was not intended to contain all considerations relevant to a participant's potential participation in a clinical trial.
Participants received placebo (matched to Efpeglenatide) as subcutaneous (SC) injection once weekly up to end of treatment.
Drug: Placebo
Participants received Efpeglenatide as SC injection 2 milligrams (mg) per week for 4 weeks then 4 mg per week up to end of treatment.
Drug: Efpeglenatide (SAR439977)
Participants received Efpeglenatide as SC injection 2 mg per week for 4 weeks, then 4 mg per week for 4 weeks and then 6 mg per week up to end of treatment.
Drug: Efpeglenatide (SAR439977)
Pharmaceutical form: Solution for injection, Route of administration: SC
Pharmaceutical form: Solution for injection Route of administration: SC
Time to First Occurrence of Major Adverse Cardiovascular Events (MACE): Event Rate Per 100 Participant-years for First Occurrence of Major Cardiovascular (CV) Event - Non-Inferiority Analysis
All MACE positively adjudicated by the clinical endpoint committee (CEC) were used in the analysis of the composite outcome of first occurrence to CV death, non-fatal myocardial infarction (MI), and non-fatal stroke. Kaplan-Meier curves of the cumulative event rate by treatment groups were used to depict the first occurrence of MACE over time. The event rate per 100 participant-years (calculated by 100\*number of participants with events/sum of time at risk (days) over all participants/365.25) measured in terms of number of events per 100 participant-years was reported.
Time frame: From Day 1 until the date of first adjudicated and confirmed occurrence of major CV event (maximum duration: up to 31.5 months)
Time to First Occurrence of Major Adverse Cardiovascular Events: Event Rate Per 100 Participant-years for First Occurrence of Major Cardiovascular Event - Superiority Analysis
All MACE positively adjudicated by the CEC were used in the analysis of the composite outcome of first occurrence to CV death, non-fatal MI, and non-fatal stroke. Kaplan-Meier curves of the cumulative event rate by treatment groups were used to depict the first occurrence of MACE over time. The event rate per 100 participant-years (calculated by 100\*number of participants with events/sum of time at risk (days) over all participants/365.25) measured in terms of number of events per 100 participant-years was reported.
Time frame: From Day 1 until the date of first adjudicated and confirmed occurrence of major CV event (maximum duration: up to 31.5 months)
Time to First Occurrence of the Expanded Major Adverse Cardiovascular Events Composite Events: Event Rate Per 100 Participant-years for First Occurrence of Expanded Major Cardiovascular Event
All MACE positively adjudicated by the CEC were used in the analysis of the expanded outcome of first occurrence to CV death (including fatal MI and fatal stroke), non-fatal MI, non-fatal stroke, coronary revascularization or hospitalization for unstable angina. Kaplan-Meier curves of the cumulative event rate by treatment groups were used to depict the first occurrence of MACE over time. The event rate per 100 participant-years (calculated by 100\*number of participants with events/sum of time at risk (days) over all participants/365.25) measured in terms of number of events per 100 participant-years was reported. Data analysis was also performed independently by external steering committee for the publication.
Time frame: From Day 1 until the date of first adjudicated and confirmed occurrence of major CV event (maximum duration: up to 31.5 months)
Time to First Occurrence of Composite Renal Endpoint: Event Rate Per 100 Participant-years for First Occurrence of Composite Renal Endpoint
Composite renal endpoint included the following: incident macroalbuminuria (defined as urinary albumin-to-creatinine ratio of greater than (\>) 300, as measured in mg of albumin to grams of creatinine, or \>33.9, as measured in mg of albumin to millimoles of creatinine), plus an increase in urinary albumin-to-creatinine ratio of at least 30% from baseline, a sustained decrease in estimated glomerular filtration rate (eGFR) of at least 40% for 30 days or more, renal-replacement therapy for 90 days or more, and a sustained eGFR of less than 15 ml per minute per 1.73 m\^2 for 30 days or more. Kaplan-Meier curves of the cumulative event rate by treatment groups were used to depict the first occurrence of renal endpoint over time. The event rate per 100 participant-years (calculated by 100\*number of participants with events/sum of time at risk (days) over all participants/365.25) measured in terms of number of events per 100 participant-years was reported.
Time frame: From Day 1 until the confirmed occurrence of composite renal endpoint (maximum duration: up to 31.5 months)
The study was conducted at 344 active sites in 28 countries. Overall, 5732 participants were screened between 27 April 2018 and 25 April 2019; of whom 4076 participants were randomized by interactive response technology (1:1:1 ratio) to receive placebo, efpeglenatide 4 milligrams (mg) or efpeglenatide 6 mg. Screen failures were mainly due to inclusion criteria not met.
| Milestone | Placebo | Efpeglenatide 4 mg | Efpeglenatide 6 mg |
|---|---|---|---|
| Started | 1359 | 1359 | 1358 |
| Randomized and treated | 1358 | 1358 | 1357 |
| Safety population | 1355 | 1360 | 1358 |
| Completed | 42 | 36 | 23 |
| Not completed | 1317 | 1323 | 1335 |
| Withdrew: Adverse event | 49 | 68 | 79 |
| Withdrew: Study terminated by sponsor | 1050 | 1063 | 1071 |
| Withdrew: Physician decision (other than adverse event) | 12 | 17 | 10 |
| Withdrew: Withdrawal by subject | 176 | 154 | 151 |
| Withdrew: Other | 29 | 20 | 23 |
| Withdrew: Randomized and not treated | 1 | 1 | 1 |
All MACE positively adjudicated by the clinical endpoint committee (CEC) were used in the analysis of the composite outcome of first occurrence to CV death, non-fatal myocardial infarction (MI), and non-fatal stroke. Kaplan-Meier curves of the cumulative event rate by treatment groups were used to depict the first occurrence of MACE over time. The event rate per 100 participant-years (calculated by 100\*number of participants with events/sum of time at risk (days) over all participants/365.25) measured in terms of number of events per 100 participant-years was reported.
| events per 100 participant-years | Efpeglenatide 4 mg+6 mg | Placebo |
|---|---|---|
| Time to First Occurrence of Major Adverse Cardiovascular Events (MACE): Event Rate Per 100 Participant-years for First Occurrence of Major Cardiovascular (CV) Event - Non-Inferiority Analysis | 3.9 (3.4 to 4.5) | 5.3 (4.4 to 6.3) |
All MACE positively adjudicated by the CEC were used in the analysis of the composite outcome of first occurrence to CV death, non-fatal MI, and non-fatal stroke. Kaplan-Meier curves of the cumulative event rate by treatment groups were used to depict the first occurrence of MACE over time. The event rate per 100 participant-years (calculated by 100\*number of participants with events/sum of time at risk (days) over all participants/365.25) measured in terms of number of events per 100 participant-years was reported.
| events per 100 participant-years | Efpeglenatide 4 mg+6 mg | Placebo |
|---|---|---|
| Time to First Occurrence of Major Adverse Cardiovascular Events: Event Rate Per 100 Participant-years for First Occurrence of Major Cardiovascular Event - Superiority Analysis | 3.9 (3.4 to 4.5) | 5.3 (4.4 to 6.3) |
All MACE positively adjudicated by the CEC were used in the analysis of the expanded outcome of first occurrence to CV death (including fatal MI and fatal stroke), non-fatal MI, non-fatal stroke, coronary revascularization or hospitalization for unstable angina. Kaplan-Meier curves of the cumulative event rate by treatment groups were used to depict the first occurrence of MACE over time. The event rate per 100 participant-years (calculated by 100\*number of participants with events/sum of time at risk (days) over all participants/365.25) measured in terms of number of events per 100 participant-years was reported. Data analysis was also performed independently by external steering committee for the publication.
| events per 100 participant-years | Efpeglenatide 4 mg+6 mg | Placebo |
|---|---|---|
| Time to First Occurrence of the Expanded Major Adverse Cardiovascular Events Composite Events: Event Rate Per 100 Participant-years for First Occurrence of Expanded Major Cardiovascular Event | 5.4 | 6.8 |
Composite renal endpoint included the following: incident macroalbuminuria (defined as urinary albumin-to-creatinine ratio of greater than (\>) 300, as measured in mg of albumin to grams of creatinine, or \>33.9, as measured in mg of albumin to millimoles of creatinine), plus an increase in urinary albumin-to-creatinine ratio of at least 30% from baseline, a sustained decrease in estimated glomerular filtration rate (eGFR) of at least 40% for 30 days or more, renal-replacement therapy for 90 days or more, and a sustained eGFR of less than 15 ml per minute per 1.73 m\^2 for 30 days or more. Kaplan-Meier curves of the cumulative event rate by treatment groups were used to depict the first occurrence of renal endpoint over time. The event rate per 100 participant-years (calculated by 100\*number of participants with events/sum of time at risk (days) over all participants/365.25) measured in terms of number of events per 100 participant-years was reported.
| events per 100 participant-years | Efpeglenatide 4 mg+6 mg | Placebo |
|---|---|---|
| Time to First Occurrence of Composite Renal Endpoint: Event Rate Per 100 Participant-years for First Occurrence of Composite Renal Endpoint | 7.7 (6.9 to 8.6) | 11.6 (10.2 to 13.1) |
Collected over From time of first injection of investigational medicinal product (IMP) to the last injection of IMP + 30 days (i.e., up to maximum duration of 31.5 months).. Non-serious events are listed at a 5% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Placebo | 49/1,355 (3.6%) | 298/1,355 (22%) | 151/1,355 (11.1%) |
| Efpeglenatide 4 mg | 40/1,360 (2.9%) | 312/1,360 (22.9%) | 348/1,360 (25.6%) |
| Efpeglenatide 6 mg | 25/1,358 (1.8%) | 275/1,358 (20.3%) | 342/1,358 (25.2%) |
| Event | Placebo | Efpeglenatide 4 mg | Efpeglenatide 6 mg |
|---|---|---|---|
| Angina UnstableCardiac disorders | 23/1355 | 20/1360 | 10/1358 |
| Angina PectorisCardiac disorders | 10/1355 | 8/1360 | 17/1358 |
| PneumoniaInfections and infestations | 15/1355 | 14/1360 | 9/1358 |
| Atrial FibrillationCardiac disorders | 12/1355 | 15/1360 | 12/1358 |
| Coronary Artery DiseaseCardiac disorders | 10/1355 | 14/1360 | 5/1358 |
| Cardiac FailureCardiac disorders | 12/1355 | 4/1360 | 1/1358 |
| Acute Kidney InjuryRenal and urinary disorders | 9/1355 | 10/1360 | 10/1358 |
| Peripheral Arterial Occlusive DiseaseVascular disorders | 8/1355 | 7/1360 | 10/1358 |
| Myocardial InfarctionCardiac disorders | 9/1355 | 4/1360 | 6/1358 |
| SepsisInfections and infestations | 9/1355 | 4/1360 | 4/1358 |
| Event | Placebo | Efpeglenatide 4 mg | Efpeglenatide 6 mg |
|---|---|---|---|
| NauseaGastrointestinal disorders | 51/1355 | 196/1360 | 167/1358 |
| DiarrhoeaGastrointestinal disorders | 64/1355 | 116/1360 | 117/1358 |
| VomitingGastrointestinal disorders | 18/1355 | 85/1360 | 75/1358 |
| Decreased AppetiteMetabolism and nutrition disorders | 15/1355 | 68/1360 | 77/1358 |
| HypoglycaemiaMetabolism and nutrition disorders | 37/1355 | 73/1360 | 53/1358 |
Analysis was performed on Intent-to-treat (ITT) population that included all randomized participants irrespective of compliance with the study protocol and procedures and were analyzed in the treatment group to which they were randomized.
| Age, Continuous(years) | Placebo | Efpeglenatide 4 mg | Efpeglenatide 6 mg | Total |
|---|---|---|---|---|
| Mean | 64.4 ± 8.3 | 64.6 ± 8.2 | 64.7 ± 8.2 | 64.5 ± 8.2 |
| Sex: Female, Male(Participants) | Placebo | Efpeglenatide 4 mg | Efpeglenatide 6 mg | Total |
|---|---|---|---|---|
| Female | 419 | 442 | 483 | 1344 |
| Male | 940 | 917 | 875 | 2732 |
| Race (NIH/OMB)(Participants) | Placebo | Efpeglenatide 4 mg | Efpeglenatide 6 mg | Total |
|---|---|---|---|---|
| American Indian or Alaska Native | 11 | 8 | 8 | 27 |
| Asian | 98 | 87 | 82 | 267 |
| Native Hawaiian or Other Pacific Islander | 0 | 1 | 2 | 3 |
| Black or African American | 50 | 38 | 55 | 143 |
| White | 1162 | 1192 | 1180 | 3534 |
| More than one race | 4 | 9 | 5 | 18 |
| Unknown or Not Reported | 34 | 24 | 26 | 84 |
| Body Mass Index (BMI)(kilogram meter per square (kg/m^2)) | Placebo | Efpeglenatide 4 mg | Efpeglenatide 6 mg | Total |
|---|---|---|---|---|
| Mean | 32.40 ± 6.01 | 32.81 ± 6.22 | 32.90 ± 6.21 | 32.70 ± 6.15 |
Showing the first 100 of 353 sites across 28 countries.
Documents are hosted by the registry — open the source record to download them.
Plan to share: No — No plan to share individual participant data (IPD) by Sanofi: product rights transferred to Hanmi pharmaceutical.
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