Efficacy and Safety of LixiLan, a Titratable Fixed-Ratio Combination of Insulin Glargine Plus Lixisenatide in Type 2 Diabetes Inadequately Controlled on Basal Insulin and Metformin: The LixiLan-L Randomized Trial

Sep 22, 2016Diabetes care

Effectiveness and Safety of a Adjustable Insulin and Lixisenatide Combination for Type 2 Diabetes Not Controlled by Basal Insulin and Metformin

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Abstract

HbA1c decreased by 1.1% in patients treated with iGlarLixi compared to a 0.6% decrease with iGlar.

iGlarLixi led to a mean final HbA1c of 6.9% (52 mmol/mol), while iGlar reached 7.5% (58 mmol/mol).
55% of patients treated with iGlarLixi achieved HbA1c levels below 7.0% (53 mmol/mol) compared to 30% with iGlar.
Mean body weight decreased by 0.7 kg in the iGlarLixi group, while it increased by 0.7 kg in the iGlar group, resulting in a 1.4 kg difference.
The incidence of documented symptomatic hypoglycemia (≤70 mg/dL) was similar between the two treatment groups.
Mild gastrointestinal side effects were slightly more common with iGlarLixi but overall were very low.

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OBJECTIVE: This study was conducted to demonstrate the efficacy and safety of LixiLan (iGlarLixi), a novel, titratable, fixed-ratio combination of insulin glargine (iGlar) (100 units) and lixisenatide, compared with iGlar in patients with type 2 diabetes inadequately controlled on basal insulin with or without up to two oral glucose-lowering agents.

RESEARCH DESIGN AND METHODS: After a 6-week run-in when iGlar was introduced and/or further titrated, and oral antidiabetic drugs other than metformin were stopped, 736 basal insulin-treated patients (mean diabetes duration 12 years, BMI 31 kg/m) were randomized 1:1 to open-label, once-daily iGlarLixi or iGlar, both titrated to fasting plasma glucose <100 mg/dL (<5.6 mmol/L) up to a maximum dose of 60 units/day. The primary outcome was change in HbAlevels at 30 weeks. 2 1c

RESULTS: HbAdecreased from 8.5% (69 mmol/mol) to 8.1% (65 mmol/mol) during the run-in period. After randomization, iGlarLixi showed greater reductions in HbAfrom baseline compared with iGlar (-1.1% vs. -0.6%, P < 0.0001), reaching a mean final HbAof 6.9% (52 mmol/mol) compared with 7.5% (58 mmol/mol) for iGlar. HbA<7.0% (53 mmol/mol) was achieved in 55% of iGlarLixi patients compared with 30% on iGlar. Mean body weight decreased by 0.7 kg with iGlarLixi and increased by 0.7 kg with iGlar (1.4 kg difference, P < 0.0001). Documented symptomatic hypoglycemia (≤70 mg/dL) was comparable between groups. Mild gastrointestinal adverse effects were very low but more frequent with iGlarLixi. 1c1c1c1c

CONCLUSIONS: Compared with iGlar, a substantially higher proportion of iGlarLixi-treated patients achieved glycemic targets with a beneficial effect on body weight, no additional risk of hypoglycemia, and low levels of gastrointestinal adverse effects in inadequately controlled, basal insulin-treated, long-standing type 2 diabetes.

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Efficacy and Safety of LixiLan, a Titratable Fixed-Ratio Combination of Insulin Glargine Plus Lixisenatide in Type 2 Diabetes Inadequately Controlled on Basal Insulin and Metformin: The LixiLan-L Randomized Trial

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