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      Effect of Food on the Pharmacokinetics of Ertugliflozin and Its Fixed‐Dose Combinations Ertugliflozin/Sitagliptin and Ertugliflozin/Metformin

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          Abstract

          Ertugliflozin, an inhibitor of sodium‐glucose cotransporter 2, is approved in the United States and European Union for the treatment of type 2 diabetes in adults, both as monotherapy and as part of fixed‐dose combination (FDC) therapies with either sitagliptin or immediate‐release metformin. The effect of a standard, high‐fat breakfast on the pharmacokinetics of the highest strengths of ertugliflozin monotherapy (15 mg), ertugliflozin/sitagliptin FDC (15‐/100‐mg), and ertugliflozin/metformin FDC (7.5‐/1000‐mg) tablets was evaluated. In 3 separate open‐label, 2‐period, 2‐sequence, single‐dose, crossover studies, 14 healthy subjects per study were randomized to receive either ertugliflozin monotherapy or FDC tablets comprising ertugliflozin and sitagliptin or ertugliflozin and metformin under fasted and fed (or vice versa) conditions. Food did not meaningfully affect the pharmacokinetics of ertugliflozin, sitagliptin, or metformin. For FDCs, the effect of food was consistent with that described for individual components. All treatments were well tolerated. Ertugliflozin and ertugliflozin/sitagliptin FDC tablets can be administered without regard to meals. As metformin is administered with meals because of its gastrointestinal side effects, the ertugliflozin/metformin FDC should also be administered with meals.

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          Phase III, efficacy and safety study of ertugliflozin monotherapy in people with type 2 diabetes mellitus inadequately controlled with diet and exercise alone.

          To conduct a phase III study to evaluate the efficacy and safety of ertugliflozin monotherapy in people with type 2 diabetes.
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            Renal sodium-glucose cotransporter inhibition in the management of type 2 diabetes mellitus.

            Hyperglycemia is the primary factor responsible for the microvascular, and to a lesser extent macrovascular, complications of diabetes. Despite this well-established relationship, approximately half of all type 2 diabetic patients in the US have a hemoglobin A1c (HbA1c) ≥7.0%. This is associated in part with the side effects, i.e., weight gain and hypoglycemia, of currently available antidiabetic agents and in part with the failure to utilize medications that reverse the basic pathophysiological defects present in patients with type 2 diabetes. The kidney has been shown to play a central role in the development of hyperglycemia by excessive production of glucose throughout the sleeping hours and enhanced reabsorption of filtered glucose by the renal tubules secondary to an increase in the threshold at which glucose spills into the urine. Recently, a new class of antidiabetic agents, the sodium-glucose cotransporter 2 (SGLT2) inhibitors, has been developed and approved for the treatment of patients with type 2 diabetes. In this review, we examine their mechanism of action, efficacy, safety, and place in the therapeutic armamentarium. Since the SGLT2 inhibitors have a unique mode of action that differs from all other oral and injectable antidiabetic agents, they can be used at all stages of the disease and in combination with all other antidiabetic medications.
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              Ertugliflozin and Sitagliptin Co-initiation in Patients with Type 2 Diabetes: The VERTIS SITA Randomized Study

              Introduction Ertugliflozin is an oral sodium-glucose cotransporter 2 inhibitor that is being developed to treat type 2 diabetes mellitus (T2DM). This study assessed the efficacy and safety of co-initiation of ertugliflozin and sitagliptin compared with placebo in patients with T2DM inadequately controlled on diet and exercise. Methods In this phase III, randomized, double-blind, multicenter, placebo-controlled 26-week study (NCT02226003), patients with T2DM and glycated hemoglobin (HbA1c) 8.0–10.5% on diet/exercise were randomized 1:1:1 to ertugliflozin 5 mg once daily (QD) and sitagliptin 100 mg QD (E5/S100), ertugliflozin 15 mg QD and sitagliptin 100 mg QD (E15/S100), or placebo. The primary efficacy endpoint was the change from baseline in HbA1c at week 26. Results The mean baseline HbA1c of the randomized patients (n = 291) was 8.9%. At week 26, both ertugliflozin/sitagliptin treatments provided significant reductions from baseline in HbA1c compared with placebo [least squares mean HbA1c change (95% confidence intervals) from baseline was − 0.4% (− 0.7, − 0.2), − 1.6% (− 1.8, − 1.4), and − 1.7% (− 1.9, − 1.5) for placebo, E5/S100, and E15/S100, respectively]. At week 26, 8.3%, 35.7%, and 31.3% of patients receiving placebo, E5/S100, and E15/S100, respectively, had HbA1c < 7.0%. Significant reductions in fasting plasma glucose, 2-h post-prandial glucose, body weight, and systolic blood pressure were observed with both ertugliflozin/sitagliptin groups compared with placebo. The incidence of adverse events (AEs) was similar across the groups. The incidences of the pre-specified AEs of urinary tract infection, genital mycotic infection, symptomatic hypoglycemia, and hypovolemia were low and not meaningfully different across groups. Conclusion Co-initiation of ertugliflozin with sitagliptin in patients with T2DM inadequately controlled on diet and exercise provided a clinically meaningful improvement in glycemic control over 26 weeks. Clinical Trial Registration Clinicaltrials.gov NCT02226003. Electronic supplementary material The online version of this article (10.1007/s13300-017-0358-0) contains supplementary material, which is available to authorized users.
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                Author and article information

                Contributors
                Vaishali.Sahasrabudhe@pfizer.com
                Journal
                Clin Pharmacol Drug Dev
                Clin Pharmacol Drug Dev
                10.1002/(ISSN)2160-7648
                CPDD
                Clinical Pharmacology in Drug Development
                John Wiley and Sons Inc. (Hoboken )
                2160-763X
                2160-7648
                14 November 2018
                July 2019
                : 8
                : 5 ( doiID: 10.1002/cpdd.v8.5 )
                : 619-627
                Affiliations
                [ 1 ] Pfizer Inc. Groton CT USA
                [ 2 ] Pfizer Inc. Collegeville PA USA
                [ 3 ] Pfizer Inc. Durham NC USA
                [ 4 ] Pfizer Inc. Andover MA USA
                [ 5 ] Merck & Co., Inc. Kenilworth NJ USA
                Author notes
                [*] [* ] Corresponding Author:

                Vaishali Sahasrabudhe, PhD, Pfizer Inc., 445 Eastern Point Road, Groton, CT 06340, USA

                (e‐mail: Vaishali.Sahasrabudhe@ 123456pfizer.com )

                [†]

                At the time the study was conducted.

                Article
                CPDD629
                10.1002/cpdd.629
                6618047
                30427588
                3b9f8ab3-5c57-41c6-a772-543e3c57c465
                © 2018 The Authors. Clinical Pharmacology in Drug Development Published by Wiley Periodicals, Inc. on behalf of The American College of Clinical Pharmacology

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 29 May 2018
                : 16 October 2018
                Page count
                Figures: 3, Tables: 3, Pages: 9, Words: 5539
                Funding
                Funded by: Merck Sharp & Dohme Corp.
                Funded by: Pfizer Inc.
                Funded by: Merck & Co., Inc
                Categories
                Original Manuscript
                Articles
                Custom metadata
                2.0
                cpdd629
                July 2019
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.5 mode:remove_FC converted:10.07.2019

                diabetes,ertugliflozin,pharmacokinetics,sglt2 inhibitor
                diabetes, ertugliflozin, pharmacokinetics, sglt2 inhibitor

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