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      Efficacy and Safety of Ertugliflozin in Patients with Overweight and Obesity with Type 2 Diabetes Mellitus

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          Abstract

          Objective

          This study aimed to evaluate ertugliflozin in patients with overweight and obesity with type 2 diabetes mellitus.

          Methods

          Data from three placebo‐controlled, randomized, Phase 3 studies were pooled. Patients with baseline BMI ≥ 25 (1,377/1,544; 89%) were assessed with a stratification by BMI subgroup.

          Results

          At week 26, reductions from baseline in glycated hemoglobin A1c (HbA1c), fasting plasma glucose, body weight (BW), and systolic blood pressure (SBP) were greater with ertugliflozin versus placebo. For placebo, ertugliflozin 5 mg, and ertugliflozin 15 mg, respectively, least squares mean change was 0.1%, −0.8%, and −0.9% for HbA1c and −1.2 kg, −3.1 kg, and −3.2 kg for BW. HbA1c reductions were consistent across BMI subgroups. For ertugliflozin 5 mg and 15 mg, least squares mean change (placebo adjusted) in absolute BW was −1.4 kg and −1.2 kg for BMI 25 to < 30, −1.8 kg and −1.9 kg for BMI 30 to < 35, and −2.5 kg and −2.9 kg for BMI ≥ 35. Percent BW changes were similar across BMI subgroups. Incidence of adverse events was 52.5%, 44.6%, and 50.1% with placebo, ertugliflozin 5 mg, and ertugliflozin 15 mg, respectively.

          Conclusions

          Meaningful reductions in HbA1c, fasting plasma glucose, BW, and SBP were observed with ertugliflozin in patients with overweight and obesity with type 2 diabetes mellitus. Ertugliflozin improved HbA1c and SBP and reduced BW across BMI subgroups. Ertugliflozin was generally well tolerated.

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          Most cited references26

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          Sodium Glucose Cotransporter 2 Inhibitors in the Treatment of Diabetes Mellitus: Cardiovascular and Kidney Effects, Potential Mechanisms, and Clinical Applications.

          Sodium-glucose cotransporter-2 (SGLT2) inhibitors, including empagliflozin, dapagliflozin, and canagliflozin, are now widely approved antihyperglycemic therapies. Because of their unique glycosuric mechanism, SGLT2 inhibitors also reduce weight. Perhaps more important are the osmotic diuretic and natriuretic effects contributing to plasma volume contraction, and decreases in systolic and diastolic blood pressures by 4 to 6 and 1 to 2 mm Hg, respectively, which may underlie cardiovascular and kidney benefits. SGLT2 inhibition also is associated with an acute, dose-dependent reduction in estimated glomerular filtration rate by ≈5 mL·min(-1)·1.73 m(-2) and ≈30% to 40% reduction in albuminuria. These effects mirror preclinical observations suggesting that proximal tubular natriuresis activates renal tubuloglomerular feedback through increased macula densa sodium and chloride delivery, leading to afferent vasoconstriction. On the basis of reduced glomerular filtration, glycosuric and weight loss effects are attenuated in patients with chronic kidney disease (estimated glomerular filtration rate 30% reductions in cardiovascular mortality, overall mortality, and heart failure hospitalizations associated with empagliflozin, even though, by design, the hemoglobin A1c difference between the randomized groups was marginal. Aside from an increased risk of mycotic genital infections, empagliflozin-treated patients had fewer serious adverse events, including a lower risk of acute kidney injury. In light of the EMPA-REG OUTCOME results, some diabetes clinical practice guidelines now recommend that SGLT2 inhibitors with proven cardiovascular benefit be prioritized in patients with type 2 diabetes mellitus who have not achieved glycemic targets and who have prevalent atherosclerotic cardiovascular disease. With additional cardiorenal protection trials underway, sodium-related physiological effects of SGLT2 inhibitors and clinical correlates of natriuresis, such as the impact on blood pressure, heart failure, kidney protection, and mortality, will be a major management focus.
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            Efficacy and safety of sodium-glucose co-transporter-2 inhibitors in type 2 diabetes mellitus: systematic review and network meta-analysis

            To assess the comparative efficacy and safety of sodium-glucose co-transporter-2 (SGLT2) inhibitors in adults with type 2 diabetes.
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              Comparative analysis of two rates.

              In this paper, we examine comparative analysis of rates with a view to each of the usual comparative parameters-rate difference (RD), rate ratio (RR) and odds ratio (OR)-and with particular reference to first principles. For RD and RR we show the prevailing statistical practices to be rather poor. We stress the need for restricted estimation of variance in the chi-square function underlying interval estimation (and also point estimation and hypothesis testing). For RR analysis we propose a chi-square formulation analogous to that for RD and, thus, one which obviates the present practice of log transformation and its associated use of Taylor series approximation of the variance. As for OR analysis, we emphasize that the chi-square function, introduced by Cornfield for unstratified data, and extended by Gart to the case of stratified analysis, is based on the efficient score and thus embodies its optimality properties. We provide simulation results to evince the better performance of the proposed (parameter-constrained) procedures over the traditional ones.
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                Author and article information

                Contributors
                steven.g.terra@pfizer.com
                Journal
                Obesity (Silver Spring)
                Obesity (Silver Spring)
                10.1002/(ISSN)1930-739X
                OBY
                Obesity (Silver Spring, Md.)
                John Wiley and Sons Inc. (Hoboken )
                1930-7381
                1930-739X
                23 March 2020
                April 2020
                : 28
                : 4 ( doiID: 10.1002/oby.v28.4 )
                : 724-732
                Affiliations
                [ 1 ] Pennington Biomedical Research Center LSU System Baton Rouge Louisiana USA
                [ 2 ] Merck & Co., Inc. Kenilworth New Jersey USA
                [ 3 ] Pfizer Pharma GmbH Berlin Germany
                [ 4 ] Pfizer Inc. Andover Massachusetts USA
                Author notes
                [*] [* ] Correspondence: Steven G. Terra ( steven.g.terra@ 123456pfizer.com )

                Author information
                https://orcid.org/0000-0003-1127-9425
                https://orcid.org/0000-0002-5815-6193
                Article
                OBY22748
                10.1002/oby.22748
                7217180
                32202075
                f2c7ab70-4d96-4e7d-a440-286d3016a9aa
                © 2020 Envision Pharma, Inc. Obesity published by Wiley Periodicals, Inc. on behalf of The Obesity Society (TOS)

                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
                : 05 November 2019
                : 23 December 2019
                Page count
                Figures: 4, Tables: 2, Pages: 9, Words: 14284
                Funding
                Funded by: Merck Sharp & Dohme , open-funder-registry 10.13039/100009947;
                Funded by: Merck , open-funder-registry 10.13039/100004334;
                Funded by: Pfizer , open-funder-registry 10.13039/100004319;
                Categories
                Original Article
                Original Articles
                Clinical Trials and Investigations
                Custom metadata
                2.0
                April 2020
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.8.1 mode:remove_FC converted:12.05.2020

                Medicine
                Medicine

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