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Phase 3 Trial of Aleglitazar to Commence
SYNCHRONY, a placebo-controlled dose ranging study in type 2 diabetes patients, showed that aleglitazar had a balanced synergistic effect on both lipid and glucose control with a good safety and tolerability profile in patients with type 2 diabetes.
Cardiovascular disease is currently the leading cause of death among those with type 2 diabetes, accounting for half of all deaths.(2) Despite guidelines recommending that cardiovascular risk in this patient group should be reduced by controlling factors such as dyslipidemia, blood pressure, body weight and hyperglycemia,(3,4) the majority of patients still do not achieve their treatment goals leaving them vulnerable to both initial and residual cardiovascular events.(3,5) Significantly, one in ten patients with an acute myocardial infarction died within a year.(6)
"Roche is confident that aleglitazar has the potential to reduce cardiovascular morbidity and mortality in this high-risk patient group and is therefore committed to pursuing its rapid development," said Jean-Jacques Garaud, Global Head of Development Pharmaceuticals Division of Roche.
The focused Phase III outcomes trial will investigate whether once daily 150 micrograms aleglitazar reduces the incidence of cardiovascular mortality, non-fatal myocardial infarction and stroke in patients with type 2 diabetes. The approach in this selected high-risk patient population will be unique as no drug has been demonstrated to reduce cardiovascular risk in type 2 diabetes patients following an ACS event.
Professor Robert Henry, SYNCHRONY Clinical Investigator and Chief VA Endocrinology & Metabolism and Professor of Medicine in Residence at the University of California at San Diego, commented: "The favorable balance in the safety and efficacy profile of aleglitazar seen in the SYNCHRONY study represents encouraging short-term clinical data for this agent and provides good evidence to enter Phase III investigation."
With the decision to move into Phase III, aleglitazar is Roche's third Phase III clinical trial program in the area of metabolism. The new Phase III study is a cardiovascular outcomes trial designed to assess the potential of once-daily 150 micrograms aleglitazar to reduce cardiovascular mortality, non-fatal myocardial infarction and stroke in type 2 diabetes patients with a recent ACS.
About the SYNCHRONY Study
SYNCHRONY was a multicenter, randomized, double-blind, placebo-controlled dose ranging study among 332 type 2 diabetes patients (either drug-naive or pre-treated with less than or equal to 2 oral agents). Designed to determine the glucose-lowering and lipid-modifying effects, and safety profile of aleglitazar, the study confirmed the favorable safety and efficacy profile of the once daily 150 microgram aleglitazar dose and supported commencement of the Phase III clinical investigation.
Patients underwent a single-blind 4- to 5-week placebo run-in period, then were randomized to receive 16 weeks treatment with either aleglitazar at one of four once daily doses (50, 150, 300 or 600 micrograms), placebo or 45 mg pioglitazone.
The primary endpoint of dose-dependent reductions from baseline HbA1c versus placebo was met and a range of responses observed from -0.36% (95% CI:0.00 to -0.70, P=0.048) with 50 micrograms aleglitazar, to -1.35% (95% CI: -0.99 to -1.70, p The study's secondary clinical endpoints were changed from baseline in fasting plasma glucose and lipid profiles. Notably, significant dose-dependent reductions versus placebo were observed with aleglitazar for fasting plasma glucose (-1.0 mmol/L with 50 micrograms to -3.3 mmol/L with 600 micrograms), triglycerides (-27.8% with 50 micrograms to -51.6% with 600 micrograms), and LDL-C (-9.1% with 50 micrograms to -25.9% with 600 micrograms), as well as a significant dose-dependent increase in HDL-C (8.2% with 50 micrograms to 22.9% with 300 micrograms). Importantly, treatment with the once daily 150 micrograms aleglitazar
dose produced a numerically superior effect on triglycerides, HDL-C, and LDL-C when compared with 45 mg pioglitazone.
Known PPAR-alpha (creatinine increase) and gamma-related effects (edema, haemodilution, and weight gain) were seen in a dose-dependent manner of which the incidence of edema for the 150 microgram aleglitazar dose was similar to placebo and numerically less than with pioglitazone, and body weight gain was numerically less than with pioglitazone.
Aleglitazar is an innovative treatment designed to reduce the incidence and impact of cardiovascular mortality, non-fatal myocardial infarction and stroke in patients with a recent ACS and type 2 diabetes.
It is a rationally designed molecule providing balanced dual PPAR alpha/gamma activation. Specifically, it combines the improvements in peripheral insulin sensitivity (and therefore glycemic control) associated with PPAR gamma activation, with improved management of dyslipidemia, which is commonly associated with PPAR alpha activation.