A Study of the Efficacy and Safety of Ertugliflozin in Participants With Type 2 Diabetes Mellitus With Stage 3 Chronic Kidney Disease Who Have Inadequate Glycemic Control on Antihyperglycemic Therapy (MK-8835-001)

Phase 3

Completed

Conditions: Type 2 Diabetes Mellitus

Interventions: Drug: Ertugliflozin 10 mg
Drug: Placebo 5 mg
Drug: Ertugliflozin 5 mg
Drug: Placebo 10 mg

Registration Number: NCT01986855

Lead Sponsor: Merck Sharp & Dohme LLC

Brief Summary: This study will evaluate the efficacy and safety of ertugliflozin (MK-8835/PF-04971729) in participants with Type 2 diabetes mellitus with Stage 3 Chronic Kidney Disease (CKD) who have inadequate glycemic control on background antihyperglycemic therapy. The duration of this trial will be up to 67 weeks. This study will consist of a 1-week Screening Period, a 10-week wash-off period from metformin, if needed, and a 2-week placebo run-in period, a 52-week double-blind treatment period, and a 14-day post-treatment follow-up period. The primary objective of this trial is to assess the hemoglobin A1C (A1C)-lowering efficacy of the addition of ertugliflozin compared to the addition of placebo with an underlying hypothesis that addition of treatment with ertugliflozin provides greater reduction in A1C compared to the addition of placebo; the primary objective will be tested for both 5-mg and 15-mg doses of ertugliflozin.

Detailed Description: Participants who meet protocol-defined glycemic rescue criteria will be permitted to have an adjustment in the dose(s) of background antihyperglycemic agent (AHA) therapy or addition of new AHA therapy as directed by their investigator until the participant no longer meets the rescue criteria.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 468

Inclusion Criteria

Diagnosis of Type 2 diabetes mellitus in accordance with American Diabetes Association guidelines
Have Stage 3 chronic kidney disease
On stable diabetes therapy (diet/exercise therapy alone or anti-hyperglycemic agents [AHA] monotherapy or combination therapy) for at least 6 weeks prior to study participation OR on metformin (with or without diet/exercise therapy or other AHA therapy) and is willing to undergo a 10-week metformin wash-off period
Have an estimated glomerular filtration rate (eGFR) of ≥30 to <60 mL/min/1.73m^2
Body Mass Index (BMI) greater than or equal to 18.0 kg/m^2
Male, postmenopausal female or surgically sterile female
If a female of reproductive potential, agrees to remain abstinent or to use (or have their partner use) 2 acceptable combinations of birth control while participating in the trial and for 14 days after the last use of study drug.

Exclusion Criteria

History of type 1 diabetes mellitus or a history of ketoacidosis
History of other specific types of diabetes (e.g., genetic syndromes, secondary pancreatic diabetes, diabetes due to endocrine disorders, drug - or chemical-induced, and post-organ transplant)
History of nephrotic range proteinuria with hypoalbuminemia and edema
History of rapidly progressive glomerulonephritis, lupus nephritis, renal or systemic vasculitis, renal artery stenosis with renovascular hypertension, or ischemic nephropathy
History of familial renal glucosuria
History of renal dialysis or renal transplant or renal disease requiring treatment with any immunosuppressive agent
A known hypersensitivity or intolerance to any (sodium-glucose co-transporter 2) SGLT2 inhibitor
On a weight-loss program or weight-loss medication or other medication associated with weight changes and is not weight stable
Has undergone bariatric surgery within the past 12 months
Has been treated with rosiglitazone or other SGLT2 inhibitors within 12 weeks of study participation
Has active, obstructive uropathy or indwelling urinary catheter
History of myocardial infarction, unstable angina, arterial revascularization, stroke, transient ischemic attack, or New York Heart Association (NYHA) functional class III-IV heart failure within 3 months of study participation
A history of malignancy ≤5 years prior to study participation, except for adequately treated basal or squamous cell skin cancer or in situ cervical cancer
Known history of Human Immunodeficiency Virus (HIV)
Has blood dyscrasias or any disorders causing hemolysis or unstable red blood cells or any other clinically significant hematological disorder (such as aplastic anemia, myeloproliferative or myelodysplastic syndromes, thrombocytopenia)
A medical history of active liver disease (other than non-alcoholic hepatic steatosis), including chronic active hepatitis B or C, primary biliary cirrhosis, or active symptomatic gallbladder disease
Has any clinically significant malabsorption condition
If taking thyroid replacement therapy, has not been on a stable dose for at least 6 weeks prior to study participation
Has been previously randomized in a study with ertugliflozin
Has participated in other studies involving an investigational drug within 30 days prior or during study participation
Has undergone a surgical procedure within 6 weeks prior to or during study participation
Has a positive urine pregnancy test
Is pregnant or breast-feeding, or is planning to conceive during the trial, including 14 days following the last dose of study medication
Planning to undergo hormonal therapy in preparation to donate eggs during the trial, including 14 days following the last dose of study medication
Excessive consumption of alcoholic beverages or binge drinking
Has donated blood or blood products within 6 weeks of study participation or plans to donate blood or blood products at any time during the trial

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Ertugliflozin (15 mg)	Ertugliflozin 10 mg	Ertugliflozin, 15 mg, oral, one 5 mg and one 10 mg tablet, once daily for 52 weeks
Placebo	Placebo 10 mg	Matching placebo
Ertugliflozin (5 mg)	Placebo 10 mg	Ertugliflozin, 5 mg, oral, one 5 mg ertugliflozin tablet and one placebo tablet, once daily for 52 weeks
Placebo	Placebo 5 mg	Matching placebo
Ertugliflozin (5 mg)	Ertugliflozin 5 mg	Ertugliflozin, 5 mg, oral, one 5 mg ertugliflozin tablet and one placebo tablet, once daily for 52 weeks

Primary Outcome Measures

Name	Time	Method
Percentage of Participants Who Discontinued Study Treatment Due to an AE	Up to 52 weeks	An AE is defined as any unfavorable and unintended sign including an abnormal laboratory finding, symptom or disease associated with the use of a medical treatment or procedure, regardless of whether it is considered related to the medical treatment or procedure, that occurs during the course of the study.
Change From Baseline in A1C at Week 26 - Excluding Rescue Approach	Baseline and Week 26	A1C is blood marker used to report average blood glucose levels over prolonged periods of time and is reported as a percentage (%). This change from baseline reflects the Week 26 A1C minus the Week 0 A1C. Excluding rescue approach data analysis excluded all data following the initiation of rescue therapy at any time point, in order to avoid the confounding influence of the rescue therapy.
Percentage of Participants Who Experienced an Adverse Event (AE)	Up to 54 weeks	An AE is defined as any unfavorable and unintended sign including an abnormal laboratory finding, symptom or disease associated with the use of a medical treatment or procedure, regardless of whether it is considered related to the medical treatment or procedure, that occurs during the course of the study.

Secondary Outcome Measures

Name	Time	Method
Change From Baseline in A1C at Week 26 - Baseline eGFR ≥45 to <60 mL/Min/1.73m^2 Stratum - Excluding Rescue Approach	Baseline and Week 26	A1C is blood marker used to report average blood glucose levels over prolonged periods of time and is reported as a percentage (%). This change from baseline reflects the Week 26 A1C minus the Week 0 A1C. Excluding rescue approach data analysis excluded all data following the initiation of rescue therapy at any time point, in order to avoid the confounding influence of the rescue therapy.
Change From Baseline in Body Weight at Week 26 - Baseline eGFR ≥45 to <60 mL/Min/1.73m^2 Stratum - Excluding Rescue Approach	Baseline and Week 26	This change from baseline reflects the Week 26 body weight minus the Week 0 body weight. Excluding rescue approach data analysis excluded all data following the initiation of rescue therapy at any time point, in order to avoid the confounding influence of the rescue therapy.
Change From Baseline in FPG at Week 26 - Baseline eGFR ≥45 to <60 mL/Min/1.73m^2 Stratum - Excluding Rescue Approach	Baseline and Week 26	This change from baseline reflects the Week 26 FPG minus the Week 0 FPG. Excluding rescue approach data analysis excluded all data following the initiation of rescue therapy at any time point, in order to avoid the confounding influence of the rescue therapy.
Percentage of Participants With A1C <7.0% (<53 mmol/Mol) at Week 26 - Baseline eGFR ≥45 to <60 mL/Min/1.73m^2 Stratum - Excluding Rescue Approach	Week 26	A1C is blood marker used to report average blood glucose levels over prolonged periods of time and is reported as a percentage (%). Excluding rescue approach data analysis excluded all data following the initiation of rescue therapy at any time point, in order to avoid the confounding influence of the rescue therapy.
Change From Baseline in Sitting Systolic Blood Pressure at Week 26 - Baseline eGFR ≥45 to <60 mL/Min/1.73m^2 Stratum - Excluding Rescue Approach	Baseline and Week 26	This change from baseline reflects the Week 26 sitting systolic blood pressure minus the Week 0 sitting systolic blood pressure. Excluding rescue approach data analysis excluded all data following the initiation of rescue therapy at any time point, in order to avoid the confounding influence of the rescue therapy.