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Ipragliflozin and HbA1C Levels

How does SGLT-2 inhibitor, ipragliflozon compare to metformin alone?….

Ipragliflozin is an oral medication in development by Astellas Pharma for the treatment of type 2 diabetes. A novel selective sodium glucose co-transporter-2 (SGLT-2) inhibitor, ipragliflozin works similarly to the first in class marketed SGLT-2 inhibitor drug, canagliflozin, by increasing urinary excretion of glucose.

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A recent study was conducted to determine the safety and efficacy of multiple-dose ipragliflozin in patients with type 2 diabetes, using metformin as an active-comparator. The multi-center study was conducted over a 12-week period and patients with type 2 diabetes were randomized to one of four ipragliflozin dose groups (12.5, 50, 150, or 300mg ipragliflozin once daily), placebo, or metformin (1000mg/day, increasing to 1500mg/d after 2 weeks). A total of 412 patients were randomized and there were no significant differences among treatment groups in mean HbA1c and FBG levels at baseline.

The study found a significant dose-dependent decrease in HbA1c with ipragliflozin (-0.49% to -0.81%) treatment at week 12, as compared with placebo (P<0.001). Metformin comparator group showed an HbA1c decrease of -0.72%. Additionally, weight loss of up to 1.7kg was seen among patients in the ipragliflozin treatment group. Adverse events did not differ significantly between groups.

The authors concluded that 12-week treatment with ipragliflozin showed a dose-dependent decrease on HbA1c at doses of 50mg and greater that was comparable to that achieved by metformin treatment in type 2 diabetic patients. Ipragliflozin treatment was also found to have potential advantages of weight loss and low hypoglycemic risk.

Practice Pearls:
  • Ipragliflozin is a novel SGLT-2 inhibitor drug that works by increasing urinary excretion of glucose.
  • Ipragliflozin treatment may be associated with weight loss and a low risk of hypoglycemia.
  • 12-week treatment with ipragliflozin showed a dose-dependent decrease on HbA1c at doses of 50mg and greater that was comparable to that achieved by metformin treatment in type 2 diabetic patients.

Diabetes/Metabolism Research & Reviews 2014 [Fonseca, V.A. et al. Active- and placebo- controlled dose-finding study to assess the efficacy, safety, and tolerability of multiple doses of ipragliflozin in patients with type 2 diabetes mellitus. Journal of Diabetes and Its Complications. 2013;27:268-273.]