A Study to Assess the Efficacy and Safety of Ipragliflozin in Subjects With Type 2 Diabetes Mellitus Who Have Inadequate Glycemic Control on Metformin

This is a phase 3, double-blind, randomized study to assess the efficacy and safety of ipragliflozin in combination with metformin compared to metformin plus placebo in subjects in Russia with type 2 diabetes mellitus who have inadequate glycemic control on metformin. Subjects will enter a 10-day (± 3 days) screening period, followed by a 2-week single-blind placebo run-in period, followed by a 24-week randomized double-blind treatment period and a 4-week follow-up period

• Ipragliflozin L-proline (Drug), also known as Suglat, ASP1941: Oral
• Metformin (Drug), also known as Riomet, Glucophage, Glumetza, Glucophage XR, Fortamet: Oral
• Placebo (Drug): Oral

Primary outcomes

• Change from baseline in HbA1c with ipragliflozin once daily added on to metformin compared to placebo added on to metformin [Baseline and 12 weeks]: Glycated hemoglobin (HbA1c)

Secondary outcomes

• Change from baseline in HbA1c in each treatment group [Baseline and 24 weeks]
• Change from baseline in FPG in each treatment group [Baseline, 12 weeks and 24 weeks]: Fasting plasma glucose (FPG)
• Number of patients reaching a treatment goal in HbA1c of < 7.0% in each treatment group [Up to 24 weeks]
• Change in body weight in each treatment group [Baseline, 12 weeks and 24 weeks]
• Change in blood pressure in each treatment group [Baseline, 12 weeks and 24 weeks]
• Number of patients with AEs [Up to 24 weeks]: Adverse Events (AEs)
• Number of patients with AEs of special interest [Up to 24 weeks]: AEs of special interest include: hypoglycemic events, dehydration/hypovolemia, urinary tract infections and genital infections
• Percentage of patients reaching a treatment goal in HbA1c of < 7.0% in each treatment group [Up to 24 weeks]
• Change from baseline in PROs as measured by European Quality of Life 5 Dimensions 5 Levels [EQ-5D-5L] questionnaire [Baseline, 12 weeks and 24 weeks]: Patient-reported outcomes (PROs)
• Change from baseline in PROs as measured by Audit of Diabetes Dependent Quality of Life [ADDQoL-19] questionnaire [Baseline, 12 weeks and 24 weeks]
• Change from baseline in PROs as measured by Work Productivity and Activity Impairment: General Health [WPAI:GH] questionnaire [Baseline, 12 weeks and 24 weeks]
• Change from baseline in PROs as measured by Diabetes Medication Satisfaction [Diab-MedSat] questionnaire [Baseline, 12 weeks and 24 weeks]
• Percentage of patients with AEs [Up to 24 weeks]
• Percentage of patients with AEs of special interest [Up to 24 weeks]: AEs of special interest include: hypoglycemic events, dehydration/hypovolemia, urinary tract infections and genital infections

Sex: All, ages: 18 Years to any

Inclusion Criteria:

* Subject has been diagnosed with type 2 diabetes mellitus at least 12 weeks before visit 1.
* Subject has been on a stable dose and a daily dose regimen of metformin ≥ 1500 mg for at least 12 weeks prior to visit 1.
* Subject has HbA1c ≥ 7.5% and ≤ 11.0% at visit 1.
* Subject has been on a stable diet and exercise program for at least 12 weeks prior to visit 1 and is willing to maintain this program for the duration of the treatment period.
* Subject has a body mass index (BMI) of 20 to 45 kg/m2, inclusive, at visit 1.
* Subjects are allowed to continue taking their medication for concomitant diseases (including over-the-counter products), provided they have been on a stable dose for a minimum of 30 days prior to visit 1.
* Female subjects must either:

  1. Be of non-childbearing potential:

     * postmenopausal (defined as at least 1 year without any menses) prior to screening, or
     * documented as surgically sterile
  2. Or, if of childbearing potential,

     * Agree not to try to become pregnant during the study and for 28 days after the final study drug administration
     * And have a negative serum pregnancy test at visit 1
     * And, if heterosexually active, agree to consistently use 2 forms of highly effective birth control (at least 1 of which must be a barrier method) starting at screening, throughout the study period and for 28 days after the final study drug administration.
* Female subjects must agree not to breastfeed starting at screening, throughout the study period and for 28 days after the final study drug administration.
* Female subjects must not donate ova starting at screening, throughout the study period and for 28 days after the final study drug administration.
* Male subjects and their female spouse/partners who are of childbearing potential must be using highly effective contraception consisting of 2 forms of birth control (at least 1 of which must be a barrier method) starting at screening and continue throughout the study period.
* Male subjects must not donate sperm starting at screening and throughout the study period.

Exclusion Criteria:

* Subject has type 1 diabetes mellitus.
* Subject has received any medication for glycemic control, with the exception of metformin, (e.g., oral antidiabetic drugs, insulin, etc.) within 12 weeks prior to visit 1.
* Subject is currently receiving an excluded medication or has received insulin within 12 weeks prior to visit 1 or during the screening period.
* Subject has a history of stroke, unstable angina, myocardial infarction, any vascular intervention or heart failure (New York Heart Association Class III-IV;) within 12 weeks prior to visit 1.
* Subject has had a malignancy in the last 5 years, except for adequately treated basal or squamous cell carcinoma of the skin or carcinoma in situ of the cervix.
* Subject has a history of diabetic coma or precoma.
* Subject has a history of ketoacidosis or lactic acidosis.
* History of drinking more than 21 units of alcohol per week (1 unit = 10 g pure alcohol = 250 mL of beer \[5%\] or 35 mL of spirits \[35%\] or 100 mL of wine \[12%\]) (> 14 units of alcohol for female subjects) or history of drugs abuse (amphetamines, barbiturates, benzodiazepines, cannabinoids, cocaine, and opiates) within 3 months prior to visit 1.
* Subject is known to have hepatitis or be a carrier of hepatitis B surface antigen (HBsAg), hepatitis C virus (HCV) antibody or is known to be positive for human immunodeficiency virus (HIV)-1 and/or HIV-2.
* Subject has a severe infection, has serious trauma, or is a perioperative subject.
* Subject has symptomatic urinary tract infection or genital infection at visit 1 and/or just prior to randomization at visit 3.
* Subject has uncontrolled severe hypertension (or subject whose systolic blood pressure is > 180 mmHg or diastolic blood pressure of > 110 mmHg measured in a sitting position after 5 minutes of rest at visit 1).
* Subject has an alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST) > 2 x the upper limit of normal (ULN) range or has a total bilirubin > 1.5 x ULN at visit 1.
* Subject has a urinary microalbumin/creatinine ratio ≥ 300 mg/g at visit 1.
* Subject has estimated glomerular filtration rate (GFR) value of < 60 mL/min/1.73 m2 at visit 1 (using the Modification of Diet in Renal Disease \[MDRD\] calculation).
* Subject has known or suspected hypersensitivity to ipragliflozin or any components of the formulations used or a history of allergy for Sodium-glucose cotransporter (SGLT)2 inhibitors.
* Subject has previously received ipragliflozin or other SGLT2 inhibitors.
* Subject is concurrently participating in another drug study or has received an investigational drug within 30 days or the limit set by national law, whichever is longer, prior to visit 1 or plans to receive another investigational drug during the study.
* Female subject who is currently pregnant or lactating
* Male or female subject who does not use appropriate contraception during the study.
* The subject is unable to adhere to the treatment regimen, protocol procedures or study requirements (including discontinuation criteria during the run-in period), in the investigator's judgment.
* Subject has an unstable medical or psychiatric illness.

• Results publication: Kashiwagi A, Shestakova MV, Ito Y, Noguchi M, Wilpshaar W, Yoshida S, Wilding JPH. Safety of Ipragliflozin in Patients with Type 2 Diabetes Mellitus: Pooled Analysis of Phase II/III/IV Clinical Trials. Diabetes Ther. 2019 Dec;10(6):2201-2217. doi: 10.1007/s13300-019-00699-8. Epub 2019 Oct 12. PMID 31606880

• Medical Monitor, Study director, Astellas Pharma Europe B.V.