Low-dose empagliflozin as adjunct-to-insulin therapy in type 1 diabetes: A valid modelling and simulation analysis to confirm efficacy

Bruce A. Perkins, Nima Soleymanlou, Julio Rosenstock, Jay S. Skyler, Lori M. Laffel, Karl Heinz Liesenfeld, Dietmar Neubacher, Matthew M. Riggs, Curtis K. Johnston, Rena J. Eudy-Byrne, Ahmed Elmokadem, Jyothis T. George, Jan Marquard, Valerie Nock

Research output: Contribution to journalArticle

Abstract

Aim: To confirm the observed reduction in HbA1c for the 2.5 mg dose in EASE-3 by modelling and simulation analyses. Materials and methods: Independent of data from EASE-3 that tested 2.5 mg, we simulated the effect of a 2.5 mg dose through patient-level, exposure-response modelling in the EASE-2 clinical study. A primary semi-mechanistic model evaluated efficacy considering clinical insulin dose adjustments made after treatment initiation that potentially limited HbA1c reductions. The model was informed by pharmacokinetic, insulin dose, mean daily glucose and HbA1c data, and was verified by comparing the simulations with the observed HbA1c change in EASE-3. One of two empagliflozin phase 3 trials in type 1 diabetes (EASE-3 but not EASE-2) included a lower 2.5 mg dose. A placebo-corrected HbA1c reduction of 0.28% was demonstrated without the increased risk of diabetic ketoacidosis observed at higher doses (10 mg and 25 mg). Since only one trial included the lower dose, we aimed to confirm the observed reduction in HbA1c for the 2.5 mg dose by modelling and simulation analyses. Results: The simulated 26-week mean HbA1c change was −0.41% without insulin dose adjustment and −0.29% at 26 weeks with insulin dose adjustment. A simplified (descriptive) model excluding insulin dose and mean daily glucose confirmed the –0.29% HbA1c change that would have been observed had the EASE-2 population received a 2.5 mg dose for 26/52 weeks. Conclusions: The HbA1c benefit of low-dose empagliflozin directly observed in the EASE-3 trial was confirmed by two modelling and simulation approaches.

Original languageEnglish (US)
Pages (from-to)427-433
Number of pages7
JournalDiabetes, Obesity and Metabolism
Volume22
Issue number3
DOIs
StatePublished - Mar 1 2020

Keywords

  • antidiabetic drug
  • dose–response relationship
  • empagliflozin
  • sodium-glucose co-transporter-2 inhibitor
  • type 1 diabetes

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

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    Perkins, B. A., Soleymanlou, N., Rosenstock, J., Skyler, J. S., Laffel, L. M., Liesenfeld, K. H., Neubacher, D., Riggs, M. M., Johnston, C. K., Eudy-Byrne, R. J., Elmokadem, A., George, J. T., Marquard, J., & Nock, V. (2020). Low-dose empagliflozin as adjunct-to-insulin therapy in type 1 diabetes: A valid modelling and simulation analysis to confirm efficacy. Diabetes, Obesity and Metabolism, 22(3), 427-433. https://doi.org/10.1111/dom.13945