Exp Clin Endocrinol Diabetes 2005; 113(4): 199-204
DOI: 10.1055/s-2005-837662
Article

J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

Adjunctive Therapy with Pramlintide Lowers HbA1c without Concomitant Weight Gain and Increased Risk of Severe Hypoglycemia in Patients with Type 1 Diabetes Approaching Glycemic Targets

R. Ratner1 , F. Whitehouse2 , M. S. Fineman3 , S. Strobel3 , L. Shen3 , D. G. Maggs3 , O. G. Kolterman3 , C. Weyer3
  • 1MedStar Clinical Research Institute, Washington, DC, USA
  • 2Henry Ford Hospital, Detroit, MI, USA
  • 3Amylin Pharmaceuticals, Inc., San Diego, CA, USA
Further Information

Publication History

Received: December 18, 2003 First decision: February 16, 2004

Accepted: September 9, 2004

Publication Date:
13 May 2005 (online)

Abstract

Aims: In long-term clinical trials in patients with type 1 diabetes spanning a wide range of HbA1c, addition of pramlintide to existing insulin regimens led to reductions in HbA1c that were accompanied by weight loss and no increase in overall severe hypoglycemia event rates. Given that weight gain and increased hypoglycemia risk contribute to the difficulty of attaining HbA1c targets (< 7 %), the question arose whether pramlintide could benefit patients approaching, but not reaching glycemic targets with insulin alone. To address this question, we conducted a pooled analysis from 3 long-term clinical trials, including all patients with an entry HbA1c between 7.0 % and 8.5 %. Methods: Within the subset of patients with an entry HbA1c between 7.0 % and 8.5 % (approximately 28 % of all patients enrolled in the 3 studies), 196 were treated with placebo + insulin (baseline HbA1c 7.9 ± 0.4 %, body weight 76.0 ± 14.3 kg [mean ± SD]) and 281 with pramlintide + insulin (baseline HbA1c 7.9 ± 0.4 %, body weight 75.4 ± 13.1 kg). Endpoints included placebo-corrected changes from baseline to week 26 in HbA1c, body weight, and the event rate of severe hypoglycemia. Results: Adjunctive therapy with pramlintide resulted in significant reductions in HbA1c and body weight from baseline to week 26 (0.3 % and 1.8 kg, placebo-corrected treatment differences, respectively, both p ≤ 0.0009). These changes occurred without an increase in the overall risk of severe hypoglycemia (1.40 pramlintide vs. 1.86 placebo, events/patient-year of exposure). Conclusions: Addition of pramlintide to insulin therapy may help patients with type 1 diabetes who are approaching, but not yet reaching, glycemic targets with insulin alone to achieve further reductions in HbA1c without concomitant weight gain and increased risk of severe hypoglycemia.

References

MD Christian Weyer

Amylin Pharmaceuticals, Inc.

9360 Towne Centre Drive

San Diego, CA 92121

USA

Fax: + 85 86 42 70 76

Email: christian.weyer@amylin.com

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