Pancreatic Safety of Once-Weekly Dulaglutide in Chinese Patients with Type 2 Diabetes Mellitus: Subgroup Analysis by Potential Influencing Factors

Abstract

Introduction: In the randomized, open-label, parallel-arm, active-controlled phase III AWARD-CHN2 trial, once-weekly dulaglutide plus concomitant oral antihyperglycemic medications (OAMs) improved HbA1c over 26 weeks compared with once-daily insulin glargine in patients with type 2 diabetes mellitus (T2DM). This post-hoc subgroup analysis of AWARD-CHN2 investigated the pancreatic safety of dulaglutide in Chinese patients with T2DM, stratified by potential influencing factors.

Methods: Changes in pancreatic enzyme (pancreatic amylase, total amylase, and lipase) levels over 26 weeks were assessed and stratified by patient age (< 60, ≥ 60 years), sex (female, male), duration of diabetes (< 10, ≥ 10 years), baseline weight (< 70, ≥ 70 kg), BMI (< 25, ≥ 25 kg/m2), HbA1c (< 8.5, ≥ 8.5%), triglycerides (< 2.3, ≥ 2.3 mmol/L), and concomitant OAMs (metformin, sulfonylurea, metformin plus sulfonylurea).

Results: A total of 203 Chinese patients with T2DM were included in this post-hoc analysis. Pancreatic enzyme levels increased within the normal range from baseline to Week 26, and no pancreatitis events were confirmed by independent adjudication. Least-squares mean increase in pancreatic amylase (U/L) from baseline to Week 26 was comparable across all subgroups with no statistically (all P-values > 0.05) or clinically significant between-group differences for age (< 60 years: 5.34; ≥ 60 years: 6.71), sex (female: 5.85; male: 5.66), duration of diabetes (< 10 years: 6.15; ≥ 10 years: 4.85), weight (< 70 kg: 6.19; ≥ 70 kg: 5.39), BMI (< 25 kg/m2: 5.92; ≥ 25 kg/m2: 5.61), HbA1c (< 8.5%: 6.82; ≥ 8.5%: 4.08), triglycerides (< 2.3 mmol/L: 4.94; ≥ 2.3 mmol/L: 8.04), and concomitant OAMs (metformin: 5.68; sulfonylurea: 5.44; metformin plus sulfonylurea: 5.87). Similar results were observed for total amylase and lipase.

Conclusion: In Chinese patients with T2DM receiving dulaglutide 1.5 mg in AWARD-CHN2, elevations of pancreatic enzymes over 26 weeks were within the normal range and were neither associated with pancreatitis nor baseline factors, which suggests the clinical use of dulaglutide in Chinese patients with T2DM is not associated with pancreatic safety issues.

Clinical trial registration: NCT01648582.

Keywords: Chinese patient; Dulaglutide; Pancreatic safety; Subgroup analysis; Type 2 diabetes.

© 2021. The Author(s).

Figures

Fig. 1

Least squares mean change in pancreatic amylase level in Chinese patients with T2DM receiving dulaglutide 1.5 mg from baseline to 26 weeks of treatment, stratified by potential influencing factors. aLS means and 95% CIs within each patient subgroup were calculated using a MMRM model. All p values were > 0.05 for each subgroup comparison. CI confidence interval, HbA1c glycated hemoglobin, LS least squares, MMRM mixed-model repeated measures, OAM oral antihyperglycemic medication, SU sulfonylurea

Fig. 2

Least squares mean change in total amylase level in Chinese patients with T2DM receiving dulaglutide 1.5 mg from baseline to 26 weeks of treatment, stratified by potential influencing factors. aLS means and 95% CIs within each patient subgroup were calculated using a MMRM model. All p values were > 0.05 for each subgroup comparison. CI confidence interval, HbA1c glycated hemoglobin, LS least squares, MMRM mixed-model repeated measures, OAM oral antihyperglycemic medication, SU sulfonylurea

Fig. 3

Least squares mean change in lipase level in Chinese patients with T2DM receiving dulaglutide 1.5 mg from baseline to 26 weeks of treatment, stratified by potential influencing factors. aLS means and 95% CIs within each patient subgroup were calculated using a MMRM model. All p values were > 0.05 for each subgroup comparison. CI confidence interval, HbA1c glycated hemoglobin, LS least squares, MMRM mixed-model repeated measures, OAM oral antihyperglycemic medication, SU sulfonylurea