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Dapagliflozin - AstraZeneca

Drug Profile

Dapagliflozin - AstraZeneca

Alternative Names: Andatang; BMS-512148; DAPA; Dapagliflozin propanediol; Farxiga; Forxiga; Oxra

Latest Information Update: 17 Sep 2021

At a glance

  • Originator Bristol-Myers Squibb
  • Developer AstraZeneca; AstraZeneca KK; Bayer; Bristol-Myers Squibb; Novo Nordisk Foundation; Ono Pharmaceutical; University Medical Center Groningen; Uppsala University
  • Class Antihyperglycaemics; Benzhydryl compounds; Chlorobenzenes; Glucosides; Heart failure therapies; Obesity therapies; Pyrans; Small molecules; Urologics
  • Mechanism of Action Sodium-glucose transporter 2 inhibitors
  • Orphan Drug Status

    Orphan designation is assigned by a regulatory body to encourage companies to develop drugs for rare diseases.

    No
  • New Molecular Entity Yes

Highest Development Phases

  • Marketed Cardiovascular disorders; Chronic heart failure; Renal failure; Type 1 diabetes mellitus; Type 2 diabetes mellitus
  • Phase III COVID 2019 infections; Heart failure; Myocardial infarction
  • Phase II Kidney disorders; Obesity; Prediabetic state

Most Recent Events

  • 14 Sep 2021 Biomarkers information updated
  • 03 Sep 2021 Registered for Renal failure in Japan (PO)
  • 03 Sep 2021 The MHLW grants priority review to a regulatory application in Japan for the treatment of chronic kidney disease (CKD) in adults with and without type-2 diabetes

Development Overview

Introduction

Forxiga (Dapagliflozin) is an oral, once-daily, sodium glucose co-transporter type 2 (SGLT2) inhibitor, being developed by Bristol-Myers Squibb (BMS) and its licensee AstraZeneca, for the treatment of type-2, type-1 diabetes mellitus, cardiovascular diseases, including acute myocardial infarction, heart failure, renal failure and COVID-19 infections. However, AstraZeneca subsequently acquired all rights to the drug from Bristol-Myers Squibb. SGLT2 is a low affinity, high-capacity transporter located in the brush-border membrane of the early segment of the proximal tubule of the kidney. The transporter is responsible for 90% of the glucose reabsorbed by the kidneys. SGLT2 inhibitors maintain blood glucose levels by regulating the re-absorption of filtered glucose. Dapagliflozin has been launched worldwide for type-2 and type-1 diabetes mellitus. The drug is also available in the US, to reduce the risk of hospitalisation for heart failure (hHF) in adults with type 2 diabetes (T2D) and established cardiovascular disease (CVD) or multiple cardiovascular (CV) risk factors. Dapaglifozin is launched in India for the treatment of heart failure associated with ejection fraction (HFrEF). The drug has been approved in US, European Union and Japan for the treatment of chronic kidney disease (CKD) in adults with and without type-2 diabetes (T2D). It is approved in European Union and Liechtenstein for type-1 and type-2 diabetes mellitus. It is approved for type 2 diabetes mellitus in Argentina and Brazil and as a combination therapy in China. The drug is approved in the Japan, the US and China for chronic heart failure. The drug is also launched in the US for renal failure. It is awaiting approval as an adjunctive treatment in type 1 diabetes mellitus in the US. Clinical development for chronic heart failure, myocardial infarction, and COVID-19 infections is ongoing in multiple countries worldwide.

Regulatory submissions were also made for dapagliflozin for the treatment of type-2 diabetes mellitus in South Africa. However, no recent reports of development have been identified. As at May 2017, development of the dapagliflozin oral solution was discontinued as the same was not listed on the company pipeline. The oral solution of dapagliflozin was in phase I development for T2DM (AstraZeneca pipeline, April 2017). As at November 2017, no recent reports of development were identified for phase I development in type II diabetes mellitus in Mexico.

Phase III trials of dapagliflozin in combination with metformin and other oral antihyperglycaemics have also been conducted. BMS and AstraZeneca have subsequently developed a fixed-dose combination of these therapies [see AdisInsight drug profiles 800027878 and 800038479].

Edistride, comprising dapagliflozin propanediol monohydrate has also been developed by AstraZeneca as monotherapy and as add-on combination therapy for the treatment of adults with type-2 diabetes mellitus. The candidate is approved in the EU as an informed consent application under the Article 10(c) of Directive 2001/83/EC.

Company Agreements

Marketing agreement

In March 2016, AstraZeneca India and Sun Pharma entered into a distribution agreement for dapagliflozin. Under the terms of agreement, Sun Pharma will market and distribute dapagliflozin under the brand name Oxra®, while AstraZeneca India will market dapagliflozin under the brand name Forxiga® and retain the intellectual property rights to dapagliflozin [1] .

In February 2014, AstraZeneca acquired global rights for development, manufacture and commercialisation of dapagliflozin Bristol-Myers Squibb (BMS). Earlier, Bristol-Myers Squibb entered into an agreement with AstraZeneca, in December 2013. Under the terms of the agreement, AstraZeneca acquired the intellectual property and global rights to BMS's diabetes portfolio, including dapagliflozin. AstraZeneca paid BMS $US2.7 billion on completion of the acquisition. The company has also agreed to pay up to $US1.4 billion to BMS in regulatory, launch and sales-related payments and various royalty payments till 2025, of which $US600 million relates to the approval of dapagliflozin in the US. Additionally, AstraZeneca announced that, it may make payments up to $US225 million on transfer of certain company assets [2] [3] [4] .

In January 2007, BMS and AstraZeneca entered into a worldwide collaboration agreement to develop and commercialise dapagliflozin and saxagliptin. Any additional sodium glucose co-transporter type 2 (SGLT2) inhibiting or dipeptidyl peptidase IV (DPP IV) inhibiting compounds to arise in development could be added to the collaboration. Under the terms of the agreement, AstraZeneca paid BMS an upfront payment of $US100 million, and will also make additional milestone payments of up to $US650 million for the two compounds, and possible sales milestones of up to $US300 million per product. Both companies will jointly develop the clinical and marketing strategy of the compounds. AstraZeneca also agreed to fund the majority of development costs from 2007 through 2009. BMS will manufacture both compounds and book sales. The agreement initially excluded all activities in Japan. However, the collaboration was expanded in December 2008 to include development and commercialisation of dapagliflozin in Japan [5] [6] .

In December 2013, AstraZeneca obtained from BMS the exclusive rights to commercialise dapagliflozin in Japan. AstraZeneca K.K. simultaneously entered into an agreement with Ono Pharmaceutical to co-promote dapagliflozin in Japan. Under the terms of the agreement, Ono will make an upfront payment, as well as launch and sales-related milestone payments, which will be shared by BMS and AstraZeneca. BMS and AstraZeneca will supply the product, and Ono will be responsible for distribution [7] .

Key Development Milestones

COVID-19 infections

In July 2020 AstraZeneca reported that Cambridge University Hospitals NHS Foundation Trust initiated a phase II/III TACTIC-E trial to evaluate the efficacy of combination of the dapagliflozin and ambrisentan be compared with the standard of care therapy in pre-ICu patients with COVID-2019 infections (EudraCT2020-002229-27; NCT04393246). The randomised, open-label trial intends to enrol approximately 1407 patients in the UK [8] [9] .

In June 2021, AstraZeneca completed the phase III Dare-19 trial that evaluated the efficacy and safety of dapagliflozin in addition to background local standard of care therapy, on the risk of all-cause death or disease progression and complications in adults who are hospitalised with COVID-19 at the time of trial enrolment (NCT04350593; D1690C00081; ESR-20-20653). Earlier in April 2021, AstraZeneca reported that the phase III DARE-19 trial did not achieve primary endpoint, in which 30 day treatment with dapagliflozin in addition of standard-of-care therapies did not showed statistically significant prevention of organ dysfunction, all-cause mortality and improvement in clinical recovery, preventing death from any cause. Safety profile of dapagliflozin in the trial was similar as reported in previous clinical trials. The trial was initiated in April 2020 and included COVID-19 patients with medical history of hypertension (HTN), atherosclerotic CV disease, heart failure with reduced or preserved ejection fraction, T2D or CKD Stage III to IV who received dapagliflozin for 30 days. The randomised, investigator-sponsored trial enrolled 1250 patients in the US, Brazil, Mexico, Canada, Argentina, India and the UK. In June 2021, safety and efficacy data from the trial was released [10] [11] [12] [13] .

Type 2 diabetes mellitus (T2DM), monotherapy, combination therapy

In January 2014, AstraZeneca and BMS announced that the US FDA approved Farxiga™ (dapagliflozin) as an adjunct to diet and exercise in patients with T2DM [4] [14] . AstraZeneca and BMS resubmitted their NDA for once-daily oral dapagliflozin in adults with T2DM to FDA in July 2013. In December 2013, the FDA's Endocrinologic and Metabolic Drugs Advisory Committee (EMDAC) recommended approval. The EMDAC voted 13-1 that the benefits outweigh identified risks and support marketing of the drug, and 10-4 that the data provided ample evidence on the acceptable cardiovascular risk of the drug relative to comparators [15] . The companies had previously received a Complete Response Letter from the FDA in January 2012 requesting additional clinical data to better assess the risk/benefit profile after the FDA's EMDAC recommended against approval, in July 2011. BMS and AstraZeneca had submitted the original NDA in December 2010, and this was accepted for review by the FDA in March 2011. The resubmitted NDA included data from new studies as well as long-term (4 years) follow-up data from previously submitted studies, increasing patient-years exposure to the drug by 50% over the initial submission [16] [17] [18] [19] [20] [21] [22] [23] . The companies plan to conduct a large, post-marketing, randomised cardiovascular outcomes study in patients with T2DM to provide data on the long-term safety profile of the drug and examine whether or not the drug may provide a cardioprotective effect [24] . In addition to this, phase III development is underway in patients with diabetes and cardiovascular disease and/or hypertension (see below).

In November 2018, the China NMPA approved dapagliflozin in combination metformin and with insulin, separately for the treatment of inadequately-controlled type-2 diabetes mellitus in China. The drug was launched for the treatment of type 2 diabetes mellitus in China in 2018 [25] . The China State Food and Drug Administration (CFDA) approved dapagliflozin for the treatment of type 2 diabetes mellitus, before April 2017 (AstraZeneca pipeline, April 2017). In January 2013, a regulatory submission for dapagliflozin for the treatment of T2DM was accepted for review by the China State Food and Drug Administration.

In February 2016, the EMA’ s Pharmacovigilance Risk Assessment Committee (PRAC) finalised a review of SGLT2 inhibitors including, dapagliflozin and made recommendations to minimise the risk of diabetic ketoacidosis. The committee recommended that if diabetic ketoacidosis is suspected or confirmed, treatment should be stopped immediately and should not be re-started unless another cause for the ketoacidosis is identified and resolved. The Committee for Medicinal Products for Human Use (CHMP) of the EMA confirmed the recommendations made by PRAC. The EMA recommended updating the product information of SGLT2 inhibitors, including dapagliflozin, to list diabetic ketoacidosis as a rare adverse reaction. Additionally, the EMA recommended temporarily stopping SGLT2 inhibitors in patients who are undergoing major surgery or are in hospital due to serious illness [26] [27] .

Dapagliflozin has been launched in Hungary, Brazil, Argentina, Phillipines, Indonesia, Belgium, Sweden for the treatment of type 2 diabetes mellitus.

Dapagliflozin has been launched in the UK, Denmark, Netherlands, Czech Republic, Austria, Poland and Portugal for the once-daily treatment of adult patients with T2DM, following approval from the EMA in this indication in November 2012. Dapagliflozin is indicated as an adjunct to diet and exercise in combination with other glucose-lowering treatments, including insulin, or as a monotherapy in metformin-intolerant patients. In June 2019, the CHMP of EMA adopted a positive opinion, recommending modification of existing authorisation of dapagliflozin, to include treatment in type 2 diabetes mellitus patients, as an adjunct to diet and exercise, as a monotherapy (when metformin is deemed inappropriate on account of intolerance) and as a combination therapy with other medicinal products [28] [29] . BMS and AstraZeneca had submitted the MAA in December 2010, which was validated by the EMA in January 2011 [23] . The Committee for Medicinal Products for Human Use (CHMP) of the EMA adopted a positive opinion for the approval of dapagliflozin, in April 2012. The positive opinion was based on data from 11 core phase III trials [30] .

In August 2019, the European Commission approved an update to include positive cardiovascular outcomes and renal data from the phase III DECLARE-TIMI 5 trial to the marketing authorisation of dapagliflozin. The trial achieved statistically significant reduction in the composite endpoint of hospitalisation for heart failure or cardiovascular deaths with fewer adverse events. Inclusion of these results in the label is under regulatory review in the US and China [31] . In October 2020, AstraZeneca announced that the NMPA approved an update to the label for dapagliflozin to include the positive CV outcomes and renal data from the DECLARE-TIMI 58 Phase III trial in adults with Type 2 diabetes mellitus in China [32] .

In November 2016, NICE issued final guidance recommending dapagliflozin for treating type-II diabetes mellitus in ‘triple therapy’. The guideline recommended dapagliflozin for use as a triple therapy regimen in combination with metformin and a sulfonylurea [33] . In May 2016, NICE issued final guidance recommending dapagliflozin as monotherapy for treating type-II diabetes mellitus in adults for whom metformin is contraindicated or not tolerated [34] . Earlier, in a final appraisal determination issued in late May 2013, the UK National Institute for Health and Care Excellence (NICE) had recommended the use of dapagliflozin in combination with metformin or in combination with insulin with or without other oral antidiabetic drugs as an option for treating T2DM [35] [36] [37] . In July 2019, NICE issued final guidance recommending dapagliflozin with insulin as an option for treating adults type-I diabetes mellitus, when insulin alone does not provide adequate glycemic control despite optimal insulin therapy. NICE will publish final guidance to the NHS in August 2019 [38] .

The Scottish Medicines Consortium has restricted the use of dapagliflozin as a combination therapy with metformin or insulin, when these alone with exercise and diet do not provide adequate glycaemic control [35] .

The EMA issued a decision on the modification of the Paediatric Investigation Plan (PIP) for dapagliflozin in September 2012. The PIP covers a tablet formulation of dapagliflozin for the treatment of T2DM in children and adolescents aged from 10 to < 18 years, with a waiver for those aged < 10 years. The PIP detailed several trials to be conducted by BMS and AstraZeneca, including a pharmacokinetics/pharmacodynamics trial assessing the ability of children to swallow tablets, oral carcinogenicity studies in mice and rats, and two clinical efficacy trials of the drug. The PIP is expected to be completed by September 2017.

AstraZeneca launched Forxiga® (dapagliflozin) as monotherapy and adjunctive therapy in India in February 2015. The approval was granted earlier in February 2015 [39] [DCGI website, April 2016].

Dapagliflozin (5mg and 10mg tablets) was launched in Japan in May 2014 as a once-daily oral treatment for T2DM [40] . The product received approval in Japan in March 2014 [41] . The regulatory filing was accepted for review in March 2013 by Japan's Ministry of Health, Labor and Welfare [42]

AstraZeneca launched Forxiga® (dapagliflozin) in Greece in April 2015. The product is also available in the Canada, Cyprus, Hong Kong, Ireland, Israel, Malaysia, Singapore, Thailand, UAE, Ukraine, Chile, Russia and Kuwait.

In June 2015, Health Canada initiated a safety review for dapagliflozin and the risk of ketoacidosis [43] . The American Association of Clinical Endocrinologists also announced plans to examine the issue of diabetic ketoacidosis among patients treated with SGLT2 inhibitors, in June 2015 [44] . In December 2014, Health Canada approved Forxiga® (dapagliflozin) to be used in combination with diet and exercise in patients with T2DM [45] . Previously, in January 2011, Health Canada issued a Notice of Noncompliance, regarding the marketing application for dapagliflozin [46] . The candidate was also launched in Switzerland after approval in August 2014 [47] .

The TGA in Australia approved dapagliflozin on 5 October 2012 and has since been launched in this country. It is indicated as a monotherapy in patients who are intolerant to metformin, as an initial combination therapy with metformin, and as an add-on therapy to either metformin, a sulfonylurea, or insulin. Dapagliflozin was rejected from being listed on the Australian Pharmaceutical Benefits Schedule in March 2012.

In September 2013, AstraZeneca reported that dapagliflozin has been approved in Brazil for the treatment of type 2 diabetes mellitus [48] . The drug regulatory agency had previously rejected the marketing application for dapagliflozin in October 2011, after it was filed in February 2011.

AstraZeneca planned a phase IV study to evaluate the effects of dapagliflozin plus metformin regimen, on the quality of life, obesity-specific quality of life and treatment satisfaction in patients with type-2 diabetes mellitus, in the real world clinical practice (FLORA; NCT02719132). Approximately 820 subjects were to be enrolled in Russia. The trial was however, withdrawn prior to enrolment [49] .

AstraZeneca completed enrolment in a post-marketing safety study of dapagliflozin in approximately 3 000 Japanese patients, aged 65 years and older, with type 2 diabetes mellitus (NCT02200627) [50] .

Owing to business decision, AstraZeneca, in September 2020, terminated a phase III trial that was designed to evaluate the safety and efficacy of dapagliflozin in patients with type 2 diabetes mellitus and inadequate glycemic control on metformin and saxagliptin (DS Navigation) (D1683C00008; NCT03608358). Earlier, in March 2020, AstraZeneca had temporarily halted the recruitment in a phase III trial, to streamline resources and re-evaluate study overall timeline. This double-blind, randomised trial was initiated in February 2019 and recruited 41 patients in Thailand and Vietnam China [51] .

In October 2017, AstraZeneca initiated a phase III trial to evaluate the efficacy and safety of the drugs dapagliflozin and saxagliptin [see Adis Insight Drug profile 800016588] in patients with type 2 diabetes who are aged 10 to below 18 years old and are currently taking metformin, insulin, or both drugs (D1680C00019; EudraCT2015-005042-66; NCT03199053; P059/2016). The double-blind, parallel, prospective, randomised trial is enrolling approximately 243 patients in the US, Poland, Finland, Australia, Brazil, Canada, Chile, Colombia, India, Italy, South Korea, Malaysia, Mexico, New Zealand, Philippines, Romania, Russia, Taiwan, Thailand, Turkey, Ukraine, in the UK and will be extending to Israel. In china trial was withdrawn prior to initiation [52] .

In December 2017, AstraZeneca completed a phase III trial that investigated the efficacy and safety of simultaneous administration of dapagliflozin and exenatide once-weekly suspension [see Adis Insight Drug profile 800022798] compared with dapagliflozin alone and exenatide alone in patients with type 2 diabetes mellitus who have inadequate glycaemic control on metformin (EuraCT2014-003503-29; NCT02229396; DURATION-8; D5553C00003). The randomised, double-blind, 28-week study was to be followed by 24-week extension study. The trial was initiated in September 2014 and enrolled 695 patients in the US, Hungary, Poland, Romania, Slovakia and South Africa. In September 2017, results from the trial were released at the 53rd Annual Meeting of the European Association for the Study of Diabetes (EASD-2017) [53] [54] .

Top-line data from the phase III DERIVE trial showed that the study met the primary endpoint in patients with type 2 diabetes and stage 3A chronic kidney disease (D1690C00024; P310-2014; EudraCT2015-000804-24; NCT02413398) [55] . AstraZeneca completed the trial in November 2017, which was initiated in August 2015. The trial evaluated the glycaemic efficacy and renal safety of dapagliflozin in patients with Type 2 diabetes and moderate renal impairment. Evaluation of the mean change from baseline in HbA1c between dapagliflozin and placebo was the primary endpoint of the trial. The randomised, double-blind, parallel-group assignment, placebo-controlled trial enrolled 323 patients in the US, Spain, Sweden, Poland, the Czech Republic, Bulgaria, Canada, Italy [56] . In February 2018, AstraZeneca reported top-line data from the phase III DERIVE trial [57] . The company plans to submit this DERIVE study results to the US FDA, to be added to the breadth of data already contained within the existing dapagliflozin (FARXIGA) prescribing information. In March 2018, the company presented safety and efficacy data at the The 100th Annual Meeting of the Endocrine Society (AMES-2018) [58] [55] . In November 2018, the European Commission approved an update of the European Study of Product Characteristics (SmPC) , based on the DERIVE trial. The updates to the SmPC included a change to allow the use of dapagliflozin by patients with type-2 diabetes mellitus and renal impairment down to and including, CKD stage 3A. The update removes the restriction for dapagliflozin to CKD, stages 2 and above [25] .

In April 2020, AstraZeneca completed a phase III trial that assessed the efficacy and safety of dapagliflozin 10mg tablet in patients with type 2 diabetes mellitus (D1690C00017; EudraCT2015-005041-31; NCT02725593). The randomised, double-blind, parallel, placebo-controlled trial was initiated in June 2016, and enrolled 72 patients (aged 10 - 24 years)in the US, Hungary, Israel, Mexico, Russia, the UK and Romania [59] .

In November 2017, Bristol-Myers Squibb and AstraZeneca completed a phase IIIb trial that evaluated the efficacy and safety of saxagliptin with dapagliflozin [see Adis Insight Drug profile 800016588], in addition to metformin, with or without sulfonylurea, when compared with insulin glargine in patients with type 2 diabetes mellitus, over a treatment period of 52 weeks (CV181-369; EudraCT2015-001702-33; NCT02551874). Mean change from baseline in Hemoglobin A1c (HbA1c) in a time frame of 24 weeks was to be evaluated as primary outcome measure. The randomised, open-label, active-controlled, parallel-group trial was initiated in October 2015 and enrolled 651 patients in the US, Czech Republic, Denmark, Hungary, Mexico, Poland, Romania, South Africa, Spain, and Sweden [60] . In June 2018, efficacy results from the trial were released by AstraZeneca [61] . Updated efficacy data from the trial were presented at the 54th Annual Meeting of the European Association for the Study of Diabetes (EASD-2018) [62] .

In June 2017, AstraZeneca completed a phase III trial that evaluated the safety and efficacy of saxagliptin 5mg co-administered with dapagliflozin 5mg, as compared with saxaglipgtin 5mg or dapagliflozin 5mg, in patients who are inadequately controlled on ≥ 1500 mg/day of metformin monotherapy (D1683C00005; EudraCT2015-005406-11; NCT02681094). The randomised, double-blind, placebo-controlled trial was initiated in February 2016, and enrolled 906 patients in the US, Canada, Germany, the Czech Republic, Mexico and Russia [63] .

AstraZeneca plans to initiate a phase III trial, with a 28-week safety extension period, to assess the safety and efficacy of dapagliflozin (5mg and 10mg) and saxagliptin (2.5mg and 5mg) [see Adis Insight Drug profile 800016588] in paediatric patients (aged 10 to 18 years) with type 2 diabetes mellitus (UKCRN31254). The double-blind, parallel-group, randomised, placebo-controlled trial will enrol patients in the UK [64] .

AstraZeneca, in April 2018, completed a phase II/III trial which assessed the effect of dapagliflozin with and without saxagliptin, and also evaluated the effect of dapagliflozin and saxagliptin on HbA1C in patients with type 2 diabetes mellitus, albuminuria and renal impairment (CKD) (NCT02547935; D1690C00023). The randomised, double-blind trial initiated in September 2015 enrolled 459 patients in the US, Australia, Canada, Japan, South Korea, Mexico, South Africa, Spain and Taiwan [65] .

In March 2012, AstraZeneca and BMS completed a 24-week phase III trial that evaluated the efficacy and safety of dapagliflozin monotherapy (NCT01294423). This randomised, double-blind, placebo-controlled study involved 261 Japanese patients with inadequately controlled T2DM [66] .

In mid-2012, BMS and AstraZeneca completed a phase III study of dapagliflozin in Asian patients with T2DM and inadequate glycaemic control with diet and exercise (NCT01095653). The double-blind, placebo-controlled, parallel group trial evaluated the safety and efficacy of dapagliflozin monotherapy in approximately 1 179 patients in China, India, South Korea and Taiwan. Patients were randomised to receive oral dapagliflozin 5 or 10mg or placebo, once-daily, for 24 weeks. Patients also had the option to receive metformin on an as-needed basis for rescue based upon protocol specific criteria [67] . As of March 2015, no recent reports of development have been identified in Taiwan for dapagliflozin as monotherapy for T2DM.

Several phase III studies have been completed examining the effect of dapagliflozin monotherapy in varying patient groups or study outcomes. This include treatment-naïve patients with T2DM not well controlled with diet and exercise or existing medication (NCT00528372) [68] , as well as patients inadequately controlled by insulin and one or two oral antidiabetics (NCT00357370) [69] [70] . Phase I and II trials have been completed to determine the effects of dapagliflozin on insulin resistance and insulin secretion (NCT00831779) [71] , efficacy and safety in Japanese patients (NCT00972244) [72] , safety and efficacy of dapagliflozin in treatment-naïve patients who had inadequate glycaemic control on diet and exercise (NCT00263276) [73] , pharmacokinetics and pharmacodynamics (NCT00162305) [74] , (NCT01165268) [75] , (NCT01072578) [76] , (NCT00538174) [77] , as well as potential drug interaction with rifampicin (NCT01068756) [78] , and glimepiride (NCT00562250) [79] . One phase I pharmacokinetic study was initiated in the US, but terminated for an undisclosed reason (NCT00726505) [80] .

Bristol-Myers Squibb completed a phase III trial investigating the efficacy and effects of dapagliflozin on endothelial and microvascular function of the retinal circulation in patients with type 2 diabetes mellitus. The primary endpoint was the retinal capillary flow. The trial was conducted in Germany and enrolled 62 patients (EudraCT2013-004169-14) [81] .

A number of phase III trials have examined the antidiabetic efficacy of dapagliflozin in combination with metformin/extended-release metformin in patients with T2DM. Completed trials include a 392-patient study (NCT01217892) [82] , a 52-week trial with a 156-week extension period in 814 patients (NCT00660907) [83] [84] [85] , a 1 093-patient trial to compare combination therapy with the drugs as monotherapy (NCT00859898) [86] [87] , a 915-patient trial that examined efficacy over 24 weeks. The study also included an extension phase for a total duration of two years (NCT00528879) [88] [89] [90] , and a 600-patient study with the combination used as initial therapy (NCT00643851) [91] [87] .

One phase III trial (EudraCT2008-004916-12) of dapagliflozin plus metformin versus sitagliptin plus metformin was initiated in March 2009 at sites in Austria, Czech Republic and the UK. However, the trial was terminated in May 2009 [92] .

A phase III study of dapagliflozin in combination with metformin has been completed in Asian patients with T2DM who have inadequate glycaemic control on metformin alone (MB102-055; NCT01095666). The double-blind, placebo-controlled trial enrolled 445 patients in China, India and South Korea [93] .

January 2016, Bristol-Myers Squibb completed a phase III trial in March 2014 that assessed the efficacy and safety of dapagliflozin as add-on therapy to insulin in Asian patients with type 2 diabetes, with inadequate glycaemic control on insulin (MB102-137; NCT02096705). The randomised, double-blinded, 24-week trial was initiated in March 2014 and enrolled 477 patients in China, South Korea and Singapore [94] .

AstraZeneca and BMS have completed an open label 52-week phase III trial in 700 Japanese patients with inadequately controlled T2DM, which evaluated the safety and efficacy of dapagliflozin alone or in combination with antihyperglycaemics (NCT01294436) [95] . A regulatory filing has been made for approval of dapagliflozin, as an add-on to sitagliptin, in the EU. A filing in the EU has also been made for the agent as an add-on to insulin and metformin.

AstraZeneca and BMS conducted a number of phase III trials examining dapagliflozin in combination with other antidiabetic drugs, including 1 240-patient study in combination with insulin (NCT00673231) [96] , a 597-patient study in combination with glimepiride (NCT00680745) [97] [98] [99] [100] , a 833-patient trial in combination with sitagliptin with or without metformin (NCT00984867) [101] , and a 972-patient study in combination with thiazolidinedione therapy (NCT00683878) [102] .

A phase III study was completed in August 2013, which evaluated the safety and efficacy of dapagliflozin in patients with type 2 diabetes mellitus who have inadequate glycaemic control on a background combination of metformin and sulfonylurea (NCT01392677). Positive results from the randomised, double-blind, placebo-controlled trial were released in September 2013 [48] . The trial was conducted by AstraZeneca and BMS, and a total of 311 patients were enrolled in Canada, Czech Republic, Germany, Poland, Slovakia and Spain [103] .

In February 2015, Bristol-Myers Squibb and AstraZeneca completed a phase III trial that assessed the safety and efficacy of adding dapagliflozin to saxagliptin plus immediate-release metformin in patients with T2DM who did not achieve adequate glycaemic control with saxagliptin plus metformin alone (NCT01646320; EudraCT2011-006324-20). The randomised, double-blind, placebo-controlled, parallel-group trial, which enrolled 320 patients in the US, Czech Republic, Poland, Puerto Rico, Romania, Russia, Mexico and the UK, was initiated in September 2012 [104] . Results reported in June 2015 showed that the trial met its primary endpoint [105] .

AstraZeneca and BMS completed a phase III trial in January 2014 which investigated the efficacy and tolerability of dapagliflozin and saxagliptin, administered alone or in combination, as an adjunct to metformin in patients with T2DM inadequately controlled by metformin (NCT01606007). The trial enrolled 536 patients in the US, Canada, South Korea, Mexico, Poland, Puerto Rico, Romania and South Africa. Positive results were reported in May 2014 [106] .

A phase III trial recruited 182 patients with T2DM from several countries in the EU to investigate the potential for dapagliflozin to assist with weight-loss (NCT00855166). When added to metformin + sitagliptin, dapagliflozin significantly reduced bodyweight compared with placebo. The trial also demonstrated that dapagliflozin significantly affected fat mass and waist circumference [107] .

In September 2019, AstraZeneca completed a phase III trial that evaluated the efficacy and safety of saxagliptin co-administered with dapagliflozin in combination with metformin compared to glimepiride in combination with metformin, in adult patients with type 2 diabetes who have inadequate glycaemic control on metformin therapy alone (CV181-365; NCT02419612). The randomised, double blind trial was initiated in August 2015, and enrolled 444 patients in the US, Czech Republic Germany, Hungary, Mexico, Poland, Romania, Russia, Sweden, United Kingdom [108] . In November 2020, long-term efficacy results from the trial on liver fat and adipose tissue volumes of patients were presented at 70th Annual Meeting of the American Association for the Study of Liver Diseases (AASLD-2020) [109] .

In November 2017, Tokushima University Graduate School, in collaboration with AstraZeneca, completed the phase II DBOT clinical trial to evaluate whether add-on of dapagliflozin on basal insulin therapy improves mean daily blood glucose levels, measured by CGM, in patients with type II diabetes mellitus (UMIN000019457; R000022501). The trial was initiated in March 2016, and enrolled 30 patients in Japan [110] .

In October 2018, AstraZeneca and Ono Pharmaceutical completed phase II DIET trial which evaluated the hypoglycemic action of dapagliflozin and its effects on body composition and dietary intake during weight loss in Japanese patients with type 2 diabetes mellitus (UMIN000019192; R000021828). The open label trial initiated in October 2015 and enrolled 60 participants in Japan [111] .

In November 2018, AstraZeneca KK and Ono Pharmaceutical completed the phase II DEFENCE trial which evaluate the positive effects of dapagliflozin on body weight, blood pressure, lipid metabolism, glycemic levels and endothelial function in type-2 diabetes patients with moderately inadequate glycaemic control (R000021695; UMIN000018754). Patients enrolled was administered dapagliflozin 5mg once per day in addition to other medications or metformin dose from 750mg up to 1500mg during the 16 week period. The randomised, open label trial, initiated in October 2015 enrolled 80 patients in Japan [112] .

In September 2014, Bristol-Myers Squibb and AstraZeneca completed a phase I trial that investigated the pharmacokinetics and pharmacodynamics of single doses of dapagliflozin in children and adolescents, aged 10-17 years, with T2DM (NCT01525238; EudraCT2011-005225-40). The randomised, open-label trial enrolled 53 patients in in the US and Mexico [113] .

In November 2012, Bristol-Myers Squibb, in collaboration with AstraZeneca, completed a phase I drug interaction trial that evaluated the pharmacokinetics of saxagliptin 5mg and dapagliflozin 10mg when these drugs are co-administered under fasting condition, in healthy volunteers (NCT01662999). The randomised, open-label, crossover trial enrolled 42 volunteers in the US [114] .

In April 2019, AstraZeneca, Kyushu University and ONO Pharmaceutical terminated a clinical trial that investigated a combination therapy of dapaglifozin coupled with intensive physical exercises, for the prevention of muscle mass reduction in patients with type 2 diabetes (R000022897; UMIN000020263). The open label, randomized trial, which was initiated in June 2016, enrolled 146 patients in Japan [115] .

Type 2 diabetes mellitus; high cardiovascular risk

BMS and AstraZeneca are also examining the effects of dapagliflozin in patients with cardiovascular conditions (such as hypertension or cardiovascular disease) in a number of studies worldwide.

In October 2019, the US FDA approved dapagliflozin to reduce the risk of hospitalisation for heart failure (hHF) in adults with type 2 diabetes (T2D) and established cardiovascular disease (CVD) or multiple cardiovascular (CV) risk factors and, was subsequently launched. The approval is based on results from DECLARE-TIMI 58 trial [see below] [116] .

In October 2020, AstraZeneca reported that the China’s National Medical Products Administration (NMPA) updated the label for dapagliflozin for inclusion of data from the DECLARE-TIMI 58 phase III trial [see below] [117]

In April 2020, AstraZeneca in collaboration with Vanderbilt University Medical Center to initiate a phase III trial to test the decongesting effects ofdapagliflozin in patients with type 2 diabetes admitted with an acute decompensation of chronic heart failure (NCT04298229; 200017). The randomized, open-label trial intends to enrol 240 patients in the US [118] .

In September 2018, AstraZeneca, in collaboration with BMS, met its primary endpoint of non-inferiority for major adverse cardiovascular events (MACE) in a completed phase III DECLARE-TIMI 58 trial that investigated the impact of adding dapagliflozin to standard of care therapy on cardiovascular events in patients with T2DM (NCT01730534; EudraCT2013-000239-28; CTRI2014-08-004872; JapicCTI142473; P207-2012; D1693C00001; UKCRN14920; DRN2246; P207-2012). Treatment with dapagliflozin significantly reduced the composite endpoint of hospitalisation for heart failure (hHF) or cardiovascular death. Additionally, fewer MACE events were observed with the treatment arm. Data from the trial confirmed the safety profile of dapagliflozin. Additional results from the trial were released in November 2018 [119] . The randomised, double-blind, placebo-controlled trial was initiated in April 2013 and enrolled 17 190 patients in the US, Argentina, Australia, Belgium, Brazil, Bulgaria, Canada, China, Czech Republic, France, Germany, Hong Kong, Hungary, India, Israel, Italy, Japan, South Korea, Mexico, Netherlands, Philippines, Poland, Romania, Russia, Slovakia, South Africa, Spain, Sweden, Taiwan, Thailand, Turkey, Ukraine, the UK and Vietnam [120] . This study data will support the regulatory filings in China, the US and EU for the use of dapagliflozin in patients with T2DM and high-risk for cardiovascular disease. In June 2020, updated efficacy results from the trial were presented at the 80th Annual Scientific Sessions of the American Diabetes Association (ADA-2020). In September 2020, data was presented at the 56th Annual Meeting of the European Association for the Study of Diabetes (EASD-2020). In November 2020, updated data of the trial was presented at the American Heart Association Scientific Sessions (AHA-2020). In June 2021, the company presented the results at the 81st Annual Scientific Sessions of the American Diabetes Association (ADA-2021) [121] [122] [123] [124] [125] [126] [127] [128] [129] [130] [15] [131] [132] [133] .

BMS and AstraZeneca have completed a phase III trial which compared the efficacy of dapagliflozin in patients with T2DM and uncontrolled hypertension (NCT01137474). The randomised, double-blind study enrolled 2 996 patients in Canada, South America, the EU, India, Russia, and the USA. The primary endpoint was the change from baseline in seated systolic blood pressure and glycosylated haemoglobin. This was assessed at 12 weeks [134] .

In February 2013, BMS completed a phase III trial in 810 patients with T2DM and hypertension inadequately controlled with two or more classes of antihypertensive medications (NCT01195662). The primary endpoint was the change from baseline in seated systolic blood pressure which was assessed after 12 weeks. Patients were enrolled in Australia, Canada, South America, the EU, India, Russia, and the USA [135] .

In December 2012, AstraZeneca in collaboration with BMS, completed a phase III trial, Study 18, which evaluated the changes in haemoglobin, body weight and blood pressure in 922 patients with T2DM, cardiovascular disease and hypertension (D1690C00018; NCT01031680). Patients were randomised to receive dapagliflozin or placebo for 24 weeks, plus a 80-week extension period [136] . The companies completed another similar trial, Study 19, in December 2012, in 964 patients with T2DM and cardiovascular disease which explored the effects of dapagliflozin on haemoglobin, body weight and blood pressure (D1690C00019; NCT01042977). Initiated in March 2010, recruitment of participants was completed in December of that year [137] .

In March 2020, AstraZeneca initiated the clinical trial LEAVE-DM determining the effect of dapagliflozin on preventing heart failure in patients with type 2 diabetes (ACTRN12619001393145; HREC324-19Alfred2019; U1111-1236-7496). The randomised, placebo-controlled trial intends to enrol approximately 400 participants in Australia [138] .

In March 2019, AstraZeneca and Ono Pharmaceutical completed a clinical trial that evaluated the cardioprotective efficacy of dapagliflozin by comparing it with conventional anti diabetic agents in type 2 diabetic patients with hypertension(UMIN000023834; R000027461). The open-label prospective randomized controlled trial was initiated in September 2016 and enrolled 78 patients in Japan [139] .

Type 2 diabetes mellitus; non-alcoholic fatty liver disease

AstraZeneca completed the phase II EFFECT II trial in December 2015, that assessed the effects of dapagliflozin and omega-3 carboxylic acids on the liver fat content in patients with type 2 diabetes mellitus (D5883C00004; EudraCT2014-003638-26; NCT02279407). The primary endpoint of the study was the change of percent of liver fat content from baseline at week 12 of the study measured by MRI. The randomised, placebo-controlled, double-blind study initiated in January 2015, enrolled 223 patients in Sweden. In November 2016, results from the trial were reported at the 67th Annual Meeting of the American Association for the Study of Liver Diseases (AASLD-2016) [140] [141] .

Type 2 diabetes mellitus; renal impairment

BMS completed a phase II/III randomised, double-blind, placebo-controlled, parallel group study that determined the safety, pharmacokinetics and pharmacodynamics of dapagliflozin in approximately 631 patients with T2DM and moderate renal impairment (NCT00663260). The study was conducted in the US, Australia, Canada, India, the EU, Latin America and Singapore [142] . In November 2010, AstraZeneca and BMS completed a phase II trial that evaluated the effects of dapagliflozin on kidney function (as assessed by glomerular filtration rate) in 75 patients with T2DM (NCT00976495) [143] .

Type 2 diabetes mellitus (oral solution)

As at May 2017, development of the dapagliflozin oral solution was discontinued as the same was not listed on the company pipeline (AstraZeneca pipeline, April 2017). In June 2010, BMS and AstraZeneca completed a phase I trial that assessed the pharmacodynamics, pharmacokinetics, safety and tolerability of dapagliflozin oral solution. The trial enrolled 30 healthy volunteers in the US (NCT01135446) [144] .

Type 1 diabetes mellitus

In March 2019, the European Commission (EC) approved dapagliflozin as an oral adjunct treatment for adult patients with type 1 diabetes [145] . The Committee for Medicinal Products for Human Use (CHMP) adopted a positive opinion and recommended dapagliflozin for approval in, February 2019. Marketing Authorisation Variation for the drug was accepted by the EMA in March 2018. The positive opinion and the submission acceptance was based on phase III data from the DEPICT clinical programme which demonstrated significant and clinically relevant reductions from baseline in HbA1c, weight and total daily insulin dose at 24 and 52 weeks, compared to placebo, at both 5mg and 10mg doses [146] [147] [148] .

In July 2019, the US FDA issued a complete response letter regarding AstraZeneca's sNDA for dapagliflozin as an adjunct treatment to insulin to improve glycaemic control in adult patients with type-1 diabetes, when insulin alone does not provide adequate glycaemic control. The sNDA was undergoing regulatory since February 2019 [147] .

In March 2019, the Japanese Ministry of Health, Labour and Welfare (MHLW) approved dapagliflozin (Forxiga) as an oral adjunct treatment to insulin in adults with type 1 diabetes. Earlier, in May 2018, AstraZeneca submitted a supplemental New Drug Application (sNDA) to Japan’s Pharmaceuticals and Medical Devices Agency (PMDA) for the use of the drug. The submission was based on the phase III DEPICT (Dapagliflozin Evaluation in Patients with Inadequately Controlled Type 1 Diabetes) trial (see below) in type 1 diabetes mellitus [149] [150] .

In June 2017, AstraZeneca completed a long-term phase III trial (Part B) that assessed the safety, efficacy, pharmacokinetics and pharmacodynamics of dapagliflozin (5mg and 10mg) tablet as an oral adjunct to insulin in patients with T1DM (aged 18 to 75 years), with inadequate glycaemic control on insulin defined as HbA1c ≥ 7.5% and ≤ 10.5% at screening visit (D1695C00001; NCT02582814; JapicCTI163162). The randomised 1:1, open-label, 2-arm, parallel-group, placebo-controlled trial was initiated in October 2015 and enrolled 170 patients in Japan [151] .

In June 2019, results from a clinical trial involving patients from the phase III DEPICT-1 and DEPICT-2 trials [see below], in type 1 diabetes mellitus were presented at the 79th Annual Scientific Sessions of the American Diabetes Association (ADA-2019). These were patients in whom, dapagliflozin treatment was discontinued owing to adverse events and patient withdrawal of consent. At this time, pooled safety data from the two trials were also presented [152] [153] .

In April 2018, AstraZeneca, in collaboration with Bristol-Myers Squibb, completed the phase III DEPICT 2 trial, which evaluated the efficacy and safety of dapagliflozin in patients with type 1 diabetes mellitus (EudraCT2014-004599-49; NCT02460978). The randomised, double blind trial was initiated in June 2015, and enrolled 815 patients in the US, Argentina, Belgium, Canada, Chile, Germany, Japan, Netherlands, Poland, Russia, Sweden, Switzerland, and the UK. As per top-line results from the trial both 5mg and 10mg dose of dapagliflozin led to significant and clinically relevant reductions in HbA1c, weight and total daily insulin dosing, compared with placebo. In September 2019, data was presented at the 55th Annual Meeting of the European Association for the Study of Diabetes (EASD-2019) [154] [57] [155] .

AstraZeneca reported top-line results from the 52-week, phase III DEPICT 1 trial in patients with type 1 diabetes. Both, the 5mg and 10mg dose of dapagliflozin led to significant and clinically relevant reductions in HbA1c, weight and total daily insulin dosing, compared with placebo (UKCRN17609; NCT02268214; MB102-229; EudraCT2013-004674-97; D1695C00006; DRN3281; MB102-229; U1111-1160-6249; DRKS00009951). The trial was completed in August 2017, and was initiated by BMS in collaboration with AstraZeneca in November 2014. The trial was designed to determine the safety and efficacy of dapagliflozin added to insulin in patients with type 1 diabetes mellitus. The primary endpoint of the study was an adjusted mean change of Hemoglobin A1C from baseline at week 24 of the study. This randomised, placebo-controlled, double-blind study enrolled 833 patients in the US, the UK, Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Hungary, Italy, Israel, Mexico, Romania, Sweden and Spain [57] [156] .

BMS and AstraZeneca have completed a phase II trial in the USA, which assessed the safety, pharmacokinetics and pharmacodynamics of dapagliflozin as an add-on to insulin therapy in 171 patients with type 1 diabetes mellitus (NCT01498185). Results were reported in July 2013 [157] [158] .

In December 2017, Kinderkrankenhaus auf der Bult, in collaboration with, AstraZeneca completed a phase I trial that evaluated the safety and efficacy of dapagliflozin as an add-on to day and night closed-loop control in patients with type 1 diabetes mellitus (ESR15-11453; NCT02987738). The randomised, cross-over trial was initiated in February 2017, and enrolled 30 patients in Germany [159] .

In June 2016, AstraZeneca completed a long-term phase I trial (Part A), which assessed the safety, efficacy, pharmacokinetics and pharmacodynamics of dapagliflozin (5mg and 10mg) tablet plus insulin in patients with T1DM (aged 18 to 65 years), with inadequate glycaemic control on insulin defined as HbA1c ≥ 7.0% and ≤ 10.0% at screening visit (D1695C00001sub; NCT02582840). The randomised 1:1:1, single-blind, 3-arm, parallel-group, placebo-controlled trial was initiated in October 2015 and enrolled 42 patients in Japan. In June 2018, data supporting adjunctive therapy of dapagliflozin with insulin in T1DM patients were presented at the 78th Annual Scientific Sessions of the American Diabetes Association (ADA-2018) [160] [161] .

Results from a preclinical study of dapagliflozin were presented at the 90th Annual Scientific Sessions of the American Heart Association (AHA/ASA-2017) in November 2017. The results showed that, in addition to an improved metabolic profile, improved coronary flow velocity reserve (CFVR) and contractile function in the treated groups were observed, indicating that micro-vascular dysfunction is ameliorated following SGLT2 inhibition [162] .

Chronic heart failure and renal failure

In August 2021, AstraZeneca announced that the Ministry of Health, Labour and Welfare (MHLW) approved dapagliflozin (Forxiga®) for the treatment of chronic kidney disease (CKD) in adults with and without type-2 diabetes (T2D). The decision is based on positive results from the DAPA-CKD Phase III trial. The decision follows the Priority Review designation granted by the MHLW earlier this year [163]

In August 2021, AstraZeneca announced that the European Medicines Agency (EMA) approved dapagliflozin (Forxiga®) for the treatment of chronic renal disease in adults with and without type-2 diabetes (T2D). The decision is based on the data obtained from a phase III DAPA-CKD trial. Earlier, Committee for Medicinal Products for Human Use of EMA had given the recommendation for approval [164] .

In April 2021, dapagliflozin (Farxiga®) was launched in the US, subsequent to the US FDA approval of the dapagliflozin oral tablets to reduce the risk of kidney function decline, kidney failure, cardiovascular death and hospitalization for heart failure in adults with renal failure (chronic kidney disease), who are at risk of disease progression [165] . In May 2020, the US FDA approved dapagliflozin (FARXIGA®) to reduce the risk of cardiovascular (CV) death or the worsening of heart failure (HF) in adults with heart failure with reduced ejection fraction (HFrEF) with and without type 2 diabetes (T2D). The supplemental New Drug Application (sNDA) was acceped and granted Priority Review, in In January 2020, by the US FDA. The Prescription Drug User Fee Act date, for this supplemental application scheduled for the second quarter of 2020. The sNDA was submitted on the basis of results from the landmark Phase III DAPA-HF trial [166] [167] .

In January 2021, AstraZeneca reported that dapagliflozin (FARXIGA ) has been granted Priority Review by the US FDA for the treatment of new or worsening chronic kidney disease (CKD) in adults with and without type 2 diabetes (T2D). The acceptance of the regulatory submission by the US FDA and the granting of priority review was based on clinical evidence from the DAPA-CKD phase III trial (see below). The Prescription Drug User Fee Action date, will be during the second quarter of 2021 [168] .

In November 2020, European Commission approved dapagliflozin (Forxiga®) for the treatment of chronic heart failure with reduced ejection fraction (HFrEF) in patients with and without type-2 diabetes [169] . In October 2020, the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA) recommended dapagliflozin (FARXIGA®) for approval for the treatment of heart failure. This recommendation is based on results of DAPA-HF trial [see below] [170] . In fourth quarter of 2019, the European Medicines Agency accepted a regulatory filing for dapagliflozin for chronic heart failure in European Union [171] .

In February 2021, China’s National Medical Products Administration (NMPA) approved dapagliflozin to reduce the risk of cardiovascular (CV) death and hospitalisation for heart failure (hHF) in adults with heart failure (NYHA class II-IV) with reduced ejection fraction (HFrEF). In fourth quarter of 2019, AstraZeneca filed a regulatory submission for dapagliflozin for chronic heart failure in China [172] [171] .

In November 2020, Japanese Ministry of Health, Labour and Welfare (MHLW) approved dapagliflozin (5mg and 10mg tablets) for the treatment of chronic heart failure who are receiving standard of care in the Japan. This approval was based on positive results of DAPA-HF trial. The product was launched subsequently [173] [174] . In fourth quarter of 2019, AstraZeneca filed a regulatory submission for dapagliflozin for chronic heart failure in Japan [171] .

In July 2020, Astra Zeneca reported that dapagliflozin (Forxiga®) was approved via accelerated approval, for the treatment of patients with heart failure with reduced ejection fraction (HFrEF). The approval was based on favourable results from the phase III DAPA-HF trial [see below] [175] .

In October 2020, the US FDA granted Breakthrough therapy designation to dapagliflozin (FARXIGA) for patients with chronic kidney disease (CKD), with and without type 2 diabetes (T2D) [176] .

In September 2019, the US FDA granted fast track designation to dapagliflozin (FARXIGA) to reduce the risk of cardiovascular death or the worsening of heart failure in adults with heart failure with reduced ejection fraction or preserved ejection fraction. The fast track designation is based on results fromtwo phase III trials, DAPA-HF and DELIVER (see below), which investigated the role of dapagliflozin in patients with heart failure with reduced ejection fraction and preserved ejection fraction respectively [177] .

In August 2019, US FDA granted fast track designation to dapagliflozin for the treatment of renal failure and prevent cardiovascular (CV) and renal death in patients with chronic kidney disease [178] .

In February 2021, AstraZeneca discontinued the phase III DETERMINE-preserved trial that evaluated the effect of dapagliflozin on exercise capacity, in heart failure patients with preserved ejection fraction (HFpEF), due to strategic reasons. In July 2020, AstraZeneca completed a phase III DETERMINE-preserved trial that evaluated the effect of dapagliflozin on exercise capacity, in heart failure patients with preserved ejection fraction (HFpEF) (NCT03877224; D169EC00001; EudraCT2018-003441-42). The randomized, double blind, placebo-controlled trial was initiated in April 2019 and enrolled 504 patients in the US, Argentina, Bulgaria, Canada, South Korea, Brazil, Denmark, Italy, Japan, Slovakia, South Africa and Sweden (AstraZeneca's pipeline, February 2021) [179] [180] .

In February 2021, AstraZeneca discontinued the phase III DETERMINE-preserved trial that evaluated the effect of dapagliflozin on exercise capacity, in heart failure patients with preserved ejection fraction (HFpEF), due to strategic reasons. In April 2019, AstraZeneca initiated, and enrolled the first patient in the phase III DETERMINE-reduced trial, to evaluate the effect of dapagliflozin on exercise capacity, in heart failure patients with reduced ejection fraction (HFrEF) (NCT03877237; D169EC00002; EudraCT2018-003442-16). The randomized, double blind, placebo-controlled trial was completed in March 2020 and enrolled 4744 patients in the US, Canada, Denmark, South Korea, Brazil, Japan, Slovakia, South Africa and Sweden. Change from baseline in 6-minute walking distance (6MWD) at week 16 will be assessed as the primary endpoint in the trial. The DETERMINE trial is a part of the extensive DapaCare clinical programme for dapagliflozin, which is designed to generate data across a spectrum of patients with CV risk factors, established CV disease and varying stages of renal disease, both with and without T2D [179] [181] .

AstraZeneca, in September 2016, announced a programme comprising of two phase IIIb outcome studies, to evaluate dapagliflozin in the management of chronic heart failure and renal failure, in patients with or without type-2 diabetes mellitus. The company also reported the initiation of mechanistic studies, to provide further rationale for the cardiovascular and renal protective effects of SGLT-2 inhibitors [182] .

In August 2018, AstraZeneca initiated the phase III DELIVER trial to evaluate the effect of dapagliflozin 10mg versus placebo, given once daily in addition to background regional standard of care therapy, including treatments to control co-morbidities, in reducing the composite of CV death or heart failure events (EudraCT2018-000802-46; NCT03619213; D169CC00001) . The double-blind, randomised, placebo-controlled trial is enrolling approximately 4 700 participants in Hungary, the US, Canada, Argentina, Belgium, Brazil, Bulgaria, China, Czech Republic, France, Japan, Mexico, Netherlands, Peru, Poland, Romania, Russia, Saudi Arabia, Spain, Taiwan, Vietnam [183] .

In July 2019, AstraZeneca completed the DAPA-HF (Dapagliflozin And Prevention of Adverse-outcomes in Heart Failure), phase III clinical trial which evaluated the efficacy of dapagliflozin, on the incidence of worsening of heart failure or cardiovascular death, in patients with chronic heart failure with reduced ejection fraction (D1699C00001; JapicCTI173524; Eudra2016-003897-41; CTRI2017-08-009207; NCT03036124). Evaluation of the time to the first occurrence of cardiovascular death, hospitalisation for heart failure, an urgent heart failure visit, is the defined primary endpoints of the study. The randomised, double blind, parallel assignment, placebo controlled trial initiated in January 2017, enrolled 4744 patients in Argentina, Brazil, Denmark, the US, the UK, Canada, China, Bulgaria, Czechia (Czech Republic), India, Japan, Netherlands, Poland, Russia, Slovakia, Sweden, Taiwan, Germany, Hungary and Vietnam [184] [185] . In August 2019, AstraZeneca announced that the trial met its primary endpoint, showed statistically-significant and clinically-meaningful reduction of cardiovascular death or the worsening of heart failure (defined as hospitalisation or an urgent heart failure visit), compared with placebo. The safety profile was consistent in the trial. In September 2019, data from the trial was presentated at the ESC Congress 2019: Annual Congress of the European Society of Cardiology (ESC-Card-2019) and sub-analysis from the trial was reported in November 2019. In November 2019, post hoc efficacy and safety analysis data from the trial was released by AstraZeneca [186] [187] [188] [189] . In June 2020, The efficacy results from the trial in prevention of diabetes were presented at 80th American Diabetes Association (ADA-2020) [190] . In August 2020, safety results from the trial were presented at the ESC Congress 2020 - Annual Congress of the European Society of Cardiology (ESC-Card-2020) [191] . In November 2020, efficacy results from the trial were presented at American Heart Association Scientific Sessions 2020 (AHA-2020) [192]

In July 2020, AstraZeneca reported that the phase III Dapa-CKD trial met its primary and secondary endpoints, showing statistically significant and clinically meaningful effect of dapagliflozin on worsening of renal function or risk of death in CKD patients with and without type-2 diabetes (T2D) (D169AC00001; EudraCT2016-003896-24; NCT03036150; JapicCTI183962). The double-blind, randomised trial was completed in June 2020. The trial was initiated in February 2017 and enrolled 4 304 patients in the US, Canada, Denmark, South Korea, Poland, Russia, Spain, Sweden, Germany, Hungary, Ukraine, Brazil, Argentina, Vietnam, Peru, Philippines, China, India, Japan Mexico, and the UK. The primary endpoint of a composite of worsening of renal function or risk of death was defined as a composite endpoint of 50% sustained decline in estimated glomerular filtration rate (eGFR), onset of end stage kidney disease (ESKD) or cardiovascular (CV) or renal death, in patients with chronic kidney disease. The safety profile was consistent with the well-established safety profile of the drug. Earlier, in March 2020, the company announced that the study was being stopped early following a recommendation from an independent Data Monitoring Committee (DMC) based on its determination of overwhelming efficacy. The decision was made following a routine assessment of efficacy and safety which showed benefits earlier than originally anticipated [193] [194] [195] [196] [197] . In August 2020, updated safety and efficacy results from the trial were released by the AstraZeneca [198] . In June 2021, the company presented updated safety and efficacy data from the trial at the 81st Annual Scientific Sessions of the American Diabetes Association (ADA-2021) [199] .

In January 2021, AstraZeneca initiated a phase II MIRACLE trial to evaluate the efficacy, safety and tolerability of AZD 9977 and dapagliflozin alone and as combination treatment in patients with heart failure and chronic kidney disease (NCT04595370; EudraCT2020-003126-23 ; D6402C00001). The randomised, double-blind, placebo-controlled trial intends to enrol 540 patients in the US and Hungary and expected to expand in Belgium, Bulgaria, Canada, Czech Republic, Denmark, Germany, Italy, Japan, Lithuania, Poland, Spain, Thialand, Ukraine [200] .

In December 2020, Nagoya Graduate School of Medicine terminated AstraZeneca funded clinical trial that evaluated effects of dapagliflozin on stabilizing coronary atherosclerotic plaques using IB-IVUS imaging study (UMIN000027422; R000031182). The trial was initiated in May 2017 and intended to enroll 100 patients in Japan [201] .

Heart failure following acute myocardial infraction

(MI): In July 2020, AstraZeneca granted Fast Track Designation in the US for the development of dapagliflozin to reduce the risk of hospitalization for heart failure (hHF) or cardiovascular (CV) death in adults following an acute myocardial infarction (MI) or heart attack. The designation is based on the phase III DAPA-MI trial that will explore the efficacy and safety of FARXIGA in this patient population. In addition to Fast Track Designation, the FDA recently granted Special Protocol Assessment (SPA) agreement to the DAPA-MI trial [202]

In August 2020, AstraZeneca, in collaboration with Uppsala University, initiated a phase III DAPA-MI trial to evaluate the effect of dapagliflozin versus placebo, given once daily in addition to standard of care therapies for the prevention of hospitalisation for heart failure or cardiovascular (CV) death in patients with myocardial infarction and without diabetes (D169DC00001; EudraCT2020-000664-31; NCT04564742). This event-driven, registry-based randomised controlled, double-blind study is enrolling approximately 6 400 patients in Sweden and will extend to sites in the United Kingdom [203] .

Obesity

In March 2016, Uppsala University, in collaboration with AstraZeneca, completed a phase II trial investigated the efficts of dapagliflozin, in combination with exenatide, on body weight in non-diabetic obese subjects (NCT02313220). The randomised, double-blind trial was initiated in December 2014 and enrolled 50 patients in Sweden [204] .

Other investigator-sponsored trials

In September 2021, Postgraduate Institute of Medical Education and Research initiated a phase II trial to evaluate the efficacy and safety of dapagliflozin in cirrhotic patients with recurrent ascites (NCT05014594). The randomized, double-blind, parallel trial is expected to enroll 44 patients in India.

Owing to the delay in the patient enrolment, in March 2020, University Medical Center Hamburg-Eppendorf and AstraZeneca terminated a phase III trial that evaluated the potential synergistic effect of dapagliflozin plus exenatide [see Adis insight drug profile800022798] once-weekly, in combination with high-dose intensive insulin therapy, in obese insulin-resistant patients with type II diabetes mellitus and inadequate glycaemic control (ESR16-12160UKE-DapEx001; UKE-DapEx001; EudraCT2016-003738-25; NCT03419624). Evaluation of the change in HbA1c level is the defined primary endpoint of the trial. The randomised, double-blind, placebo-controlled trial was initiated in February 2018 and enrolled approximately 13 patients in Germany [205] .

In January 2021, KRKA d.d initiated a phase II trial to evaluate the bioavailability of dapagliflozin 10 mg formulations in healthy volunteers in fed conditions (EudraCT2020-005842-41; KRK-001). The randomised, controlled trial intends to enrol approximately 24 healthy adults in Slovenia.

In March 2019, the Japan Society for Patient Reported Outcome (PRO) and Saitama Medical University completed a phase II trial which evaluated the efficacy of dapagliflozin versus sitagliptin, for preventing of cardiovascular risk factors in patients with type II diabetes mellitus patients (UMIN000029640; R000033859). Primary endpoint of the trial was 24-hour Holter electrocardiogram, frequency of arrhythmia, and its symptom. The Randomised, open label trial that was initiated in November 2017 enrolled 40 patients in Japan [206] .

In March 2019, Toho University Omori Medical Center and the Japan Society for Patient Reported Outcome (PRO) in collaboration with AstraZeneca completed the DIVERSITY-CVR trial which evaluated the efficacy of dapagliflozin versus sitagliptin, for preventing of cardiovascular risk factors in patients with type II diabetes mellitus patients (R000032081; UMIN000028014). The open label trial that was initiated in July 2017 enrolled 340 patients in Japan. In the trial no severe adverse events were reported in both the groups. In September 2019, results from the trial were presented at the 55th Annual Meeting of the European Association for the Study of Diabetes (ESAD-2019) [207] [208] .

In April 2016, the Seoul National University Hospital in collaboration with AstraZeneca completed a phase II trial which investigated the effect of dapagliflozin on the incretin sensitivity of the pancreatic beta cell (NCT02420392). The trial enrolled 30 patients with type II diabetes in South Korea [209] .

In June 2014, the King's College London and the Guy's and St. Thomas NHS Foundation Trust initiated a phase III trial to study the protective effect on renal disease in patients with type 2 diabetes and diabetic nephropathies (DEER; EudraCT2013-004042-42). The trial compares the combination effect of dapagliflozin and ramipril on reduction in microalbuminuria compared with ramipril alone. The randomised, open-label trial is intended to enrol 40 patients in the UK [210] .

In October 2018, Steno Diabetes Center, Copenhagen in collaboration with the Novo Nordic Foundation, Rigshospitalet, AstraZeneca and Bayer completed the phase II PRE-D trial in patients with pre-diabetic state and obesity. The trial is designed to compare the short-term (3 months) effectiveness of dapagliflozin, metformin and physical activity on glucose variability, body composition, and cardiometabolic risk factors in overweight or obese individuals with pre-diabetes (EudraCT2015-001552-30; NCT02695810). The trial enrolled 120 patients in Denmark. In the trial, statistically significant differences were not observed in any of the glucagon measures in patients with prediabetes, when treated with dapagliflozin, metformin or exercise from baseline to 13 or 26 weeks. The trial was initiated in February 2016. In June 2019, efficacy data from the trial were presented at the 79th Annual Scientific Sessions of the American Diabetes Association (ADA-2019) [211] [212] . Results from the trial were presented at the 80th Annual Scientific Sessions of the American Diabetes Association (ADA-2020) [213] [214] .

In November 2017, AstraZeneca in collaboration with University Medical Center Groningen initiated the phase II DIAMOND trial to test the hypothesis that dapagliflozin lowers proteinuria in patients with non-diabetic chronic kidney disease (NCT03190694; EudraCT2017-001090-16; 2017003001). The crossover, double-blind, prospective, randomised trial is enrolling approximately 53 patients in the Netherlands and may extend to Canada and Malaysia [215] .

In February 2021, Jiangsu Hansoh Pharmaceutical completed a phase I trial which evaluated bioequivalence of two formulations of dapagliflozin 10 mg tablets in healthy volunteers under fasting conditions.(NCT04880993;2020-4925).The trial also evaluated the safety and tolerability of the treatment.The primary endpoint of the trial was peak plasma concentration (Cmax) of dapagliflozin in plasma after administration of the test and the reference products. The randomized, open-label, cross-over, prospective, single-dose trial was initiated in December 2020 and enrolled 30 healthy volunteers in Canada [216]

Labelling information

In November 2019, AstraZeneca reported that the US FDA has updated label of dapagliflozin (Farxiga) with use to reduce the risk of hospitalisation for heart failure (hHF) in adults with type 2 diabetes mellitus and established cardiovascular diseases (CVD) or multiple cardiovascular (CV) risk factors. In May 2015, the FDA issued a Safety Communication, warning against the risk of diabetic ketoacidosis caused by all SGLT2 inhibitors. The warning was issued following the agency received reports of 20 patients suffering from the condition after taking the medications [217] [218] .

Patent Information

qBMS owns a patent covering the composition of matter of dapagliflozin which has an expiry date of October 2020 in the US and May 2023 in the EU.

Drug Properties & Chemical Synopsis

  • Route of administration PO
  • Formulation Liquid, Tablet, unspecified
  • Class Antihyperglycaemics, Benzhydryl compounds, Chlorobenzenes, Glucosides, Heart failure therapies, Obesity therapies, Pyrans, Small molecules, Urologics
  • Target Sodium-glucose transporter 2
  • Mechanism of Action Sodium-glucose transporter 2 inhibitors
  • WHO ATC code

    A10B-X09 (Dapagliflozin)

    C01 (Cardiac Therapy)

    G04B (Urologicals)

    J05 (Antivirals for Systemic Use)

  • EPhMRA code

    A10X (Other Drugs Used in Diabetes)

    A8 (Antiobesity Preparations, Excluding Dietetics)

    C1 (Cardiac Therapy)

    J5 (Antivirals for Systemic Use)

  • Chemical name (2S,3R,4R,5S,6R)-2-[4-Chloro-3-(4-ehoxybenzyl)phenyl]-6-(hydroxymethyl)tetrahydro-2H-pyran-3,4,5-triol
  • Molecular formula C21 H25 Cl O6
  • SMILES C1C(=CC(=C(C=1)Cl)CC1C=CC(=CC=1)OCC)C1C(C(C(C(O1)CO)O)O)O
  • Chemical Structure
  • CAS Registry Number 461432-26-8

Biomarkers Sourced From Trials

Indication Biomarker Function Biomarker Name Number of Trials

Acute heart failure

Brief Title

timeless circadian clock

Rho guanine nucleotide exchange factor 5

1

1

Acute heart failure

Eligibility Criteria

BNP

1

Acute heart failure

Official Title

timeless circadian clock

Rho guanine nucleotide exchange factor 5

1

1

adenocarcinoma

Brief Title

solute carrier family 5 (sodium/glucose cotransporter), member 2

2

adenocarcinoma

Eligibility Criteria

T-cell surface antigen CD4

PSA

2

1

adenocarcinoma

Official Title

solute carrier family 5 (sodium/glucose cotransporter), member 2

2

adenocarcinoma

Outcome Measure

Carbohydrate antigen 19-9 (CA 19-9)

1

Alzheimer's disease

Brief Summary

N-Acetyl-L-aspartic acid

L-Aspartic acid

1

1

Alzheimer's disease

Detailed Description

Tumor necrosis factor alpha (TNF-alpha)

RAC-alpha serine/threonine-protein kinase (AKT)

mTOR

Monocyte chemoattractant protein-1 (MCP-1/CCL2)

Insulin

Eotaxin (CCL11)

Citrate synthase

C-reactive protein (CRP)

alkylglycerone phosphate synthase

3-Hydroxybutyric acid

1

1

1

1

1

1

1

1

1

1

Alzheimer's disease

Outcome Measure

Tumor necrosis factor alpha (TNF-alpha)

RAC-alpha serine/threonine-protein kinase (AKT)

N-Acetyl-L-aspartic acid

Monocyte chemoattractant protein-1 (MCP-1/CCL2)

L-Aspartic acid

Insulin

Eotaxin (CCL11)

C-reactive protein (CRP)

3-Hydroxybutyric acid

1

1

1

1

1

1

1

1

1

carcinoma

Brief Title

solute carrier family 5 (sodium/glucose cotransporter), member 2

1

carcinoma

Eligibility Criteria

T-cell surface antigen CD4

1

carcinoma

Official Title

solute carrier family 5 (sodium/glucose cotransporter), member 2

1

carcinoma

Outcome Measure

Carbohydrate antigen 19-9 (CA 19-9)

1

cardiomegaly

Brief Title

solute carrier family 5 (sodium/glucose cotransporter), member 2

1

cardiomegaly

Detailed Description

solute carrier family 5 (sodium/glucose cotransporter), member 2

1

cardiomegaly

Official Title

solute carrier family 5 (sodium/glucose cotransporter), member 2

1

cardiomyopathies

Brief Title

solute carrier family 5 (sodium/glucose cotransporter), member 2

1

cardiomyopathies

Official Title

solute carrier family 5 (sodium/glucose cotransporter), member 2

1

cardiomyopathies

Outcome Measure

MPO

BNP

1

1

cardiovascular disorders

Outcome Measure

ZGLP1

Tumor necrosis factor alpha (TNF-alpha)

Transforming growth factor-beta (TGF-beta)

Renin

RAGE

PAI-1

Monocyte chemoattractant protein-1 (MCP-1/CCL2)

MMP9

MMP-2

Leptin

Interleukin-6 (IL-6)

Interleukin 1 Beta (IL-1β)

Insulin

ICAM-1 (Intercellular Adhesion Molecule 1)

Hematopoietic progenitor cell antigen CD34

Ghrelin

GCG

euchromatic histone-lysine N-methyltransferase 1

connective tissue growth factor

C-reactive protein (CRP)

BNP

Aldosterone

Adiponectin (ADIPOQ)

Adenosine

8-oxo-7-hydrodeoxyguanosine

1

1

1

1

1

1

1

1

1

1

2

1

1

1

1

1

1

1

1

1

1

1

1

1

1

cardiovascular disorders

Brief Title

timeless circadian clock

Rho guanine nucleotide exchange factor 5

1

1

cardiovascular disorders

Detailed Description

ZGLP1

Tumor necrosis factor alpha (TNF-alpha)

SDF-1 alpha (CXCL12)

Leptin

Interleukin-6 (IL-6)

Insulin

Hematopoietic progenitor cell antigen CD34

Ghrelin

GCG

euchromatic histone-lysine N-methyltransferase 1

dentin sialophosphoprotein

Creatinine

C-reactive protein (CRP)

Adiponectin (ADIPOQ)

1

1

1

1

1

1

1

1

1

1

1

1

1

1

cardiovascular disorders

Eligibility Criteria

solute carrier family 5 (sodium/glucose cotransporter), member 2

L-Aspartic acid

D-Galactose

Creatinine

BNP

Ataxia telangiectasia mutated

ALT

Alkaline phosphatase (ALPL)

1

1

1

1

2

1

1

1

cardiovascular disorders

Official Title

timeless circadian clock

Rho guanine nucleotide exchange factor 5

2

2

cardiovascular disorders

Brief Summary

dentin sialophosphoprotein

1

carotid artery diseases

Brief Summary

VCAM-1

Tumor necrosis factor alpha (TNF-alpha)

Nitric Oxide (NO)

Leptin

Interleukin-6 (IL-6)

Interleukin-2 (IL-2)

ICAM-1 (Intercellular Adhesion Molecule 1)

C-reactive protein (CRP)

Adiponectin (ADIPOQ)

1

1

1

1

1

1

1

1

1

carotid artery diseases

Outcome Measure

VCAM-1

Tumor necrosis factor alpha (TNF-alpha)

Leptin

Interleukin-6 (IL-6)

Interleukin-2 (IL-2)

ICAM-1 (Intercellular Adhesion Molecule 1)

Endothelin 1

C-reactive protein (CRP)

Adiponectin (ADIPOQ)

1

1

1

1

1

1

1

1

1

Chronic heart failure

Detailed Description

BNP

2

Chronic heart failure

Eligibility Criteria

D-Galactose

BNP

1

5

Chronic heart failure

Official Title

solute carrier family 5 (sodium/glucose cotransporter), member 2

1

Chronic heart failure

Outcome Measure

BNP

3

coronary artery disease

Outcome Measure

VCAM-1

Tumor necrosis factor alpha (TNF-alpha)

progesterone receptor membrane component 1

Monocyte chemoattractant protein-1 (MCP-1/CCL2)

MMP9

Leptin

Interleukin-8 (IL-8)

Interleukin-6 (IL-6)

Interleukin-2 (IL-2)

Interleukin-17 (IL-17)

Interleukin-10 (IL-10)

Interleukin 1 Beta (IL-1β)

Interleukin 1 alpha (IL-1α)

ICAM-1 (Intercellular Adhesion Molecule 1)

Endothelin 1

C-reactive protein (CRP)

BNP

Adiponectin (ADIPOQ)

1

2

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

2

coronary artery disease

Brief Title

solute carrier family 5 (sodium/glucose cotransporter), member 2

1

coronary artery disease

Detailed Description

Tumor necrosis factor alpha (TNF-alpha)

P-selectin

Interleukin-6 (IL-6)

C-reactive protein (CRP)

BNP

1

1

1

1

1

coronary artery disease

Eligibility Criteria

Insulin

1

coronary artery disease

Official Title

solute carrier family 5 (sodium/glucose cotransporter), member 2

1

coronary artery disease

Brief Summary

VCAM-1

Tumor necrosis factor alpha (TNF-alpha)

Nitric Oxide (NO)

Leptin

Interleukin-6 (IL-6)

Interleukin-2 (IL-2)

ICAM-1 (Intercellular Adhesion Molecule 1)

C-reactive protein (CRP)

BNP

Adiponectin (ADIPOQ)

1

1

1

1

1

1

1

1

1

1

cOVID 2019 infections

Eligibility Criteria

D-Galactose

1

cOVID 2019 infections

Outcome Measure

Lactate dehydrogenase (LDH)

Interleukin-6 (IL-6)

Ferritin

D-dimer

C-reactive protein (CRP)

1

1

1

1

1

cystinuria

Brief Title

L-Cystine

1

cystinuria

Detailed Description

L-Cystine

1

cystinuria

Official Title

L-Cystine

1

cystinuria

Outcome Measure

L-Cysteine

1

Decompensated heart failure

Arm Group Label

solute carrier family 5 (sodium/glucose cotransporter), member 2

1

Decompensated heart failure

Outcome Measure

BNP

1

Decompensated heart failure

Arm Group Description

solute carrier family 5 (sodium/glucose cotransporter), member 2

Insulin

1

1

Decompensated heart failure

Detailed Description

solute carrier family 5 (sodium/glucose cotransporter), member 2

1

Decompensated heart failure

Eligibility Criteria

C-reactive protein (CRP)

BNP

1

2

Decompensated heart failure

Brief Summary

BNP

1

diabetes mellitus

Outcome Measure

Tumor necrosis factor alpha (TNF-alpha)

PYY

Leptin

Interleukin-6 (IL-6)

Insulin

Ghrelin

C-reactive protein (CRP)

1

1

1

1

1

1

1

diabetes mellitus

Brief Title

solute carrier family 5 (sodium/glucose cotransporter), member 2

1

diabetes mellitus

Detailed Description

solute carrier family 5 (sodium/glucose cotransporter), member 2

1

diabetes mellitus

Eligibility Criteria

C-peptide

1

diabetes mellitus

Official Title

solute carrier family 5 (sodium/glucose cotransporter), member 2

1

diabetic cardiomyopathy

Outcome Measure

Cardiac Troponin I

1

diabetic ketoacidosis

Arm Group Description

Pro-opiomelanocortin (POMC

1

diabetic ketoacidosis

Brief Summary

GCG

1

diabetic ketoacidosis

Eligibility Criteria

Thyroid stimulating hormone beta (TSH)

Creatine

C-peptide

1

1

1

diabetic ketoacidosis

Official Title

Pro-opiomelanocortin (POMC

1

essential hypertension

Brief Summary

Creatinine

1

exercise-induced hypoglycaemia

Outcome Measure

somatostatin

GCG

1

1

focal segmental glomerulosclerosis

Eligibility Criteria

actinin, alpha 4

1

focal segmental glomerulosclerosis

Outcome Measure

Inulobiose

1

glucose intolerance

Outcome Measure

Insulin

GCG

AT-rich interaction domain 4B

1

1

1

Glucose metabolism disorders

Outcome Measure

Insulin

GCG

AT-rich interaction domain 4B

1

1

1

heart failure

Outcome Measure

Uric acid

syndecan binding protein 2

MPO

MMP-1

IL1RL1

dehydrodolichyl diphosphate synthase subunit

choline phosphotransferase 1

Cardiac Troponin T

Cardiac Troponin I

CA125 ovarian cancer antigen (MUC16)

BNP

1

1

1

1

1

1

1

1

1

1

5

heart failure

Brief Title

solute carrier family 5 (sodium/glucose cotransporter), member 2

2

heart failure

Arm Group Description

Angiotensin-converting enzyme (ACE

1

heart failure

Eligibility Criteria

PTPRN

ladinin 1

IA2 Auto-antibodies

IA-2

D-Galactose

C-peptide

BNP

Ataxia telangiectasia mutated

1

1

1

1

1

1

4

1

heart failure

Official Title

solute carrier family 5 (sodium/glucose cotransporter), member 2

2

hypercholesterolaemia

Brief Summary

L-Leucine

1

hypercholesterolaemia

Detailed Description

L-Leucine

1

hyperglycaemia

Arm Group Description

Insulin

1

hyperglycaemia

Arm Group Label

Insulin

1

hypertension

Outcome Measure

Uric acid

1

hypertension

Brief Title

solute carrier family 5 (sodium/glucose cotransporter), member 2

1

hypertension

Detailed Description

solute carrier family 5 (sodium/glucose cotransporter), member 2

1

hypertension

Eligibility Criteria

C-peptide

1

hypertension

Official Title

solute carrier family 5 (sodium/glucose cotransporter), member 2

1

hypertension in diabetes

Outcome Measure

Uric acid

Angiotensinogen (AGT

2

1

hypertension in diabetes

Brief Title

solute carrier family 5 (sodium/glucose cotransporter), member 2

Angiotensinogen (AGT

Angiotensin-converting enzyme (ACE

1

1

1

hypertension in diabetes

Eligibility Criteria

sex hormone-binding globulin

L-Aspartic acid

Insulin

hydroxysteroid (17-beta) dehydrogenase 4

group-specific component (vitamin D binding protein)

D-box binding PAR bZIP transcription factor

Creatine

coiled-coil alpha-helical rod protein 1

C-peptide

bestrophin 1

Angiotensin-converting enzyme (ACE

ALT

1

1

2

1

1

1

1

1

2

1

1

1

hypertension in diabetes

Official Title

solute carrier family 5 (sodium/glucose cotransporter), member 2

Angiotensinogen (AGT

Angiotensin-converting enzyme (ACE

1

1

1

hypertension in diabetes

Brief Summary

Angiotensinogen (AGT

1

hyperuricaemia

Brief Title

Uric acid

1

hyperuricaemia

Official Title

Uric acid

1

insulin resistance

Outcome Measure

Insulin

GCG

AT-rich interaction domain 4B

1

1

1

kidney disorders

Detailed Description

Uric acid

Creatine

1

1

kidney disorders

Eligibility Criteria

solute carrier family 5 (sodium/glucose cotransporter), member 2

L-Aspartic acid

D-Galactose

ALT

Alkaline phosphatase (ALPL)

1

1

1

1

1

kidney disorders

Outcome Measure

Tumor necrosis factor alpha (TNF-alpha)

Transforming growth factor-beta (TGF-beta)

Renin

RAGE

PAI-1

Monocyte chemoattractant protein-1 (MCP-1/CCL2)

MMP9

MMP-2

Interleukin-6 (IL-6)

Interleukin 1 Beta (IL-1β)

ICAM-1 (Intercellular Adhesion Molecule 1)

connective tissue growth factor

Aldosterone

Adenosine

8-oxo-7-hydrodeoxyguanosine

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

left ventricular hypertrophy

Outcome Measure

Uric acid

BNP

1

1

metabolic syndrome

Brief Title

Insulin

1

metabolic syndrome

Detailed Description

Insulin

Creatinine

1

1

metabolic syndrome

Official Title

Insulin

1

metabolic syndrome

Outcome Measure

Uric acid

Insulin

1

1

muscle fatigue

Eligibility Criteria

BNP

1

myocardial infarction

Eligibility Criteria

D-Galactose

Ataxia telangiectasia mutated

1

1

obesity

Arm Group Label

solute carrier family 5 (sodium/glucose cotransporter), member 2

1

obesity

Outcome Measure

Uric acid

Tumor necrosis factor alpha (TNF-alpha)

TRG

Testosterone

sex hormone-binding globulin

Resistin

PYY

Progesterone

Leptin

Interleukin-6 (IL-6)

Interleukin-10 (IL-10)

Insulin

Hydrocortisone

Ghrelin

GCG

Docosahexaenoyl Ethanolamide

Dehydroepiandrosterone sulfate

Dehydroepiandrosterone

Cervonoyl ethanolamide

C-reactive protein (CRP)

C-peptide

Androstenedione

Adiponectin (ADIPOQ)

1

2

1

2

2

1

1

1

3

2

2

5

1

2

1

1

1

1

1

2

1

1

2

obesity

Brief Title

solute carrier family 5 (sodium/glucose cotransporter), member 2

Insulin

1

1

obesity

Arm Group Description

solute carrier family 5 (sodium/glucose cotransporter), member 2

Insulin

1

1

obesity

Detailed Description

Uric acid

Tumor necrosis factor alpha (TNF-alpha)

solute carrier family 5 (sodium/glucose cotransporter), member 2

Resistin

Leptin

Interleukin-6 (IL-6)

Interleukin-10 (IL-10)

Insulin

GLP1R

Ghrelin

GCG

C-reactive protein (CRP)

Alpha-D-Glucose

Adiponectin (ADIPOQ)

1

1

1

1

1

1

2

1

1

1

1

1

1

2

obesity

Eligibility Criteria

urocortin 3

Thyroid stimulating hormone beta (TSH)

dentin sialophosphoprotein

D-Galactose

1

1

1

1

obesity

Official Title

solute carrier family 5 (sodium/glucose cotransporter), member 2

Insulin

GLP1R

2

1

1

obesity

Brief Summary

Insulin

1

pancreatic cancer

Brief Title

solute carrier family 5 (sodium/glucose cotransporter), member 2

1

pancreatic cancer

Eligibility Criteria

T-cell surface antigen CD4

1

pancreatic cancer

Official Title

solute carrier family 5 (sodium/glucose cotransporter), member 2

1

pancreatic cancer

Outcome Measure

Carbohydrate antigen 19-9 (CA 19-9)

1

prediabetic state

Brief Title

Insulin

1

prediabetic state

Eligibility Criteria

D-Galactose

1

prediabetic state

Official Title

Insulin

1

prediabetic state

Outcome Measure

Uric acid

progesterone receptor membrane component 1

Insulin

1

1

2

prostate cancer

Brief Title

solute carrier family 5 (sodium/glucose cotransporter), member 2

1

prostate cancer

Eligibility Criteria

T-cell surface antigen CD4

PSA

1

1

prostate cancer

Official Title

solute carrier family 5 (sodium/glucose cotransporter), member 2

1

proteinuria

Outcome Measure

Uric acid

Tumor necrosis factor alpha (TNF-alpha)

Transforming growth factor-beta (TGF-beta)

solute carrier family 5 (sodium/glucose cotransporter), member 2

nephrosis 1, congenital, Finnish type (nephrin)

Interleukin-6 (IL-6)

Creatinine

Aldosterone

8-oxo-7-hydrodeoxyguanosine

1

1

1

1

1

1

1

1

1

proteinuria

Brief Title

solute carrier family 5 (sodium/glucose cotransporter), member 2

2

proteinuria

Arm Group Description

Creatinine

1

proteinuria

Detailed Description

solute carrier family 5 (sodium/glucose cotransporter), member 2

Renin

Aldosterone

2

1

1

proteinuria

Eligibility Criteria

Creatinine

bestrophin 1

1

1

proteinuria

Official Title

solute carrier family 5 (sodium/glucose cotransporter), member 2

3

proteinuria

Brief Summary

solute carrier family 5 (sodium/glucose cotransporter), member 2

Renin

Aldosterone

1

1

1

renal failure

Outcome Measure

Insulin

Creatinine

1

1

renal failure

Brief Title

solute carrier family 5 (sodium/glucose cotransporter), member 2

1

renal failure

Detailed Description

Insulin

1

renal failure

Eligibility Criteria

tissue factor pathway inhibitor (lipoprotein-associated coagulation inhibitor)

solute carrier family 5 (sodium/glucose cotransporter), member 2

D-Galactose

BNP

1

1

1

1

renal failure

Official Title

solute carrier family 5 (sodium/glucose cotransporter), member 2

1

sleep apnoea syndrome

Brief Summary

solute carrier family 5 (sodium/glucose cotransporter), member 2

1

sleep apnoea syndrome

Brief Title

solute carrier family 5 (sodium/glucose cotransporter), member 2

1

sleep apnoea syndrome

Official Title

solute carrier family 5 (sodium/glucose cotransporter), member 2

1

squamous cell cancer

Brief Title

solute carrier family 5 (sodium/glucose cotransporter), member 2

1

squamous cell cancer

Eligibility Criteria

T-cell surface antigen CD4

1

squamous cell cancer

Official Title

solute carrier family 5 (sodium/glucose cotransporter), member 2

1

squamous cell cancer

Outcome Measure

Carbohydrate antigen 19-9 (CA 19-9)

1

stroke

Eligibility Criteria

Ataxia telangiectasia mutated

1

type 1 diabetes mellitus

Arm Group Label

Insulin

1

type 1 diabetes mellitus

Outcome Measure

somatostatin

Norepinephrine

lipase E, hormone sensitive type

leucine rich repeat containing 6

Ketone bodies

Interleukin-6 (IL-6)

Interleukin 1 Beta (IL-1β)

Interleukin 1 alpha (IL-1α)

Insulin

Hydrocortisone

growth hormone 1

glycosylated serum albumin

GCG

Fructosamine

Citrate synthase

C-reactive protein (CRP)

Alkaline phosphatase (ALPL)

Acetoacetic acid

3-Hydroxybutyric acid

3

1

1

1

3

1

1

1

5

2

2

1

7

1

1

1

1

1

2

type 1 diabetes mellitus

Brief Title

solute carrier family 5 (sodium/glucose cotransporter), member 2

Insulin

1

3

type 1 diabetes mellitus

Arm Group Description

Pro-opiomelanocortin (POMC

Insulin

1

3

type 1 diabetes mellitus

Detailed Description

solute carrier family 5 (sodium/glucose cotransporter), member 2

lipase E, hormone sensitive type

Ketone bodies

Insulin

Hydrocortisone

GLP1R

GCG

Fructosamine

Acetoacetic acid

3-Hydroxybutyric acid

2

1

1

1

1

1

2

1

1

2

type 1 diabetes mellitus

Eligibility Criteria

ZnT8 Auto-antibodies

Thyroid stimulating hormone beta (TSH)

solute carrier family 30, member 10

PAMG-1

MAFD2

Insulin

Gad65 Auto-antibodies

GAD2

dipeptidyl-peptidase 4

D-Galactose

Creatinine

Creatine

C-peptide

1

4

1

1

2

5

1

1

1

1

1

2

11

type 1 diabetes mellitus

Official Title

Pro-opiomelanocortin (POMC

Insulin

glucagon receptor

1

7

1

type 1 diabetes mellitus

Brief Summary

somatostatin

NDC80

Interleukin 1 Beta (IL-1β)

Interleukin 1 alpha (IL-1α)

Insulin

GCG

C-reactive protein (CRP)

Alpha-D-Glucose

1

1

1

1

2

5

1

1

type 2 diabetes mellitus

Arm Group Label

solute carrier family 5 (sodium/glucose cotransporter), member 2

Insulin

3

3

type 2 diabetes mellitus

Outcome Measure

ZGLP1

Visfatin

VCAM-1

Uric acid

Tumor necrosis factor alpha (TNF-alpha)

Transforming growth factor-beta (TGF-beta)

Toll-Like Receptor 4 (TLR4)

Testosterone

Taurine

syndecan binding protein 2

suppressor of cytokine signaling 3

SUMO1/sentrin specific peptidase 6

Succinic acid

solute carrier family 5 (sodium/glucose cotransporter), member 2

single-strand-selective monofunctional uracil-DNA glycosylase 1

sex hormone-binding globulin

serglycin

Resistin

Renin

RAGE

PTH

Paraoxonase 1

Palmitic acid

PAI-1

oviductal glycoprotein 1

Osteocalcin (OC)

NPY6R

NPPA

NGAL

NFkB

neutrophil cytosolic factor 1

nephrosis 1, congenital, Finnish type (nephrin)

MPO

Monocyte chemoattractant protein-1 (MCP-1/CCL2)

MMP9

MMP-2

MMP-1

meningioma expressed antigen 5 (hyaluronidase)

Lp-PLA2

lipoprotein lipase

Leptin

L-Valine

L-Threonine

L-Leucine

KIM-1

JNK1

Inulobiose

Interleukin-8 (IL-8)

Interleukin-6 (IL-6)

Interleukin-2 (IL-2)

Interleukin-17 (IL-17)

Interleukin-10 (IL-10)

Interleukin 1 Beta (IL-1β)

Interleukin 1 alpha (IL-1α)

Insulin

IL1RL1

ICAM-1 (Intercellular Adhesion Molecule 1)

Hydrocortisone

Hippuric acid

Hematopoietic progenitor cell antigen CD34

Guanosine monophosphate

guanine nucleotide binding protein (G protein), alpha inhibiting activity polypeptide 2

growth hormone 1

Glutathione

glutamic-oxaloacetic transaminase 2

GLP1R

GIP

Ghrelin

GDF15

GCG

Fructosamine

fibrosin

fibroblast growth factor 21

Fetuin-A

F-box protein 8

euchromatic histone-lysine N-methyltransferase 1

Endothelin 1

Dimethylamine

Creatinine

Creatine

connective tissue growth factor

coiled-coil alpha-helical rod protein 1

Citrate synthase

cholesteryl ester transfer protein

Cardiac Troponin T

Cardiac Troponin I

CA125 ovarian cancer antigen (MUC16)

C1q and tumor necrosis factor related protein 1

C-reactive protein (CRP)

C-peptide

BNP

Betaine

ATP-binding cassette, sub-family A (ABC1), member 1

Apolipoprotein B (AOPB)

Apolipoprotein A1 (APOA1)

ApoE

Angiotensinogen (AGT

ALT

Alpha-D-Glucose

Alkaline phosphatase (ALPL)

Aldosterone

Adiponectin (ADIPOQ)

Adenosine monophosphate

Adenosine

8-oxo-7-hydrodeoxyguanosine

4-Aminohippuric acid

3-Hydroxybutyric acid

24,25-Dihydroxyvitamin D

2

1

1

7

7

2

1

1

1

1

1

1

1

1

1

1

3

1

2

1

1

1

1

2

5

1

1

1

1

1

1

1

1

2

2

1

1

1

1

1

4

1

1

1

1

1

1

2

6

1

1

1

3

1

23

1

2

2

1

1

1

1

1

1

1

1

2

2

1

8

3

1

1

1

1

2

1

1

4

1

1

1

1

1

1

1

1

1

5

6

7

1

1

2

1

1

2

1

1

1

2

6

1

1

2

1

1

1

type 2 diabetes mellitus

Brief Title

Testosterone

solute carrier family 5 (sodium/glucose cotransporter), member 2

membrane palmitoylated protein 1

Insulin

GIP

Angiotensinogen (AGT

Angiotensin-converting enzyme (ACE

1

12

1

12

1

1

1

type 2 diabetes mellitus

Arm Group Description

solute carrier family 5 (sodium/glucose cotransporter), member 2

Insulin

GIP

GCG

dipeptidyl-peptidase 4

Creatinine

C-peptide

6

8

2

1

3

1

1

type 2 diabetes mellitus

Detailed Description

ZGLP1

Visfatin

VCAM-1

Uric acid

Tumor necrosis factor alpha (TNF-alpha)

solute carrier family 5 (sodium/glucose cotransporter), member 2

SOD1

sex hormone-binding globulin

serglycin

SDF-1 alpha (CXCL12)

Resistin

Renin

Palmitic acid

PAI-1

P-selectin

oviductal glycoprotein 1

NGAL

NFkB

Monoethylhexyl phthalic acid

microRNA 29b-1

microRNA 27b

microRNA 210

microRNA 130a

lipoprotein lipase

Leptin

L-Leucine

KIM-1

Interleukin-8 (IL-8)

Interleukin-6 (IL-6)

Insulin

Hydrocortisone

Hematopoietic progenitor cell antigen CD34

growth hormone 1

Glutathione

GLP1R

Ghrelin

GCG

euchromatic histone-lysine N-methyltransferase 1

dipeptidyl-peptidase 4

dentin sialophosphoprotein

Creatinine

coiled-coil alpha-helical rod protein 1

cholesteryl ester transfer protein

C-reactive protein (CRP)

C-peptide

BNP

Apolipoprotein B (AOPB)

Aldosterone

Adiponectin (ADIPOQ)

acrosin

Acetoacetic acid

8-isoprostane

3-Hydroxybutyric acid

1

1

1

1

3

4

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

2

1

1

1

3

10

1

1

1

1

1

1

4

1

1

1

4

1

1

2

2

1

1

1

2

1

1

1

1

type 2 diabetes mellitus

Eligibility Criteria

urocortin 3

tissue factor pathway inhibitor (lipoprotein-associated coagulation inhibitor)

Thyroxine (T4)

Thyroid stimulating hormone beta (TSH)

solute carrier family 5 (sodium/glucose cotransporter), member 2

sex hormone-binding globulin

serine/threonine/tyrosine interacting protein

PTPRN

ladinin 1

lactase

L-Aspartic acid

Insulin

IA2 Auto-antibodies

IA-2

hydroxysteroid (17-beta) dehydrogenase 4

group-specific component (vitamin D binding protein)

glutamate-ammonia ligase

GLB1

Gad65 Auto-antibodies

GAD2

FSH

dipeptidyl-peptidase 4

dentin sialophosphoprotein

D-Galactose

D-box binding PAR bZIP transcription factor

Creatinine

Creatine

coiled-coil alpha-helical rod protein 1

C-peptide

Bilirubin

bestrophin 1

Ataxia telangiectasia mutated

Angiotensin-converting enzyme (ACE

ALT

Alkaline phosphatase (ALPL)

1

3

2

10

2

1

1

2

1

1

3

13

2

2

1

1

1

1

1

1

2

1

1

2

1

7

2

1

23

1

2

1

1

3

1

type 2 diabetes mellitus

Official Title

timeless circadian clock

Testosterone

solute carrier family 5 (sodium/glucose cotransporter), member 2

Rho guanine nucleotide exchange factor 5

Insulin

GLP1R

GIP

Angiotensinogen (AGT

Angiotensin-converting enzyme (ACE

1

1

15

1

14

1

1

1

1

type 2 diabetes mellitus

Brief Summary

VCAM-1

Tumor necrosis factor alpha (TNF-alpha)

Testosterone

solute carrier family 5 (sodium/glucose cotransporter), member 2

sex hormone-binding globulin

serpin family A member 5

Renin

Nitric Oxide (NO)

Leptin

L-Leucine

Interleukin-6 (IL-6)

Interleukin-2 (IL-2)

Insulin

ICAM-1 (Intercellular Adhesion Molecule 1)

GCG

dentin sialophosphoprotein

Creatinine

C-reactive protein (CRP)

C-peptide

BNP

Angiotensinogen (AGT

Aldosterone

Adiponectin (ADIPOQ)

2

1

1

3

1

1

1

1

1

1

1

1

6

1

2

1

1

1

1

1

1

1

1

Biomarker

Drug Name Biomarker Name Biomarker Function
Dapagliflozin - AstraZeneca 24,25-Dihydroxyvitamin D Outcome Measure
25-Hydroxyvitamin D2 Outcome Measure
3-Hydroxybutyric acid Detailed Description, Outcome Measure
4-Aminohippuric acid Outcome Measure
5'-nucleotidase, cytosolic IA Outcome Measure
8-isoprostane Detailed Description
8-oxo-7-hydrodeoxyguanosine Outcome Measure
Acetoacetic acid Detailed Description, Outcome Measure
acrosin Detailed Description, Outcome Measure
actinin, alpha 4 Eligibility Criteria
Adenosine Outcome Measure
Adenosine monophosphate Outcome Measure
Adiponectin (ADIPOQ) Brief Summary, Detailed Description, Outcome Measure
Aldosterone Arm Group Description, Detailed Description, Official Title, Outcome Measure
Alkaline phosphatase (ALPL) Detailed Description, Eligibility Criteria, Outcome Measure
alkylglycerone phosphate synthase Detailed Description
Alpha-D-Glucose Brief Summary, Detailed Description, Outcome Measure
ALT Detailed Description, Eligibility Criteria, Outcome Measure
Androstenedione Outcome Measure
Angiotensin II Detailed Description
Angiotensin-converting enzyme (ACE Arm Group Description, Brief Title, Eligibility Criteria, Official Title
Angiotensinogen (AGT Brief Summary, Brief Title, Detailed Description, Official Title, Outcome Measure
ApoE Outcome Measure
Apolipoprotein A1 (APOA1) Outcome Measure
Apolipoprotein B (AOPB) Detailed Description, Outcome Measure
AT-rich interaction domain 4B Outcome Measure
Ataxia telangiectasia mutated Eligibility Criteria
AVP Detailed Description, Outcome Measure
bestrophin 1 Eligibility Criteria
Betaine Outcome Measure
Bilirubin Detailed Description, Eligibility Criteria, Outcome Measure
BNP Brief Summary, Detailed Description, Eligibility Criteria, Outcome Measure
C-peptide Arm Group Description, Brief Summary, Detailed Description, Eligibility Criteria, Outcome Measure
C-reactive protein (CRP) Brief Summary, Detailed Description, Eligibility Criteria, Outcome Measure
C1q and tumor necrosis factor related protein 1 Detailed Description, Outcome Measure
calcineurin binding protein 1 Outcome Measure
Carbohydrate antigen 19-9 (CA 19-9) Outcome Measure
Cardiac Troponin I Outcome Measure
Cardiac Troponin T Outcome Measure
CBLIF Outcome Measure
CD45 (leukocyte common antigen) Detailed Description
Cervonoyl ethanolamide Outcome Measure
cholesteryl ester transfer protein Detailed Description, Outcome Measure
choline phosphotransferase 1 Outcome Measure
Citrate synthase Detailed Description, Outcome Measure
coiled-coil alpha-helical rod protein 1 Detailed Description, Eligibility Criteria, Outcome Measure
connective tissue growth factor Outcome Measure
Creatine Detailed Description, Eligibility Criteria, Outcome Measure
Creatinine Brief Summary, Detailed Description, Eligibility Criteria, Outcome Measure
cytochrome P450 family 2 subfamily C member 8 Eligibility Criteria
D-box binding PAR bZIP transcription factor Eligibility Criteria
D-dimer Outcome Measure
D-Galactose Eligibility Criteria
dehydrodolichyl diphosphate synthase subunit Outcome Measure
Dehydroepiandrosterone Outcome Measure
Dehydroepiandrosterone sulfate Outcome Measure
dentin sialophosphoprotein Brief Summary, Detailed Description, Eligibility Criteria
Dimethylamine Outcome Measure
dipeptidyl-peptidase 4 Arm Group Description, Arm Group Label, Brief Title, Detailed Description, Eligibility Criteria, Official Title
Docosahexaenoyl Ethanolamide Outcome Measure
E-selectin Detailed Description
Endothelin 1 Outcome Measure
Eotaxin (CCL11) Detailed Description, Outcome Measure
Epidermal growth factor receptor (EGFR) Eligibility Criteria
Erythropoietin (EPO) Outcome Measure
Estradiol-17beta 3-sulfate Eligibility Criteria
Estrogen receptor alpha (ER alpha) Eligibility Criteria
euchromatic histone-lysine N-methyltransferase 1 Detailed Description, Eligibility Criteria, Outcome Measure
F-box protein 8 Outcome Measure
F2-isoprostanes Detailed Description
Fc fragment of IgG receptor Ib Detailed Description
Ferritin Detailed Description, Outcome Measure
Fetuin-A Outcome Measure
FGF23 Outcome Measure
Fibrinogen Detailed Description
fibroblast growth factor 21 Outcome Measure
fibrosin Outcome Measure
Fructosamine Detailed Description, Outcome Measure
FSH Eligibility Criteria, Outcome Measure
G protein-coupled receptor 83 Detailed Description
GAD2 Eligibility Criteria
Gad65 Auto-antibodies Eligibility Criteria
Galectin-3 (Gal-3) Detailed Description
gamma-glutamyltransferase 2 Outcome Measure
gamma-glutamyltransferase light chain 1 Outcome Measure
gamma-glutamyltransferase light chain 3 Outcome Measure
GCG Arm Group Description, Arm Group Label, Brief Summary, Brief Title, Detailed Description, Eligibility Criteria, Official Title, Outcome Measure
GDF15 Outcome Measure
GGT Outcome Measure
GGTLC4P Outcome Measure
GGTLC5P Outcome Measure
Ghrelin Detailed Description, Outcome Measure
GIP Arm Group Description, Brief Title, Detailed Description, Official Title, Outcome Measure
GLB1 Eligibility Criteria
GLP1R Detailed Description, Eligibility Criteria, Official Title, Outcome Measure
glucagon receptor Official Title
glutamate-ammonia ligase Eligibility Criteria
glutamic-oxaloacetic transaminase 2 Outcome Measure
Glutathione Detailed Description, Outcome Measure
glycosylated serum albumin Outcome Measure
group-specific component (vitamin D binding protein) Eligibility Criteria
growth hormone 1 Detailed Description, Outcome Measure
guanine nucleotide binding protein (G protein), alpha inhibiting activity polypeptide 2 Detailed Description, Outcome Measure
Guanosine monophosphate Outcome Measure
Gut Microbiome Brief Title, Official Title
H3P10 Outcome Measure
Hematopoietic progenitor cell antigen CD34 Detailed Description, Outcome Measure
HER2/ERBB2 Brief Summary, Brief Title, Eligibility Criteria, Official Title
Hippuric acid Outcome Measure
Hydrocortisone Detailed Description, Outcome Measure
hydroxysteroid (17-beta) dehydrogenase 4 Eligibility Criteria
IA-2 Eligibility Criteria
IA2 Auto-antibodies Eligibility Criteria
ICAM-1 (Intercellular Adhesion Molecule 1) Brief Summary, Detailed Description, Outcome Measure
IL1RL1 Detailed Description
Insulin Arm Group Description, Arm Group Label, Brief Summary, Brief Title, Detailed Description, Eligibility Criteria, Official Title, Outcome Measure
Interleukin 1 alpha (IL-1α) Brief Summary, Outcome Measure
Interleukin 1 Beta (IL-1β) Brief Summary, Outcome Measure
interleukin 34 Brief Summary, Detailed Description, Official Title
Interleukin-10 (IL-10) Detailed Description, Outcome Measure
Interleukin-12A (IL-12p35) Detailed Description
Interleukin-12B (IL-12p40) Detailed Description
Interleukin-17 (IL-17) Outcome Measure
Interleukin-2 (IL-2) Brief Summary, Detailed Description, Outcome Measure
Interleukin-6 (IL-6) Brief Summary, Detailed Description, Outcome Measure
Interleukin-8 (IL-8) Detailed Description, Outcome Measure
Inulobiose Outcome Measure
JNK1 Outcome Measure
Ketone bodies Detailed Description, Outcome Measure
KIM-1 Detailed Description, Outcome Measure
klotho Brief Summary, Outcome Measure
L-Aspartic acid Brief Summary, Eligibility Criteria, Outcome Measure
L-Cysteine Outcome Measure
L-Cystine Brief Title, Detailed Description, Official Title
L-Leucine Brief Summary, Detailed Description, Outcome Measure
L-Threonine Outcome Measure
L-Valine Outcome Measure
lactase Eligibility Criteria
Lactate dehydrogenase (LDH) Outcome Measure
Leptin Brief Summary, Detailed Description, Outcome Measure
leucine rich repeat containing 6 Outcome Measure
leucyl and cystinyl aminopeptidase Brief Summary, Detailed Description, Official Title
lipase E, hormone sensitive type Detailed Description, Outcome Measure
lipoprotein lipase Detailed Description, Outcome Measure
LOC102724197 Outcome Measure
Lp-PLA2 Outcome Measure
MAFD2 Eligibility Criteria
Malondialdehyde Outcome Measure
membrane palmitoylated protein 1 Brief Title
meningioma expressed antigen 5 (hyaluronidase) Outcome Measure
Metenamine Detailed Description
microRNA 126 Detailed Description, Outcome Measure
microRNA 130a Detailed Description
microRNA 21 Detailed Description, Outcome Measure
microRNA 210 Detailed Description
microRNA 27b Detailed Description
microRNA 29b-1 Detailed Description
MMP-1 Outcome Measure
MMP-2 Outcome Measure
MMP9 Outcome Measure
Monocyte chemoattractant protein-1 (MCP-1/CCL2) Detailed Description, Outcome Measure
Monoethylhexyl phthalic acid Detailed Description
MPO Detailed Description, Outcome Measure
mTOR Detailed Description
N-Acetyl-L-aspartic acid Brief Summary, Outcome Measure
NDC80 Brief Summary
neutrophil cytosolic factor 1 Outcome Measure
NFkB Detailed Description, Outcome Measure
NGAL Detailed Description, Outcome Measure
Nitric Oxide (NO) Brief Summary
Norepinephrine Outcome Measure
NPPA Outcome Measure
NPY6R Outcome Measure
Osteocalcin (OC) Outcome Measure
oviductal glycoprotein 1 Brief Summary, Detailed Description, Outcome Measure
P-selectin Detailed Description
p16 Outcome Measure
PAI-1 Detailed Description, Outcome Measure
Palmitic acid Detailed Description, Outcome Measure
PAMG-1 Eligibility Criteria
Paraoxonase 1 Outcome Measure
PGR Eligibility Criteria
PIK3CA Brief Summary, Brief Title, Detailed Description, Eligibility Criteria, Official Title
platelet-activating factor acetylhydrolase 1b, regulatory subunit 1 (45kDa) Arm Group Description
pre-B lymphocyte 1 Outcome Measure
Pro-opiomelanocortin (POMC Arm Group Description, Official Title
Progesterone Outcome Measure
progesterone receptor membrane component 1 Outcome Measure
PSA Eligibility Criteria
PTH Outcome Measure
PTPRN Eligibility Criteria
PYY Outcome Measure
RAC-alpha serine/threonine-protein kinase (AKT) Detailed Description, Outcome Measure
RAGE Outcome Measure
RBP4 Outcome Measure
Renin Detailed Description, Official Title, Outcome Measure
Resistin Detailed Description, Outcome Measure
RET Eligibility Criteria
Rho guanine nucleotide exchange factor 5 Brief Title, Official Title
SDF-1 alpha (CXCL12) Detailed Description
serglycin Detailed Description, Outcome Measure
serine/threonine/tyrosine interacting protein Eligibility Criteria
serpin family A member 5 Brief Summary
sex hormone-binding globulin Brief Summary, Detailed Description, Eligibility Criteria, Outcome Measure
single-strand-selective monofunctional uracil-DNA glycosylase 1 Outcome Measure
SOD1 Detailed Description
solute carrier family 30, member 10 Eligibility Criteria
solute carrier family 5 (sodium/glucose cotransporter), member 2 Arm Group Description, Arm Group Label, Brief Summary, Brief Title, Detailed Description, Eligibility Criteria, Official Title, Outcome Measure
solute carrier family 5 member 1 Official Title
somatostatin Brief Summary, Outcome Measure
Succinic acid Arm Group Description, Outcome Measure
suppressor of cytokine signaling 3 Outcome Measure
T-cell surface antigen CD4 Eligibility Criteria
Taurine Outcome Measure
TCEAL1 Outcome Measure
Testosterone Brief Summary, Brief Title, Official Title, Outcome Measure
Thyroid stimulating hormone beta (TSH) Detailed Description, Eligibility Criteria, Outcome Measure
Thyroxine (T4) Eligibility Criteria, Outcome Measure
timeless circadian clock Brief Title, Official Title
TIMP-1 Detailed Description
tissue factor pathway inhibitor (lipoprotein-associated coagulation inhibitor) Detailed Description, Eligibility Criteria
Toll-Like Receptor 4 (TLR4) Outcome Measure
Transforming growth factor-beta (TGF-beta) Detailed Description, Outcome Measure
TRG Outcome Measure
Tumor necrosis factor alpha (TNF-alpha) Brief Summary, Detailed Description, Outcome Measure
uPAR Brief Summary, Outcome Measure
Uric acid Brief Title, Detailed Description, Official Title, Outcome Measure
urocortin 3 Eligibility Criteria
Vasopressin Detailed Description, Outcome Measure
VCAM-1 Brief Summary, Detailed Description, Outcome Measure
Visfatin Detailed Description, Outcome Measure
YWHAE Arm Group Description
ZAP-70 Eligibility Criteria
ZGLP1 Detailed Description, Eligibility Criteria, Outcome Measure
ZnT8 Auto-antibodies Eligibility Criteria
For more detail, check out BiomarkerBase: the leading source of information about biomarkers used in drug development and diagnostic tests, tracking a comprehensive list of biomarker uses worldwide by over 800 companies

Development Status

Summary Table

Indication Qualifier Patient Segment Phase Countries Route / Formulation Developers Event Date
COVID 2019 infections with cardiometabolic disease (hypertension, type 2 diabetes, atherosclerotic cardiovascular disease, heart failure, and/or kidney disease) - Phase III Argentina, Brazil, Canada, India, Mexico, USA, United Kingdom PO / Tablet AstraZeneca 27 Aug 2020
COVID 2019 infections in combination with ambrisentan Combination therapy Phase II/III United Kingdom PO / Tablet AstraZeneca 03 Jul 2020
Cardiovascular disorders to reduce the risk of hospitalisation for heart failure in adults with type 2 diabetes mellitus and established cardiovascular disease or multiple cardiovascular risk factors - Marketed USA PO / unspecified AstraZeneca 19 Oct 2019
Chronic heart failure with reduced ejection fraction (HFrEF) In adults, In the elderly Marketed European Union, Iceland, India, Japan, Liechtenstein, Norway PO / Tablet AstraZeneca 28 Nov 2020
Chronic heart failure In patients with reduced ejection fraction with and without type 2 diabetesno In adults, In the elderly Registered China, USA PO / Tablet AstraZeneca 04 Feb 2021
Chronic heart failure - - Phase III United Kingdom unspecified / unspecified AstraZeneca 12 Sep 2016
Chronic heart failure - In adults, In the elderly Phase III Argentina, Brazil, Canada, Denmark, Russia, Slovakia, South Africa, South Korea, Sweden, Taiwan, Vietnam PO / Tablet AstraZeneca 09 Apr 2019
Chronic heart failure - First-line therapy, In adults, In the elderly, Monotherapy Phase II Hungary, USA PO / Tablet AstraZeneca 26 Jan 2021
Chronic heart failure in combination with AZD 9977 Combination therapy, First-line therapy, In adults, In the elderly Phase II Hungary, USA PO / Tablet AstraZeneca 26 Jan 2021
Heart failure - Adjunctive treatment, In adults, In the elderly, Prevention Phase III Sweden PO / Tablet AstraZeneca, Uppsala University 12 Aug 2020
Heart failure With Preserved Ejection Fraction - Phase III Bulgaria, Italy, Slovakia, South Africa PO / Tablet AstraZeneca 04 Apr 2019
Heart failure in patients with type 2 diabetes In the elderly, Prevention Clinical Phase Unknown Australia PO / Tablet AstraZeneca 01 Mar 2020
Kidney disorders - First-line therapy, In adults, In the elderly, Monotherapy Phase II Hungary, USA PO / Tablet AstraZeneca 26 Jan 2021
Kidney disorders in combination with AZD9977 in combination with AZD 9977 Combination therapy, First-line therapy, In adults, In the elderly Phase II Hungary, USA PO / Tablet AstraZeneca 26 Jan 2021
Kidney disorders - - Phase II Netherlands PO / Tablet AstraZeneca, University Medical Center Groningen 12 Nov 2017
Myocardial infarction acute myocardial infarction Adjunctive treatment, In adults, In the elderly, Prevention Phase III Sweden PO / Tablet AstraZeneca, Uppsala University 12 Aug 2020
Obesity - - Phase II Denmark PO / unspecified AstraZeneca, Novo Nordisk Foundation, Bayer 15 Jul 2019
Obesity in combination with exenatide Combination therapy Phase II Sweden PO / unspecified AstraZeneca, Uppsala University 01 Dec 2014
Prediabetic state - - Phase II Denmark PO / Tablet AstraZeneca, Novo Nordisk Foundation, Bayer 01 Feb 2016
Renal failure chronic kidney disease - Marketed USA PO / Tablet AstraZeneca 01 May 2021
Renal failure chronic kidney disease - Registered European Union, Japan PO / Tablet AstraZeneca 03 Sep 2021
Renal failure chronic kidney disease - Phase III Argentina, Brazil, Canada, China, India, Mexico, Peru, Philippines, Russia, South Korea, Ukraine, United Kingdom, Vietnam PO / Tablet AstraZeneca 22 Feb 2017
Type 1 diabetes mellitus - Adjunctive treatment Marketed Austria, Croatia, Czech Republic, Denmark, Finland, Iceland, Japan, Netherlands, Norway, Poland, Portugal, Slovakia, Slovenia, Spain, United Kingdom PO / Tablet AstraZeneca 28 Mar 2019
Type 1 diabetes mellitus - Adjunctive treatment Registered European Union, Liechtenstein PO / Tablet AstraZeneca 27 Mar 2019
Type 1 diabetes mellitus - Adjunctive treatment Preregistration USA PO / Tablet AstraZeneca 01 Feb 2019
Type 1 diabetes mellitus - - Phase III Argentina, Australia, Canada, Chile, Israel, Japan, Mexico PO / Tablet AstraZeneca 08 Jul 2015
Type 1 diabetes mellitus - Adjunctive treatment Phase I Germany PO / Tablet AstraZeneca 09 Feb 2017
Type 2 diabetes mellitus - - Marketed Singapore, United Arab Emirates PO / Tablet Bristol-Myers Squibb 11 May 2017
Type 2 diabetes mellitus Add on to antihyperglycaemics, including insulin; In metformin-intoelrant patients Add on to antihyperglycaemics, including insulin; In metformin-intolerant patients Add on to antihyperglycaemics, including insulin Add on to antihyperglycaemics, including insulin; in metformin-intolerant patients In combination with metformin, or as an add-on therapy to either metformin, a sulfonylurea, or insulin; In metformin-intolerant patients Combination therapy, Monotherapy Marketed Australia, Austria, Croatia, Czech Republic, Denmark, Finland, Germany, Iceland, Netherlands, New Zealand, Norway, Poland, Portugal, Slovakia, Slovenia, Spain, United Kingdom PO / Tablet AstraZeneca 11 May 2017
Type 2 diabetes mellitus - - Marketed Argentina, Belgium, Brazil, Canada, Chile, China, Cyprus, Greece, Hong Kong, Hungary, Indonesia, Ireland, Israel, Kuwait, Malaysia, Mexico, Philippines, Russia, South Korea, Sweden, Switzerland, Thailand, USA, Ukraine PO / Tablet AstraZeneca 04 Nov 2020
Type 2 diabetes mellitus - In adults, Monotherapy Marketed India PO / Tablet AstraZeneca 25 Feb 2016
Type 2 diabetes mellitus - - Marketed Japan PO / Tablet AstraZeneca, Ono Pharmaceutical 23 May 2014
Type 2 diabetes mellitus - Adjunctive treatment, In adults Marketed India PO / Tablet AstraZeneca 25 Feb 2016
Type 2 diabetes mellitus Add on to antihyperglycaemics, including insulin; In metformin-intoelrant patients - Centralised Procedure for marketing approval Combination therapy, Monotherapy Registered European Union, Liechtenstein PO / Tablet AstraZeneca 27 Mar 2019
Type 2 diabetes mellitus Add-on to insulin or metformin Combination therapy Registered China PO / Tablet AstraZeneca 01 Nov 2018
Type 2 diabetes mellitus - - Registered Argentina, Brazil PO / Tablet AstraZeneca 22 Nov 2013
Type 2 diabetes mellitus on diet and exercise and metformin Adjunctive treatment, In adolescents, In children Phase III Argentina, Australia, Brazil, Canada, Chile, Colombia, Finland, India, Israel, Italy, Malaysia, Mexico, New Zealand, Philippines, Poland, Romania, Russia, South Korea, Taiwan, Thailand, Turkey, USA, Ukraine, United Kingdom PO / Tablet AstraZeneca 11 Oct 2017
Type 2 diabetes mellitus - Adjunctive treatment Phase III China, Thailand, Vietnam PO / Tablet AstraZeneca 10 Mar 2020
Type 2 diabetes mellitus as add-on to insulin in Asian patients Combination therapy Phase III South Korea PO / Tablet Bristol-Myers Squibb 01 Mar 2014
Type 2 diabetes mellitus - Adjunctive treatment, Combination therapy Phase III Canada, Czech Republic, Denmark, Germany, Hungary, Mexico, Poland, Romania, Russia, South Africa, Spain, Sweden, USA