Drug Res (Stuttg) 2019; 69(06): 314-322
DOI: 10.1055/a-0662-0209
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Effect of Renal Impairment on the Pharmacokinetics and Pharmacodynamics of Tofogliflozin (A SELECTIVE SGLT2 Inhibitor) in Patients with Type 2 Diabetes Mellitus

Sachiya Ikeda
1   Primary lifecycle Management Department, Chugai Pharmaceutical Co., Ltd., Tokyo, Japan
,
Yasuki Takano
2   Clinical Science and Strategy Department, Chugai Pharmaceutical Co., Ltd., Tokyo, Japan
,
Dietmar Schwab
3   Pharmaceutical Sciences, Clinical Pharmacology, Roche Pharma Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland
,
Agnes Portron
3   Pharmaceutical Sciences, Clinical Pharmacology, Roche Pharma Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland
,
Nahoko Kasahara-Ito
4   Translational Clinical Research, Clinical Pharmacology Department, Chugai Pharmaceutical Co., Ltd., Tokyo, Japan
,
Tomohisa Saito
4   Translational Clinical Research, Clinical Pharmacology Department, Chugai Pharmaceutical Co., Ltd., Tokyo, Japan
,
Satofumi Iida
4   Translational Clinical Research, Clinical Pharmacology Department, Chugai Pharmaceutical Co., Ltd., Tokyo, Japan
› Author Affiliations
Further Information

Publication History

received 12 April 2018

accepted 17 July 2018

Publication Date:
13 August 2018 (online)

Abstract

Purpose Tofogliflozin is an orally available selective inhibitor of sodium-glucose co-transporter 2 for treatment of type 2 diabetes mellitus (T2DM). Two studies were conducted to evaluate the effect of renal impairment on pharmacokinetics and pharmacodynamics of tofogliflozin.

Methods The studies were: 1) single dose study in T2DM patients with normal renal function and mild, moderate and severe renal impairment, and 2) multiple dose study for 24 weeks in T2DM patients with normal renal function and moderate renal impairment.

Results Renal function did not have a clinically relevant effect on the PK of tofogliflozin. Urinary glucose excretion up to 24 h after administration of tofogliflozin (UGE24h) decreased with decreasing glomerular filtration rate. Lowering UGE24h resulted in waning glycemic control but not body weight reduction.

Conclusions Single and multiple administrations of tofogliflozin were generally well tolerated in T2DM patients with various renal functions. As far as investigated here, these studies indicate no dose adjustment is required for patients with renal impairment.

Supporting Information

 
  • References

  • 1 World Health Organization. Global report on diabetes. Geneva: World Health Organization; 2016
  • 2 De Nicola L, Gabbai FB, Liberti ME. et al. Sodium/glucose cotransporter 2 inhibitors and prevention of diabetic nephropathy: targeting the renal tubule in diabetes. Am J Kidney Dis 2014; 64: 16-24
  • 3 Obata A, Kubota N, Kubota T. et al. Tofogliflozin improves insulin resistance in skeletal muscle and accelerates lipolysis in adipose tissue in male mice. Endocrinology. 2016; 157: 1029-1042
  • 4 Bolinder J, Ljunggren Ö, Johansson L. et al. Dapagliflozin maintains glycaemic control while reducing weight and body fat mass over 2 years in patients with type 2 diabetes mellitus inadequately controlled on metformin. Diabetes Obes Metab 2014; 16: 159-169
  • 5 Blonde L, Stenlöf K, Fung A. et al. Effects of canagliflozin on body weight and body composition in patients with type 2 diabetes over 104 weeks. Postgrad Med. 2016; 128: 371-380
  • 6 Ohki T, Isogawa A, Toda N. et al. Effectiveness of ipragliflozin, a sodium-glucose co-transporter 2 inhibitor, as a second-line treatment for non-alcoholic fatty liver disease patients with type 2 diabetes mellitus who do not respond to incretin-based therapies including glucagon-like peptide-1 analogs and dipeptidyl peptidase-4 inhibitors. Clin Drug Investig 2016; 36: 313-319
  • 7 Davies MJ, Trujillo A, Vijapurkar U. et al. Effect of canagliflozin on serum uric acid in patients with type 2 diabetes mellitus. Diabetes Obes Metab. 2015; 17: 426-429 Erratum in: Diabetes Obes Metab. 2015;17:708
  • 8 Suzuki M, Honda K, Fukazawa M. et al. Tofogliflozin, a potent and highly specific sodium/glucose cotransporter 2 inhibitor, improves glycemic control in diabetic rats and mice. J Pharmacol Exp Ther 2012; 341: 692-701
  • 9 Kaku K, Watada H, Iwamoto Y. et al. Efficacy and safety of monotherapy with the novel sodium/glucose cotransporter-2 inhibitor tofogliflozin in Japanese patients with type 2 diabetes mellitus: a combined Phase 2 and 3 randomized, placebo-controlled, double-blind, parallel-group comparative study. Cardiovasc Diabetol. 2014; 13: 65
  • 10 Tanizawa Y, Kaku K, Araki E. et al. Tofogliflozin 004 and 005 Study group. Long-term safety and efficacy of tofogliflozin, a selective inhibitor of sodium-glucose cotransporter 2, as monotherapy or in combination with other oral antidiabetic agents in Japanese patients with type 2 diabetes mellitus: multicenter, open-label, randomized controlled trials. Expert Opin Pharmacother 2014; 15: 749-766
  • 11 Yamane M, Kawashima K, Yamaguchi K. et al. In vitro profiling of the metabolism and drug–drug interaction of tofogliflozin, a potent and highly specific sodium-glucose co-transporter 2 inhibitor, using human liver microsomes, human hepatocytes, and recombinant human CYP. Xenobiotica 2015; 45: 230-238
  • 12 Schwab D, Portron A, Backholer Z. et al. A novel double-tracer technique to characterize absorption, distribution, metabolism and excretion (ADME) of [14C]tofogliflozin after oral administration and concomitant intravenous microdose administration of [13C]tofogliflozin in humans. Clin Pharmacokinet 2013; 52: 463-473
  • 13 Zell M, Husser C, Kuhlmann O. et al. Metabolism and mass balance of SGLT2 inhibitor tofogliflozin following oral administration to humans. Xenobiotica 2014; 44: 369-378
  • 14 Kasahara-Ito N, Fukase H, Ogama Y. et al. Pharmacokinetics and pharmacodynamics of tofogliflozin (a selective SGLT2 inhibitor) in healthy male subjects. Drug Res (Stuttg) 2017; 67: 349-357
  • 15 Kasahara N, Fukase H, Ohba Y. et al. A pharmacokinetic/pharmacodynamic drug-drug interaction study of tofogliflozin (a new SGLT2 inhibitor) and selected anti-type 2 diabetes mellitus drugs. Drug Res (Stuttg) 2016; 66: 74-81
  • 16 Betônico CC, Titan SM, Correa-Giannella ML. et al. Management of diabetes mellitus in individuals with chronic kidney disease: therapeutic perspectives and glycemic control. Clinics (Sao Paulo) 2016; 71: 47-53
  • 17 World Medical Association. Declaration of Helsinki – Ethical principles for medical research involving human subjects. Available from http://dl.med.or.jp/dl-med/wma/helsinki2013e.pdf Accessed March 11, 2016
  • 18 Stevens LA, Coresh J, Greene T. et al. Assessing kidney function--measured and estimated glomerular filtration rate. N Engl J Med 2006; 354: 2473-2483
  • 19 Guidance for Industry; Pharmacokinetics in Patients with Impaired Renal Function – Study Design, Data Analysis, and Impact on Dosing and Labeling. FDA, May 1998
  • 20 Note for Guidance on the Evaluation of the Pharmacokinetics of Medical Products in Patients with Impaired Renal Function. EMEA, June 2004
  • 21 National Kidney Foundation. K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification and Stratification. Am J Kidney Dis 39: S1-S266 2002; (Suppl. 01)
  • 22 Matsuo S, Imai E, Horio M. et al. Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis 2009; 53: 982-992
  • 23 Yale JF, Bakris G, Cariou B. et al. Efficacy and safety of canagliflozin in subjects with type 2 diabetes and chronic kidney disease. Diabetes Obes Metab 2013; 15: 463-473
  • 24 Kohan DE, Fioretto P, Tang W. et al. Long-term study of patients with type 2 diabetes and moderate renal impairment shows that dapagliflozin reduces weight and blood pressure but does not improve glycemic control. Kidney Int. 2014; 85: 962-971
  • 25 Barnett AH, Mithal A, Manassie J. et al. Efficacy and safety of empagliflozin added to existing antidiabetes treatment in patients with type 2 diabetes and chronic kidney disease: a randomised, double-blind, placebo-controlled trial. Lancet Diabetes Endocrinol 2014; 2: 369-384
  • 26 Kashiwagi A, Takahashi H, Ishikawa H. et al. A randomized, double-blind, placebo-controlled study on long-term efficacy and safety of ipragliflozin treatment in patients with type 2 diabetes mellitus and renal impairment: results of the long-term ASP1941 safety evaluation in patients with type 2 diabetes with renal impairment (LANTERN) study. Diabetes Obes Metab 2015; 17: 152-160
  • 27 Haneda M, Seino Y, Inagaki N. et al. Influence of Renal Function on the 52-Week Efficacy and Safety of the Sodium Glucose Cotransporter 2 Inhibitor Luseogliflozin in Japanese Patients with Type 2 Diabetes Mellitus. Clinical Therapeutics 2016; 38: 66-88
  • 28 Wanner C, Inzucchi SE, Lachin JM. et al. Empagliflozin and progression of kidney disease in type 2 diabetes. N Engl J Med 2016; 375: 323-334
  • 29 Mahaffey KW, Neal B, Perkovic V. et al. Canagliflozin for Primary and Secondary Prevention of Cardiovascular Events: Results From the CANVAS Program (Canagliflozin Cardiovascular Assessment Study). Circulation. 2018; 137: 323-334
  • 30 Jerums G, Premaratne E, Panagiotopoulos S. et al. The clinical significance of hyperfiltration in diabetes. Diabetologia. 2010; 53: 2093-2104
  • 31 Ruggenenti P, Porrini EL, Gaspari F. et al. Glomerular hyperfiltration and renal disease progression in type 2 diabetes. Diabetes Care. 2012; 35: 2061-2068