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Satisfying the Regulatory Requirements for New Antidiabetic Drugs for Type 2 Diabetes Most Expeditiously

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Book cover Cardiovascular Safety in Drug Development and Therapeutic Use

Abstract

The regulatory landscapes for the prospective exclusion of unacceptable cardiovascular risk associated with new antidiabetic drugs for type 2 diabetes in the USA and Europe were formalized in 2008 and 2012, respectively. The FDA’s Guidance for Industry specifically addressing this landscape was issued in final format (a rare occurrence) in December 2008 (FDA 2008). The EMA’s updated general guidance document addresses this topic. Following the release of a first draft in 2010 and a revised draft in 2011 (a period for public comment followed each release), the document was finalized in May 2012 and became effective in November 2012 (EMA 2012). The first section of this chapter presents the key aspects of each document.

There is considerable interest among many stakeholders regarding ways in which the existing regulatory requirements can be met more efficiently.

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References

  • CANVAS. CANagliflozin cardioVascular Assessment Study (2015). Available at http://clinicaltrials.gov/ct2/show/NCT01032629?term=CANVAS&rank=1. Accessed 31 Aug 2015

  • Cox DR (1972) Regression models and life tables (with discussion). J R Stat Soc Ser B 34:187–220

    Google Scholar 

  • EMA (2012) Guideline on the clinical investigation of medicinal products in the treatment or prevention of diabetes mellitus. Effective November 2012. Available at. http://www.ema.europa.eu/docs/en_GB/document_library/Scientific_guideline/2012/06/WC500129256.pdf Accessed 2 Jan 2016

  • FDA (CDER). Summary review(s) for canagliflozin. Application number: 204042Orig1s000. Available at http://www.accessdata.fda.gov/drugsatfda_docs/nda/2013/204042Orig1s000SumR.pdf. Accessed 31 Aug 2015

  • FDA (CDER). Summary review for Linagliptin. Application number: 201280Orig1s000. Available at http://www.accessdata.fda.gov/drugsatfda_docs/nda/2011/201280Orig1s000SumR.pdf. Accessed 31 Aug 2015

  • FDA (2008) Guidance for industry. Diabetes Mellitus—evaluating cardiovascular risk in new antidiabetic therapies to treat type 2 diabetes. December 2008. Available at. http://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/ucm071627.pdf. Accessed 2 Jan 2016

  • FDA (2010) Guidance for industry. Adaptive design clinical trials for drugs and biologics. February 2010 (Draft). Available at. http://www.fda.gov/downloads/drugs/guidancecomplianceregulatoryinformation/guidances/ucm201790.pdf. Accessed 31 August 2015

  • FDA. Statistics review(s) for Empagliflozin marketing application. Available at http://www.accessdata.fda.gov/drugsatfda_docs/nda/2014/204629Orig1s000StatR.pdf. Accessed 12 Dec 2015

  • Geiger MJ, Mehta C, Turner JR et al (2015) Clinical development approaches and statistical methodologies to prospectively assess the cardiovascular risk of new antidiabetic therapies for type 2 diabetes. Ther Innov Regul Sci 49:50–64

    Article  Google Scholar 

  • Green JB, Bethel MA, Armstrong PW, TECOS Study Group et al (2015) Effect of sitagliptin on cardiovascular outcomes in type 2 diabetes. N Engl J Med 373:232–242

    Article  CAS  PubMed  Google Scholar 

  • Horsdal HT, Sondergaard F, Johnsen SP, Rungby J (2011) Antidiabetic treatments and risk of hospitalization with myocardial infarction: a nationwide case-control study. Pharmacoepidemiol Drug Saf 20:331–337

    Article  CAS  PubMed  Google Scholar 

  • Lan KKG, DeMets DL (1983) Discrete sequential boundaries for clinical trials. Biometrika 70:659–663

    Article  Google Scholar 

  • McMurray JJ, Gerstein HC, Holman RR, Pfeffer MA (2014) Heart failure: a cardiovascular outcome in diabetes that can no longer be ignored. Lancet Diab Endocrinol 2:843–851

    Article  CAS  Google Scholar 

  • O’Brien PC, Fleming TR (1979) A multiple testing procedure for clinical trials. Biometrics 35:549–556

    Article  PubMed  Google Scholar 

  • Pfeffer MA, Claggett B, Diaz R, ELIXA Investigators et al (2015) Lixisenatide in patients with type 2 diabetes and acute coronary syndrome. N Engl J Med 373:2247–2257

    Article  CAS  PubMed  Google Scholar 

  • Pocock SJ (1977) Group sequential methods in the design and analysis of clinical trials. Biometrika 64:191–199

    Article  Google Scholar 

  • Preiss D, Sattar N, McMurray JJ (2011) A systematic review of event rates in clinical trials in diabetes mellitus: the importance of quantifying baseline cardiovascular disease history and proteinuria and implications for clinical trial design. Am Heart J 161:210–219

    Article  PubMed  Google Scholar 

  • Phung OJ, Schwartzman E, Allen RW, Engel SS, Rajpathak SN (2013) Sulphonylureas and risk of cardiovascular disease: systematic review and meta-analysis. Diabet Med 30:1160–1171

    Article  CAS  PubMed  Google Scholar 

  • Roumie CL, Hung AM, Greevy RA et al (2012) Comparative effectiveness of sulfonylurea and metformin monotherapy on cardiovascular events in type 2 diabetes mellitus: a cohort study. Ann Intern Med 157:601–610

    Article  PubMed  PubMed Central  Google Scholar 

  • Royston P, Parmar M (2011) The use of restricted mean survival time to estimate the treatment effect in randomized clinical trials when the proportional hazards assumption is in doubt. Stat Med 30:2409–2421

    Article  PubMed  Google Scholar 

  • Sager PT, Seltzer J, Turner JR et al (2015) Cardiovascular safety outcome trials: a meeting report from the Cardiac Safety Research Consortium. Am Heart J 169:486–495

    Article  PubMed  Google Scholar 

  • Sahlroot JT (2012) FDA experience with the diabetes guidance: statistical update. Cardiovascular Safety and State-of-the-art Development Issues, Washington, DC, 17th April 2012

    Google Scholar 

  • Sanofi (2014) Press release. Sanofi provides update on lixisenatide New Drug Application in U.S. 12th September 2013. Available at http://m-en.sanofi.com/Images/33756_20130912_lixisenatide_en.pdf. Accessed 3 Jan 2016

  • Schramm TK, Gislason GH, Vaag A et al (2011) Mortality and cardiovascular risk associated with different insulin secretagogues compared with metformin in type 2 diabetes, with or without a previous myocardial infarction: a nationwide study. Eur Heart J 32:1900–1908

    Article  CAS  PubMed  Google Scholar 

  • Scirica BM, Bhatt DL, Braunwald E, SAVOR-TIMI 53 Steering Committee and Investigators et al (2013) Saxagliptin and cardiovascular outcomes in patients with type 2 diabetes mellitus. N Engl J Med 369:1317–1326

    Article  CAS  PubMed  Google Scholar 

  • Scirica BM, Braunwald E, Raz I, Cavender MA, SAVOR-TIMI 53 Steering Committee and Investigators et al (2014) Heart failure, saxagliptin, and diabetes mellitus: observations from the SAVOR-TIMI 53 randomized trial. Circulation 130:1579–1588

    Article  CAS  PubMed  Google Scholar 

  • Sponsor’s Background Document (2015) Dapagliflozin. Prepared for the US FDA Endocrinologic & Metabolic Advisory Committee Meeting, 19th July 2011. Available at http://www.fda.gov/downloads/advisorycommittees/committeesmeetingmaterials/drugs/endocrinologicandmetabolicdrugsadvisorycommittee/ucm262996.pdf. Accessed 31 Aug 2015

  • Tian L, Cai T, Pfeffer MA et al (2009) Exact and efficient inference procedure for meta-analysis and its application to the analysis of independent 2x2 tables with all available data but without artificial continuity correction. Biostatistics 10:275–281

    Article  PubMed  Google Scholar 

  • Uno H, Wittes J, Fu H, Solomon SD et al (2015) Alternatives to hazard ratios for comparing the efficacy or safety of therapies in noninferiority studies. Ann Intern Med 163:127–134

    Article  PubMed  PubMed Central  Google Scholar 

  • White WB, Cannon CP, Heller SR, EXAMINE Investigators et al (2013) Alogliptin after acute coronary syndrome in patients with type 2 diabetes. N Engl J Med 369:1327–1335

    Article  CAS  PubMed  Google Scholar 

  • Zannad F, Cannon CP, Cushman WC et al (2015) EXAMINE investigators. Heart failure and mortality outcomes in patients with type 2 diabetes taking alogliptin versus placebo in EXAMINE: a multicentre, randomised, double-blind trial. Lancet 385:2067–2076

    Article  CAS  PubMed  Google Scholar 

  • Zhao L, Tian L, Uno H et al (2012) Utilizing the integrated difference of two survival functions to quantify the treatment contrast for designing, monitoring, and analyzing a comparative clinical study. Clin Trials 9:570–577

    Article  PubMed  PubMed Central  Google Scholar 

  • Zinman B, Wanner C, Lachin JM, EMPA-REG OUTCOME Investigators et al (2015) Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med 373:2117–2128

    Article  CAS  PubMed  Google Scholar 

Further Reading

  • Abbas AS, Dehbi HM, Ray KK (2016) Cardiovascular and non-cardiovascular safety of dipeptidyl peptidase-4 inhibition: a meta-analysis of randomized controlled cardiovascular outcome trials. Diabetes Obes Metab 18:295–299

    Article  CAS  PubMed  Google Scholar 

  • Al-Tabakha MM (2015) Future prospect of insulin inhalation for diabetic patients: the case of Afrezza versus Exubera. J Control Release 215:25–38

    Article  CAS  PubMed  Google Scholar 

  • Ard J, Cannon A, Lewis CE, Satiety Clinical Adiposity – Liraglutide Evidence in Non-diabetic Diabetic Individuals (SCALE) Study Groups et al (2016) The efficacy and safety of liraglutide 3.0 mg for weight management are similar across races: subgroup analysis across SCALE and phase 2 randomized trials. Diabetes Obes Metab 18:430–435

    Article  CAS  PubMed  Google Scholar 

  • Azimova K, San Juan Z, Mukherjee D (2014) Cardiovascular safety profile of currently available diabetic drugs. Ochsner J 14:616–632

    PubMed  PubMed Central  Google Scholar 

  • Bekiari E, Rizava C, Athanasiadou E et al (2015) Systematic review and meta-analysis of vildagliptin for treatment of type 2 diabetes. Endocrine 52(3):458–480 [Epub ahead of print]

    Article  PubMed  CAS  Google Scholar 

  • Bentley-Lewis R, Aguilar D, Riddle MC, ELIXA Investigators et al (2015) Rationale, design, and baseline characteristics in evaluation of LIXisenatide in acute coronary syndrome, a long-term cardiovascular end point trial of lixisenatide versus placebo. Am Heart J 169:631–638.e7

    Article  CAS  PubMed  Google Scholar 

  • Bhatt HB (2015) Thoughts on the progression of type 2 diabetes drug discovery. Expert Opin Drug Discov 10:107–110

    Article  CAS  PubMed  Google Scholar 

  • Boyle LD, Wilding JP (2014) A safety evaluation of canagliflozin: a first-in-class treatment for type 2 diabetes. Expert Opin Drug Saf 13:1535–1544

    Article  CAS  PubMed  Google Scholar 

  • Cameron FJ, Wherrett DK (2015) Care of diabetes in children and adolescents: controversies, changes, and consensus. Lancet 385:2096–2106

    Article  PubMed  Google Scholar 

  • Cefalu WT, Buse JB, Del Prato S et al (2014) Beyond metformin: safety considerations in the decision-making process for selecting a second medication for type 2 diabetes management: reflections from a diabetes care editors’ expert forum. Diabetes Care 37:2647–2659

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Cernea S, Cahn A, Raz I (2016) Saxagliptin for the treatment of diabetes: a focus on safety. Expert Opin Drug Saf 15:696–707

    Google Scholar 

  • Chatterjee S, Davies MJ (2015) Current management of diabetes mellitus and future directions in care. Postgrad Med J 91:612–621

    Article  PubMed  Google Scholar 

  • Cho YM (2015) Cardiovascular effects of the incretin-based therapy: the good, the bad, or the ugly? J Diab Investig 6:597–599

    Article  Google Scholar 

  • Dailey G (2015) Empagliflozin for the treatment of type 2 diabetes mellitus: an overview of safety and efficacy based on Phase 3 trials. J Diabetes 7:448–461

    Article  CAS  PubMed  Google Scholar 

  • Deacon CF, Lebovitz HE (2016) A comparative review of DPP-4 inhibitors and sulphonylureas. Diabetes Obes Metab 18:333–347

    Article  CAS  PubMed  Google Scholar 

  • Doggrell SA, Dimmitt SB (2016) Sitagliptin and other ‘gliptins’- why prescribe them? Expert Opin Pharmacother 17:757–760

    Article  CAS  PubMed  Google Scholar 

  • Erdmann E, Califf R, Gerstein HC et al (2015) Effects of the dual peroxisome proliferator-activated receptor activator aleglitazar in patients with type 2 diabetes mellitus or prediabetes. Am Heart J 170:117–122

    Article  CAS  PubMed  Google Scholar 

  • Ferdinand KC, Botros FT, Atisso CM, Sager PT (2016) Cardiovascular safety for once-weekly dulaglutide in type 2 diabetes: a pre-specified meta-analysis of prospectively adjudicated cardiovascular events. Cardiovasc Diabetol 15:38

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Fiorentino TV, Sesti G (2015) Lessons learned from cardiovascular outcome clinical trials with dipeptidyl peptidase 4 (DPP-4) inhibitors. Endocrine. [Epub ahead of print]

    Google Scholar 

  • Gallwitz B (2016) Novel therapeutic approaches in diabetes. Endocr Dev 31:43–56

    Article  PubMed  Google Scholar 

  • Ghosal S, Sinha B (2016) Gliptins and cardiovascular outcomes: a comparative and critical analysis after TECOS. J Diab Res 2016:1643496

    Google Scholar 

  • Ghosh RK, Bandyopadhyay D, Hajra A, Biswas M, Gupta A (2016) Cardiovascular outcomes of sodium-glucose cotransporter 2 inhibitors: a comprehensive review of clinical and preclinical studies. Int J Cardiol 212:29–36

    Article  PubMed  Google Scholar 

  • Gilbert RE, Krum H (2015) Heart failure in diabetes: effects of anti-hyperglycaemic drug therapy. Lancet 385:2107–2117

    Article  CAS  PubMed  Google Scholar 

  • Giorda CB, Picariello R, Tartaglino B et al (2015) Hospitalisation for heart failure and mortality associated with dipeptidyl peptidase 4 (DPP-4) inhibitor use in an unselected population of subjects with type 2 diabetes: a nested case-control study. BMJ Open 5:e007959

    Article  PubMed  PubMed Central  Google Scholar 

  • Green JB (2014) Understanding the type 2 diabetes mellitus and cardiovascular disease risk paradox. Postgrad Med 126:190–204

    Article  PubMed  Google Scholar 

  • Green JB, Bethel MA, Paul SK et al (2013) Rationale, design, and organization of a randomized, controlled Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS) in patients with type 2 diabetes and established cardiovascular disease. Am Heart J 166:983–989.e7

    Article  CAS  PubMed  Google Scholar 

  • Gunton JE, Cheung NW, Davis TM, Zoungas S, Colagiuri S, Australian Diabetes Society (2014) A new blood glucose management algorithm for type 2 diabetes: a position statement of the Australian Diabetes Society. Med J Aust 201:650–653

    Article  PubMed  Google Scholar 

  • Guo X (2016) The value of short- and long-acting glucagon-like peptide-1 agonists in the management of type 2 diabetes mellitus: experience with exenatide. Curr Med Res Opin 32:61–76

    Article  CAS  PubMed  Google Scholar 

  • Halimi S, Vergès B (2014) Adverse effects and safety of SGLT-2 inhibitors. Diabetes Metab 40(6 Suppl 1):S28–S34

    Article  CAS  PubMed  Google Scholar 

  • Hedrington MS, Davis SN (2015) The role of empagliflozin in the management of type 2 diabetes by patient profile. Ther Clin Risk Manag 11:739–49

    PubMed  PubMed Central  Google Scholar 

  • Heller S, Darpö B, Mitchell MI et al (2015) Considerations for assessing the potential effects of antidiabetes drugs on cardiac ventricular repolarization: a report from the Cardiac Safety Research Consortium. Am Heart J 170:23–35

    Article  CAS  PubMed  Google Scholar 

  • Hiatt WR, Kaul S, Smith RJ (2013) The cardiovascular safety of diabetes drugs: insights from the rosiglitazone experience. N Engl J Med 369:1285–1287

    Article  CAS  PubMed  Google Scholar 

  • Hirshberg B, Katz A (2013) Cardiovascular outcome studies with novel antidiabetes agents: scientific and operational considerations. Diabetes Care 36(Suppl 2):S253–S258

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Iijima H, Kifuji T, Maruyama N, Inagaki N (2015) Pharmacokinetics, pharmacodynamics, and safety of canagliflozin in Japanese patients with type 2 diabetes mellitus. Adv Ther 32:768–782

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Johansen OE (2015) Interpretation of cardiovascular outcome trials in type 2 diabetes needs a multiaxial approach. World J Diab 6:1092–1096

    Article  Google Scholar 

  • Kannan S, Pantalone KM, Matsuda S et al (2016) Risk of overall mortality and cardiovascular events in patients with type 2 diabetes on dual drug therapy including metformin: a large database study from the Cleveland Clinic. J Diabetes 8:279–285

    Article  CAS  PubMed  Google Scholar 

  • Kappel BA, Marx N, Federici M (2015) Oral hypoglycemic agents and the heart failure conundrum: lessons from and for outcome trials. Nutr Metab Cardiovasc Dis 25:697–705

    Article  CAS  PubMed  Google Scholar 

  • Li L, Li S, Deng K, Liu J et al (2016) Dipeptidyl peptidase-4 inhibitors and risk of heart failure in type 2 diabetes: systematic review and meta-analysis of randomised and observational studies. BMJ 352:i610

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Lindamood CA, Taylor JR (2015) Emerging new therapies for the treatment of type 2 diabetes mellitus: glucagon-like peptide-1 receptor agonists. Clin Ther 37:483–493

    Article  CAS  PubMed  Google Scholar 

  • Lueza B, Mauguen A, Pignon JP, Rivero-Arias O, Bonastre J, MAR-LC Collaborative Group (2016) Difference in restricted mean survival time for cost-effectiveness analysis using individual patient data meta-analysis: evidence from a case study. PLoS One 11:e0150032

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • MacConell L, Gurney K, Malloy J, Zhou M, Kolterman O (2015) Safety and tolerability of exenatide once weekly in patients with type 2 diabetes: an integrated analysis of 4,328 patients. Diabetes Metab Syndr Obes 8:241–253

    CAS  PubMed  PubMed Central  Google Scholar 

  • Marx N, Rosenstock J, Kahn SE et al (2015) Design and baseline characteristics of the CARdiovascular Outcome Trial of LINAgliptin Versus Glimepiride in Type 2 Diabetes (CAROLINA®). Diab Vasc Dis Res 12:164–174

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Menon V, Lincoff AM (2014) Cardiovascular safety evaluation in the development of new drugs for diabetes mellitus. Circulation 129:2705–2713

    Article  PubMed  Google Scholar 

  • Nathan DM (2015) Diabetes: advances in diagnosis and treatment. JAMA 314:1052–1062

    Article  CAS  PubMed  Google Scholar 

  • Neeland IJ, Salahuddin U, McGuire DK (2016) A safety evaluation of empagliflozin for the treatment of type 2 diabetes. Expert Opin Drug Saf 15:393–402

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Ndefo UA, Anidiobi NO, Basheer E, Eaton AT (2015) Empagliflozin (Jardiance): a novel SGLT2 inhibitor for the treatment of type-2 diabetes. P T 40:364–368

    PubMed  PubMed Central  Google Scholar 

  • Ommen ES, Xu L, O’Neill EA et al (2015) Comparison of treatment with sitagliptin or sulfonylurea in patients with type 2 diabetes mellitus and mild renal impairment: a post hoc analysis of clinical trials. Diabetes Ther 6:29–40

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Ou HT, Chang KC, Li CY, Wu JS (2016) Risks of cardiovascular diseases associated with dipeptidyl peptidase-4 inhibitors and other antidiabetic drugs in patients with type 2 diabetes: a nation-wide longitudinal study. Cardiovasc Diabetol 15:41

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Paneni F (2015) DPP-4 inhibitors, heart failure and type 2 diabetes: all eyes on safety. Cardiovasc Diagn Ther 5:471–478

    PubMed  PubMed Central  Google Scholar 

  • Patorno E, Everett BM, Goldfine AB et al (2016) Comparative cardiovascular safety of glucagon-like peptide-1 receptor agonists versus other antidiabetic drugs in routine care: a cohort study. Diabetes Obes Metab. [Epub ahead of print]

    Google Scholar 

  • Pladevall M, Riera-Guardia N, Margulis AV et al (2016) Cardiovascular risk associated with the use of glitazones, metformin and sufonylureas: meta-analysis of published observational studies. BMC Cardiovasc Disord 16:14

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Ponzani P, Scardapane M, Nicolucci A, Rossi MC (2016) Effectiveness and safety of liraglutide after three years of treatment. Minerva Endocrinol 41:35–42

    PubMed  Google Scholar 

  • Prasad-Reddy L, Isaacs D (2015) A clinical review of GLP-1 receptor agonists: efficacy and safety in diabetes and beyond. Drugs Context 4:212283

    Article  PubMed  PubMed Central  Google Scholar 

  • Pryor R, Cabreiro F (2015) Repurposing metformin: an old drug with new tricks in its binding pockets. Biochem J 471:307–322

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Quan H, Li M, Zhao PL et al (2013) Considerations for design and data analysis of noninferiority/superiority cardiovascular trials. J Biopharm Stat 23:239–260

    Article  PubMed  Google Scholar 

  • Rosenstock J, Marx N, Kahn SE et al (2013) Cardiovascular outcome trials in type 2 diabetes and the sulphonylurea controversy: rationale for the active-comparator CAROLINA trial. Diab Vasc Dis Res 10:289–301

    Article  PubMed  CAS  Google Scholar 

  • Rosenstock J, Marx N, Neubacher D et al (2015) Cardiovascular safety of linagliptin in type 2 diabetes: a comprehensive patient-level pooled analysis of prospectively adjudicated cardiovascular events. Cardiovasc Diabetol 14:57

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Royston P, Parmar MK (2013) Restricted mean survival time: an alternative to the hazard ratio for the design and analysis of randomized trials with a time-to-event outcome. BMC Med Res Methodol 13:152

    Article  PubMed  PubMed Central  Google Scholar 

  • Royston P, Parmar MK (2016) Augmenting the logrank test in the design of clinical trials in which non-proportional hazards of the treatment effect may be anticipated. BMC Med Res Methodol 16:16

    Article  PubMed  PubMed Central  Google Scholar 

  • Sanford M (2014) Dulaglutide: first global approval. Drugs 74:2097–2103

    Article  CAS  PubMed  Google Scholar 

  • Scheen AJ (2013) Cardiovascular effects of dipeptidyl peptidase-4 inhibitors: from risk factors to clinical outcomes. Postgrad Med 125:7–20

    Article  PubMed  Google Scholar 

  • Scheen AJ (2015) Pharmacodynamics, efficacy and safety of sodium-glucose co-transporter type 2 (SGLT2) inhibitors for the treatment of type 2 diabetes mellitus. Drugs 75:33–59

    Article  CAS  PubMed  Google Scholar 

  • Scheen AJ (2015) SGLT2 inhibition: efficacy and safety in type 2 diabetes treatment. Expert Opin Drug Saf 14:1879–1904

    Article  CAS  PubMed  Google Scholar 

  • Schwartz SS, Ahmed I (2016) Sodium-glucose cotransporter-2 inhibitors: an evidence-based practice approach to their use in the natural history of type 2 diabetes. Curr Med Res Opin 32:907–919

    Article  CAS  PubMed  Google Scholar 

  • Seshasai SR, Bennett RL, Petrie JR et al (2015) Cardiovascular safety of the glucagon-like peptide-1 receptor agonist taspoglutide in people with type 2 diabetes: an individual participant data meta-analysis of randomized controlled trials. Diabetes Obes Metab 17:505–510

    Article  CAS  PubMed  Google Scholar 

  • Shah S, Sharma SK, Singh P, Muruganathan A, Das AK, Diabetes Consensus Group (2014) Consensus evidence-based guidelines for insulin initiation, optimization and continuation in type 2 diabetes mellitus. J Assoc Physicians India 62(7 Suppl):49–54

    PubMed  Google Scholar 

  • Singh S (2014) Type 2 diabetes pharmacoepidemiology update 2014: safety versus efficacy. Curr Diab Rep 14:563

    Article  PubMed  CAS  Google Scholar 

  • Sportiello L, Rafaniello C, Scavone C et al (2016) The importance of pharmacovigilance for the drug safety: focus on cardiovascular profile of incretin-based therapy. Int J Cardiol 202:731–735

    Article  PubMed  Google Scholar 

  • Steinberg HO (2016) Sodium-glucose cotransporter 2 inhibitors and cardiovascular outcomes. Postgrad Med 128:398–408

    Article  PubMed  Google Scholar 

  • Tella SH, Rendell MS (2015) DPP-4 inhibitors: focus on safety. Expert Opin Drug Saf 14:127–140

    Article  CAS  PubMed  Google Scholar 

  • Thompson AM, Trujillo JM (2015) Dulaglutide: the newest GLP-1 receptor agonist for the management of type 2 diabetes. Ann Pharmacother 49:351–359

    Article  CAS  PubMed  Google Scholar 

  • Tian L, Zhao L, Wei LJ (2014) Predicting the restricted mean event time with the subject’s baseline covariates in survival analysis. Biostatistics 15:222–233

    Article  PubMed  Google Scholar 

  • Tiwari P (2015) Recent trends in therapeutic approaches for diabetes management: a comprehensive update. J Diabetes Res 2015:340838

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Trinquart L, Jacot J, Conner SC, Porcher R (2016) Comparison of treatment effects measured by the hazard ratio and by the ratio of restricted mean survival times in oncology randomized controlled trials. J Clin Oncol. 34:1813–1819 [Epub ahead of print]

    Google Scholar 

  • Trujillo JM, Nuffer W (2014) GLP-1 receptor agonists for type 2 diabetes mellitus: recent developments and emerging agents. Pharmacotherapy 34:1174–1186

    Article  CAS  PubMed  Google Scholar 

  • Uccellatore A, Genovese S, Dicembrini I, Mannucci E, Ceriello A (2015) Comparison review of short-acting and long-acting glucagon-like peptide-1 receptor agonists. Diabetes Ther 6:239–256

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Umezawa S, Kubota A, Maeda H et al (2015) Two-year assessment of the efficacy and safety of sitagliptin in elderly patients with type 2 diabetes: post hoc analysis of the ASSET-K study. BMC Endocr Disord 15:34

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Uno H, Claggett B, Tian L et al (2014) Moving beyond the hazard ratio in quantifying the between-group difference in survival analysis. J Clin Oncol 32:2380–2385

    Article  PubMed  PubMed Central  Google Scholar 

  • Van Dieren S, Beulens JSJ, Kengne AP et al (2012) Prediction models for the risk of cardiovascular disease in patients with type 2 diabetes: a systematic review. Heart 98:360–369

    Article  PubMed  Google Scholar 

  • Varas-Lorenzo C, Margulis AV, Pladevall M et al (2014) The risk of heart failure associated with the use of noninsulin blood glucose-lowering drugs: systematic review and meta-analysis of published observational studies. BMC Cardiovasc Disord 14:129

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Waldrop G, Zhong J, Peters M, Rajagopalan S (2016) Incretin-based therapy for diabetes: what a cardiologist needs to know. J Am Coll Cardiol 67:1488–1496

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Wei Y, Royston P, Tierney JF, Parmar MK (2015) Meta-analysis of time-to-event outcomes from randomized trials using restricted mean survival time: application to individual participant data. Stat Med 34:2881–2898

    Article  PubMed  PubMed Central  Google Scholar 

  • White JR Jr (2015) Empagliflozin, an SGLT2 inhibitor for the treatment of type 2 diabetes mellitus: a review of the evidence. Ann Pharmacother 49:582–598

    Article  CAS  PubMed  Google Scholar 

  • White JR Jr (2015) Sodium glucose cotransporter 2 inhibitors. Med Clin North Am 99:131–143

    Article  PubMed  Google Scholar 

  • White WB, Baker WL (2016) Cardiovascular effects of incretin-based therapies. Annu Rev Med 67:245–260

    Article  CAS  PubMed  Google Scholar 

  • Wu JH, Foote C, Blomster J et al (2016) Effects of sodium-glucose cotransporter-2 inhibitors on cardiovascular events, death, and major safety outcomes in adults with type 2 diabetes: a systematic review and meta-analysis. Lancet Diabetes Endocrinol. 4:411–419 [Epub ahead of print]

    Google Scholar 

  • Wu S, Hopper I, Skiba M, Krum H (2014) Dipeptidyl peptidase-4 inhibitors and cardiovascular outcomes: meta-analysis of randomized clinical trials with 55,141 participants. Cardiovasc Ther 32:147–158

    Article  CAS  PubMed  Google Scholar 

  • Yabe D, Seino Y (2016) Alogliptin for the treatment of type 2 diabetes: a drug safety evaluation. Expert Opin Drug Saf 15:249–264

    Article  CAS  PubMed  Google Scholar 

  • Yang F, Stewart M, Ye J, DeMets D (2015) Type 2 diabetes mellitus development programs in the new regulatory environment with cardiovascular safety requirements. Diabetes Metab Syndr Obes 8:315–325

    Article  PubMed  PubMed Central  Google Scholar 

  • Zhao L, Claggett B, Tian L et al (2015) On the restricted mean survival time curve in survival analysis. Biometrics 72:215–221

    Article  PubMed  PubMed Central  Google Scholar 

  • Zinman B, Inzucchi SE, Lachin JM et al (2014) Rationale, design, and baseline characteristics of a randomized, placebo-controlled cardiovascular outcome trial of empagliflozin (EMPA-REG OUTCOME™). Cardiovasc Diabetol 13:102

    Article  PubMed  PubMed Central  CAS  Google Scholar 

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Turner, J.R., Karnad, D.R., Kothari, S. (2017). Satisfying the Regulatory Requirements for New Antidiabetic Drugs for Type 2 Diabetes Most Expeditiously. In: Cardiovascular Safety in Drug Development and Therapeutic Use. Adis, Cham. https://doi.org/10.1007/978-3-319-40347-2_13

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