Importance:Oral small-molecule glucagon-like peptide-1 receptor agonists (GLP-1 RAs) may address limitations of injectable and peptide-based agents for type 2 diabetes.
Objective:To evaluate the efficacy and safety of HRS-7535, an oral nonpeptide GLP-1 RA, as add-on therapy among adults with type 2 diabetes inadequately controlled with metformin.
Design, Setting, and Participants:
This 16-week, phase 2, double-blind, placebo-controlled randomized clinical trial was conducted at 44 centers in China. Adults aged 18 to 75 years with type 2 diabetes, hemoglobin A
1c
(HbA
1c
) levels ranging from 7.5% to 11.0%, and receiving stable metformin therapy were enrolled between May 10 and December 18, 2023. Data were analyzed from May 8 to 22, 2024.
Interventions:Participants were randomized (1:1:1:1:1) to once-daily oral HRS-7535 (15, 30, 60, or 90 mg) or matching placebo. The 60- and 90-mg treatment groups used dose-escalation regimens.
Main Outcomes and Measures:
The primary outcome was change in HbA
1c
level from baseline to week 16. Secondary outcomes included changes in fasting plasma glucose level, 2-hour postprandial glucose level, body weight, and the proportion of patients achieving HbA
1c
levels less than 7.0%. Safety outcomes included adverse events (AEs), hypoglycemia, and AEs of special interest.
Results:
Of 194 randomized patients (mean [SD] age, 52.3 [11.0] years; 115 [59.3%] men; mean [SD] HbA
1c
level, 8.5% [0.7]), 177 (91.2%) completed treatment. The mean changes in HbA
1c
level at week 16 were −1.19% (95% CI, −1.54% to −0.84%) with the 15-mg dose, −1.59% (95% CI, −1.94% to −1.24%) with the 30-mg dose, −1.82% (95% CI, −2.16% to −1.48%) with the 60-mg dose, and −1.64% (95% CI, −1.97% to −1.30%) with the 90-mg dose compared with −0.25% (95% CI, −0.60% to 0.09%) with placebo; placebo-adjusted differences ranged from −0.94% (95% CI, −1.43% to −0.45%) to −1.57% (95% CI, −2.05% to −1.08%) (all
P
< .001). HbA
1c
level less than 7.0% was achieved in proportions ranging from 48.7% (95% CI, 32.4%-65.2%) to 63.2% (95% CI, 46.0%-78.2%) of HRS-7535–treated patients vs 15.4% (95% CI, 5.9%-30.5%) with placebo. The 90-mg group had greater body weight reduction than placebo (−2.63% [95% CI, −3.72% to −1.54%] vs −1.30% [95% CI, −2.46% to −0.15%]). AEs occurred in 28 of 39 (71.8%) to 33 of 39 (84.6%) HRS-7535–treated patients and 28 of 39 (71.8%) placebo-treated patients and were predominantly mild to moderate gastrointestinal events. Level 1 hypoglycemia occurred in 9 HRS-7535–treated patients; no level 2 or 3 hypoglycemia, pancreatitis, or elevations of alanine aminotransferase or aspartate aminotransferase levels greater than 3 times the upper limit of normal occurred.
Conclusions and Relevance:In this randomized clinical trial of adults with type 2 diabetes inadequately controlled with metformin, oral HRS-7535 improved glycemic control and was associated with modest weight reduction, with a safety profile consistent with that of GLP-1 RAs. Because HRS-7535 is a nonpeptide oral GLP-1 RA that does not require fasting administration or injection, it may be a viable treatment option, pending confirmation in phase 3 trials.
Trial Registration:
ClinicalTrials.gov Identifier:
NCT05759897