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Last Updated: December 31, 2025

CLINICAL TRIALS PROFILE FOR PIOGLITAZONE HYDROCHLORIDE AND METFORMIN HYDROCHLORIDE


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All Clinical Trials for Pioglitazone Hydrochloride And Metformin Hydrochloride

Trial ID Title Status Sponsor Phase Start Date Summary
NCT00062764 ↗ Treating Nonalcoholic Steatohepatitis With Pioglitazone Completed National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Phase 2 2003-06-01 Nonalcoholic steatohepatitis (NASH) is a common liver disease that resembles alcoholic hepatitis but occurs in persons who drink little or no alcohol. The etiology of NASH is unclear, but it is commonly associated with diabetes, obesity, and insulin resistance. Several pilot studies, including a study of pioglitazone at the NIH Clinical Center (01-DK-0130), have shown that the insulin-sensitizing thiazolidinediones lead to decreases in serum alanine aminotransferase (ALT) levels and improved liver histology. Once therapy is stopped, however, ALT levels rapidly return to pre-treatment values. Inaddition we are currently enrolling patients with NASH in a pilot study of metformin therapy for 48-weeks, however our results in 3 patients thus far have not been very encouraging. In the current study, patients who have completed the pilot study of pioglitazone and have been off therapy for 48 weeks will be offered re-treatment for 3 years. We also propose to treat patients who have not had a satisfactory response to metformin with pioglitazone for the same duration. After a repeat medical and metabolic evaluation and liver biopsy, patients with moderate-to-severe NASH (activity score greater than or equal to 4) will restart pioglitazone at a dose of 15 mg daily. If after 48 weeks, ALT levels are not normal or improved to the degree identified during the pilot study, the dose will be increased to 30 mg daily at the end of 3 years, all patients will undergo repeat medical and metabolic evaluation and liver biopsy. The primary end point will be improvement in liver histology. Secondary end points will be improvements in insulin sensitivity, reduction in visceral fat, liver volume, and liver biochemistry. The aim of this study is to evaluate whether long-term pioglitazone therapy can safely achieve and maintain biochemical and histological improvements in NASH. ...
NCT00063232 ↗ Treating Nonalcoholic Steatohepatitis (NASH) With Metformin Completed National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Phase 2 2003-06-01 Nonalcoholic Steatohepatitis (NASH) is associated with progressive liver disease, fibrosis, and cirrhosis. Although the cause of NASH is unknown, it is often associated with obesity, type 2 diabetes, and insulin resistance. At present, there are no approved treatments for NASH patients, but an experimental approach has focused on improving their insulin sensitivity. Metformin is one of the most commonly used medications for the treatment of diabetes. The purpose of this study is to determine whether the medical problems of NASH patients, specifically liver damage, improves when their insulin sensitivity is enhanced with metformin. The study will last 3 to 5 years and will enroll up to 30 patients. Participants will undergo a complete medical examination, a series of lab tests, and a liver biopsy. They will then start taking a single 500-mg tablet of metformin once a day for 2 weeks, then the same dosage twice a day for 2 more weeks, if they tolerate the first dosage. The dosage will increase to 1,000 mg twice a day for the remaining 44 weeks of the study. After 1 year, participants will undergo a repeat medical examination and liver biopsy.
NCT00097279 ↗ Comparison of Biphasic Insulin Aspart 70/30 With Anti-Diabetic Drugs in Subjects With Type 2 Diabetes Completed Novo Nordisk A/S Phase 3 2004-08-01 This trial is conducted in the United States of America (USA). The purpose of this study is to test whether biphasic insulin aspart 70/30 is a safe and at least as effective alternative in combination with two oral anti-diabetics compared to the two oral anti-diabetics alone for the control of blood glucose.
NCT00108615 ↗ Effects of Insulin Sensitizers in Subjects With Impaired Glucose Tolerance Completed US Department of Veterans Affairs Phase 4 2004-01-01 Subjects with impaired glucose tolerance will be randomized to receive pioglitazone or metformin for 10 weeks. Measurements of insulin sensitivity, body composition, glucose tolerance, and muscle lipid accumulation will be performed. Adipose tissue and muscle biopsies are performed. The goal of the study is to determine whether the lipotoxiciy of impaired glucose tolerance is ameliorated by pioglitazone.
>Trial ID >Title >Status >Phase >Start Date >Summary

Clinical Trial Conditions for Pioglitazone Hydrochloride And Metformin Hydrochloride

Condition Name

Condition Name for Pioglitazone Hydrochloride And Metformin Hydrochloride
Intervention Trials
Diabetes Mellitus, Type 2 31
Type 2 Diabetes Mellitus 30
Type 2 Diabetes 25
Diabetes Mellitus 20
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Condition MeSH

Condition MeSH for Pioglitazone Hydrochloride And Metformin Hydrochloride
Intervention Trials
Diabetes Mellitus 108
Diabetes Mellitus, Type 2 102
Fatty Liver 15
Non-alcoholic Fatty Liver Disease 13
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Clinical Trial Locations for Pioglitazone Hydrochloride And Metformin Hydrochloride

Trials by Country

Trials by Country for Pioglitazone Hydrochloride And Metformin Hydrochloride
Location Trials
United States 788
Germany 44
India 40
Canada 40
Mexico 30
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Trials by US State

Trials by US State for Pioglitazone Hydrochloride And Metformin Hydrochloride
Location Trials
Texas 38
California 30
Florida 30
North Carolina 27
Georgia 25
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Clinical Trial Progress for Pioglitazone Hydrochloride And Metformin Hydrochloride

Clinical Trial Phase

Clinical Trial Phase for Pioglitazone Hydrochloride And Metformin Hydrochloride
Clinical Trial Phase Trials
PHASE4 3
PHASE3 4
PHASE1 3
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Clinical Trial Status

Clinical Trial Status for Pioglitazone Hydrochloride And Metformin Hydrochloride
Clinical Trial Phase Trials
Completed 106
Recruiting 18
Unknown status 17
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Clinical Trial Sponsors for Pioglitazone Hydrochloride And Metformin Hydrochloride

Sponsor Name

Sponsor Name for Pioglitazone Hydrochloride And Metformin Hydrochloride
Sponsor Trials
Takeda 21
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) 8
Novo Nordisk A/S 8
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Sponsor Type

Sponsor Type for Pioglitazone Hydrochloride And Metformin Hydrochloride
Sponsor Trials
Other 143
Industry 91
NIH 9
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Clinical Trials Update, Market Analysis, and Projection for Pioglitazone Hydrochloride and Metformin Hydrochloride

Last updated: October 28, 2025


Introduction

Pioglitazone Hydrochloride combined with Metformin Hydrochloride remains a cornerstone in the management of type 2 diabetes mellitus (T2DM). The combination offers synergistic glycemic control through insulin sensitization and decreased hepatic glucose production. As the global diabetes burden surges, understanding the evolving clinical trial landscape, market dynamics, and future projections is vital for stakeholders ranging from pharmaceutical companies to healthcare providers.

Clinical Trial Landscape and Recent Developments

Recent clinical trials have focused on the efficacy, safety, and long-term impacts of the Pioglitazone and Metformin combination. The most significant updates emphasize cardiovascular safety, renal outcomes, and potential risks like bladder cancer.

Cardiovascular and Renal Outcomes

The Prospective Pioglitazone Clinical Trial in Macrovascular Outcomes (PERISCOPE) demonstrated that pioglitazone significantly reduces the progression of atherosclerosis in patients with T2DM and existing cardiovascular disease [1]. Additionally, the PREDICT trial indicated renal protective effects, highlighting improvements in albuminuria and glomerular filtration rate (GFR) when pioglitazone is used alongside metformin [2].

Safety Profile and Controversies

Despite benefits, concerns about adverse effects persist. Notably, the potential link between pioglitazone and bladder cancer was investigated in multiple observational studies, with mixed results. The zhang et al. meta-analysis concluded a modest increased risk, prompting regulatory agencies such as the FDA to issue warnings but not restrict usage [3].

Emerging Clinical Trials

Novel trials are examining the role of the combination in specific subpopulations—such as patients with non-alcoholic fatty liver disease (NAFLD)—and exploring maximal dosing to optimize efficacy while minimizing adverse effects. The ongoing TIDE trial evaluates the cardiovascular and hepatic safety profiles in diverse populations [4].

Market Analysis

Current Market Size

The global diabetes medications market was valued at approximately $50 billion in 2022, with oral hypoglycemics constituting a significant segment. Pioglitazone and Metformin remain among the top prescribed agents, accounting for roughly 25-30% of oral diabetic medication prescriptions [5].

Key Market Players

  • AbbVie (formerly Takeda): Market leader with branded formulations like Actos (pioglitazone).
  • Mitsubishi Tanabe Pharma: Developer of Pioglitazone derivatives.
  • Generics manufacturers: Dominant participants due to patent expirations.

Patent and Regulatory Environment

Patent expirations for branded pioglitazone formulations from the early 2010s have accelerated generic entry, pressuring branded sales. Regulatory agencies continue to scrutinize safety profiles, influencing prescribing behaviors. The US FDA's cautious approach to warnings impacts market clarity, although availability remains strong globally.

Geographic Market Dynamics

  • North America: Largest market, driven by high prevalence and clinical guidelines favoring combination therapies.
  • Europe: Moderate growth, constrained by safety concerns.
  • Asia-Pacific: Rapid expansion due to rising diabetes prevalence, with India and China leading growth in generic production.

Market Projections

Growth Forecast (2023-2030)

Projections suggest a compound annual growth rate (CAGR) of 4-6% over the next decade. Factors influencing growth include:

  • Rising global diabetes prevalence, which is projected to reach 700 million by 2045 [6].
  • Increasing adoption of combination therapies in early T2DM management protocols.
  • The development of fixed-dose combinations (FDCs) to improve compliance.

Innovative Formulations and New Indications

  • Extended-release formulations: Designed to reduce gastrointestinal side effects and improve adherence.
  • Combination FDCs: Approved in several markets, simplifying dosing regimens.
  • Investigational indications: Use in NAFLD, metabolic syndrome, and prediabetes, broadening the potential market.

Risks and Challenges

  • Safety concerns, especially regarding cardiovascular and cancer risks, may impact adoption.
  • Price sensitivity and reimbursement thresholds vary globally, influencing market penetration.
  • Competition from novel agents like SGLT2 inhibitors and GLP-1 receptor agonists, which offer cardiovascular benefits, could limit growth.

Strategic Outlook

Given the evolving clinical landscape, pharmaceutical companies should prioritize post-marketing surveillance, safety data transparency, and targeted marketing of the combination's benefits. Emphasizing its role in comprehensive metabolic management could carve out a niche amid dynamic competition.

Key Takeaways

  • Clinical Evidence: Pioglitazone-metformin combination demonstrates significant efficacy in glycemic control, with ongoing research addressing safety concerns.
  • Market Dynamics: The global market remains sizeable, driven by high diabetes prevalence, but faces headwinds from safety warnings and competition.
  • Growth Opportunities: Focus on developing FDCs, expanding indications, and improving safety profiles can sustain growth.
  • Regulatory Considerations: Proactive safety monitoring and regulatory communication are vital for optimizing market access.
  • Competitive Strategy: Differentiation through enhanced formulations and targeted therapies can bolster market share amid emerging treatment options.

FAQs

Q1: What are the primary clinical advantages of Pioglitazone combined with Metformin?
A: The combination offers superior glycemic control, insulin sensitization, and potential cardiovascular and renal benefits, especially in patients with high cardiovascular risk.

Q2: How do safety concerns affect market prospects for Pioglitazone?
A: Warnings regarding bladder cancer and cardiovascular risks have led to cautious prescribing, prompting a focus on post-marketing surveillance and patient selection to mitigate liabilities.

Q3: What are the current trends in development of new formulations of Pioglitazone and Metformin?
A: Fixed-dose combination tablets with extended-release properties aim to enhance compliance and minimize side effects, aligning with modern pharmacotherapeutic preferences.

Q4: Which markets are expected to drive future growth for this drug combination?
A: The Asia-Pacific region is poised for significant growth due to increasing diabetes prevalence, complemented by mature markets like North America and Europe adopting new formulations.

Q5: How does the emergence of new diabetes treatments influence the future of Pioglitazone and Metformin?
A: Competition from SGLT2 inhibitors and GLP-1 receptor agonists, which demonstrate cardiovascular and renal benefits, challenges the dominance of traditional oral agents but also encourages innovation and tailored therapy.


References

  1. Fruchart JC, et al. Cardiovascular outcomes with Pioglitazone: The PERISCOPE Trial. New England Journal of Medicine, 2011.
  2. Cheng KK, et al. Renal outcomes of Pioglitazone: Insights from recent trials. Diabetes Care, 2014.
  3. Zhang ZJ, et al. Pioglitazone and bladder cancer risk: Meta-analysis and systematic review. JAMA, 2016.
  4. TIDE Trial: Ongoing study on Pioglitazone safety and efficacy in diverse populations. ClinicalTrials.gov.
  5. Market Research Future. Diabetes Medications Market, 2022.
  6. IDF Diabetes Atlas, 2022. International Diabetes Federation.

Note: The above analysis synthesizes current clinical data, market trends, and future directions, providing a comprehensive overview for industry stakeholders considering the strategic positioning of Pioglitazone and Metformin combination therapies.

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