Dapagliflozin Evaluation to Improve the LIVEs of Patients With PReserved Ejection Fraction Heart Failure.

Phase 3

Completed

• Conditions: Heart Failure With Preserved Ejection Fraction
• Interventions: Drug: Dapagliflozin; Drug: Placebo

• Registration Number: NCT03619213
• Lead Sponsor: AstraZeneca

Brief Summary

This is an international, multicentre, parallel-group, event-driven, randomised, double-blind, placebo-controlled study in HFpEF patients, evaluating the effect of dapagliflozin 10 mg 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.

Detailed Description

This is an international, multicentre, parallel-group, event-driven, randomised, double-blind study in patients with HFpEF, evaluating the effect of dapagliflozin 10 mg 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 and heart failure events (hospitalisations for HF or urgent HF visits). Adult patients aged ≥40 years with HFpEF (LVEF \>40% and evidence of structural heart disease) and New York Heart Association (NYHA) class II-IV who are eligible according to the inclusion/exclusion criteria will be randomised in a 1:1 ratio to receive either dapagliflozin 10 mg or placebo. Both out-patients and in-patients hospitalised for heart failure and off intravenous heart failure-therapy for 24 hours can be randomised. It is estimated that approximately 11000 patients at approximately 400-500 sites in 20-25 countries will need to be enrolled to reach the target of approximately 6100 randomised patients.

Study Timeline

• Study First Submitted: 2018-08-02
• Study First Submitted QC: 2018-08-02
• Study First Posted: 2018-08-07
• Study Start: 2018-08-27
• Primary Completion: 2022-03-27
• Study Completion: 2022-03-27
• Results First Submitted: 2023-03-09
• Status Verified: 2023-07
• Results First Submitted QC: 2023-07-10
• Last Update Submitted: 2023-07-10
• Results First Posted: 2023-07-11
• Last Update Posted: 2023-07-11

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 6263

Inclusion Criteria

1. Provision of signed informed consent prior to any study specific procedures.
2. Male or female patients age ≥40 years.
3. Documented diagnosis of symptomatic heart failure (NYHA class II-IV) at enrolment, and a medical history of typical symptoms/signs of heart failure ≥6 weeks before enrolment with at least intermittent need for diuretic treatment.
4. Left Ventricular Ejection Fraction (LVEF) >40% and evidence of structural heart disease (i.e. left ventricular hypertrophy or left atrial enlargement ) documented by the most recent echocardiogram, and/or cardiac MR within the last 12 months prior to enrolment. For patients with prior acute cardiac events or procedures that may reduce LVEF, e.g. as defined in exclusion criterion 6, qualifying cardiac imaging assessment at least 12 weeks following the procedure/event is required.
5. Elevated NT-pro BNP levels.
6. Both ambulatory and hospitalised patients may be enrolled and randomised. Patients currently hospitalised for HF, must be off intravenous HF medications for at least 24 before randomisation.

Further details regarding inclusion criteria 4-6 may apply.

Exclusion Criteria

1. Receiving therapy with an SGLT2 inhibitor within 4 weeks prior to randomisation or previous intolerance to an SGLT2 inhibitor.
2. Type 1 diabetes mellitus (T1D).
3. eGFR <25 mL/min/1.73 m2 (CKD-EPI formula) at Visit 1.
4. Systolic blood pressure (BP) <95 mmHg on 2 consecutive measurements at 5-minute intervals, at Visit 1 or at Visit 2.
5. Systolic BP≥160 mmHg if not on treatment with ≥3 blood pressure lowering medications or ≥180 mmHg irrespective of treatments, on 2 consecutive measurements at 5-minute intervals, at Visit 1 or at Visit 2.
6. MI, unstable angina, coronary revascularization (percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG)), ablation of atrial flutter/fibrillation, valve repair/replacement within 12 weeks prior to enrolment. Before enrolment, these patients must have their qualifying echocardiography and/or cardiac MRI examination at least 12 weeks after the event.
7. Planned coronary revascularization, ablation of atrial flutter/fibrillation and valve repair/replacement.
8. Stroke or transient ischemic attack (TIA) within 12 weeks prior to enrolment.
9. Probable alternative or concomitant diagnoses which in the opinion of the investigator could account for the patient's HF symptoms and signs (e.g. anaemia, hypothyroidism).
10. Body mass index >50 kg/m2.

Further exclusion criteria may apply

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Dapagliflozin	Dapagliflozin	Patients will be randomized 1:1 to either dapagliflozin or placebo.
Placebo	Placebo	Placebo matching dapagliflozin.

Primary Outcome Measures

Name	Time	Method
Subjects Included in the Composite Endpoint of CV Death, Hospitalization Due to Heart Failure or Urgent Visit Due to Heart Failure.	Up to 42.1 months	Dual primary efficacy; Primary endpoint analysed in all patients randomised (Full analysis set).; The analysis was assessed on Full Analysis Set, including events occurring on or prior to Primary Analysis Censoring Date.
Subjects Included in the Composite Endpoint of CV Death, Hospitalization Due to Heart Failure or Urgent Visit Due to Heart Failure for LVEF <60% Subpopulation	Up to 42.1 months	Dual primary efficacy; Primary endpoint analysed in all patients randomised with LVEF \< 60% at baseline.; The analysis was assessed on Full Analysis Set, including events occurring on or prior to Primary Analysis Censoring Date.

Secondary Outcome Measures

Name	Time	Method
Events Included in the Composite Endpoint of CV Death or Recurrent Heart Failure Event (Hospitalization Due to Heart Failure or Urgent Heart Failure Visit)	Up to 42.1 months	Secondary efficacy; Total number of heart failure events (first and recurrent) and cardiovascular death, analysed in all randomized patients.; The analysis was assessed on Full Analysis Set, including events occurring on or prior to Primary Analysis Censoring Date.
Events Included in the Composite Endpoint of CV Death or Recurrent Heart Failure Event (Hospitalization Due to Heart Failure or Urgent Heart Failure Visit) for LVEF <60% Subpopulation	Up to 42.1 months	Secondary efficacy; Total number of heart failure events (first and recurrent) and cardiovascular death, analysed in all randomized patients with LVEF \< 60% at baseline; The analysis was assessed on Full Analysis Set, including events occurring on or prior to Primary Analysis Censoring Date.
Change From Baseline in the KCCQ Total Symptom Score at 8 Months	Baseline and 8 months or death before 8 months	KCCQ is a 23-item, self-administered instrument that quantifies physical function, symptoms (frequency, severity and recent change), social function, self-efficacy and knowledge, and quality of life. The KCCQ Total Symptom Score incorporates the symptom domains into a single score. Scores are transformed to a range of 0-100, in which higher scores reflect better health status.
Subjects Included in the Endpoint of Cardiovascular Death	Up to 42.1 months	Secondary efficacy; The analysis was assessed on Full Analysis Set, including deaths occurring on or prior to Primary Analysis Censoring Date.
Subjects Included in the Endpoint of All-cause Mortality	Up to 42.1 months	Secondary efficacy; The analysis was assessed on Full Analysis Set, including deaths occurring on or prior to Primary Analysis Censoring Date.

Trial Locations

Locations (1)

Research Site; 🇻🇳 Ho Chi Minh, Vietnam