ERtugliflozin triAl in DIabetes With Preserved or Reduced ejeCtion FrAcTion mEchanistic Evaluation in Heart Failure: "ERADICATE-HF"
试验速览
- 阶段
- 2 期
- 状态
- 已完成
- 入组人数
- 34
- 试验地点
- 3
- 主要终点
- Fractional Excretion of Lithium (FELi)
研究概览
简要总结
This study aims to elucidate the mechanisms whereby the SGLT2i "ertugliflozin" modifies cardiorenal interactions that regulate fluid volume and neurohormonal activation in patients with type 2 diabetes and heart failure (T2D-HF).
详细描述
Newer agents called sodium glucose co-transporter-2 inhibitors (SGLT2i) have been developed to improve glycemic control and lower hemoglobin A1c by increasing glycosuria. SGLT2i also reduce blood pressure and albuminuria in T2D - possibly through natriuresis. Importantly, a landmark trial "EMPA-REG OUTCOME" demonstrated that the SGLT2i "empagliflozin" is the first anti- hyperglycemic agent to reduce mortality and HF risk, and also to decrease the risk of progressive diabetic nephropathy. Similar benefits were also recently reported in the CANVAS Program trial with canagliflozin. Despite the benefits observed in these two pivotal trials, the mechanisms responsible for beneficial effects of SGLT2i in patients with T2D with respect to the development and/or worsening of HF are not currently known.
In light of the results of EMPA-REG OUTCOME, the investigators aim to elucidate the mechanisms whereby the SGLT2i "ertugliflozin" modifies cardiorenal interactions that regulate fluid volume and neurohormonal activation in patients with T2D and HF (T2D-HF). The investigators will test the hypothesis that ertugliflozin increases proximal tubular natriuresis, thereby reducing plasma volume, without inducing significant renal vasoconstriction or activation of the sympathetic nervous system (SNS) (see below, Figure 1). The systematic understanding of the effects of SGLT2i in the setting of HF will enable the design of rational physiology based strategies to decrease the burden of HF, which could have major clinical and research implications internationally.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
盲法说明
Double-blind study
入排标准
- 年龄范围
- 19 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Male or female subjects diagnosed with T2D ≥12 months prior to informed consent;
- •eGFR ≥30 ml/min/1.73m2;
- •Age >18 years;
- •HbA1c 6.5%-10.5%;
- •Body Mass Index (BMI) 18.5-45.0 kg/m2;
- •Blood pressure ≤160/110 and ≥90/60 at screening,
- •Heart failure with New York Heart Association (NYHA) class 2-3 symptoms and ejection fraction ≥20%
- •Stable dose of maximally tolerated ACE inhibitor, angiotensin receptor blocker or renin inhibitor for at least 30 days
- •Stable diuretic dose for at least 30 days at the time of baseline physiological assessment
- •BNP levels at baseline ≥100 pg/ml (no atrial fibrillation), ≥200 pg/ml if in atrial fibrillation
排除标准
- •Type 1 Diabetes;
- •Leukocyte and/or nitrite positive urinalysis that is untreated;
- •Severe hypoglycaemia within 2 months prior to screening;
- •History of brittle diabetes or hypoglycaemia unawareness based on investigator judgement;
- •Unstable coronary artery disease with acute coronary syndrome, percutaneous intervention or bypass surgery within 3 months;
- •Clinically significant valvular disease;
- •Congestive heart failure secondary to an infiltrative cardiomyopathic process (for example amyloid) or pericardial constriction;
- •Uncontrolled systemic hypertension (systolic blood pressure >160 mmHg and/or diastolic blood pressure >110) or systemic hypotension (systolic blood pressure < 90/60 mmHg);
- •Bariatric surgery or other surgeries that induce chronic malabsorption;
- •Anti-obesity drugs or diet regimen and unstable body weight three months prior to screening;
- •Treatment with systemic corticosteroids;
- •Blood dyscrasias or any disorders causing hemolysis or unstable red blood cells;
- •Pre-menopausal women who are nursing, pregnant, or of child-bearing potential and not practicing an acceptable method of birth control;
- •Participation in another trial with an investigational drug within 30 days of informed consent;
- •Alcohol or drug abuse within three months prior to informed consent that would interfere with trial participation or any ongoing clinical condition that would jeopardize subject safety or study compliance based on investigator judgement;
- •Liver disease, defined by serum levels of alanine transaminase, aspartate transaminase, or alkaline phosphatase >3 x upper limit of normal as determined during screening;
- •Active malignancy at the time of screening;
研究组 & 干预措施
Ertuglifozin Treatment Arm
Ertugliflozin Tablets Total Dose 15mg (10mg + 5 mg) for 12 weeks
干预措施: Ertugliflozin (Drug)
Placebo Arm
Placebo Matching Ertugliflozin Tablet for 12 weeks
干预措施: Placebo (Drug)
结局指标
主要结局
Fractional Excretion of Lithium (FELi)
时间窗: Change in outcomes was measured acute (1 week minus baseline values) and chronic (12 weeks minus baseline values)
The difference in fractional excretion of lithium (FELi) with ertugliflozin vs. placebo. This was measured using exogenous lithium administration 12 hours before lithium excretion was measured in urine and blood.
Fractional Excretion of Sodium (FENa)
时间窗: Change in outcomes was measured acute (1 week minus baseline values) and chronic (12 weeks minus baseline values)
The difference in fractional excretion of sodium (FENa) with ertugliflozin vs. placebo. This was measured using exogenous lithium administration 12 hours before sodium excretion was measured in urine and blood.
Change in Absolute Fractional Distal Sodium Reabsorption From Baseline (FELi-FENa)
时间窗: Change in outcomes was measured acute (1 week minus baseline values) and chronic (12 weeks minus baseline values)
The difference in fractional excretion of lithium and fractional excretion of sodium (calculated by the difference between FELi and FENa) with ertugliflozin vs. placebo. This was measured using exogenous lithium administration 12 hours before sodium excretion was measured in urine and blood.
次要结局
- Heart Rate (HR)(chronic (12 weeks))
- LV Ejection Fraction(chronic (12 weeks))
- Carotid-femoral Pulse Wave Velocity(chronic (12 weeks))
- Plasma Volume(chronic (12 weeks))
- Extracellular Water(chronic (12 weeks))
- Cardiac Output(chronic (12 weeks))
- Systemic Vascular Resistance(chronic (12 weeks))
- Blood Angiotensin II(chronic (12 weeks))
- BNP(chronic (12 weeks))
- Norepinephrine(chronic (12 weeks))
- Urinary Adenosine(chronic (12 weeks))
- Glomerular Filtration Rate (GFR)(Glomerular Filtration Rate (GFR, based on plasma iohexol clearance) will be measured at 12 weeks)
- Effective Renal Plasma Flow (ERPF)(Effective Renal Plasma Flow (ERPF, based on paraaminohippurate plasma clearance) will be measured at 12 weeks)
- Systolic Blood Pressure (SBP)(chronic (12 weeks))
- Diastolic Blood Pressure (DBP)(chronic (12 weeks))
研究者
David Z.I. Cherney
Associate Professor of Medicine, Clinician Scientist
University Health Network, Toronto