Empagliflozin Reduces Progression of Diabetic Retinopathy in Patients With High Risk of Diabetic Macular Edema

Diabetes Mellitus, Type II Clinical Trial

Official title:

SGLT2-inhibition With Empagliflozin Reduces Progression of Diabetic Retinopathy in Patients With High Risk of Diabetic Macular Edema (The SUPER-Trial)

Clinical Trial Details — Status: Terminated

Administrative data

• NCT number: NCT02985242
• Other study ID #: M16-04EMPA-EYE
• Secondary ID: 2016-000825-38
• Status: Terminated
• Phase: Phase 4
• Start date: June 12, 2017
• Est. completion date: August 16, 2018

Study information

• Verified date: September 2018
• Source: Hannover Medical School
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This is a prospective, randomized, active control, two-arm parallel, double-blind, monocenter phase IV clinical trial. The trial compares empagliflozin to glimepiride in patients with type 2 diabetes mellitus in addition to standard of care treatment.

Patients with type 2 diabetes mellitus who are between 18 and 80 years of age will be recruited for the clinical trial and randomly allocated to either receive empagliflozin or glimepiride.

The assumption of the study is that empagliflozin slows down diabetic retinopathy progression rate and thus a lower microaneurysm formation rate compared to subjects treated with glimepiride by substantially decreased cellular glucotoxicity will be achieved.

Recruitment information / eligibility

• Status: Terminated
• Enrollment: 6
• Est. completion date: August 16, 2018
• Est. primary completion date: August 1, 2018
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 80 Years

Eligibility

Inclusion Criteria:

1. women and men between 18 - 80 years of age

2. type 2 diabetes mellitus

3. early to moderate stage diabetic retinopathy (ETDRS: 20 (microaneurysms only) to 35 (microaneurysms/ hemorrhages and/or hard exsudates)) in one or both eyes

4. stable HbA1c (± 0.5%) for at least 12 weeks

5. antidiabetic treatment with either diet, metformin, DPP4, GLP1, pioglitazone, acarbose, or respective combinations

6. HbA1c = 6.5 and = 10.0 %

7. body mass index < 46 kg/m2

8. office blood pressure = 150/95 mmHg (confirmed on a second day; 24h ambulatory blood pressure measurement (ABPM) is allowed to check accuracy of office values; inclusion with 24h mean blood pressure = 145/90 mm Hg is possible); patients with hypertension should be treated according to current treatment guidelines

9. either women without childbearing potential defined by:

• at least 6 weeks after surgical sterilization by bilateral tubal ligation or bilateral oophorectomy

• hysterectomy

• = 50 years and in postmenopausal state > 1 year

• < 50 years and in postmenopausal state > 1 year with serum follicle stimulating hormone (FSH) > 40 IU/l and serum estrogen < 30 ng/l or a negative estrogen test, both at screening or women of childbearing potential with a negative serum beta human chorionic gonadotropin (ß-hCG) pregnancy test at screening who agree to meet one of the following criteria from the time of screening, during the study and for a period of 4 days following the last administration of study medication:

• correct use of one of the following accepted contraception methods: hormonal contraceptives (combined oral contraceptives, implants, transdermal patches, hormonal vaginal devices or injections with prolonged release), intrauterine device (IUD/IUS) or a double barrier method, e.g. condom and occlusive cap (diaphragm or cervical/vault caps) with spermicide (foam, gel, film, cream or suppository)

• true abstinence (periodic abstinence and withdrawal are not acceptable methods of contraception)

• sexual relationship only with female partners

• sterile male partners

10. signed written informed consent and willingness to comply with treatment and follow-up procedures

11. capability of understanding the investigational nature, potential risks and benefits of the clinical trial

Exclusion Criteria:

1. Type 1 diabetes

2. uncontrolled diabetes mellitus type 2 with fasting glucose > 13.3 mmol/l confirmed on a second day

3. known or suspected hypersensitivity to empagliflozin, glimepiride, or any excipients; and / or known or suspected hypersensitivity to sulfonylureas, sulfonamides or SGLT2 inhibitors in general

4. history of multiple severe hypoglycemic episodes within the last two years

5. use of Insulin, SGLT2-inhibitor, sulfonylurea derivate or a glinide within past 3 months

6. clinical significant macular edema in both eyes and indication for intravitreal anti-VEGF treatment for both eyes at screening or baseline visit. Eyes with a small amount of intraretinal or subretinal fluid (seen in OCT) but no need for intravitreal treatment as judged by the investigator (according to current practice patterns) may be included. Eyes with a history of intravitreal treatment of macular edema which do not need ongoing intravitreal treatment at the time of screening may be included.

7. eye diseases or pathologies that prevent clear ophthalmoscopy and evaluation of study parameters, thus not allowing study participation according to the investigator´s judgment, such as (but not only) vitreous hemorrhage, mature cataract, macular pathologies other than diabetic maculopathy

8. history of ketoacidosis or metabolic acidosis

9. use of loop diuretics

10. history of > 1 urogenital infection/year

11. any history of stroke, transient ischemic attack (TIA), instable angina pectoris or myocardial infarction within last 3 months prior to baseline visit

12. congestive heart failure New York Heart Association (NYHA) III and IV

13. severe valvular or left ventricular outflow obstruction disease needing intervention;

14. atrial fibrillation/flutter with a mean ventricular response rate at rest >100 beats per minute

15. chronic lower urinary tract infections (but not simple asymptomatic bacteriuria)

16. eGFR < 60 ml/min/1,73 m2 (MDRD-formula, confirmed on a second day)

17. chronic diarrhea, any clinical signs of volume depletion or a hematocrit > 48 % (women) and > 53 % (men)

18. elevated risk for volume depletion, e.g. history of severe volume depletion that required medical therapy

19. chronic liver disease (including known active hepatitis) and/or screening alanine transaminase (ALT) or aspartate transaminase (AST) > 3 x upper limit of normal (ULN) (confirmed on a second day)

20. Subjects with known seropositivity to human immunodeficiency virus.

21. acute illness at screening or randomization according to judgement by the investigator or patient

22. drug or alcohol abuse

23. psychosomatic or psychiatric diseases requiring hospitalization during the last 12 months

24. clinical evidence of current malignancy with exception of basal cell or squamous cell carcinoma of the skin, and cervical intraepithelial neoplasia (5 years prior to randomization)

25. any medical or surgical intervention planned for the next 13 months after randomization not allowing study participation according to the investigator´s judgment

26. current participation in any other clinical trial or participation in another clinical trial within 30 days before screening

Related Conditions & MeSH terms

• Diabetes Mellitus
• Diabetes Mellitus, Type 2
• Diabetes Mellitus, Type II
• Diabetic Retinopathy
• Macular Edema

Intervention

Drug:
• Empagliflozin
Empagliflozin film-coated tablet
• Glimepiride
Glimepiride tablet
• Empagliflozin placebo
Placebo tablet manufactured to mimic Empagliflozin 25 mg film-coated tablet
• Glimepiride placebo
Placebo tablet manufactured to mimic Glimepiride 2 mg tablet

Locations

Country	Name	City	State
Germany	Hannover Medical School, University Eye Hospital and CRC Core Facility Hannover	Hanover	Lower Saxony

Sponsors (1)

Lead Sponsor	Collaborator
Hannover Medical School

Country where clinical trial is conducted

Germany, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Microaneurysm formation rate over 12 months, i.e. number of newly developed microaneurysms within 12 months		Weeks 27 and 52
Secondary	Change in diabetic retinopathy stage (= 2 step change on ETDRS severity score)		Weeks 27 and 52
Secondary	Change in microaneurysm count		Weeks 27 and 52
Secondary	Microaneurysm formation rate after 6 months (compared to baseline)		after 6 months
Secondary	Change in retinal thickness (as measured by Optical Coherence Tomography)		Weeks 27 and 52
Secondary	Change in retinal perfusion of microvasculature within the retina (flow in Optical Coherence Tomography Angiography)		Weeks 27 and 52
Secondary	Progression to clinically significant macular edema (CSME)		Up to 52 weeks
Secondary	Change in intraocular lipid content (hard exsudates)		Weeks 27 and 52
Secondary	Change in composite clinical outcome evaluating progression to proliferative diabetic retinopathy (PDR) based on photography, angiography plus clinically important events defining PDR (e.g. vitreous haemorrhage)		Weeks 27 and 52
Secondary	Change in best corrected visual acuity (BCVA [ETDRS letters])		Weeks 27 and 52
Secondary	Change in HbA1c		Weeks 2, 7, 12, 17, 22, 27, 32, 37, 42, 47, 52 and 55
Secondary	Change in fasting glucose		Weeks 2, 7, 12, 17, 22, 27, 32, 37, 42, 47, 52 and 55
Secondary	Change in body weight and body fat mass		Weeks 27, 52 and 55
Secondary	Change in ambulatory blood pressure		Weeks 27 and 52