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Clinical Trial Details — Status: Withdrawn

Administrative data

NCT number NCT04782245
Other study ID # 69HCL20_1135
Secondary ID 2020-005713-40
Status Withdrawn
Phase Phase 2
First received
Last updated
Start date September 2022
Est. completion date April 2024

Study information

Verified date August 2023
Source Hospices Civils de Lyon
Contact n/a
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

In the DAPA-HF trial, the use of dapagliflozin, an inhibitor of sodium-glucose cotransporter 2 (SGLT2), reduced significantly the risk of worsening heart failure or death from cardiovascular causes compared to placebo among patients with heart failure (HF) and a reduced ejection fraction. This new drug offers a very potent and interesting therapeutic pathway since it reduces clinical congestion, it preserves glomerular renal function, does not appear to cause symptomatic clinical hypotension and improves symptoms and quality of life compared to placebo. Advanced heart failure patients with reduced ejection fraction represent a small and severe subgroup of heart failure of patients with frequent worsening heart failure events and high rates of death. The effect of dapagliflozin in this subgroup of patients was not assessed in the DAPA-HF study. The therapeutic profile of SGLT2 inhibitors appears to be of high interest, since this group of patients has a poor tolerance to usual heart failure drugs, frequent worsening renal function and congestive symptoms persistence with poor quality of life scores. Soluble urokinase-type plasminogen activator receptor (suPAR) is a signaling glycoprotein considered to be involved in the pathogenesis of kidney disease. It is associated with the risk of acute kidney injury in different clinical and experimental situation. It is also a new validated biomarker predictive of adverse clinical outcome in heart failure patients. This biomarker allows a better risk stratification in heart failure patients after adjustment for Nt-proBNP. As a useful biomarker implicated in both heart failure and acute kidney injury, suPAR seems to be an interesting biomarker to assess cardio-renal benefits of dapagliflozin. The aim of this study is to investigate if a treatment by dapagliflozin reduces significantly suPAR compared to placebo in a population of advanced heart failure patients, candidates to heart transplantation. The effect of dapagliflozin compared to placebo will also be assessed on other secondary heart failure outcomes in this patient population.


Recruitment information / eligibility

Status Withdrawn
Enrollment 0
Est. completion date April 2024
Est. primary completion date April 2024
Accepts healthy volunteers No
Gender All
Age group 18 Years and older
Eligibility Inclusion Criteria: 1. Patient has signed informed consent form 2. Age = 18 years 3. NYHA class =3 4. LVEF = 35% 5. On optimal medical management (OMM) based on current heart failure practice guidelines at maximal tolerated dose for at least 30 days 6. On waiting list for heart transplantation after multidisciplinary Heart Team decision, with anticipated access to heart transplant = 6 months Exclusion Criteria: 1. Priority patient on waiting list for heart transplantation 2. Etiology of heart failure due to or associated with uncorrected thyroid disease, obstructive cardiomyopathy, pericardial disease, amyloidosis or restrictive cardiomyopathy 3. Inotrope dependent, existence of ongoing mechanical circulatory support 4. Current acute decompensated HF or hospitalization due to decompensated HF <30 days prior to the enrolment 5. History of any organ transplant or prior implantation of a ventricular assistance device (VAD) or similar device, or implantation expected after randomization 6. Presence of an active, uncontrolled infection 7. Any recent interventional procedure likely to improve symptoms and heart failure status (coronary revascularization, percutaneous mitral valve intervention, cardiac resynchronization therapy) < 60 days 8. Glomerular filtration rate < 30 ml/min/1.73 m2, according to CKD-EPI formula 9. Unstable or rapidly progressing renal disease 10. Patients with severe hepatic impairment (Child-Pugh class C) 11. Chronic treatment with dapagliflozin or other SGLT2 inhibitors 12. Patient with known history of severe drug intolerance to dapagliflozin or any excipients of the dapagliflozin (galactose, lactase) 13. Type 1 diabetes mellitus 14. Any surgical or medical condition which might significantly alter the absorption, distribution, metabolism, or extraction of study drug at investigators' discretion 15. Participation in another clinical interventional trial 16. Any condition other than heart failure that could limit survival to less than 24 months 17. Positive pregnancy test if of childbearing potential or refusal to use adequate contraception or women breast-feeding 18. Patients with any legal protection measure 19. Patients without any health coverage 20. Psychiatric disease/disorder, irreversible cognitive dysfunction or psychological issues that are likely to impair compliance

Study Design


Related Conditions & MeSH terms


Intervention

Drug:
Dapagliflozin 10mg
The intervention group will receive, during 6 months, dapagliflozin per oral route at a dose of 10 mg once daily in addition to the optimal medical management based on current heart failure practice guidelines.
Placebo
Patients randomized in the control group will receive during 6 months, placebo once daily per oral route, in addition to the optimal medical management based on current heart failure practice guidelines.

Locations

Country Name City State
France Hôpital Pneumologique et Cardiovasculaire Louis Pradel Bron

Sponsors (1)

Lead Sponsor Collaborator
Hospices Civils de Lyon

Country where clinical trial is conducted

France, 

Outcome

Type Measure Description Time frame Safety issue
Primary Levels of suPAR (ng/ml) 6 months
Secondary VO2 max assessment VO2 max assessment to evaluate the functional status 6 months
Secondary cardiac output assessed by right heart catheterization The impact of dapagliflozin on hemodynamic parameters between baseline and 6 months assessed by right heart catheterization hemodynamic parameters 6 months
Secondary pulmonary capillary wedge pressure assessed by right heart catheterization The impact of dapagliflozin on hemodynamic parameters between baseline and 6 months assessed by right heart catheterization hemodynamic parameters 6 months
Secondary pulmonary artery systolic and mean pressure assessed by right heart catheterization The impact of dapagliflozin on hemodynamic parameters between baseline and 6 months assessed by right heart catheterization hemodynamic parameters 6 months
Secondary mean pressure assessed by right heart catheterization The impact of dapagliflozin on hemodynamic parameters between baseline and 6 months assessed by right heart catheterization hemodynamic parameters 6 months
Secondary right atrial pressure assessed by right heart catheterization The impact of dapagliflozin on hemodynamic parameters between baseline and 6 months assessed by right heart catheterization hemodynamic parameters 6 months
Secondary Left Ventricular Ejection Function assessed by echocardiography The impact of dapagliflozin on echocardiographic parameters between baseline and 6 months 6 months
Secondary Left ventricular end-diastolic diameter assessed by echocardiography The impact of dapagliflozin on echocardiographic parameters between baseline and 6 months 6 months
Secondary Left ventricular end systolic volume assessed by echocardiography The impact of dapagliflozin on echocardiographic parameters between baseline and 6 months 6 months
Secondary mitral regurgitation grade assessed by echocardiography The impact of dapagliflozin on echocardiographic parameters between baseline and 6 months 6 months
Secondary left atrial volume assessed by echocardiography The impact of dapagliflozin on echocardiographic parameters between baseline and 6 months 6 months
Secondary Nt-proBNP level 6 months
Secondary Creatinine level 6 months
Secondary Quality of life assessed by Kansas City Cardiomyopathy Questionnaire (KCCQ) 6 months
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