Pentoxifylline in Diabetic Kidney Disease

Diabetic Kidney Disease Clinical Trial

— PTXRx  

Official title:

CSP #2008 - Pentoxifylline in Diabetic Kidney Disease

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT03625648
• Other study ID #: 2008
• Status: Recruiting
• Phase: Phase 4
• Start date: November 18, 2019
• Est. completion date: July 8, 2030

Study information

• Verified date: April 2024
• Source: VA Office of Research and Development
• Contact: Douglas E Lammie, MPH RD
• Phone: (708) 202-8387
• Email: douglas.lammie[@]va.gov
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Pentoxifylline (PTX) is a medication that has been on the market since 1984 for use in disease in the blood vessels of the legs. There is some preliminary information that it may protect the kidneys from damage due to diabetes and other diseases. "Pentoxifylline in Diabetic Kidney Disease" is a study to bee conducted in 40 VA hospitals across the nation to determine definitively whether or not PTX can prevent worsening of kidney disease and delay death in patients with diabetic kidney disease.

Description:

Diabetic kidney disease (DKD) is the most frequent cause of chronic kidney disease (CKD) and end-stage renal disease (ESRD) in the U.S. and in U.S. Veterans. Control of blood pressure and reduction in proteinuria, for instance by blockade of the renin-angiotensin-aldosterone system (RAAS) with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin-receptors blockers (ARBs), have led to some improvement in outcomes in recent years. However, many patients continue to progress to ESRD, requiring costly dialysis or transplantation and resulting in high mortality. Patients with ESRD on maintenance dialysis also have markedly impaired quality of life. Thus, novel treatments are needed for this disease.

The non-specific phosphodiesterase inhibitor pentoxifylline (PTX) was approved by the FDA in 1984 for the treatment of peripheral vascular disease. Therefore, this drug has been in clinical use for over 3 decades and has been found to have an excellent safety profile. Recent experimental and clinical data suggest that PTX, when added to usual care in patients with DKD, leads to a reduction in albuminuria and reduced inflammation, as evidenced by lower levels of inflammatory cytokines, and may decrease progression of renal disease. The available evidence thus suggests the possibility of the use of PTX as a valuable repurposing of an old drug in the treatment of DKD. However, a large scale multicenter randomized clinical trial is needed to determine whether this agent can reduce hard endpoints such as ESRD and death in patients with DKD.

The objective of this study is to test the hypothesis that PTX, when added to usual care, leads to a reduction in the incidence of ESRD and mortality in type-2 diabetic patients with DKD when compared to usual care plus placebo.

The primary endpoint will be time to ESRD or death. ESRD will be defined as need for chronic dialysis or renal transplantation.

Secondary efficacy endpoints will be: (1) quality of life as measured by the Kidney Disease Quality of Life Short Form (KDQoL-SF), (2) time until doubling of serum creatinine, (3) hospitalization for congestive heart failure (CHF), (4) a three-point MACE (cardiovascular death, non-fatal myocardial infarction, non-fatal stroke), (5) peripheral vascular disease (PVD), (6) percentage of participants with 50% reduction in UACR from baseline, (7) Rate of change in eGFR per year during the study period. Safety (serious adverse events and adverse events possibly or probably related to study drug, discontinuation of study drug) will also be analyzed as a secondary safety outcome.

The design will be simple with only 2 face-to-face visits (randomization and end of trial visits). The remaining quarterly contacts can be conducted by telephone collecting minimal targeted information. Laboratory testing specifically for the study will be done only at randomization, at 6 months and the end of the study, if needed. However, coordinators will assure that a serum creatinine will have been measured every 6 months as part of routine clinical care or, in rare instances where one has not been done, obtain this measurement. Other than randomization to PTX or matched placebo, patient care will be handled by usual providers according to recommended standards of care.

There will be a one-year ramp-up phase which will include 6 VA hospitals. The purpose of the ramp-up phase will be to optimize procedures prior to widespread implementation, including assessing the recruitment rate to determine whether the expected rate can be achieved and assessing the efficacy of central distribution of study drug/placebo.

In addition, the investigators will refine methods of recruitment, demonstrate that the proposed follow-up methods are working as intended, and address unforeseen problems. This will be followed by the full study at 40 sites (which includes the 6 ramp-up sites) and will involve 3 years of recruitment and 5 years of follow-up.

Sample size calculation, assuming a 26.6% event rate in the control group and 21.6% event rate in PTX group (corresponding to a 19% relative reduction), two-sided alpha = 0.05, 85% power, a 3-year enrollment period, a minimum 5-year follow-up period, and one proposed interim analysis indicates that 2510 participants will need to be randomized.

If this study is successful and PTX is found to reduce the incidence of ESRD and/or death, this will reduce the personal and financial burden of renal replacement therapy (dialysis/transplantation) for Veterans with diabetic kidney disease

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 2510
• Est. completion date: July 8, 2030
• Est. primary completion date: January 3, 2028
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

A. Inclusion Criteria:

1. Type 2 diabetes.

2. Meet one of the following categories at a time that is greater than 90 days prior to randomization

• Group I: eGFR 15 to less than 30 mL/min/1.73 m2, or

• Group II: eGFR 30 to less than 45 mL/min/1.73 m2 with UACR > 30 mg/g or UPCR > 150 mg/g, or

• Group III: eGFR 45 to less than 60 mL/min/1.73 m2 with UACR > 300 mg/g or UPCR > 500 mg/g

3. Participants need to be in one of the following categories at the time of randomization:

• Group I: eGFR 15 to less than 30 mL/min/1.73 m2

, or

• Group II: eGFR 30 to less than 45 mL/min/1.73 m2 with UACR > 30 mg/g, or

• Group III: eGFR 45 to less than 60 mL/min/1.73 m2 with UACR > 300 mg/g

Participants must be a United States Veteran, currently receiving care at a VA hospital with a local study team.

Exclusion Criteria:

1. Type 1 diabetes

2. History of non-diabetic kidney disease

3. Severe comorbid conditions expected to reduce life expectancy to less than 1 year, as determined by LSI

4. Active substance abuse, homelessness, or other condition that is likely to result in participant non,ompliance as determined by the LSI

5. Previous organ or bone marrow transplant

6. Pregnancy, breast feeding or female of child-bearing potential unwilling to use a reliable form of contraception

7. A recent (within 3 months) cerebral hemorrhage

8. Current use of oral pentoxifylline

9. Hypersensitivity to pentoxifylline or any of the components of the formulation

10. Current use of systemic ketorolac, oral or IV (contraindicated with pentoxifylline)

11. Current use of riociguat (contraindicated with pentoxifylline)

12. Current use of dialysis

13. Unable to provide informed consent

14. or any condition that in the opinion of the LSI would make the potential participant non-compliant

Related Conditions & MeSH terms

• Diabetic Kidney Disease
• Diabetic Nephropathies
• Kidney Diseases

Intervention

Drug:
• Pentoxifylline
The non-specific phosphodiesterase inhibitor pentoxifylline (PTX) was approved by the FDA in 1984 for the treatment of peripheral vascular disease.
• Placebo
placebo

Locations

Country	Name	City	State
United States	New Mexico VA Health Care System, Albuquerque, NM	Albuquerque	New Mexico
United States	VA Ann Arbor Healthcare System, Ann Arbor, MI	Ann Arbor	Michigan
United States	Rocky Mountain Regional VA Medical Center, Aurora, CO	Aurora	Colorado
United States	Bay Pines VA Healthcare System, Pay Pines, FL	Bay Pines	Florida
United States	Cincinnati VA Medical Center, Cincinnati, OH	Cincinnati	Ohio
United States	Harry S. Truman Memorial, Columbia, MO	Columbia	Missouri
United States	Wm. Jennings Bryan Dorn VA Medical Center, Columbia, SC	Columbia	South Carolina
United States	VA North Texas Health Care System Dallas VA Medical Center, Dallas, TX	Dallas	Texas
United States	Dayton VA Medical Center, Dayton, OH	Dayton	Ohio
United States	Atlanta VA Medical and Rehab Center, Decatur, GA	Decatur	Georgia
United States	Durham VA Medical Center, Durham, NC	Durham	North Carolina
United States	North Florida/South Georgia Veterans Health System, Gainesville, FL	Gainesville	Florida
United States	Edward Hines Jr. VA Hospital, Hines, IL	Hines	Illinois
United States	Michael E. DeBakey VA Medical Center, Houston, TX	Houston	Texas
United States	Iowa City VA Health Care System, Iowa City, IA	Iowa City	Iowa
United States	Kansas City VA Medical Center, Kansas City, MO	Kansas City	Missouri
United States	Lexington VA Medical Center, Lexington, KY	Lexington	Kentucky
United States	Central Arkansas VHS John L. McClellan Memorial Veterans Hospital, Little Rock, AR	Little Rock	Arkansas
United States	VA Loma Linda Healthcare System, Loma Linda, CA	Loma Linda	California
United States	VA Long Beach Healthcare System, Long Beach, CA	Long Beach	California
United States	Memphis VA Medical Center, Memphis, TN	Memphis	Tennessee
United States	Clement J. Zablocki VA Medical Center, Milwaukee, WI	Milwaukee	Wisconsin
United States	Minneapolis VA Health Care System, Minneapolis, MN	Minneapolis	Minnesota
United States	Omaha VA Nebraska-Western Iowa Health Care System, Omaha, NE	Omaha	Nebraska
United States	VA Palo Alto Health Care System, Palo Alto, CA	Palo Alto	California
United States	Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA	Philadelphia	Pennsylvania
United States	Phoenix VA Health Care System, Phoenix, AZ	Phoenix	Arizona
United States	VA Portland Health Care System, Portland, OR	Portland	Oregon
United States	Hunter Holmes McGuire VA Medical Center, Richmond, VA	Richmond	Virginia
United States	St. Louis VA Medical Center John Cochran Division, St. Louis, MO	Saint Louis	Missouri
United States	Salem VA Medical Center, Salem, VA	Salem	Virginia
United States	VA Salt Lake City Health Care System, Salt Lake City, UT	Salt Lake City	Utah
United States	South Texas Health Care System, San Antonio, TX	San Antonio	Texas
United States	VA Puget Sound Health Care System Seattle Division, Seattle, WA	Seattle	Washington
United States	James A. Haley Veterans' Hospital, Tampa, FL	Tampa	Florida

Sponsors (1)

Lead Sponsor	Collaborator
VA Office of Research and Development

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Time to ESRD or death	ESRD will be defined as need for chronic dialysis or renal transplantation.	5 to 9 years
Secondary	Quality of life (KDQoL-SF)	Quality of life as measured by the Kidney Disease Quality of Life Short Form (KDQoL-SF)	5 to 9 years
Secondary	Time until doubling of serum creatinine	Time until doubling of serum creatinine	5 to 9 years
Secondary	Incidence of congestive heart failure hospitalization (CHF)	The risk of a CHF hospitalization will be based on the participant-time data, specifically, the number of events per years.	5 to 9 years
Secondary	Incidence of a three-point MACE	The risk of a MACE event will be based on participant-time data, specifically, the number of events per participant years.	5 to 9 years
Secondary	Incidence of a peripheral vascular disease (PVD)	The risk of a PVD event will be based on participant-time data, specifically, the number of events per participant years.	5 to 9 years
Secondary	Percentage of participants with 50% reduction in UACR from baseline	Percentage of participants with 50% reduction in UACR from baseline	5 to 9 years
Secondary	Rate of change in eGFR per year during the study period	Rate of change in eGFR per year during the study period.	5 to 9 years