Comparison of Eplerenone Versus Spironolactone in Heart Failure Patients With Glucose Intolerance or Type 2 Diabetes

Heart Failure Clinical Trial

— SNOW  

Official title:

A Comparison of the Effects of Selective and Non Selective Mineralocorticoid Antagonism on Glucose Homeostasis and Lipid Profile of Heart Failure Patients With Glucose Intolerance or Type 2 Diabetes.

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT01586442
• Other study ID #: WS1911307
• Status: Completed
• Phase: Phase 3
• Start date: March 2012
• Est. completion date: July 29, 2018

Study information

• Verified date: October 2022
• Source: Montreal Heart Institute
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

In this proposal,the investigators will examine whether the selectivity of eplerenone for the MR will translate into a better glucose and metabolic profile compare to spironolactone in patients with HF with glucose intolerance or type 2 diabetes. In addition, the investigators will also compare the impact of these two agents on changes of concentrations of established prognostic biomarkers of neurohormonal activation and extracellular matrix turnover.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 62
• Est. completion date: July 29, 2018
• Est. primary completion date: March 2015
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

1. Male or female at least 18 years old.

2. Symptomatic HF corresponding to NYHA class II-IV symptoms for at least 4 weeks prior randomization.

3. A diagnosis of 1) impaired glucose tolerance described as overnight fasting between blood glucose 5.6 and 6.9 mmol/L on two occasions; or 2) type 2 diabetes defined as overnight fasting between blood glucose of 7.0 mmol/L or more on two occasions; a HbA1c equal to or higher than 6.5% or more on two occasions; or as a history of type II diabetes treated with hypoglycemic agents.

4. LVEF equal to or lower than 40% documented by, contrast ventriculography, magnetic resonance imaging, radionuclide ventriculography or quantitative echocardiography within the previous 12 months if no cardiac event occurred since the measurement of the LVEF. The most recent measurements should be used.

5. Treatment with an optimal and stable dose of ACE inhibitor (or ARB) for at least 4 weeks prior to enrolment in the study. In addition, patients should be treated with a stable dose of beta-blockers for at least 4 weeks prior enrolment in the study. Patients incapable to tolerate bisoprolol, carvedilol or metoprolol will be allowed within the trial.

6. Informed consent must be obtained before any study specific procedures are performed

Exclusion Criteria:

1. Current treatment with a combination of an ARB, an ACE or a renin inhibitor.

2. Type 1 diabetes

3. Known intolerance or allergy to eplerenone or spironolactone, including gynecomastia with spironolactone.

4. Estimated GFR < 30 mL/min/1.73 m2 as calculated using the MDRD equation (Appendix 1).

5. Current serum potassium higher than 5.0 mmol/L (higher than 5.0 mEq/L).

6. Current symptomatic hypotension and/or systolic B.P. < 90 mmHg.

7. Persistent systolic or diastolic hypertension (systolic > 170 mmHg or diastolic > 100 mmHg despite use of antihypertensive therapy).

8. HF secondary to any of the following conditions: hemodynamically significant primary stenotic valvular cardiomyopathy, isolated right sided CHF, non cardiac disease (e.g. uncorrected thyroid disease), pericardial disease, complex congenital heart disease, myocarditis.

9. Decompensated heart failure described as hospitalization or I.V. administration of medication in emergency room or heart failure clinic within 4 weeks (ex.: diuretics, inotropes, vasodilatators)

10. Current treatment with insulin

11. Stroke, acute coronary syndrome, PCI within the last 4 weeks before randomization.

12. Cardiac surgery within 3 months.

13. Significant liver disease (ALT x 3 times limit of normal).

14. Planned cardiac surgery expected to be performed within the next 6 months.

15. Previous heart transplant or heart transplant expected to be performed within the next 6 months.

16. Presence of any non-cardiac diseases likely to significantly shorten life expectancy to < 1 year.

17. Pregnant or lactating women or women of childbearing potential who are not protected from pregnancy by an accepted method of contraception, such as the oral contraceptive pill, an intrauterine device or surgical sterilization (all women of childbearing potential must have a negative pregnancy test before randomization).

18. Any condition that in the opinion of the investigator would jeopardize the evaluation on efficacy or safety or be associated with poor adherence to the protocol.

19. Treatment with any investigational agent or device within 4 weeks of randomization.

Related Conditions & MeSH terms

• Diabetes Mellitus
• Diabetes Mellitus, Type 2
• Glucose Intolerance
• Heart Failure
• Type 2 Diabetes

Intervention

Drug:
• Eplerenone
Eplerenone 25mg once daily titrated to 50 mg once daily for 4 months
• Spironolactone
Spironolactone 12,5mg daily titrated to 25mg once daily for 16 weeks

Locations

Country	Name	City	State
Canada	Montreal Heart Institute	Montreal	Quebec

Sponsors (2)

Lead Sponsor	Collaborator
Montreal Heart Institute	Pfizer

Country where clinical trial is conducted

Canada, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Glycated hemoglobin	Change in glycated hemoglobin	4 months
Primary	Fasting glucose and lipid profile		4 months
Primary	Plasma insulin		4 months
Primary	Cortisol		4 months
Primary	Adiponectin		4 months
Primary	NT-proBNP		4 months
Primary	PIIINP		4 months