Dapagliflozin and Effect on Cardiovascular Events in Acute Heart Failure -Thrombolysis in Myocardial Infarction 68 (DAPA ACT HF-TIMI 68)

Heart Failure Clinical Trial

Official title:

A Multicenter, Randomized, Double-Blind, Parallel Group, Placebo-Controlled Trial to Evaluate the Effect of In-Hospital Initiation of Dapagliflozin on Clinical Outcomes in Patients Who Have Been Stabilized During Hospitalization for Acute Heart Failure DAPAgliflozin and Effect on Cardiovascular Events in ACuTe Heart Failure -Thrombolysis in Myocardial Infarction 68 (DAPA ACT HF-TIMI 68)

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT04363697
• Other study ID #: D1690C00078
• Status: Recruiting
• Phase: Phase 4
• Start date: September 24, 2020
• Est. completion date: March 2024

Study information

• Verified date: March 2023
• Source: The TIMI Study Group
• Contact: Abby Cange
• Phone: 800-385-4444
• Email: acange[@]bwh.harvard.edu
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This is an international, multicenter, parallel-group, randomized, double-blind, placebo-controlled trial in patients who have been stabilized during hospitalization for acute heart failure, evaluating the effect of in-hospital initiation of dapagliflozin versus placebo on the clinical outcome of cardiovascular death or worsening heart failure.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 2400
• Est. completion date: March 2024
• Est. primary completion date: January 2024
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria

1. Age =18 years (male or female)

2. Currently hospitalized for AHF defined as meeting all the following criteria:

1. Presentation with worsening symptoms of heart failure (e.g., worsening dyspnea or dyspnea at rest, progressive fatigue, rapid weight gain, worsening edema/abdominal distention/anasarca)

2. Objective signs or diagnostic testing consistent with volume overload (e.g., jugular venous distension, pulmonary basilar crackles, S3 gallop, ascites, hepatomegaly, peripheral edema, radiological evidence of pulmonary congestion, noninvasive or invasive hemodynamic evidence of elevated filling pressures)

3. Intensification of AHF therapy during admission defined as at least one of the following: i. Augmentation of oral diuretic therapy [e.g., =2x outpatient regimen dose, addition of a second diuretic agent, or new initiation of diuretic therapy in a previously naïve patient] ii. Initiation of intravenous diuretic therapy iii. Initiation of intravenous vasoactive agent (e.g., inotrope or vasodilator) The majority of enrolled patients should have an established history of heart failure (defined as present for =2 months and for which the patient is on treatment). Trial leadership will monitor this proportion and may cap enrollment of patients without an established history of heart failure (i.e., patients presenting with de novo heart failure).

3. Left ventricular ejection fraction (LVEF) measured within the past 12 months (including during the current hospitalization)

4. Elevated NT-proBNP or BNP during current hospitalization:

1. For patients with LVEF =40%: NT-proBNP =1600 pg/mL or BNP =400 pg/mL (NT-proBNP =2400 pg/mL or BNP =600 pg/mL if patient in atrial fibrillation or atrial flutter)

2. For patients with LVEF >40%: NT-proBNP =1200 pg/mL or BNP =300 pg/mL (NT-proBNP =1800 pg/mL or BNP =450 pg/mL if patient in atrial fibrillation or atrial flutter)

5. Eligible patients will be randomized no earlier than 24 hours and up to 14 days after

presentation while still hospitalized once they have been stabilized, as defined by:

1. No increase (i.e., intensification) in the dose of intravenous diuretics during the 12 hours prior to randomization

2. No use of intravenous vasodilators or inotropes during the 24 hours prior to randomization Patients across the spectrum of LVEF are eligible for participation in the trial. Trial leadership will monitor the proportion of patients with various LVEFs and may cap enrollment of certain subgroups to ensure a broad population. In addition, patients with and without type 2 diabetes are eligible for participation in the trial. Trial leadership will monitor the proportion of patients with and without type 2 diabetes and may cap enrollment of one subgroup to ensure adequate representation of the other. Exclusion Criteria

1. Symptomatic hypotension in the past 24 hours

2. Concurrent use of two or more intravenous inotropic agents during the index hospitalization

3. eGFR <25 ml/min/1.73 m2 as measured by the CKD-EPI equation at screening or rapidly progressive renal disease

4. Current use of an SGLT2 inhibitor

5. Prior intolerance of SGLT2 inhibitors

6. Type 1 diabetes mellitus or history of diabetic ketoacidosis

7. (Only applies to patients with T2DM who are on insulin and/or a sulfonylurea) History of recurrent major hypoglycemia (i.e., resulting in severe impairment in consciousness or behavior, or requiring emergency external assistance)

8. Implantation of a cardiac resynchronization therapy (CRT) device or valve repair or replacement within 30 days prior to randomization or intent to do so during the trial

9. ST-segment elevation myocardial infarction or coronary revascularization (percutaneous coronary intervention or coronary artery bypass grafting) within 30 days prior to randomization or intent to undergo coronary revascularization during the trial

10. Untreated sustained ventricular arrhythmias or Mobitz type II or third-degree heart block (i.e., without an ICD or pacemaker, respectively)

11. History of heart transplantation or current transplant listing; mechanical circulatory support use (either durable or temporary) during the index hospitalization

12. History of heart failure due to restrictive or infiltrative cardiomyopathy, active myocarditis, constrictive pericarditis, hypertrophic (obstructive) cardiomyopathy, uncorrected primary valvular disease, complex congenital heart disease, or heart failure felt to be due to a transient process (e.g., stress [takotsubo] cardiomyopathy, tachycardia-induced cardiomyopathy) expected to resolve within 2 months.

13. History of end-stage liver disease

14. Women of child-bearing potential (unless using adequate contraception) or currently breastfeeding

15. Current participation in a clinical trial with an unlicensed drug or device

16. Study staff or their family members

17. Any condition that, in the opinion of the investigator, would make trial participation not in the best interest of the subject, or would compromise compliance with the trial protocol (e.g., active severe infection, active malignancy)

Related Conditions & MeSH terms

• Acute Heart Failure
• Heart Failure
• Infarction
• Myocardial Infarction

Intervention

Drug:
• Dapagliflozin
Dapagliflozin
• Placebo
Matched placebo

Locations

Country	Name	City	State
United States	TIMI Study Group	Boston	Massachusetts

Sponsors (3)

Lead Sponsor	Collaborator
The TIMI Study Group	AstraZeneca, Worldwide Clinical Trials

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Symptomatic hypotension	Symptomatic hypotension leading to hospitalization or study drug discontinuation	2 months
Other	Worsening renal function	Worsening renal function resulting in at least a doubling of serum creatinine (sCr), hospitalization, study drug discontinuation, dialysis, or renal death	2 months
Primary	Cardiovascular (CV) death or worsening heart failure	Time to first occurrence of CV death or worsening heart failure	2 months
Secondary	Composite CV death, rehospitalization for heart failure, urgent heart failure visit	Time to first occurrence of composite of CV death, rehospitalization for heart failure, or urgent heart failure visit	2 months
Secondary	Composite CV death, rehospitalization for heart failure	Time to first occurrence of composite of CV death or rehospitalization for heart failure	2 months
Secondary	Rehospitalization for heart failure, urgent heart failure visit	Time to first occurrence of rehospitalization for heart failure or urgent heart failure visit	2 months
Secondary	Readmission	Readmission within 30 days of hospital discharge	2 months
Secondary	CV death	Time to CV death	2 months
Secondary	Death	Time to death	2 months