“SALT Trial” Study of Ascending Levels of Tolvaptan in Hyponatremia

Inappropriate ADH Syndrome Clinical Trial

Official title:

Multicenter, Randomized, Double-Blind, Placebo-Controlled, Efficacy and Safety Study of the Effects of Titrated Oral Tolvaptan Tablets in Patients With Hyponatremia

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT00072683
• Other study ID #: 156-02-235
• Status: Completed
• Phase: Phase 3
• First received: November 7, 2003
• Last updated: January 24, 2007
• Start date: April 2003
• Est. completion date: February 2006

Study information

• Verified date: January 2007
• Source: Otsuka Pharmaceutical Development & Commercialization, Inc.
• Contact: n/a
• Is FDA regulated: No
• Health authority: United States: Food and Drug Administration
• Study type: Interventional

Clinical Trial Summary

This study’s purpose is to determine whether tolvaptan can safely and effectively return the body’s balance of sodium and water toward normal, and to characterize and quantify the potential clinical benefits of this treatment.

Description:

Hyponatremia is defined as a serum sodium concentration below the lower limit of normal and is the most frequently encountered electrolyte abnormality in hospitalized patients. Generally speaking, most cases of hyponatremia are mild. However, as the serum sodium falls below 130 mEq/L, the possibility of significant morbidity and mortality increases, and most clinicians will initiate corrective therapy for serum sodium values approaching 130 mEq/L and lower. The reasons for treating hyponatremia relate both to the symptoms, which may be quite disturbing to patients, as well as to potential outcomes including permanent neurological damage and death. There is also growing awareness of the association between hyponatremia and increased mortality in patients with heart failure.A common theme underlying the occurrence of hyponatremia whether in the setting of congestive heart failure, hepatic failure with ascites, or the syndrome of inappropriate anti-diuretic hormone (SIADH) is the non-osmotic secretion of arginine vasopressin (AVP). The presence of excess AVP leads to fluid retention and hyponatremia. Agents that antagonize AVP, causing proportionally more water diuresis than solute excretion, could offer a significant treatment option for patients with hyponatremia, compared to fluid restriction alone. Treatment of hyponatremia, particularly in clinical settings such as decompensated congestive heart failure, is difficult as conventional diuretics cause neurohormonal activation and further stimulate the inappropriate release of vasopressin, leading to additional retention of free water and aggravation of hypoosmolality. Similarly, for cirrhosis with ascites and SIADH, conventional diuretics are either minimally effective or completely contraindicated. An alternative approach to symptom relief and treatment of hyponatremia may be the use of vasopressin antagonists, which increase free water clearance with proportionally less effect on sodium excretion. Tolvaptan is an oral vasopressin antagonist with relative affinity for the V2 receptor which has been shown to induce a diuresis with proportionally more free-water than sodium loss. The current study is being undertaken in order to evaluate whether tolvaptan, an oral AVP inhibitor, will be effective in correcting mild to moderate hyponatremia, and to elucidate the effect of this correction on the subject’s well-being.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 240
• Est. completion date: February 2006
• Accepts healthy volunteers: No
• Gender: Both
• Age group: 18 Years and older

Eligibility

Inclusion Criteria

• Hyponatremia in euvolemic or hypervolemic states, defined as serum sodium <135 mEq/L prior to randomization.

• Able to give Informed Consent

Exclusion Criteria

• Women who are breast feeding and females of childbearing potential who are not using acceptable contraceptive methods

• Hyponatremia in hypovolemic states.

• Acute and transient hyponatremia associated with head trauma or post-operative state.

• Hyponatremia due to uncontrolled hypothyroidism or uncontrolled adrenal insufficiency.

• Cardiac surgery within 30 days of potential study enrollment, excluding percutaneous coronary interventions.

• History of a myocardial infarction within 30 days of potential study enrollment.

• History of sustained ventricular tachycardia or ventricular fibrillation within 30 days, unless in the presence of an automatic implantable cardioverter defibrillator.

• Severe angina including angina at rest or at slight exertion and/or unstable angina.

• History of a cerebrovascular accident within the last 30 days. 10) Subjects with psychogenic polydipsia may not be included, however subjects with other psychiatric illness may be included.

• Systolic arterial blood pressure <90 mmHg.

• History of hypersensitivity and/or idiosyncratic reaction to benzazepine or benzazepine derivatives (such as benazepril).

• History of drug or medication abuse within the past year,or current alcohol abuse.

• Uncontrolled diabetes mellitus defined as fasting glucose >300mg/dL.

• Urinary tract obstruction except BPH if non-obstructive.

• Previous participation in another clinical drug trial within the past 30 days.

• Previous participation in this or any other tolvaptan clinical trial.

• Terminally ill or moribund condition with little chance of short term survival.

• Serum creatinine >3.5 mg/dL.

• Serum sodium <120 mEq/L with associated neurologic impairment, i.e. symptoms such as apathy, confusion, seizures.

• Patients with progressive or episodic neurologic disease such as multiple sclerosis or history of multiple strokes.

• Child-Pugh score greater than 10 (unless approved)

• Patients receiving intravenous fluids at a rate greater than KVO (Keep Vein Open).

• Hyponatremia due to lab artifacts

• Patients receiving AVP or its analogs for treatment of any condition.

• Patients receiving within 7 days of randomization, other medications for treatment of hyponatremia specifically: demeclocycline, lithium carbonate or urea

• Patients likely requiring IV saline for correction of symptomatic or asymptomatic severe hyponatremia during the course of the study.

• Severe pulmonary artery hypertension

• Hyponatremia should not be the result of any medication that can safely be withdrawn

Study Design

Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double-Blind, Primary Purpose: Treatment

Related Conditions & MeSH terms

• Hyponatremia
• Hyponatremias
• Inappropriate ADH Syndrome
• Water Intoxication
• Water-Electrolyte Imbalance
• Water-Electrolyte Imbalances

Intervention

Drug:
• tolvaptan

Locations

Country	Name	City	State
United States	Medical College of Georgia	Augusta	Georgia
United States	Mercury Street Medical	Butte	Montana
United States	University of North Carolina, Div. of Cardiology	Chapel Hill	North Carolina
United States	Northwestern University	Chicago	Illinois
United States	University of Chicago	Chicago	Illinois
United States	University Hospitals of Cleveland	Cleveland	Ohio
United States	Ohio State University Medical Center	Columbus	Ohio
United States	Aurora Denver Cardiology Association	Denver	Colorado
United States	University of Colorado Heath Science Center	Denver	Colorado
United States	University of Florida Gainesville	Gainesville	Florida
United States	Northshore University Hospital	Great Neck	New York
United States	University of Iowa Hospital	Iowa City	Iowa
United States	UCLA	Los Angeles	California
United States	VA Greater Los Angeles Health Care Ctr	Los Angeles	California
United States	Baptist Clinical Research Ctr	Memphis	Tennessee
United States	Minneapolis VA Medical Center	Minneapolis	Minnesota
United States	The Arthur P. Noyes Research Foundation	Norristown	Pennsylvania
United States	University of Pittsburgh Medical Center	Pittsburgh	Pennsylvania
United States	Charlotte Heart Group Research Ctr	Port Charlotte	Florida
United States	UCSF Medical Center	San Francisco	California
United States	Washington University Ctr for Clinical Studies	St. Louis	Missouri
United States	Tennessee Center for Clinical Trials	Tullahoma	Tennessee

Sponsors (2)

Lead Sponsor	Collaborator
Otsuka Pharmaceutical Development & Commercialization, Inc.	Otsuka Pharmaceutical Co., Ltd.

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	The average daily area under the curve of change from baseline in serum sodium level up to Day 4 within the double-blind on therapy period. and/or
Primary	The average daily area under the curve of change from baseline in serum sodium level up to Day 30 within
Secondary	The average daily area under the curve of change from baseline in serum sodium level up to Day 4 within the double-blind on therapy period for patients with severe hyponatremia (serum sodium <130 mEq/L at baseline).
Secondary	The average daily area under the curve of change from baseline in serum sodium level up to Day 30 within the double-blind on therapy period for patients with severe hyponatremia (serum sodium <130 mEq/L at baseline).
Secondary	Percentage of patients with normalized serum sodium at Day 4.
Secondary	Percentage of patients with normalized serum sodium at Day 30.
Secondary	Time to first normalization in serum sodium.
Secondary	Change from baseline in serum sodium at Day 4.
Secondary	Change from baseline in serum sodium at Day 30.
Secondary	Percentage of patients requiring fluid restriction at any time during the double-blind on therapy period of the study.
Secondary	Urine output at Day 1.
Secondary	Change from baseline in body weight at Day 1 (hypervolemic patients only).
Secondary	Fluid balance at Day 1 (hypervolemic patients only).
Secondary	Change from baseline in the SF-12 (health survey)Physical Component Summary (PCS)and Mental Component Summary (MCS)scales at Week 1 and Day 30.
Secondary	Categorical change in serum sodium at Day 4 and Day 30 for patients with baseline serum sodium <130 mEq/L.
Secondary	Categorical change in serum sodium at Day 4 and Day 30 for patients with baseline serum sodium =130 mEq/L.
Secondary	The percentage of patients who are designated as treatment failure due to the need for saline infusion,with or without fluid restriction.
Secondary	Safety:Adverse events,vital signs,clinical laboratory tests,12- lead electrocardiograms.
Secondary	PK:Plasma tolvaptan and DM-4103 concentrations.