Sotagliflozin Safety and Tolerability Among Renal Transplant Recipients

Kidney Transplant Clinical Trial

— START  

Official title:

Sotagliflozin Safety and Tolerability Among Renal Transplant Recipients

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT05405556
• Other study ID #: 2022P000454
• Status: Recruiting
• Phase: Phase 2
• Start date: October 17, 2022
• Est. completion date: November 2023

Study information

• Verified date: January 2023
• Source: Brigham and Women's Hospital
• Contact: Martina M McGrath, MBBCh
• Phone: 6177325500
• Email: mmcgrath8[@]bwh.harvard.edu
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This is an investigator-initiated, randomized controlled trial in adult KTRs (N=50) with stable allograft function to assess: 1) the reversibility of the expected acute changes in eGFR with sotagliflozin (donated by Lexicon); 2) proportion of patients completing the protocol according to different eGFR reporting strategies (using a predefined algorithm to manage the expected pharmacological effect of sotagliflozin on eGFR); 3) safety and tolerability of sotagliflozin.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 50
• Est. completion date: November 2023
• Est. primary completion date: July 2023
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Adults =18 years

• Recipients of kidney transplant with stable eGFR*

• eGFR-creatinine (CKD-EPI 2021) =25 mL/min/1.73 m2

• Informed consent

• Stable eGFR will be ascertained by careful chart review establishing that the patient's current graft has been functioning for at least 12 months post-transplantation, patients have not been treated for acute rejection within the prior 3 months, and a creatinine-based eGFR is stable (two consecutive measurements separated by at least 28 days within 5 mL/min/1.73 m2) and =25 mL/min/1.73 m2.

Exclusion Criteria:

• Recurrent urinary tract infections (>2 episodes/year or antibiotic prophylaxis)

• Biopsy-proven acute rejection within 12 weeks

• Screening serum potassium >5.5 mmol/L

• Uncontrolled hypertension (systolic blood pressure >180/100 mmHg)

• New York Heart Association (NYHA) Class IV HF

• Myocardial infarction, unstable angina, revascularization procedure (e.g., stent or bypass graft surgery), or cerebrovascular accident within 12 weeks

• History of diabetic ketoacidosis

• Type 1 Diabetes Mellitus

• Hereditary glucose-galactose malabsorption or primary renal glucosuria

• Liver disease (e.g., acute hepatitis, chronic active hepatitis, cirrhosis); Alanine aminotransferase (ALT) levels >2.0 times the upper limit of normal (ULN) or total bilirubin >1.5 times the ULN, unless consistent with Gilbert's disease

• Malignancy within 5 years (exceptions: squamous and basal cell carcinomas of the skin and carcinoma of the cervix in situ, or a malignancy that in the opinion of the investigator is considered cured with minimal risk of recurrence)

• Human immunodeficiency virus antibody positive

• Major surgery within 12 weeks

• Atraumatic amputation within past 12 months of screening, or an active skin ulcer, osteomyelitis, gangrene, or critical ischemia of the lower extremity within 6 months of screening

• Combination use of ACEi and ARB

• Current use of an SGLT2 inhibitor (within 12 weeks prior to randomization)

• Known allergies, hypersensitivity, or intolerance to SGLT2i or its excipients

• Digoxin plasma level >1.2 ng/mL

• Clofibrate, fenofibrate, dronedarone, or ranolazine treatment that has not been at a stable dose in the 30 days prior to screening or randomization, or a dose adjustment is expected

• Received an active investigational drug (including vaccines) other than a placebo agent, or used an investigational medical device within 12 weeks before Day 1/baseline

• Pregnant or breast-feeding or planning to become pregnant or breast-feed during the study

• Women of childbearing potential not willing to use a highly-effective method(s) of birth control, or who are unwilling or unable to be tested for pregnancy

• Any condition that in the opinion of the investigator would make participation not in the best interest of the subject

Related Conditions & MeSH terms

• Kidney Transplant

Intervention

Diagnostic Test:
• eGFR reporting
To test the proportion of patients successfully completing the protocol according to different eGFR reporting strategies, randomization in a 1:1 fashion at the patient level (n=50) will occur as follows: only study-related eGFR values >25% below baseline will be reported to patients and providers all study-related eGFR will be provided to patients and providers

Locations

Country	Name	City	State
United States	Brigham and Women's	Boston	Massachusetts

Sponsors (1)

Lead Sponsor	Collaborator
Martina McGrath, MD

Country where clinical trial is conducted

United States, 

References & Publications (1)

Bhatt DL, Szarek M, Pitt B, Cannon CP, Leiter LA, McGuire DK, Lewis JB, Riddle MC, Inzucchi SE, Kosiborod MN, Cherney DZI, Dwyer JP, Scirica BM, Bailey CJ, Diaz R, Ray KK, Udell JA, Lopes RD, Lapuerta P, Steg PG; SCORED Investigators. Sotagliflozin in Patients with Diabetes and Chronic Kidney Disease. N Engl J Med. 2021 Jan 14;384(2):129-139. doi: 10.1056/NEJMoa2030186. Epub 2020 Nov 16. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Safety Assessments	- Acute changes in eGFR (baseline to 4 weeks)	4 weeks
Other	Safety Assessments	- Longer-term changes in eGFR (baseline to 12 weeks and 4 weeks to 12 weeks)	12 weeks
Other	Safety Assessments	- Reversibility of changes in eGFR (12 to 16 weeks - after drug discontinuation)	Weeks 12-16 (off-drug)
Other	Safety Assessments	- Acute Kidney Injury (>50% increase in serum creatinine/40% decline in eGFR within one week), which will be assessed throughout the on-drug period of 12 weeks	12 weeks
Other	Safety Assessments	- All adverse events (AEs)	12 weeks
Other	Safety Assessments	- All serious adverse events (SAEs)	12 weeks
Other	Safety Assessments	- Diarrhea	12 weeks
Other	Safety Assessments	- Infection requiring treatment with anti-microbials (including urogenital infection and urinary tract infections)	12 weeks
Other	Safety Assessments	- Severe hypoglycemia (event that requires assistance of another person to actively administer carbohydrates, glucagon, or take other corrective actions)	12 weeks
Other	Safety Assessments	- Diabetic ketoacidosis	12 weeks
Other	Safety Assessments	- Hyperkalemia (>5.5 mmol/L)	12 weeks
Other	Safety Assessments	- Hypotension (symptomatic SBP <90 mmHg or hypotension requiring adjustment in blood pressure medications or treatment in an emergency or hospitalized setting)	12 weeks
Other	Tolerability Assessments	- Proportion of participants able to complete the full 12 weeks of treatment, according to randomized arm	12 weeks
Other	Tolerability Assessments	- Study medication discontinuation rates	12 weeks
Other	Tolerability Assessments	- KDQOL-36 questionnaire	12 weeks
Primary	Reversibility of eGFR changes	Following 12 weeks of open-label drug treatment, participants will stop drug and be followed for a further four weeks (16 weeks total). Reversibility will be assessed as the proportion of patients who return to baseline eGFR (+/- 10%) by the end of the 4-week off-treatment period.	16 weeks total
Secondary	Proportion of patients successfully completing the full treatment protocol, according to randomized groups	Following 12 weeks of open-label drug treatment, participants will stop drug and be followed for a further four weeks. The proportion of patients completing the full 16 weeks will be compared according to randomized groups.	16 weeks total