Acute Decompensated Heart Failure Clinical Trial
Official title:
A Pilot Study to Investigate the Safety and Efficacy of a Novel Furosemide Regimen, Administered Subcutaneously for the Treatment of Fluid Overload and to Evaluate the Feasibility for Home Treatment
This is a, prospective, single center, open-label, pilot study to evaluate the safety and efficacy of the subcutaneous administration of a novel furosemide formulation. The results of this pilot study will be reviewed to determine the safety of the subcutaneous treatment regimen and to evaluate patient selection criteria for possible at home treatment. The intent is to conduct a future follow on study looking at the feasibility of at home treatment of patients referred to a hospital for treatment of fluid overload.
In this pilot study, the treatment in the hospital setting will simulate how the patient
would be treated at home in the feasibility study. The results of this pilot will be used to
inform the design of the feasibility study. The future feasibility study will test the
concept that removing the need for professional care for furosemide administration allows a
proportion of these patients to go home and be treated safely at home.
A total of 10 patients will be studied using an open label approach to assess efficacy,
tolerability and safety of subcutaneous administration of a novel furosemide regimen,
administered subcutaneously.
Patients who are referred to the hospital for treatment of fluid overload will complete
screening and treatment phases. Subjects meeting the eligibility criteria will be
administered a test dose of 80mg furosemide USP administered by intravenous (IV) bolus over
2 minutes. Fluid intake will be restricted during the 2-hour observation period.
Only patients who respond to the test dose of commercially available 80mg intravenous (IV)
furosemide (alternatively, bumetanide 2 mg IV ) by means of diuresis in excess of 400 mL
over 2 hours will be eligible to enter the treatment phase of the study with the
Investigational Medicinal Product. Patients who have responded to the equivalent dose of
furosemide or bumetanide as part of their clinical care for heart failure in the hospital
within 24 hours of recruitment will not require this test dose and will be eligible for
entry into the study provided they meet all of the entry criteria for the study.
Non-responders will be treated in the hospital with usual care.
Investigational Medicinal Product:
Subjects who are Diuretic Responders will be treated with the Investigational Medicinal
Product for a period of 24 hours. Furosemide Injection Solution, 8 mg/mL (80 mg total dose)
will be administered subcutaneously by means of the B. Braun Perfusor® Space Infusion Pump
System. The pump will be programmed to deliver 80mg of furosemide over 5 hours with 30mg
administered during the first hour followed by 12.5mg/hour for 4 hours.
Subjects will be treated with twice daily dosing, by default, but may be reduced to once
daily if it is desired to reduce the daily urine response. The duration and frequency of the
treatment will be determined by the attending cardiologist.
If the subject requires further diuresis after 24 hours, they will be converted to usual
care at that time. If the attending cardiologist makes the determination at any time that
the diuresis is not adequate, the subject's participation in the study will be stopped, and
the patient will convert over to usual care.
Urine output every 24 hours will be recorded, as will daily weights. Serum potassium,
sodium, blood urea nitrogen, creatinine and hemoglobin will be assessed daily. All patients
will be monitored for heart rhythm continuously during the hospitalization. Temperature
every 8 hours will be recorded, and the injection site will be assessed daily for signs of
erythema.
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