Treating to Reduce Albuminuria and Normalize Hemodynamic Function in Focal ScLerosis With dApagliflozin Trial Effects (TRANSLATE)

January 11, 2018 updated by: David Z.I. Cherney, University Health Network, Toronto

Treating to Reduce Albuminuria and Normalize Hemodynamic Function in Focal ScLerosis With dApagliflozin Trial Effects: "The TRANSLATE Study"

Patients with Focal Segmental Glomerulosclerosis (FSGS) constitute an increasing proportion of the total glomerulonephritis (GN) patient cohort in North America while FSGS is a risk factor for end stage renal failure. Current non-immunological FSGS therapies include the use of angiotensin converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARB), to reduce intraglomerular hypertension. Unfortunately, these agents lead to incomplete renal protection. The aim of the current study is to determine whether the addition of novel sodium glucose cotransport-2 inhibitors (SGLT2i) to standard of care leads to reduced intraglomerular pressure and suppression of proteinuria. We hypothesize that combination therapy of SGLT2i drugs and conventional RAASi results in additive renal protective effects in FSGS patients. A further goal is to examine mechanisms of SGLT2 inhibition by measuring renal hemodynamic function and sodium handling. Kidney function will be assessed in FSGS patients before and after an 8 week treatment with SGLT2i dapagliflozin.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

FSGS and diabetic nephropathy may have common pathogenic mechanisms, that are mediated by intraglomerular hypertension, leading to hyperfiltration and proteinuria. Given that SGLT2i corrects early hemodynamic abnormalities in patients with diabetes, our aim is to determine if a similar benefit may extend to patients with FSGS. Based on previous experimental and clinical data, we hypothesize that SGLT2i will improve renal hemodynamic abnormalities characteristic of FSGS that promote renal injury and proteinuria.

Study Type

Interventional

Enrollment (Actual)

10

Phase

  • Phase 4

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

    • Ontario
      • Toronto, Ontario, Canada, M5G 2N2
        • Renal Physiology Laboratory, University Health Network

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Male or female subjects diagnosed with FSGS ≥1 month prior to informed consent
  • eGFR≥45 ml/min/1.73m2
  • Age 18 years or greater
  • No history of diabetes
  • Body Mass Index (BMI) 18.5 - 45.0 kg/ m2
  • Blood pressure ≥ 100/60 at screening
  • Stable therapy with either an ACEi or angiotensin II receptor blocker or direct renin inhibitor for > 1 month
  • >30 mg/day and <6 g/day of proteinuria unless the patient is not a candidate for immunosuppressive therapy

Exclusion Criteria:

  • Leukocyte and/or nitrite positive urinalysis that is untreated;
  • History of organ transplantation, cancer, liver disease;
  • Bariatric surgery or other gastrointestinal surgeries that induce chronic malabsorption within the past two years;
  • Current treatment with systemic corticosteroids, calcineurin inhibitors, or other immunosuppressant medications;
  • Blood dyscrasias or any disorders causing hemolysis or unstable red blood cells;
  • Pre-menopausal women who are nursing, pregnant, or of child-bearing potential and not practising an acceptable method of birth control;
  • Participation in another therapeutic trial with an investigational drug within 30 days prior to informed consent;
  • Alcohol or drug abuse within three months prior to informed consent that would interfere with trial participation or any ongoing clinical condition that would jeopardize subject safety or study compliance based on investigator judgement;
  • Liver disease, defined by serum levels of alanine transaminase, aspartate transaminase, or alkaline phosphatase >3 x upper limit of normal as determined during screening;
  • Cardiac, lung or peripheral vascular disease or stroke;
  • Pancreas, pancreatic islet cells or renal transplant recipient;
  • Medical history of cancer or treatment for cancer in the last five years prior to screening;
  • History of allergy or angioedema with RAAS inhibitor exposure;
  • Kidney disease due primarily to another condition aside from FSGS;

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: N/A
  • Interventional Model: Single Group Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Dapagliflozin (trade name Farxiga®)
Oral tablet, 10mg, PO, 8 weeks
Oral tablet, 10mg, PO, 8 weeks
Other Names:
  • Trade name Farxiga®

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
The change in Glomerular Filtration Rate (GFR) After an 8 week treatment with dapagliflozin
Time Frame: Before and after an 8 week treatment with dapagliflozin
Glomerular Filtration Rate (GFR, based on plasma inulin clearance) will be measured at baseline and after 8 weeks of treatment.
Before and after an 8 week treatment with dapagliflozin

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
The change in Effective Renal Plasma Flow (ERPF) After an 8 week treatment with dapagliflozin
Time Frame: Before and after an 8 week treatment with dapagliflozin
Effective Renal Plasma Flow (ERPF, based on paraaminohippurate plasma clearance) will be measured at baseline and after 8 weeks of treatment.
Before and after an 8 week treatment with dapagliflozin
The change in Blood Pressure After an 8 week treatment with dapagliflozin
Time Frame: Before and after 8 weeks of treatment with dapagliflozin
Before and after 8 weeks of treatment with dapagliflozin
The change in albuminuria after 8 weeks of treatment with dapagliflozin
Time Frame: Before and after 8 weeks of treatment with dapagliflozin
Before and after 8 weeks of treatment with dapagliflozin
The change in urinary vasoactive mediators after 8 weeks of treatment with dapagliflozin
Time Frame: Before and after 8 weeks of treatment with dapagliflozin
Before and after 8 weeks of treatment with dapagliflozin

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Collaborators

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

September 1, 2015

Primary Completion (Actual)

April 24, 2017

Study Completion (Actual)

April 24, 2017

Study Registration Dates

First Submitted

October 22, 2015

First Submitted That Met QC Criteria

October 22, 2015

First Posted (Estimate)

October 23, 2015

Study Record Updates

Last Update Posted (Actual)

January 16, 2018

Last Update Submitted That Met QC Criteria

January 11, 2018

Last Verified

January 1, 2018

More Information

Terms related to this study

Other Study ID Numbers

  • REB# 14-8284-B

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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