Effect of Sulodexide in Early Diabetic Nephropathy

February 22, 2018 updated by: Keryx Biopharmaceuticals

The Collaborative Study Group Trial: The Effect of Sulodexide in Patients With Type 2 Diabetes and Microalbuminuria

The purpose of the study is to determine whether treatment with sulodexide is effective in reducing the level of urine albumin excretion in patients with early diabetic kidney disease expressed as microalbuminuria.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Diabetic nephropathy is an important cause of morbidity and mortality in patients with either type 1 or type 2 diabetes mellitus. The pathogenesis and natural history of diabetic nephropathy is characterized initially by microalbuminuria followed by a progressive decline in glomerular function. An emerging body of evidence supports the notion that glomerular capillary wall and mesangial alterations in diabetic nephropathy involve pathobiochemical alterations of glycoproteins in these structures. Evidence, in experimental animals rendered diabetic, reveals that the administration of heparin and other anionic glycoproteins (GAG) can effectively prevent the biochemical alterations which are responsible for albuminuria. Sulodexide, an orally active agent which does not have anticoagulant properties associated with its oral dose range, is comprised of three naturally occurring glycosaminoglycan (GAG) polysaccharide components isolated from porcine intestinal mucosa. Small clinical studies employing sulodexide, have shown that albuminuria is significantly diminished in patients with diabetic nephropathy, even when these patients are receiving angiotensin II receptor blockers (ARB) or angiotensin converting enzyme inhibitors (ACEI), agents already proven to reduce albuminuria and slow progressive diabetic nephropathy.

This study is designed to evaluate whether sulodexide is safe and effective in treating subjects with type 2 diabetic nephropathy. Subjects with type 2 diabetes and microalbuminuria (defined as a urinary albumin to creatinine ratio,(ACR)in men 35-200 mg/G and in women 45-200 mg/G) who are also receiving either irbesartan 300 mg/day, losartan 100 mg/day, or a maximum approved dose of an angiotensin receptor blocker (ARB) or angiotensin converting enzyme inhibitor (ACEI) will be enrolled in the study. The study will consist of the following periods:

  • Screening: of 1-2 weeks for assessing basic eligibility/exclusion criteria
  • Run-in: of up to 16 weeks on maximal dose of ARB or ACE with stable blood pressure control
  • Qualifying visit: qualifying patients are on maximal dose of ARB or ACE for a minimum of 4 months with stable BP control, SBP <150 mmHg, DBP <90 mmHg and albumin to creatinine ratio, (ACR) between in men 35-200 mg/G and in women 45-200 average of 3 first morning voids
  • Randomization: patients are randomized to sulodexide 100 mg or matching placebo administered orally twice a day.
  • Maintenance: 26 week maintenance period, with 4 visits to monitor safety and ACR
  • Washout Period: 8 week washout period, with 2 visits to monitor safety and ACR

Study Type

Interventional

Enrollment (Actual)

1056

Phase

  • Phase 3

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

  • Australia
    • Victoria
      • Melbourne, Victoria, Australia, 3168
        • The Collaborative Study Group, Clinical Coordinating Center for the Pacific Region, Monash Medical Center
  • Netherlands
      • Groningen, Netherlands, 9713 AV
        • The Collaborative Study Group, Clinical Coordinating Center for European Clinics, University of Groningen
  • United States
    • Illinois
      • Chicago, Illinois, United States, 60612
        • The Collaborative Study Group, Clinical Coordinating Center for U.S. and Canadian clinics, Rush University Medical Center

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:

  • Diagnosis of type 2 diabetes
  • Serum creatinine equal to or less than 1.5 mg/dL
  • Microalbuminuria, defined by a urine albumin/creatinine ratio in men; 35- 200 mg albumin/G creatinine, in women; 45-200 mg albumin/G creatinine
  • Blood pressure controlled to less than 150/90 mmHg
  • Willing to change antihypertensive medication regimen if necessary

Exclusion Criteria:

  • Age of onset of type 2 diabetes <18 years;
  • HbA1C >10.0%;
  • Morbid obesity defined as a body mass index (BMI) >= 45 kg/m2;
  • Type 1 (insulin-dependent; juvenile onset) diabetes;

  • Renal disease as follows:

    • Patients with known non-diabetic renal disease
    • Renal allograft
  • Absolute requirement for combination therapy of angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB);

  • Cardiovascular disease as follows:

    • Unstable angina pectoris within 3 months of study entry;
    • Myocardial infarction, coronary artery bypass graft surgery, or percutaneous transluminal coronary angioplasty or stent placement within 3 months of study entry;
    • Transient ischemic attack within 3 months of study entry;
    • Cerebrovascular accident within 3 months of study entry;
    • Symptomatic heart failure requiring ACE inhibition;
    • New York Heart Association Functional Class III or IV heart failure;
    • Obstructive valvular heart disease or hypertrophic cardiomyopathy;
    • Second or third degree atrioventricular block not successfully treated with a pacemaker
  • Need for chronic (>2 weeks) immunosuppressive therapy, including corticosteroids (excluding inhaled or nasal steroids);
  • History of multiple drug allergies;
  • New diagnosis of cancer or recurrent cancer within 5 years of screening ( (except non-melanoma skin cancer);
  • Psychiatric disorder that interferes with the patient's ability to comply with the protocol;
  • Inability to tolerate oral medication or a history of significant malabsorption;

  • Inability to remain on a stable dose of the following class of medications 30 days prior to randomization and throughout the study:

    • 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins);
    • Peroxisome proliferator-activated receptor gamma (PPAR gamma inhibitors (glitazones);
    • Cyclooxygenase-2 inhibitors (COX-2 inhibitors); or
    • Non-steroidal anti-inflammatory drugs (NSAIDS);
  • History of alcohol or other drug abuse within 12 months of study entry;
  • Known human immunodeficiency virus (HIV) disease;
  • Any other medical condition which renders the patient unable to or unlikely to complete the study, or which would interfere with optimal participation in the study or produce significant risk to the patient;
  • Receipt of any investigational drugs (including placebo) within 30 days of enrollment;
  • Evidence of hepatic dysfunction including total bilirubin >2.0 mg/dL or liver transaminase (AST or ALT) >3 times upper limit of normal;
  • Anticipated surgery within trial period;
  • Inability to cooperate with study personnel or history of noncompliance to medical regimen (i.e., patients who would be expected to comply poorly with treatment);
  • Known allergies or intolerance to any heparin-like compound;
  • Untreated urinary tract infection that would impact urinary protein values; or
  • Prior exposure to sulodexide, either in a clinical setting or as a participant in another clinical study.

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: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Triple

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Sulodexide
Also known as KRX-101. All patients will be on standard of care ACE or ARBs.
Drug: Sulodexide
100 mg sulodexide gelcaps
Other Names:
  • KRX-101
Placebo Comparator: Placebo
All patients will be on standard of care ACE or ARBs.
Drug: Placebo
0 mg gelcap
Other Names:
  • Placebo oral gelcap

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Number of Subjects With Conversion From Microalbuminuria to Normoalbuminuria
Time Frame: 26 Weeks
The primary efficacy variable was the fraction of those patients in the ITT population with valid baseline and Week 26 ACRs in whom "therapeutic success" was achieved at Week 26 measured as a conversion of microalbuminuria to normoalbuminuria and at least a 25% reduction in ACR relative to baseline
26 Weeks
Number of Subjects With Greater Than 50% Reduction in Microalbuminuria
Time Frame: 26 Weeks
During the treatment period, KRX-101 is being compared to placebo to assess whether a 50% reduction in microalbuminuria has been achieved.
26 Weeks

Secondary Outcome Measures

Outcome Measure
Time Frame
Change in Serum Albumin From Baseline to End of 26 Weeks
Time Frame: 26 Weeks
26 Weeks

Collaborators and Investigators

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

Sponsor

Keryx Biopharmaceuticals

Collaborators

Collaborative Study Group (CSG)

Investigators

  • Study Director: Edmund J Lewis, M.D., The Collaborative Study Group, Rush University Medical Center, Chicago, IL USA
  • Principal Investigator: Robert C Atkins, M.D., The Collaborative Study Group, Monash Medical Center, Clayton, Victoria, AUSTRALIA
  • Principal Investigator: Dick deZeeuw, M.D., The Collaborative Study Group, University of Groningen, NETHERLANDS
  • Principal Investigator: Itamar Raz, M.D., The Collaborative Study Group, Hadassah University, Jerusalem, ISRAEL

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

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

August 1, 2005

Primary Completion (Actual)

January 1, 2008

Study Completion (Actual)

February 1, 2008

Study Registration Dates

First Submitted

August 11, 2005

First Submitted That Met QC Criteria

August 11, 2005

First Posted (Estimate)

August 15, 2005

Study Record Updates

Last Update Posted (Actual)

March 23, 2018

Last Update Submitted That Met QC Criteria

February 22, 2018

Last Verified

February 1, 2018

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • KRX-101-301

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

No

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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