- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02585843
Mineralocorticoid Receptor Antagonists (MRA) in Heart Failure (HF) and Loop Diuretic Resistance
July 24, 2019 updated by: Arthur R. Garan, Columbia University
Pilot Study of Natriuretic Versus Standard Doses of Mineralocorticoid Receptor Antagonists in Heart Failure and Loop Diuretic Resistance in Outpatients
This is a prospective, single-center, double-blind and randomized placebo controlled trial for evaluation of a 7-day 100mg daily dose of spironolactone on weight loss and resolution of signs and symptoms of congestion in outpatients with acute decompensated heart failure (ADHF).
Patients who are not responding to their current loop diuretics will be considered for this study.
Mineralocorticoid receptor antagonists (MRAs) are recommended as standard of care in management of heart failure (HF) patients.
However, recommended doses of MRAs (spironolactone 25mg/daily or eplerenone 50mg/daily) will not have any impact on signs and symptoms of volume overload.
Therefore, the proposed study will aim to show the impact of this outpatient regimen to improve diuresis and possible reduction in hospitalization for further diuretic management in HF patients with signs and symptoms of congestion.
Study Overview
Status
Completed
Conditions
Intervention / Treatment
Detailed Description
The incidence and prevalence of heart failure (HF) is rising with more than 5 million Americans suffering from this syndrome.
Hospitalization rates for acute decompensated heart failure (ADHF) are also remarkably high, exceeding more than 1 million admissions per year.
Congestion is the main cause of hospitalization for ADHF.
Loop diuretics as the main therapy for decongestion, often are not adequate since many patients with ADHF develop "loop diuretic resistance".
These patients will require hospitalization for intravenous diuretic or other advanced decongestion therapies.
Thus, novel decongestion therapies are needed to decrease hospital admission rates and subsequent complications of multiple hospitalizations.
Hyperaldosteronism, not only is a pivotal pathogenic factor in HF, but also contributes to loop diuretic resistance.
Attempts for normalization of circulatory aldosterone with mineralocorticoid receptor antagonists (MRAs), mainly spironolactone, have shown to decrease mortality in HF patients with reduced left ventricular ejection fraction (LVEF).
Moreover, MRAs significantly decrease the rate of rehospitalization in both HF with preserved and reduced LVEF.
The dose of spironolactone in these trials is 25mg daily.
However, this dose does not increase natriuresis (urinary sodium excretion).
Natriuresis is achieved with higher doses of MRAs.
Therefore, the primary aim of this study is to examine the efficacy of 7-day 100mg daily of spironolactone on weight loss and resolution of signs and symptoms of congestion in patients aged 60 years with ADHF and loop diuretic resistance.
Study Type
Interventional
Enrollment (Actual)
20
Phase
- Phase 2
- 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
-
-
New York
-
New York, New York, United States, 10032
- Columbia 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:
- History of heart failure with either reduced or preserved ejection fraction for 3 months
- Patients with New York Heart Association (NYHA) class II- IV heart failure symptoms, with at least one worsening symptom (Dyspnea on exertion, shortness of breath, orthopnea, early satiety) and one sign of congestion (pulmonary rales, elevated jugular venous pressure10cmHg, peripheral edema and ascites)
- Decision by primary cardiologist or heart failure (HF) specialist to increase the home diuretic dose
- Stable treatment with beta-blockers for 1 month unless contraindicated (i.e. intolerance, bradycardia) as specified by primary cardiologist/HF provider
- Stable treatment with angiotensin converting enzyme-1 (ACE-1) or angiotensin receptor blocker (ARB) for 1 month
- Spironolactone dose 25mg or eplerenone 50mg per day
- Daily furosemide or furosemide equivalent dose of 80mg or greater
- Serum potassium concentration 4.5 mmol/L or 5.0 mmol/L if on potassium supplements
- Estimated Glomerular Filtration Rate (eGFR) by Modification of Diet in Renal Disease (MDRD) equation 40 ml/min/1.73
Exclusion Criteria:
- Inability to complete informed consent form
- Allergy or intolerance to spironolactone
- Systolic blood pressure <100 mmHg
- Patient in need of hospitalization per cardiologist decision
- Current inotrope dependency
- Current mechanical circulatory support
- Acute coronary syndromes or unstable angina within the past 4 weeks
- History of cardiac transplant
- Obstructive cardiac valvular disease
- Primary hypertrophic cardiomyopathy, infiltrative cardiomyopathy
- Significant ventricular arrhythmia necessitating defibrillator therapy within the past 14 days
- Atrioventricular conduction abnormality greater than first-degree block
- Primary liver disease resulted in cirrhosis or abnormal liver function tests (transaminases and alkaline phosphatase levels 3 times the upper limit of normal
- Acute malignancy
- Active infection requiring antimicrobial treatment (Suppression antimicrobial for chronic infections are exempt)
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: High-dose
Spironolactone 100mg: 100mg/day of spironolactone (2 capsules), PO (oral) for 7 days
|
2 capsules of study medication consist of 100mg, PO (oral) for 7 days
Other Names:
|
Active Comparator: Standard of Care
Spironolactone 25mg: 25mg/day of spironolactone, PO (oral)
|
25mg/day of spironolactone
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Body Weight
Time Frame: 7 days
|
change in body weight measured in kilograms between weight at baseline and weight at 7 days
|
7 days
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Estimated Jugular Venous Pressure (cmH2O)
Time Frame: 7 days
|
Change in estimated jugular venous pressure by physical exam in cmH2O between baseline and 7 days
|
7 days
|
Change in 6-minute Walk Test Distance (6MWT)
Time Frame: 7 days
|
At baseline and final visit.
The 6MWT will be conducted per American Thoracic Society guidelines.
|
7 days
|
Change in Score on the Visual Analogue Scale (VAS)
Time Frame: 7 days
|
Dyspnea will be assessed at baseline and at 7 days with the score on the visual analogue scale (VAS).
The scores range from 0 (minimum) to 100 (maximum) with higher numbers representing improvements in dyspnea (i.e.
better) and lower numbers representing worsening of dyspnea (i.e.
worse).
|
7 days
|
Change From Baseline to Day 7 on the Seven-Level Likert Scale
Time Frame: 7 days
|
Dyspnea will be assessed using a Seven-Level Likert Scale at baseline and the day 7 visit.
The outcome measure will be reported as a difference between these two assessments (value at 7 days minus the value at baseline).
The values on this scale range from 1 to 7 with higher numbers indicating overall better subjective assessment related to the symptom of dyspnea.
Therefore, positive numbers represent an overall improvement in dyspnea during the study intervention and the higher (more positive) this difference is, the better the subject's relief of dyspnea at the conclusion of the study intervention.
|
7 days
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Investigators
- Principal Investigator: Arthur R Garan, MD, Columbia University
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 (Actual)
November 1, 2015
Primary Completion (Actual)
March 31, 2017
Study Completion (Actual)
March 31, 2017
Study Registration Dates
First Submitted
August 30, 2015
First Submitted That Met QC Criteria
October 22, 2015
First Posted (Estimate)
October 23, 2015
Study Record Updates
Last Update Posted (Actual)
August 8, 2019
Last Update Submitted That Met QC Criteria
July 24, 2019
Last Verified
July 1, 2019
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- AAAO9102
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Undecided
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Yes
Studies a U.S. FDA-regulated device product
No
product manufactured in and exported from the U.S.
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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