- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02646540
AiDing Diuresis wIth Tolvaptan (ADD-IT) (ADD-IT)
March 25, 2019 updated by: Divya Gupta, Emory University
The purpose of this study is to test the use of tolvaptan (commercial name Samsca) when given in addition to intravenous (IV) diuretics early during an episode of acute heart failure.
It will be compared to a high dose of IV diuretics alone or the use of metolazone in addition to IV diuretics.
The investigators are looking to see if there is improvement in the symptoms and outcomes of persons with acute heart failure.
Study Overview
Status
Completed
Conditions
Intervention / Treatment
Detailed Description
This is a single-center, randomized trial to assess the effects of 30 mg daily of tolvaptan when given concomitantly with home dose of diuretic (Lasix equivalent) intravenously (IV) versus 5mg daily of metolazone given concomitantly with home dose of diuretic (Lasix equivalent) IV, versus 2.5 times home dose of diuretic (Lasix equivalent) IV in participants hospitalized for acutely decompensated heart failure (ADHF).
Study Type
Interventional
Enrollment (Actual)
14
Phase
- Phase 1
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
-
-
Georgia
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Atlanta, Georgia, United States, 30322
- Emory University Hospital
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Atlanta, Georgia, United States, 30308
- Emory University Hospital Midtown
-
-
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:
- Participants hospitalized for worsening acute heart failure and randomized within 36 hours of initial presentation
- New York Heart Association (NYHA) Class III or IV on admission to the hospital with at least 1 month history of treated heart failure
- Able to understand content of and willing to provide written informed consent
The participant must have signs of extracellular volume expansion, defined as two or more of the following four signs or symptoms:
- signs of RHF (right heart failure) (jugular venous distention, pitting edema, or (≥1+), ascites and/or signs of LHF (left heart failure) (pulmonary congestion on chest x-ray, pulmonary rales)
- Brain Natriuretic Peptide (BNP) > 450
- serum sodium < 140 mEq/L
Exclusion Criteria:
- Positive urine pregnancy test for women of child bearing potential
- Inability to provide written informed consent
- Cardiac surgery within 60 days prior to study randomization
- Acute Coronary Syndrome (ACS) or percutaneous coronary intervention within 30 days prior to study randomization
- Planned revascularization procedures, cardiac mechanical support implantation, cardiac transplantation, or other cardiac surgery within 30 days following study randomization
- Planned electrophysiologic (EP) device implantation within 7 days following study randomization
- Subjects who are on cardiac mechanical support
- Co- morbid condition with an expected survival less than six months
- History of a cerebrovascular accident within the last 30 days
- Hemodynamically significant uncorrected primary cardiac valvular disease
- Hypertrophic cardiomyopathy (obstructive or non-obstructive)
- Uncorrected thyroid disease, active myocarditis or known amyloid cardiomyopathy
- History of primary significant liver disease or acute hepatic failure, defined as 3x upper limit of normal (ULN)
- Chronic uncontrolled diabetes mellitus with Hemoglobin A1C > 10%
- Supine systolic arterial blood pressure < 90 mmHg
- Serum creatinine > 3.5 mg/dL or undergoing dialysis
- Hemoglobin < 9 g/dL
- History of hypersensitivity and/or idiosyncratic reaction to benzazepine derivatives (such as benazepril)
- Inability to take oral medications
- Participation in another clinical drug or device trial where the last dose of drug was within the past 30 days or an investigational medical device is currently implanted
- Previous exposure to tolvaptan within 7 days prior to randomization
- Subjects with refractory, end-stage, heart failure defined as subjects who are appropriate candidates for specialized treatment strategies, such as ventricular assist devices, continuous positive IV inotropic therapy, or hospice care
- Ultrafiltration within 7 days prior to randomization or planned.
- Active gout
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
- Masking: NONE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
EXPERIMENTAL: Tolvaptan 30 mg and IV Lasix
Participants admitted to the hospital and diagnosed with acutely decompensated heart failure (ADHF) will receive 30 mg of tolvaptan concomitantly with their standard dose of diuretics.
|
Participants will receive oral daily tolvaptan 30 mg concomitantly with their standard dose of intravenous (IV) diuretics for the duration of their hospitalization.
Other Names:
|
ACTIVE_COMPARATOR: Metolazone 5mg and IV Lasix
Participants admitted to the hospital and diagnosed with acutely decompensated heart failure (ADHF) will receive 5mg metolazone concomitantly with their standard dose of diuretics.
|
Participants will receive oral daily metolazone 5 mg concomitantly with their standard dose of intravenous (IV) diuretics for the duration of their hospitalization.
Other Names:
|
ACTIVE_COMPARATOR: IV Lasix
Participants admitted to the hospital and diagnosed with acutely decompensated heart failure (ADHF) will receive two and a half (2.5) times their standard dose of diuretics.
|
Participants will receive two and a half (2.5) times their standard dose of intravenous (IV) diuretics for the duration of their hospitalization.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Length of Hospitalization Measured in Days
Time Frame: Duration of Hospitalization (Average of Five Days)
|
The number of days hospitalized until discharge.
|
Duration of Hospitalization (Average of Five Days)
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Body Weight
Time Frame: Baseline (hospital admission), Discharge (Average of 5 Days)
|
The difference in body weight from hospital admission to discharge measured in kilograms.
|
Baseline (hospital admission), Discharge (Average of 5 Days)
|
Total Diuretic Dose
Time Frame: Up to Five Days
|
The total dose of diuretics given throughout the duration of hospitalization measured in milligrams (mg).
|
Up to Five Days
|
Change in estimated glomerular filtration rate (eGFR)
Time Frame: Baseline (hospital admission), Discharge (Average of 5 days)
|
The difference in eGFR from baseline (hospital admission) to discharge.
|
Baseline (hospital admission), Discharge (Average of 5 days)
|
Number of Days Alive
Time Frame: Post Hospital Discharge (30 days)
|
The number of days participants remain alive over thirty days after hospital discharge.
|
Post Hospital Discharge (30 days)
|
Rate of Re-Hospitalization
Time Frame: 30 Days Post Hospitalization
|
The number of participants re-hospitalized for worsening heart failure or death at 30 days.
|
30 Days Post Hospitalization
|
Number of Electrolyte Imbalance Related Adverse Events
Time Frame: Duration of Hospitalization (Average of Five Days)
|
The number of adverse events due to electrolyte imbalance throughout the duration of hospitalization.
|
Duration of Hospitalization (Average of Five Days)
|
Number of Participants Requiring Electrolyte Repletion
Time Frame: Duration of Hospitalization (Average of Five Days)
|
The number of participants that require electrolyte repletion throughout the duration of hospitalization.
|
Duration of Hospitalization (Average of Five Days)
|
Change in Sodium Level
Time Frame: Baseline (hospital admission), Discharge (Average of 5 days)
|
The difference in sodium levels from baseline to hospital discharge measured in milliequivalents per liter (mEqL).
|
Baseline (hospital admission), Discharge (Average of 5 days)
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Investigators
- Principal Investigator: Divya Gupta, MD, Emory 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
January 1, 2016
Primary Completion (ACTUAL)
December 30, 2018
Study Completion (ACTUAL)
December 30, 2018
Study Registration Dates
First Submitted
January 4, 2016
First Submitted That Met QC Criteria
January 4, 2016
First Posted (ESTIMATE)
January 5, 2016
Study Record Updates
Last Update Posted (ACTUAL)
March 27, 2019
Last Update Submitted That Met QC Criteria
March 25, 2019
Last Verified
March 1, 2019
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Heart Diseases
- Cardiovascular Diseases
- Heart Failure
- Cardiomyopathies
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Antihypertensive Agents
- Natriuretic Agents
- Membrane Transport Modulators
- Sodium Chloride Symporter Inhibitors
- Sodium Potassium Chloride Symporter Inhibitors
- Antidiuretic Hormone Receptor Antagonists
- Furosemide
- Diuretics
- Tolvaptan
- Metolazone
Other Study ID Numbers
- IRB00080051
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Yes
Studies a U.S. FDA-regulated device product
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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