- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03398577
Effects of SGLT2 Inhibitor in Diabetic Patients With Coronary Artery Disease
Effects of SGLT2 Inhibitor on Markers of Inflammation, Atherosclerosis and Left Ventricular Strain in Diabetic Patients With Coronary Artery Disease
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Patients with ischemic heart disease and diabetes are at a particularly high risk for the recurrence of cardiovascular events, conversely, certain classes of oral anti-diabetic medications have been shown to cause hypoglycemia with adverse cardiovascular implications 1,2. Diabetes induces complex vascular changes, promoting accelerated atherosclerosis and a hyper-coagulable state, as can be assessed indirectly by a number of markers. Principal perturbations include endothelial dysfunction, increased inflammatory plaque infiltration, adhesion molecule over-expression and adverse effects of circulating fatty acids and advanced glycosylation end-products.
Cardiovascular safety of anti-diabetic medications is of paramount importance and has been under recent FDA and EDQM scrutiny. A number of hypoglycemic drugs, especially sulfonylureas, have been associated with significant hypoglycemia and adverse events induced by sympathetic activation. Activation of the sympathetic system has numerous implications, including surges of heart rate, blood pressure but also pro-inflammatory and pro-coagulant effects. This partially explains increased cardiovascular adverse events noted with these drugs. Newer classes of antidiabetic medication have recently shown improved survival outcomes in patients with cardiovascular disease, yet the exact mechanisms of the observed risk reduction are mostly yet to be elucidated 3,4. One possible mechanism is anti-inflammatory effect exerted directly or indirectly by SGLT2I or diuretic effect leading to left ventricular unloading with NT pro BNP level reduction.
The aim of this study is to explore the effect of newly added SGLT2I medication or placebo, to standard medication regimen in diabetic patients with documented stable coronary disease. Reduction of inflammatory marker levels is of great clinical importance and has been shown to correlate with reduction in significant clinical events5. Therefore, in the present study we plan to focus on possible anti-inflammatory and athero-thrombotic protective effects of Dapagliflozin compared to placebo, in secondary prevention population of stable coronary patients with diabetes. Additionally, the investigators will explore NT proBNP dynamics, which related to ventricular filling pressures in this specific population.
Key representative markers for the present study are chosen in order to correctly represent alterations in: inflammation (hs-CRP, IL(interleukin) -1 beta, IL-6, P-Selectin, TNF-alfa), and LV strain (NT pro BNP).
The effect of SGLT2I on the above-mentioned parameters has not been studied in humans. Accordingly, the demonstration of significant improvements in markers of athero-thrombosis and inflammation in high-risk diabetic patients is of great clinical importance and novelty that may be employed for the reduction of major cardiovascular events in this population.
Importantly, the effects of SGLT2I therapy will be evaluated in a prospective controlled clinical trial in a closely supervised cardiac rehabilitation setting, which includes lifestyle changes, regular, quantifiable physical activity, and predefined nutritional interventions.
Study Type
Enrollment (Anticipated)
Phase
- Phase 4
Contacts and Locations
Study Contact
- Name: Gal Shmukler, MA
- Phone Number: +972-3-5344703
- Email: Gal.Shmukler@sheba.health.gov.il
Study Locations
-
-
-
Tel Hashomer, Israel, 52621
- Sheba Medical Center, Cardiac Rehabilitation Institute
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Type 2 Diabetes Mellitus on oral therapy
- Stable documented ischemic Heart disease (> 60 days post AMI, CABG or PCI)
- Sub-optimal Hb A1c defined as ≥ 7%
- Age > 21
- Life expectancy >1 year
Exclusion Criteria:
- Events of clinical hypoglycemia during the past 6 months
- Recent (< 60 days) acute coronary syndrome (ACS) or Cerebrovascular accident
- Transient ischemic attack (TIA) within the past year.
- Significant renal impairment (eGFR < 60 ml/min/1.73 m2)
- History of recurrent UTI \ vaginitis
- Past bladder cancer (TCC or other)
- History of diabetic keto-acidosis
- Planned coronary intervention or planed surgical intervention (PCI or CABG)
- Unstable arrhythmias (i.e. rapid atrial fibrillation, symptomatic bradycardia, recurrent ventricular arrhythmia that are clinically significant, etc.)
- Known hypersensitivity to study drug
- Type I diabetes
- Current Hb A1c >9%
- Current Insulin treatment
- Active treatment with SGLT2I medication
- Inability to comply with study protocol
- Active malignancy other than basal cell carcinoma (BCC)
- Clinically advanced congestive heart failure - NYHA class III-IV
- Severe left ventricular dysfunction (LVEF<30%) with NYHA II or any NYHA class with documented recent heart failure decompensation (<3 months)
- Severe stable cardiac angina CCS III - IV or Unstable angina
- Chronic inflammation (i.e. IBD, Lupus, inflammatory arthritis, rheumatoid arthritis) or chronic infection (i.e. chronic diabetic foot infection)
- Pregnancy, lactation or child-bearing potential
Study Plan
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: Intervention group
Eligible patients (HbA1C ≥ 7% and ≤ 9%) , who were allocated to the Intervention group will receive Dapagliflozin 10 mg in addition to oral anti-diabetic medication administered prior to study enrollment.
|
Computer based randomization software will be used in order to randomize eligible consenting subjects to placebo or Dapagliflozin 10 mg treatment using a 1:2 ratio.
Other Names:
|
Placebo Comparator: Control group
Eligible patients (HbA1C ≥ 7% and ≤ 9%) , who were allocated to the Control group will receive placebo in addition to oral anti-diabetic medication administered prior to study enrollment.
|
Computer based randomization software will be used in order to randomize eligible consenting subjects to placebo or Dapagliflozin 10 mg treatment using a 1:2 ratio.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Percent reduction in interleukin (IL)-1β levels
Time Frame: 3 months
|
Percent reduction in IL-1 β will be calculated as follows:(Baseline IL-1 minus follow-up [3-month] IL-1)/Baseline IL1; with value multiplied by 100.
|
3 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Percent reduction in additional biomarkers
Time Frame: 3 months
|
Additional biomarkers including: IL-1 alpha, IL-8, IL-10, IL-17, tumor necrosis factor (TNF)-alpha, monocyte chemotactic protein (MCP-1) .
Percent reduction will be calculated as mentioned above
|
3 months
|
Safety from events of clinical hypoglycemia
Time Frame: 3 Months
|
Events of clinical hypoglycemia are defined as: palpitations, tremor, hunger, sweating and objective measurement of blood glucose ≤ 70 mg/dl |
3 Months
|
Reduction in BMI
Time Frame: 3 Months
|
Changes in BMI will be calculated according to weight and height measurements at enrollment comparing to its value following 3-month active treatment period.
|
3 Months
|
Reduction in HB A1c
Time Frame: 3 Months
|
Reduction will be calculated by comparing HB A1c value at enrollment to its value following 3-month active treatment period.
|
3 Months
|
NTpro BNP
Time Frame: 3 Months
|
Changes in BNP will be calculated by comparing it's value at enrollment to its value following 3-month active treatment period.
|
3 Months
|
MMP-9 percent reduction
Time Frame: 3 Months
|
Percent reduction will be calculated as mentioned on outcome 1
|
3 Months
|
Percent change in Adiponectin levels
Time Frame: 3 Months
|
Percent reduction will be calculated as mentioned on outcome 1
|
3 Months
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Robert Klempfner, Proffesor, Sheba Medical Center
Study record dates
Study Major Dates
Study Start (Anticipated)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Heart Diseases
- Cardiovascular Diseases
- Vascular Diseases
- Arteriosclerosis
- Arterial Occlusive Diseases
- Coronary Artery Disease
- Myocardial Ischemia
- Coronary Disease
- Hypoglycemic Agents
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Sodium-Glucose Transporter 2 Inhibitors
- Dapagliflozin
Other Study ID Numbers
- SGLT2
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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.
Clinical Trials on Coronary Disease With Diabetes Mellitus
-
Seoul St. Mary's HospitalCompletedCoronary Artery Disease | Cardiovascular Disease | Atherosclerosis | Asymptomatic Patients With Type 2 Diabetes MellitusKorea, Republic of
-
Oregon Research InstituteNational Heart, Lung, and Blood Institute (NHLBI)CompletedHeart Diseases | Cardiovascular Diseases | Coronary Disease | Diabetes Mellitus, Non-insulin Dependent | Coronary Heart Disease Risk Reduction
-
Associacao para Investigacao e Desenvolvimento...AstraZeneca; Cardiovascular Centre of the University of Lisbon (CCUL)Active, not recruitingCoronary Heart Disease | Type2 Diabetes MellitusPortugal
-
University of OxfordBayerCompletedCoronary Heart Disease | Acute Coronary Syndrome | Impaired Glucose Tolerance | Type 2 Diabetes Mellitus (T2DM)China, Hong Kong
-
Inova Health Care ServicesTerminatedDiabetes Mellitus, Type 2 | Percutaneous Coronary Intervention | Dyslipidemia Associated With Type II Diabetes MellitusUnited States
-
IKFE Institute for Clinical Research and DevelopmentTakeda; Heidelberg University; Johannes Gutenberg University MainzCompletedCardiovascular Disease | Type 2 Diabetes MellitusGermany
-
Elpen Pharmaceutical Co. Inc.CompletedCoronary Artery Disease (CAD) | Type 2 Diabetes Mellitus (T2DM) | Myocardial InfractionGreece
-
City, University of LondonUniversity College, LondonCompletedType 2 Diabetes | Coronary Heart DiseaseUnited Kingdom
-
SanofiCompletedMicrovascular Coronary Artery DiseaseGermany
-
Second Hospital of Shanxi Medical UniversityCompleted
Clinical Trials on Dapagliflozin 10 MG [Farxiga]
-
Jiangsu Hansoh Pharmaceutical Co., Ltd.Completed
-
Jiangsu Hansoh Pharmaceutical Co., Ltd.Completed
-
Fundación Pública Andaluza para la Investigación...Unknown
-
Holbaek SygehusEnrolling by invitationEnd Stage Renal Disease | Peritoneal Dialysis ComplicationDenmark
-
George Clinical Pty LtdUniversity Medical Center Groningen; Ground Zero PharmaceuticalsUnknownDiabetes Mellitus, Type 2 | Impaired Renal FunctionCanada
-
University of Campinas, BrazilAstraZenecaCompletedCoronary Artery Disease | Diabetes Mellitus, Type 2 | Carotid Artery DiseasesBrazil
-
Northwestern UniversityNational Heart, Lung, and Blood Institute (NHLBI); National Institutes of Health...RecruitingHeart Failure | Kidney Diseases | Chronic Kidney Diseases | Heart Failure With Preserved Ejection FractionUnited States
-
Chang Gung Memorial HospitalActive, not recruitingCatheter Ablation | Atrial Fibrillation RecurrentTaiwan
-
Dong-A UniversityRecruitingRenal Insufficiency, Chronic | Percutaneous Coronary Intervention | Cardiac CatheterizationKorea, Republic of
-
AstraZenecaCompletedType 2 Diabetes MellitusUnited States, Italy, Spain, Sweden, Canada, Bulgaria, Poland, Czechia