- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04736433
Replication of the PARADIGM-HF Heart Failure Trial in Healthcare Claims Data.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Study Type
Enrollment (Actual)
Contacts and Locations
Study Locations
-
-
Massachusetts
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Boston, Massachusetts, United States, 02120
- Brigham and Women's Hospital
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Sampling Method
Study Population
This study will involve a new user, parallel group retrospective cohort study design comparing sacubitril/valsartan to ACE inhibitors. Although the trial compared sacubitril/valsartan to enalapril, we expanded the definition of the comparator group to include all ACEi therapies to improve power, since all medications within this class of medication are indicated and guideline recommended for use in heart failure with reduced ejection fraction patients and would be expected to have similar effects on the primary outcome of CV death and HF hospitalization.
The patients will be required to have continuous enrollment during the baseline period of 180 days before initiation of sacubitril/valsartan or a ACEi (cohort entry).
Description
Please see https://drive.google.com/drive/folders/1WD618wrywYjEaXzfLTcuK-VCcnb6b-gV for full code and algorithm definitions.
All patients will be required to have continuous enrollment during the baseline period of 180 days before initiation of sacubitril/valsartan or a ACEi (cohort entry).
Eligible cohort entry dates:
Market availability of sacubitril/valsartan in the U.S. started on July 7, 2015.
- For Marketscan: July 7, 2015 - December 31, 2018 (end of data availability)
- For Optum: July 7, 2015 - March 31, 2020 (end of data availability)
- For Medicare: July 7, 2015 - December 31, 2017 (end of data availability)
Inclusion Criteria:
- Age 18 years or older
- NYHA functional class II-IV
- LVEF ≤ 35%
AND the following:
Hospitalization for heart failure within the last 12 months
- Treatment with a stable dose of an ACE inhibitor or an ARB equivalent to enalapril 10 mg/day for at least 4 weeks before the screening visit; and treatment with a stable dose of a beta-blocker for at least 4 weeks prior to the screening visit, unless contraindicted or not tolerated
- Treatment with a stable dose of an ACE inhibitor or an ARB equivalent to enalapril 10 mg/day for at least 4 weeks before the screening visit
AND the following:
- Treatment with a stable dose of a beta-blocker for at least 4 weeks prior to the screening visit, unless contraindicated or not tolerated
Exclusion Criteria:
- Known history of angioedema
- Requirement for treatment with both ACEIs and ARBs
- Current acute decompensated heart failure (exacerbation of chronic heart failure manifested by signs and symptoms that may require intravenous therapy)
- Symptomatic hypotension and/or a systolic blood pressure <100 mmHg at Visit 1 (screening) or <95 mmHg at Visit 3 or at Visit 5 (randomization)
- Estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m2 at Visit 1 (screening), Visit 3 (end of enalapril run-in), or Visit 5 (end of LCZ696 run-in and randomization) or >35% decline in eGFR between Visit 1 and Visit 3 or between Visit 1 and Visit 5
- Serum potassium >5.2 mmol/L at Visit 1 (screening) or >5.4 mmol/L at Visit 3 or Visit 5 (randomization)
- Acute coronary syndrome, stroke, transient ischaemic attack, cardiac, carotid, or other major cardiovascular surgery, PCI, or carotid angioplasty within the 3 months prior to Visit 1.
- Implantation of a cardiac resynchronization therapy (CRT) device within 3 months prior Visit 1 or intent to implant a CRT
- History of heart transplant or on a transplant list or with LV assistance device
- History of severe pulmonary disease
- Diagnosis of peripartum- or chemotherapy-induced cardiomyopathy within the 12 months prior to Visit 1
- Documented untreated ventricular arrhythmia with syncopal episodes within the 3 months prior to Visit 1
- Documented ventricular arrhythmia within the 3 months prior to Visit 1
AND the following:
- Syncopal episodes within the 3 months prior to Visit 1
AND the following:
- Untreated ventricular arrhythmia within the 3 months prior to visit 1
OR the following:
- Untreated ventricular arrhythmia within the 3 months prior to visit 1
- Symptomatic bradycardia or second- or third-degree atrioventricular block without a pacemaker
- Presence of haemodynamically significant mitral and/or aortic valve disease, except mitral regurgitation secondary to LV dilatation
- Presence of other haemodynamically significant obstructive lesions of the LV outflow tract, including aortic and subaortic stenosis
- Any surgical or medical condition which might significantly alter the absorption, distribution, metabolism, or excretion of study drugs, including, but not limited to, any of the following:
- History of active inflammatory bowel disease during the 12 months before Visit 1
OR the following:
- Active duodenal or gastric ulcers during the 3 months prior to Visit 1
OR the following:
- Evidence of hepatic disease as determined by any one of the following: aspartate aminotransferase or alanine aminotransferase values exceeding 2× upper limit of normal at Visit 1, history of hepatic encephalopathy, history of oesophageal varices, or history of porto-caval shunt
OR the following:
- Current treatment with cholestyramine or colestipol resins
- Presence of any other disease with a life expectancy of 5 years
- Any Ivabradine use -- Approved in April 2015 (same year as Entresto)
Study Plan
How is the study designed?
Design Details
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
---|---|
ACE Inhibitors
Reference group
|
ACE inhibitor dispensing claim is used as the reference
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Sacubitril/Valsartan
Exposure group
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Sacubitril/Valsartan dispensing claim is used as the reference
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Composite outcome of death from cardiovascular causes or hospitalization for heart failure
Time Frame: Through study completion (a median of 102-139 days)
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Through study completion (a median of 102-139 days)
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Shirley Wang, PhD, ScM, Brigham and Women's Hospital
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
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
- Heart Failure
- Molecular Mechanisms of Pharmacological Action
- Antihypertensive Agents
- Enzyme Inhibitors
- Protease Inhibitors
- Angiotensin II Type 1 Receptor Blockers
- Angiotensin Receptor Antagonists
- Valsartan
- Sacubitril and valsartan sodium hydrate drug combination
- Angiotensin-Converting Enzyme Inhibitors
Other Study ID Numbers
- 2018P002966-DUP-PARADIGM-HF
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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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