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Functional Impact of GLP-1 for Heart Failure Treatment (FIGHT) (FIGHT)

14. februar 2017 opdateret af: Duke University

Functional Impact of GLP-1 for Heart Failure Treatment

The primary objective is to test the hypothesis that, compared with placebo, therapy with Subcutaneous (SQ) GLP-1 agonist in the post-Acute Heart Failure Syndrome (AHFS) discharge period will be associated with greater clinical stability at six months as assessed by a composite clinical endpoint.

Studieoversigt

Status

Afsluttet

Betingelser

Intervention / Behandling

Detaljeret beskrivelse

Hospitalization for AHFS identifies individuals at increased risk of death and re-hospitalization following discharge. This increased risk justifies intervention with novel therapy during the vulnerable post-discharge period to enhance clinical stability and prevent early HF mortality and readmissions.

As heart failure (HF) progresses, impairments in metabolism render the heart substrate constrained, limiting cardiac metabolism. Glucagon-like peptide-1 (GLP-1) is a naturally occurring incretin peptide that enhances cellular glucose uptake by stimulating insulin secretion and insulin sensitivity in target tissues. Preclinical and early-phase clinical data support GLP-1 as an effective therapy for advanced HF while use of GLP-1 receptor agonists in large numbers of patients with diabetes reveal a good safety profile and reductions in adverse cardiac outcomes.

Undersøgelsestype

Interventionel

Tilmelding (Faktiske)

300

Fase

  • Fase 2

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiesteder

  • Forenede Stater
    • Delaware
      • Newark, Delaware, Forenede Stater, 19718
        • Christiana Care Health Services
    • Georgia
      • Atlanta, Georgia, Forenede Stater, 30322
        • Emory University School of Medicine
    • Illinois
      • Chicago, Illinois, Forenede Stater, 60611
        • Northwestern University
    • Maryland
      • Baltimore, Maryland, Forenede Stater, 21287
        • Johns Hopkins Hospital
    • Massachusetts
      • Boston, Massachusetts, Forenede Stater, 02115
        • Brigham and Women's Hospital
      • Boston, Massachusetts, Forenede Stater, 02114
        • Massachusetts General Hospital
      • Boston, Massachusetts, Forenede Stater, 02111
        • Tufts Medical Center
      • West Roxbury, Massachusetts, Forenede Stater, 02132
        • Boston VA Healtcare System
    • Minnesota
      • Rochester, Minnesota, Forenede Stater, 55905
        • Mayo Clinic
    • Missouri
      • St. Louis, Missouri, Forenede Stater, 63110
        • Washington University
      • St. Louis, Missouri, Forenede Stater, 63117
        • Saint Louis University Hospital
    • North Carolina
      • Durham, North Carolina, Forenede Stater, 27705
        • Duke University
      • Lumberton, North Carolina, Forenede Stater, 28538
        • Southeast Regional Medical Center
    • Ohio
      • Cleveland, Ohio, Forenede Stater, 44195
        • Cleveland Clinic
      • Cleveland, Ohio, Forenede Stater, 44109
        • Metro Health System
      • Cleveland, Ohio, Forenede Stater, 44106
        • University Hospitals- Case Medical Center
    • Pennsylvania
      • Lancaster, Pennsylvania, Forenede Stater, 17603
        • Lancaster Heart and Stroke Foundation
      • Philadelphia, Pennsylvania, Forenede Stater, 19107
        • Jefferson Medical College
      • Philadelphia, Pennsylvania, Forenede Stater, 19140
        • Temple University Hospital
      • Philadelphia, Pennsylvania, Forenede Stater, 19104
        • University of Pennsylvaina
    • Texas
      • Houston, Texas, Forenede Stater, 77030
        • Michael DeBakey VA Medical Center
    • Utah
      • Murray, Utah, Forenede Stater, 84157
        • Intermountain Medical Center
      • Salt Lake City, Utah, Forenede Stater, 84132
        • University of Utah School of Medicine
      • Salt Lake City, Utah, Forenede Stater, 84132
        • Utah VA Medical Center
    • Vermont
      • Burlington, Vermont, Forenede Stater, 05401
        • The University of Vermont- Fletcher Allen Health Care

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

18 år og ældre (Voksen, Ældre voksen)

Tager imod sunde frivillige

Ingen

Køn, der er berettiget til at studere

Alle

Beskrivelse

Inclusion Criteria:

  1. Age ≥ 18 years
  2. AHFS as defined by the presence of at least 1 symptom (dyspnea, orthopnea, or edema) AND 1 sign (rales on auscultation, peripheral edema, ascites, pulmonary vascular congestion on chest radiography)
  3. AHFS is the primary cause of hospitalization
  4. Prior clinical diagnosis of HF
  5. Left Ventricular Ejection Fraction(LVEF) ≤ 40% during the preceding 3 months (if no echo within the preceding 3 months, an LVEF ≤ 30% during the preceding three years is acceptable)
  6. On evidence-based medication for HF (including beta-blocker and ACE-inhibitor/ARB) or previously deemed intolerant
  7. Use of at least 80 mg or furosemide total daily dose (or equivalent) prior to admission for AHFS (a lower dose of a loop diuretic combined with a thiazide will count as an "equivalent")
  8. Willingness to provide informed consent

Exclusion Criteria:

  1. AHFS due to acute myocarditis or acute Myocardial Infarction
  2. Ongoing hemodynamically significant arrhythmias contributing to HF decompensation
  3. Inotrope, intra-aortic balloon pump (IABP) or other mechanical circulatory support use at the time of consent. Prior use will not exclude a patient.
  4. Current or planned left ventricular assist device therapy in next 180 days
  5. United Network for Organ Sharing status 1A or 1B
  6. B-type natriuretic peptide(BNP)< 250 or NT-proBNP<1,000 (Not required per protocol but if available and too low would be an exclusion; within 48 hours of consent)
  7. Hemoglobin (Hgb) < 8.0 g/dl
  8. Glomerular filtration rate(GFR) < 20 ml/min/1.73 m2 within 48 hours of consent
  9. Systolic blood pressure < 80 mmHg at consent
  10. Resting Heart Rate > 110 at consent
  11. Acute coronary syndrome within 4 weeks as defined by electrocardiographic (ECG) changes and biomarkers of myocardial necrosis (e.g. troponin) in an appropriate clinical setting (chest discomfort or anginal equivalent)
  12. Percutaneous Coronary Intervention, coronary artery bypass grafting or new biventricular pacing within past 4 weeks
  13. Primary hypertrophic cardiomyopathy
  14. Infiltrative cardiomyopathy
  15. Constrictive pericarditis or tamponade
  16. Complex congenital heart disease
  17. Non-cardiac pulmonary edema
  18. More than moderate aortic or mitral stenosis
  19. Intrinsic (prolapse, rheumatic) valve disease with severe mitral, aortic or tricuspid regurgitation
  20. Sepsis, active infection (excluding cystitis) or other comorbidity driving the HF decompensation
  21. Acute or chronic severe liver disease as evidenced by any of the following: encephalopathy, variceal bleeding, International Normalized Ration (INR) > 1.7 in the absence of anticoagulation treatment
  22. Terminal illness (other than HF) with expected survival of less than 1 year
  23. Previous adverse reaction to the study drug
  24. Receipt of any investigational product in the previous 30 days.
  25. Enrollment or planned enrollment in another randomized therapeutic clinical trial in next 6 months.
  26. Inability to comply with planned study procedures
  27. Pregnancy or breastfeeding mothers
  28. Women of reproductive age not on adequate contraception
  29. History of acute or chronic pancreatitis
  30. History of symptomatic gastroparesis
  31. Familial or personal history of medullary thyroid cancer or multiple endocrine neoplasia type-2 (MEN2)
  32. Prior weight-loss surgery (i.e., Roux-en-Y gastric bypass) or other gastric surgery associated with increased endogenous GLP-1 production
  33. Prior or ongoing treatment with GLP-1 receptor agonists
  34. Ongoing treatment with dipeptidyl peptide-IV inhibitors (1 week washout required)
  35. Ongoing treatment with thiazolidinedione
  36. Oxygen-dependent chronic obstructive pulmonary disease
  37. Diabetic patients with history of 2 or more severe hypoglycemia, Diabetic Ketoacidosis(DKA) or hyperglycemic, hyperosmotic nonketotic coma in the preceding 12 months.
  38. Diagnosis of Type 1 Diabetes Mellitus

40. If diabetic, inadequate glycemic control with glucose level > 300 mg/dL within 24 hours of randomization

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Behandling
  • Tildeling: Randomiseret
  • Interventionel model: Parallel tildeling
  • Maskning: Dobbelt

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Aktiv komparator: Liraglutide
Increasing dose from 0.6mg, 1.2mg to 1.8mg SQ daily.
Medicin: Liraglutide
Active Drug
Andre navne:
  • Victoza
Placebo komparator: Placebo
Placebo dose increasing from 0.6mg, 1.2mg to 1.8 mg SQ daily.
Medicin: Placebo
Placebo

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Global Ranking of Predefined Events
Tidsramme: Randomization to 180 days
A rank score based on time to death, time to adjudicated heart failure hospitalization, and time-averaged proportional change in NTproBNP through d180. For patients that died, the patient with the shortest time from randomization to death is assigned rank 1, the second shortest time is assigned rank 2, etc. The patient with the longest time from randomization to death is assigned rank X. For patients that did not die but had a heart failure hospitalization, the patient with the shortest time from randomization to re-admission is assigned rank X+1 and the patient with the longest time from randomization to heart failure hospitalization is assigned rank Y. For patients that did not die or have a heart failure hospitalization, increases in time-averaged proportional change in NTproBNP indicate a worse result and the largest increase is assigned rank Y+1. The patient with the largest decrease is assigned rank N, where N is the sample size.
Randomization to 180 days

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Change in Left Ventricular End-Diastolic Volume Index
Tidsramme: Baseline to 180 days
Change in Left Ventricular End-Diastolic Volume Index from baseline to 180 days.
Baseline to 180 days
Change in Left Ventricular End-systolic Volume Index
Tidsramme: Baseline to 180 days
Change in left ventricular end-systolic volume index from baseline to day 180.
Baseline to 180 days
Change in Left Ventricular Ejection Fraction
Tidsramme: Baseline to 180 days
Change in left ventricular ejection fraction from baseline to day 180
Baseline to 180 days
Change in Medial Filling Pressure
Tidsramme: Baseline to 180 days
Change in medial filling pressure baseline to day 180.
Baseline to 180 days
Change in Lateral Filling Pressure
Tidsramme: Baseline to 180 days
Change in lateral filling pressure baseline to day 180.
Baseline to 180 days
Change in 6 Minute Walk Distance
Tidsramme: Baseline to day 30
Change in 6 minute walk distance baseline to day 30
Baseline to day 30
Change in 6 Minute Walk Distance
Tidsramme: Baseline to 90 days
Change in 6 minute walk distance baseline to 90 days.
Baseline to 90 days
Change in 6 Minute Walk Distance
Tidsramme: Baseline to 180 days
Change in 6 minute walk distance baseline to 180 days.
Baseline to 180 days
Change in Clinical Summary Score Using the Kansas City Cardiomyopathy Questionnaire (KCCQ)
Tidsramme: Baseline to 30 days
Change in clinical summary score using the Kansas City Cardiomyopathy Questionnaire (KCCQ) baseline to 30 days. The Kansas City Cardiomyopathy Questionnaire is a 23-item, self-administered instrument that quantifies physical function, symptoms (frequency, severity and recent change), social function, self-efficacy and knowledge, and quality of life.In the KCCQ, an overall summary score can be derived from the physical function, symptom (frequency and severity), social function and quality of life domains. For each domain, the validity, reproducibility, responsiveness and interpretability have been independently established. Each question is answered by the subject on a 6 point scale (Extremely limited, quite a bit limited, moderately limited, slightly limited, not at all limited, Limited for other reasons or did not do this activity).Scores are transformed to a range of 0-100, in which higher scores reflect better health status.
Baseline to 30 days
Change in Clinical Summary Score Using the Kansas City Cardiomyopathy Questionnaire (KCCQ)
Tidsramme: Baseline to 90 days
Change in clinical summary score using the Kansas City Cardiomyopathy Questionnaire (KCCQ) baseline to 90 days.The Kansas City Cardiomyopathy Questionnaire is a 23-item, self-administered instrument that quantifies physical function, symptoms (frequency, severity and recent change), social function, self-efficacy and knowledge, and quality of life.In the KCCQ, an overall summary score can be derived from the physical function, symptom (frequency and severity), social function and quality of life domains. For each domain, the validity, reproducibility, responsiveness and interpretability have been independently established. Each question is answered by the subject on a 6 point scale (Extremely limited, quite a bit limited, moderately limited, slightly limited, not at all limited, Limited for other reasons or did not do this activity).Scores are transformed to a range of 0-100, in which higher scores reflect better health status.
Baseline to 90 days
Change in Clinical Summary Score Using the Kansas City Cardiomyopathy Questionnaire (KCCQ)
Tidsramme: Baseline to day 180
Change in clinical summary score using the Kansas City Cardiomyopathy Questionnaire (KCCQ) from baseline to day 180.The Kansas City Cardiomyopathy Questionnaire is a 23-item, self-administered instrument that quantifies physical function, symptoms (frequency, severity and recent change), social function, self-efficacy and knowledge, and quality of life.In the KCCQ, an overall summary score can be derived from the physical function, symptom (frequency and severity), social function and quality of life domains. For each domain, the validity, reproducibility, responsiveness and interpretability have been independently established. Each question is answered by the subject on a 6 point scale (Extremely limited, quite a bit limited, moderately limited, slightly limited, not at all limited, Limited for other reasons or did not do this activity).Scores are transformed to a range of 0-100, in which higher scores reflect better health status.
Baseline to day 180
Change in Kansas City Cardiomyopathy Questionnaire (KCCQ) Overall Summary Score
Tidsramme: Baseline to 30 days
Kansas City Cardiomyopathy Questionnaire (KCCQ) change in overall summary score baseline to 30 days.The Kansas City Cardiomyopathy Questionnaire is a 23-item, self-administered instrument that quantifies physical function, symptoms (frequency, severity and recent change), social function, self-efficacy and knowledge, and quality of life.In the KCCQ, an overall summary score can be derived from the physical function, symptom (frequency and severity), social function and quality of life domains. For each domain, the validity, reproducibility, responsiveness and interpretability have been independently established. Each question is answered by the subject on a 6 point scale (Extremely limited, quite a bit limited, moderately limited, slightly limited, not at all limited, Limited for other reasons or did not do this activity).Scores are transformed to a range of 0-100, in which higher scores reflect better health status.
Baseline to 30 days
Change in Kansas City Cardiomyopathy Questionnaire (KCCQ) Overall Summary Score
Tidsramme: Baseline to 90 days
Kansas City Cardiomyopathy Questionnaire (KCCQ) change in overall summary score baseline to 90 days.The Kansas City Cardiomyopathy Questionnaire is a 23-item, self-administered instrument that quantifies physical function, symptoms (frequency, severity and recent change), social function, self-efficacy and knowledge, and quality of life.In the KCCQ, an overall summary score can be derived from the physical function, symptom (frequency and severity), social function and quality of life domains. For each domain, the validity, reproducibility, responsiveness and interpretability have been independently established. Each question is answered by the subject on a 6 point scale (Extremely limited, quite a bit limited, moderately limited, slightly limited, not at all limited, Limited for other reasons or did not do this activity).Scores are transformed to a range of 0-100, in which higher scores reflect better health status.
Baseline to 90 days
Change in Kansas City Cardiomyopathy Questionnaire (KCCQ) Overall Summary Score.
Tidsramme: Baseline to 180 days
Kansas City Cardiomyopathy Questionnaire (KCCQ) change in overall summary score baseline to 180 days.The Kansas City Cardiomyopathy Questionnaire is a 23-item, self-administered instrument that quantifies physical function, symptoms (frequency, severity and recent change), social function, self-efficacy and knowledge, and quality of life.In the KCCQ, an overall summary score can be derived from the physical function, symptom (frequency and severity), social function and quality of life domains. For each domain, the validity, reproducibility, responsiveness and interpretability have been independently established. Each question is answered by the subject on a 6 point scale (Extremely limited, quite a bit limited, moderately limited, slightly limited, not at all limited, Limited for other reasons or did not do this activity).Scores are transformed to a range of 0-100, in which higher scores reflect better health status.
Baseline to 180 days
Individual Component of the Primary Endpoint- Mortality
Tidsramme: Randomization to 180 days
Individual component of the primary endpoint of mortality at 180 days after randomization
Randomization to 180 days
Individual Component of the Primary Endpoint- Heart Failure Hospitalization
Tidsramme: Randomization to 180 days
Individual component of the primary endpoint- Heart Failure hospitalization from randomization to 180 days
Randomization to 180 days
Individual Component of the Primary Endpoint- Time-averaged Proportional Change in NT-proBNP
Tidsramme: Baseline to 180 days
Individual component of the primary endpoint- time-averaged proportional change in NT-proBNP from baseline to 180 days
Baseline to 180 days
Global Ranking of Predefined Events
Tidsramme: Baseline to 180 days
A rank score based on time to death, time to adjudicated heart failure hospitalization, time to emergency department visit and time-averaged proportional change in NTproBNP through d180. See Outcome Measure 1 for a general description of the outcome derivation.
Baseline to 180 days

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Sponsor

Duke University

Samarbejdspartnere

National Heart, Lung, and Blood Institute (NHLBI)

Efterforskere

  • Studiestol: Eugene Bruanwald, MD, Harvard University

Publikationer og nyttige links

Den person, der er ansvarlig for at indtaste oplysninger om undersøgelsen, leverer frivilligt disse publikationer. Disse kan handle om alt relateret til undersøgelsen.

Generelle publikationer

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart

1. april 2013

Primær færdiggørelse (Faktiske)

1. oktober 2015

Studieafslutning (Faktiske)

1. oktober 2015

Datoer for studieregistrering

Først indsendt

7. februar 2013

Først indsendt, der opfyldte QC-kriterier

26. februar 2013

Først opslået (Skøn)

28. februar 2013

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

15. februar 2017

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

14. februar 2017

Sidst verificeret

1. februar 2017

Mere information

Begreber relateret til denne undersøgelse

Yderligere relevante MeSH-vilkår

Andre undersøgelses-id-numre

  • Pro00042633
  • 5U10HL084904-09 (U.S. NIH-bevilling/kontrakt)

Disse oplysninger blev hentet direkte fra webstedet clinicaltrials.gov uden ændringer. Hvis du har nogen anmodninger om at ændre, fjerne eller opdatere dine undersøgelsesoplysninger, bedes du kontakte register@clinicaltrials.gov. Så snart en ændring er implementeret på clinicaltrials.gov, vil denne også blive opdateret automatisk på vores hjemmeside .

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