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

14. Februar 2017 aktualisiert von: 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.

Studienübersicht

Status

Abgeschlossen

Bedingungen

Intervention / Behandlung

Detaillierte Beschreibung

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.

Studientyp

Interventionell

Einschreibung (Tatsächlich)

300

Phase

  • Phase 2

Kontakte und Standorte

Dieser Abschnitt enthält die Kontaktdaten derjenigen, die die Studie durchführen, und Informationen darüber, wo diese Studie durchgeführt wird.

Studienorte

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

Teilnahmekriterien

Forscher suchen nach Personen, die einer bestimmten Beschreibung entsprechen, die als Auswahlkriterien bezeichnet werden. Einige Beispiele für diese Kriterien sind der allgemeine Gesundheitszustand einer Person oder frühere Behandlungen.

Zulassungskriterien

Studienberechtigtes Alter

18 Jahre und älter (Erwachsene, Älterer Erwachsener)

Akzeptiert gesunde Freiwillige

Nein

Studienberechtigte Geschlechter

Alle

Beschreibung

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

Studienplan

Dieser Abschnitt enthält Einzelheiten zum Studienplan, einschließlich des Studiendesigns und der Messung der Studieninhalte.

Wie ist die Studie aufgebaut?

Designdetails

  • Hauptzweck: Behandlung
  • Zuteilung: Zufällig
  • Interventionsmodell: Parallele Zuordnung
  • Maskierung: Doppelt

Waffen und Interventionen

Teilnehmergruppe / Arm
Intervention / Behandlung
Aktiver Komparator: Liraglutide
Increasing dose from 0.6mg, 1.2mg to 1.8mg SQ daily.
Arzneimittel: Liraglutide
Active Drug
Andere Namen:
  • Victoza
Placebo-Komparator: Placebo
Placebo dose increasing from 0.6mg, 1.2mg to 1.8 mg SQ daily.
Arzneimittel: Placebo
Placebo

Was misst die Studie?

Primäre Ergebnismessungen

Ergebnis Maßnahme
Maßnahmenbeschreibung
Zeitfenster
Global Ranking of Predefined Events
Zeitfenster: 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

Sekundäre Ergebnismessungen

Ergebnis Maßnahme
Maßnahmenbeschreibung
Zeitfenster
Change in Left Ventricular End-Diastolic Volume Index
Zeitfenster: 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
Zeitfenster: 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
Zeitfenster: Baseline to 180 days
Change in left ventricular ejection fraction from baseline to day 180
Baseline to 180 days
Change in Medial Filling Pressure
Zeitfenster: Baseline to 180 days
Change in medial filling pressure baseline to day 180.
Baseline to 180 days
Change in Lateral Filling Pressure
Zeitfenster: Baseline to 180 days
Change in lateral filling pressure baseline to day 180.
Baseline to 180 days
Change in 6 Minute Walk Distance
Zeitfenster: Baseline to day 30
Change in 6 minute walk distance baseline to day 30
Baseline to day 30
Change in 6 Minute Walk Distance
Zeitfenster: Baseline to 90 days
Change in 6 minute walk distance baseline to 90 days.
Baseline to 90 days
Change in 6 Minute Walk Distance
Zeitfenster: 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)
Zeitfenster: 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)
Zeitfenster: 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)
Zeitfenster: 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
Zeitfenster: 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
Zeitfenster: 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.
Zeitfenster: 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
Zeitfenster: 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
Zeitfenster: 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
Zeitfenster: 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
Zeitfenster: 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

Mitarbeiter und Ermittler

Hier finden Sie Personen und Organisationen, die an dieser Studie beteiligt sind.

Sponsor

Duke University

Mitarbeiter

National Heart, Lung, and Blood Institute (NHLBI)

Ermittler

  • Studienstuhl: Eugene Bruanwald, MD, Harvard University

Publikationen und hilfreiche Links

Die Bereitstellung dieser Publikationen erfolgt freiwillig durch die für die Eingabe von Informationen über die Studie verantwortliche Person. Diese können sich auf alles beziehen, was mit dem Studium zu tun hat.

Allgemeine Veröffentlichungen

Studienaufzeichnungsdaten

Diese Daten verfolgen den Fortschritt der Übermittlung von Studienaufzeichnungen und zusammenfassenden Ergebnissen an ClinicalTrials.gov. Studienaufzeichnungen und gemeldete Ergebnisse werden von der National Library of Medicine (NLM) überprüft, um sicherzustellen, dass sie bestimmten Qualitätskontrollstandards entsprechen, bevor sie auf der öffentlichen Website veröffentlicht werden.

Haupttermine studieren

Studienbeginn

1. April 2013

Primärer Abschluss (Tatsächlich)

1. Oktober 2015

Studienabschluss (Tatsächlich)

1. Oktober 2015

Studienanmeldedaten

Zuerst eingereicht

7. Februar 2013

Zuerst eingereicht, das die QC-Kriterien erfüllt hat

26. Februar 2013

Zuerst gepostet (Schätzen)

28. Februar 2013

Studienaufzeichnungsaktualisierungen

Letztes Update gepostet (Tatsächlich)

15. Februar 2017

Letztes eingereichtes Update, das die QC-Kriterien erfüllt

14. Februar 2017

Zuletzt verifiziert

1. Februar 2017

Mehr Informationen

Begriffe im Zusammenhang mit dieser Studie

Zusätzliche relevante MeSH-Bedingungen

Andere Studien-ID-Nummern

  • Pro00042633
  • 5U10HL084904-09 (US NIH Stipendium/Vertrag)

Diese Informationen wurden ohne Änderungen direkt von der Website clinicaltrials.gov abgerufen. Wenn Sie Ihre Studiendaten ändern, entfernen oder aktualisieren möchten, wenden Sie sich bitte an register@clinicaltrials.gov. Sobald eine Änderung auf clinicaltrials.gov implementiert wird, wird diese automatisch auch auf unserer Website aktualisiert .

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