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Evaluation of the Efficacy and Safety of Tirzepatide, a Dual GLP-1/GIP Agonist, on Functional Capacity in Reduced Ejection Fraction Heart Failure Patients With Obesity (DUAL-HFrEF)

30 luglio 2026 aggiornato da: Shadi Shafaghi, Shahid Beheshti University of Medical Sciences

Evaluation of the Efficacy and Safety of Tirzepatide, a Dual GLP-1/GIP Agonist, on Functional Capacity in Reduced Ejection Fraction Heart Failure Patients With Obesity: A Double-Blinded Randomized Controlled Trial

The goal of this clinical trial is to learn if tirzepatide works to improve physical function in adults with heart failure and obesity. It will also learn about the safety of tirzepatide. The main questions it aims to answer are:

Does tirzepatide improve how far participants can walk in 6 minutes? Does tirzepatide improve heart failure symptoms and quality of life? What side effects do participants have when taking tirzepatide?

Researchers will compare tirzepatide to a placebo (a look-alike substance that contains no drug) to see if tirzepatide improves physical function in people with heart failure and obesity.

Participants will:

Get a weekly injection of tirzepatide or a placebo under the skin for 6 months Start at a low dose, which may be raised slowly based on how well they tolerate it Keep taking their usual heart failure medicines Visit the clinic for checkups, blood tests, heart ultrasounds, and a 6-minute walk test Answer questions about their quality of life and heart failure symptoms

Panoramica dello studio

Stato

Non ancora reclutamento

Condizioni

Intervento / Trattamento

Descrizione dettagliata

This is a phase 3, randomized, double-blind (participant, care provider, investigator, and outcomes assessor blinded), placebo-controlled, parallel- group clinical trial evaluating the efficacy and safety of tirzepatide, a dual glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) receptor agonist, in participants with heart failure with reduced ejection fraction (HFrEF) and obesity.

Eligible participants are adults aged 18 years or older with HFrEF (left ventricular ejection fraction ≤40% on echocardiography within the prior 3 months), a body mass index ≥27 kg/m² with at least one obesity-related comorbidity (hypertension, diabetes, or dyslipidemia), and stable guideline-directed heart failure therapy for at least 4 weeks prior to enrollment. Key exclusion criteria include recent acute heart failure decompensation or hospitalization, uncontrolled blood pressure, advanced kidney disease (eGFR <30 mL/min/1.73m²), significant hepatic impairment, active pancreatitis, personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia type 2, and pregnancy or breastfeeding.

A total of 60 participants will be randomized 1:1 using a computer-generated block randomization schedule (block size of 4) to receive either tirzepatide or matching placebo, both administered as weekly subcutaneous injections. Study drug is initiated at 2.5 mg once weekly and titrated every 4 weeks, as tolerated, up to a maximum of 10 mg once weekly, continuing through month 6. The placebo pen is identical in appearance, packaging, and dosing schedule to maintain blinding.

The primary outcome is change in 6-minute walk distance from baseline to 6 months. Secondary outcomes include change in New York Heart Association functional class, Kansas City Cardiomyopathy Questionnaire quality-of-life score, body mass index, ejection fraction, pulmonary artery pressure, and metabolic parameters (fasting glucose, glycated hemoglobin, lipid panel), measured at baseline and at months 2, 4, and 6. Safety outcomes include gastrointestinal adverse events, injection-site reactions, hypoglycemia, pancreatitis, gallbladder events, and changes in liver enzymes, amylase, and lipase. An exploratory outcome evaluates shared molecular and genetic pathways linking obesity and HFrEF using peripheral blood RNA analysis via quantitative PCR or next-generation sequencing.

The study is being conducted at seven sites in Tehran, Iran, including Masih Daneshvari Hospital, Shahid Rajaei Cardiovascular Medical and Research Center, Rasoul Akram Hospital, Tehran Heart Center, Firoozgar Hospital, Ayatollah Taleghani Hospital, and Imam Khomeini Hospital Complex.

Tipo di studio

Interventistico

Iscrizione (Stimato)

60

Fase

  • Fase 3

Contatti e Sedi

Questa sezione fornisce i recapiti di coloro che conducono lo studio e informazioni su dove viene condotto lo studio.

Contatto studio

Criteri di partecipazione

I ricercatori cercano persone che corrispondano a una certa descrizione, chiamata criteri di ammissibilità. Alcuni esempi di questi criteri sono le condizioni generali di salute di una persona o trattamenti precedenti.

Criteri di ammissibilità

Età idonea allo studio

  • Adulto
  • Adulto più anziano

Accetta volontari sani

No

Descrizione

Inclusion Criteria:

  • Age 18 years or older
  • Heart failure with reduced ejection fraction, defined as left ventricular ejection fraction ≤40% on echocardiography performed within the prior 3 months
  • Body mass index ≥27 kg/m², with at least one obesity-related comorbidity (hypertension, diabetes, or dyslipidemia)
  • Stable heart failure therapy for at least 4 weeks prior to enrollment, including beta-blockers, renin-angiotensin system inhibitors/angiotensin receptor-neprilysin inhibitors, and sodium-glucose cotransporter-2 inhibitors, if prescribed
  • Written informed consent

Exclusion Criteria:

  • Acute heart failure decompensation or cardiac hospitalization within the prior 4 weeks
  • Uncontrolled blood pressure (systolic blood pressure <90 mmHg or ≥180 mmHg)
  • Advanced renal impairment (estimated glomerular filtration rate <30 mL/min/1.73m²)
  • Severe hepatic impairment (liver enzymes elevated to 3 times the upper limit of normal)
  • Active pancreatitis
  • Personal or first-degree family history of medullary thyroid carcinoma or multiple endocrine neoplasia type 2
  • Pregnancy or breastfeeding
  • Known hypersensitivity to glucagon-like peptide-1 (GLP-1) or glucose-dependent insulinotropic polypeptide (GIP) receptor agonist drugs
  • Concurrent use of other weight-loss medications

Piano di studio

Questa sezione fornisce i dettagli del piano di studio, compreso il modo in cui lo studio è progettato e ciò che lo studio sta misurando.

Come è strutturato lo studio?

Dettagli di progettazione

  • Scopo principale: Trattamento
  • Assegnazione: Randomizzato
  • Modello interventistico: Assegnazione parallela
  • Mascheramento: Quadruplicare

Armi e interventi

Gruppo di partecipanti / Arm
Intervento / Trattamento
Sperimentale: Tirzepatide
Participants receive tirzepatide via prefilled subcutaneous injection pen once weekly, in addition to standard heart failure therapy. Starting dose is 2.5 mg once weekly for 4 weeks, titrated based on tolerability every 4 weeks up to a maximum of 10 mg once weekly, continued through month 6.
dual GLP-1/GIP receptor agonist administered subcutaneously; brief dosing summary
Altri nomi:
  • Spartina
Comparatore placebo: Placebo
Participants receive matching placebo via identical prefilled subcutaneous injection pen once weekly, in addition to standard heart failure therapy, with the same dosing schedule and titration pattern as the tirzepatide group, continued through month 6.
Matching placebo pen containing all inactive ingredients except tirzepatide
Altri nomi:
  • Spartina

Cosa sta misurando lo studio?

Misure di risultato primarie

Misura del risultato
Misura Descrizione
Lasso di tempo
Change in 6-Minute Walk Distance
Lasso di tempo: Baseline and 6 months after intervention start
The 6-minute walk test will be performed according to the American Thoracic Society standard guidelines in a straight 30-meter corridor. Participants will be asked to walk as far as possible in 6 minutes at their own pace, with rest breaks permitted if needed. Total distance walked will be recorded in meters. This is a standardized, validated, and reproducible tool for assessing functional capacity and exercise tolerance in patients with heart failure.
Baseline and 6 months after intervention start

Misure di risultato secondarie

Misura del risultato
Misura Descrizione
Lasso di tempo
NYHA Functional Class
Lasso di tempo: Baseline and 6 months after intervention start
Heart failure severity classified according to the New York Heart Association (NYHA) functional classification system.
Baseline and 6 months after intervention start
Glycated Hemoglobin (HbA1c)
Lasso di tempo: Baseline, end of month 2, end of month 4, and end of month 6
Measured using standard biochemical assay kit.
Baseline, end of month 2, end of month 4, and end of month 6
Fasting Blood Glucose
Lasso di tempo: Baseline, end of month 2, end of month 4, and end of month 6
Venous blood sample collected after at least 8 hours of fasting; fasting glucose measured using standard enzymatic glucose oxidase laboratory kit.
Baseline, end of month 2, end of month 4, and end of month 6
Body Mass Index (BMI)
Lasso di tempo: Baseline and 6 months after intervention start
Calculated as weight in kilograms divided by height in meters squared, using standardized stadiometer and scale.
Baseline and 6 months after intervention start
Quality of Life (QoL)
Lasso di tempo: Baseline and 6 months after intervention start
Assessed using the Kansas City Cardiomyopathy Questionnaire (KCCQ) score.
Baseline and 6 months after intervention start
Systolic Blood Pressure
Lasso di tempo: Baseline, end of month 2, end of month 4, and end of month 6
Measured using a calibrated automatic blood pressure device after at least 5 minutes of rest in a seated position.
Baseline, end of month 2, end of month 4, and end of month 6
Serum Amylase
Lasso di tempo: Baseline, end of month 2, end of month 4, and end of month 6
Venous blood sample; serum amylase measured using standard colorimetric enzymatic laboratory kit.
Baseline, end of month 2, end of month 4, and end of month 6
Alanine Aminotransferase (ALT)
Lasso di tempo: Baseline, end of month 2, end of month 4, and end of month 6
Venous blood sample; serum ALT measured using standard enzymatic spectrophotometric laboratory kit.
Baseline, end of month 2, end of month 4, and end of month 6
N-terminal Pro B-type Natriuretic Peptide (NT-proBNP)
Lasso di tempo: Baseline, end of month 2, end of month 4, and end of month 6
Measured using human NT-proBNP ELISA kit.
Baseline, end of month 2, end of month 4, and end of month 6
Total Cholesterol
Lasso di tempo: Baseline, end of month 2, end of month 4, and end of month 6
Venous blood sample collected after at least 8 hours of fasting; total cholesterol measured using standard colorimetric enzymatic laboratory kit.
Baseline, end of month 2, end of month 4, and end of month 6
Ejection Fraction
Lasso di tempo: Baseline, end of month 2, end of month 4, and end of month 6
Assessed by echocardiography.
Baseline, end of month 2, end of month 4, and end of month 6
Number of Participants With Gallbladder Problems
Lasso di tempo: Baseline, end of month 2, end of month 4, and end of month 6
Gallbladder problems (gallstones or cholecystitis) confirmed by abdominal ultrasound.
Baseline, end of month 2, end of month 4, and end of month 6
Number of Participants With Hypoglycemia
Lasso di tempo: Baseline, end of month 2, end of month 4, and end of month 6
Hypoglycemia, defined as blood glucose below 70 mg/dL, measured using standard enzymatic glucose oxidase laboratory kit.
Baseline, end of month 2, end of month 4, and end of month 6
Number of Participants With Injection Site Reactions
Lasso di tempo: Baseline, end of month 2, end of month 4, and end of month 6
Injection site reactions (including redness, swelling, itching, or pain at the injection site) assessed by physical examination.
Baseline, end of month 2, end of month 4, and end of month 6
Number of Participants With Gastrointestinal Adverse Events
Lasso di tempo: Baseline, end of month 2, end of month 4, and end of month 6
Gastrointestinal adverse events (including nausea, vomiting, diarrhea, constipation, or abdominal pain) graded according to the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0, and assessed through participant interview and monitoring form.
Baseline, end of month 2, end of month 4, and end of month 6
Number of Participants With Pancreatitis
Lasso di tempo: Baseline, end of month 2, end of month 4, and end of month 6
Pancreatitis diagnosed according to the revised Atlanta classification criteria, requiring at least two of the following: characteristic abdominal pain, serum amylase or lipase greater than three times the upper limit of normal, or characteristic findings on abdominal imaging.
Baseline, end of month 2, end of month 4, and end of month 6
Number of Participants With Tachycardia
Lasso di tempo: Baseline, end of month 2, end of month 4, and end of month 6
Tachycardia, defined as a resting heart rate greater than 100 beats per minute measured by pulse oximetry or ECG monitoring at scheduled study visits.
Baseline, end of month 2, end of month 4, and end of month 6
Diastolic Blood Pressure
Lasso di tempo: Baseline, end of month 2, end of month 4, and end of month 6
Measured using a calibrated automatic blood pressure device after at least 5 minutes of rest in a seated position.
Baseline, end of month 2, end of month 4, and end of month 6
Serum Lipase
Lasso di tempo: Baseline, end of month 2, end of month 4, and end of month 6
Venous blood sample; serum lipase measured using standard colorimetric enzymatic laboratory kit.
Baseline, end of month 2, end of month 4, and end of month 6
Aspartate Aminotransferase (AST)
Lasso di tempo: Baseline, end of month 2, end of month 4, and end of month 6
Venous blood sample; serum AST measured using standard enzymatic spectrophotometric laboratory kit.
Baseline, end of month 2, end of month 4, and end of month 6
Alkaline Phosphatase
Lasso di tempo: Baseline, end of month 2, end of month 4, and end of month 6
Venous blood sample; serum alkaline phosphatase measured using standard enzymatic spectrophotometric laboratory kit.
Baseline, end of month 2, end of month 4, and end of month 6
Low-Density Lipoprotein (LDL)
Lasso di tempo: Baseline, end of month 2, end of month 4, and end of month 6
Venous blood sample collected after at least 8 hours of fasting; serum LDL measured using standard colorimetric enzymatic laboratory kit.
Baseline, end of month 2, end of month 4, and end of month 6
High-Density Lipoprotein (HDL)
Lasso di tempo: Baseline, end of month 2, end of month 4, and end of month 6
Venous blood sample collected after at least 8 hours of fasting; serum HDL measured using standard colorimetric enzymatic laboratory kit.
Baseline, end of month 2, end of month 4, and end of month 6
Triglycerides
Lasso di tempo: Baseline, end of month 2, end of month 4, and end of month 6
Venous blood sample collected after at least 8 hours of fasting; serum triglycerides measured using standard colorimetric enzymatic laboratory kit at the central laboratory.
Baseline, end of month 2, end of month 4, and end of month 6
Pulmonary Artery Pressure
Lasso di tempo: Baseline, end of month 2, end of month 4, and end of month 6
Assessed by echocardiography.
Baseline, end of month 2, end of month 4, and end of month 6

Altre misure di risultato

Misura del risultato
Misura Descrizione
Lasso di tempo
Change in Gene Expression of Obesity- and Heart Failure-Related Pathways
Lasso di tempo: Baseline and 6 months after intervention start
Venous blood sampling before the intervention and at the end of the study, extraction of ribonucleic acid from peripheral blood samples, and assessment of changes in the expression of genes involved in the shared molecular pathways of obesity and Heart Failure with Reduced Ejection Fraction using quantitative real-time polymerase chain reaction (PCR).
Baseline and 6 months after intervention start

Collaboratori e investigatori

Qui è dove troverai le persone e le organizzazioni coinvolte in questo studio.

Sponsor

Collaboratori

Pubblicazioni e link utili

La persona responsabile dell'inserimento delle informazioni sullo studio fornisce volontariamente queste pubblicazioni. Questi possono riguardare qualsiasi cosa relativa allo studio.

Pubblicazioni generali

Studiare le date dei record

Queste date tengono traccia dell'avanzamento della registrazione dello studio e dell'invio dei risultati di sintesi a ClinicalTrials.gov. I record degli studi e i risultati riportati vengono esaminati dalla National Library of Medicine (NLM) per assicurarsi che soddisfino specifici standard di controllo della qualità prima di essere pubblicati sul sito Web pubblico.

Studia le date principali

Inizio studio (Stimato)

18 luglio 2026

Completamento primario (Stimato)

11 giugno 2027

Completamento dello studio (Stimato)

22 dicembre 2027

Date di iscrizione allo studio

Primo inviato

27 luglio 2026

Primo inviato che soddisfa i criteri di controllo qualità

30 luglio 2026

Primo Inserito (Effettivo)

31 luglio 2026

Aggiornamenti dei record di studio

Ultimo aggiornamento pubblicato (Effettivo)

3 agosto 2026

Ultimo aggiornamento inviato che soddisfa i criteri QC

30 luglio 2026

Ultimo verificato

1 luglio 2026

Maggiori informazioni

Termini relativi a questo studio

Informazioni su farmaci e dispositivi, documenti di studio

Studia un prodotto farmaceutico regolamentato dalla FDA degli Stati Uniti

Sì

Studia un dispositivo regolamentato dalla FDA degli Stati Uniti

No

prodotto fabbricato ed esportato dagli Stati Uniti

Sì

Queste informazioni sono state recuperate direttamente dal sito web clinicaltrials.gov senza alcuna modifica. In caso di richieste di modifica, rimozione o aggiornamento dei dettagli dello studio, contattare register@clinicaltrials.gov. Non appena verrà implementata una modifica su clinicaltrials.gov, questa verrà aggiornata automaticamente anche sul nostro sito web .