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- Klinische proef NCT05569772
Semaglutide voor de behandeling van glucose-intolerantie bij vrouwen met eerdere zwangerschapsdiabetes (SERENA)
Semaglutide voor de behandeling van glucose-intolerantie bij vrouwen met eerdere zwangerschapsdiabetes: een dubbelblinde RCT
Studie Overzicht
Toestand
Interventie / Behandeling
Gedetailleerde beschrijving
Patiëntenpopulatie: Vrouwen met een recente voorgeschiedenis van zwangerschapsdiabetes (GDM) en aanhoudende glucose-intolerantie in het vroege postpartum vormen een bijzonder risicogroep: ongeveer 50% ontwikkelt diabetes type 2 (T2DM) binnen 5 jaar na de bevalling. Semaglutide is een langwerkende glucagonachtige peptide-1 (GLP-1)-agonist met meerdere gunstige metabole effecten, waaronder een glucoseverlagend effect, gewichtsverlies en cardiovasculaire beschermende effecten. Onze hypothese is dat bij vrouwen met eerdere GDM en glucose-intolerantie in de vroege postpartumbehandeling met semaglutide het risico op het ontwikkelen van T2DM op de lange termijn zal verminderen in vergelijking met placebo.
Interventie en vergelijking: Belgische multicentrische dubbelblinde RCT met 12 centra om semaglutide (eenmaal per week) te vergelijken met placebo bij vrouwen met een recente geschiedenis van GDM en glucose-intolerantie [verminderde nuchtere glycemie (IFG) en/of verminderde glucosetolerantie (IGT) ] 6-24 weken na de bevalling. Deelnemers worden 1/1 gerandomiseerd naar semaglutide of placebo op basis van leefstijlmaatregelen. Semaglutide wordt gedurende een periode van 8 weken verhoogd naar 1 mg/week. De deelnemers worden gedurende 3 jaar gevolgd. Deelnemers krijgen 3 maanden na het stoppen van de interventie een orale glucosetolerantietest (OGTT) van 75 g. Randomisatie zal worden gestratificeerd volgens BMI tijdens het vroege postpartumbezoek (
Resultaten: Het primaire eindpunt is de ontwikkeling van T2DM gedefinieerd door OGTT en/of HbA1c. Belangrijke secundaire eindpunten zijn onder meer de behoefte aan reddingstherapie voor diabetes, regressie naar normoglykemie, gewichtsverlies, bètacelfunctie, insulineresistentie en het metabool syndroom. Om een power van 80% te bereiken, plannen we een steekproefomvang van 206 om een geschatte vermindering van 50% van het risico op het ontwikkelen van T2DM tussen beide groepen te detecteren, uitgaande van een verlies voor follow-up van 30% tijdens het onderzoek.
Studietype
Inschrijving (Geschat)
Fase
- Fase 3
Contacten en locaties
Studiecontact
- Naam: Katrien Benhalima, MD PhD
- Telefoonnummer: 32 16340614
- E-mail: katrien.benhalima@uzleuven.be
Studie Locaties
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Aalst, België
- Werving
- AZORG
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Contact:
- Katrien Wierckx
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Antwerp, België
- Werving
- UZA
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Contact:
- Niels Bochanen
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Antwerp, België
- Werving
- ZAS
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Contact:
- Ann Verhaegen
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Bruges, België
- Werving
- AZ St Jan Brugge
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Contact:
- Sara Vandewalle, MD
- Telefoonnummer: 003250 45 23 3
- E-mail: SARA.VANDEWALLE@azsintjan.be
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Brussels, België
- Werving
- UZ Brussel
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Contact:
- Nancy Van Wilder
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Brussels, België
- Werving
- Erasme
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Contact:
- Maria Lytrivi
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Ieper, België
- Werving
- Jan Yperman
-
Contact:
- An Nollet, MD
- Telefoonnummer: 003257 35 72 70
- E-mail: an.nollet@yperman.net
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Kortrijk, België
- Werving
- AZ Groeninge Kortrijk
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Contact:
- Gertjan Vereecke
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Leuven, België
- Werving
- UZ Leuven
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Contact:
- Katrien Benhalima
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Liège, België
- Werving
- CHU de Liege
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Contact:
- JC Philips
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Mouscron, België
- Werving
- Centre Hospitalier Mouscron
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Contact:
- Philippe Oriot
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Sint-Niklaas, België
- Werving
- Vitaz
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Contact:
- Peter Coremans
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Turnhout, België
- Werving
- AZ Turnhout
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Contact:
- Joke Cuypers, MD
- Telefoonnummer: 003214 44 44 32
- E-mail: joke.cuypers@azturnhout.be
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Deelname Criteria
Geschiktheidscriteria
Leeftijden die in aanmerking komen voor studie
Accepteert gezonde vrijwilligers
Beschrijving
Inclusiecriteria:
- Vrijwillige schriftelijke geïnformeerde toestemming van de deelnemer is verkregen voorafgaand aan eventuele screeningprocedures
- Gebruik van zeer effectieve anticonceptiemethoden
- Geschiedenis van GDM (gediagnosticeerd met 2013 WHO-criteria 24-32 weken zwangerschap) en glucose-intolerantie 6-24 weken postpartum (gebaseerd op de ADA-criteria)
- Moet Nederlands, Frans of Engels kunnen verstaan en spreken
Uitsluitingscriteria:
- 1. Deelnemer heeft een voorgeschiedenis van elk type diabetes of auto-antilichamen voor type 1 diabetes, voorgeschiedenis van pancreatitis, familie- of persoonlijke voorgeschiedenis van medullair schildkliercarcinoom of multipel endocrien neoplasiesyndroom type 2, ernstige psychiatrische stoornis in het afgelopen jaar, hartfalen NYHA klasse 4, nierziekte in het eindstadium (eGFR
Studie plan
Hoe is de studie opgezet?
Ontwerpdetails
- Primair doel: Preventie
- Toewijzing: Gerandomiseerd
- Interventioneel model: Parallelle opdracht
- Masker: Verdrievoudigen
Wapens en interventies
Deelnemersgroep / Arm |
Interventie / Behandeling |
|---|---|
|
Actieve vergelijker: semaglutide
semaglutide s.c. eenmaal per week, optitratie over een periode van 2 maanden tot 1 mg/week (0,25 mg eenmaal per week, na 4 weken 0,5 mg eenmaal per week en na 8 weken de onderhoudsdosis van 1 mg eenmaal per week), behandelingsduur van max. 3 jaar
|
onderhoudsdosis van 1 mg SC eenmaal per week
Andere namen:
|
|
Placebo-vergelijker: placebo
placebo s.c. eenmaal per week, hetzelfde doseringsschema, met bijpassende injecties, behandelingsduur van max. 3 jaar
|
onderhoudsdosis van 1 mg SC eenmaal per week
|
Wat meet het onderzoek?
Primaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
|---|---|---|
|
Development of T2DM
Tijdsspanne: by 160 weeks
|
Defined by FPG, OGTT, and/or HbA1c according to the ADA criteria
|
by 160 weeks
|
Secundaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
|---|---|---|
|
Need for glucose-lowering (rescue) therapy
Tijdsspanne: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
Percentage need for rescue therapy for diabetes
|
Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
|
Frequency of prediabetes based on FPG, OGTT, and/or HbA1c
Tijdsspanne: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
Percentage of prediabetes based on FPG, OGTT, and/or HbA1c
|
Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
|
Regression to normoglycaemia
Tijdsspanne: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
Percentage regression to normoglycaemia, based on fasting glycaemia, oral glucose tolerance test and/or HbA1c (ADA criteria)
|
Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
|
Change in body weight
Tijdsspanne: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
Change in body weight (kg)
|
Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
|
BMI
Tijdsspanne: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
Mean BMI (Kg/m2)
|
Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
|
Waist circumference
Tijdsspanne: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
Mean waist circumference (cm)
|
Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
|
Waist-to-hip ratio
Tijdsspanne: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
Waist/hip circumference ratio
|
Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
|
Proportion of participants achieving ≥5% weight loss
Tijdsspanne: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
Percentage weight loss ≥5%
|
Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
|
Proportion of participants achieving ≥10% weight loss
Tijdsspanne: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
Percentage weight loss ≥10%
|
Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
|
Proportion of participants achieving ≥15% weight loss
Tijdsspanne: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
Percentage weight loss ≥15%
|
Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
|
Body fat percentage assessed by bioelectrical impedance analysis (Bodystat 1500®)
Tijdsspanne: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
Percentage body fat measured by bioelectrical impedance analysis
|
Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
|
β-cell function, assessed by HOMA-B
Tijdsspanne: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
Beta-cell function measured by the HOMA-B index
|
Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
|
Insulinogenic index divided by HOMA-IR
Tijdsspanne: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
Beta-cell function measured by the by the insulinogenic index divided by HOMA-insulin resistance index
|
Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
|
Insulin secretion-sensitivity index-2
Tijdsspanne: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
Beta-cell function measured by theby the insulin-secretion sensitivity-2 index
|
Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
|
Stumvoll index
Tijdsspanne: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
Beta-cell function measured by the Stumvoll index
|
Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
|
Insulin sensitivity, assessed by the Matsuda index (reflecting whole body insulin sensitivity)
Tijdsspanne: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
Whole body Insulin sensitivity measured by the insulin sensitivity index of Matsuda
|
Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
|
1/HOMA-IR, reflecting primarily hepatic insulin sensitivity
Tijdsspanne: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
The reciprocal of the homeostasis model assessment of insulin resistance (1/HOMA-IR)
|
Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
|
Prevalence of the metabolic syndrome
Tijdsspanne: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
Percentage of the metabolic syndrome based on the WHO criteria
|
Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
|
Blood pressure (blood pressure ≥140/90 mmHg)
Tijdsspanne: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
Percentage blood pressure ≥140/90mmHg
|
Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
|
Heart rate
Tijdsspanne: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
Mean heart rate
|
Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
|
Lipid profile, including low density lipoprotein-cholesterol (LDL-cholesterol, ≥100 mg/dL or ≥2,6 mmol/L)
Tijdsspanne: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
Percentage LDL cholesterol ≥100mg/dl or ≥2,6 mmol/L
|
Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
|
Lipid profile, including triglycerides (≥150 mg/dL or ≥1,7 mmol/L)
Tijdsspanne: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
Percentage triglycerides ≥150mg/dl or ≥1,7 mmol/L
|
Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
|
Health-related quality of life assessed by SF-36
Tijdsspanne: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
Health-related quality of life assessed using the 36-Item Short Form Health Survey (SF-36).
Scores range from 0 to 100, with higher scores indicating better health-related quality of life
|
Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
|
Health-related quality of life assessed by EQ-5D-5L
Tijdsspanne: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
Health-related quality of life assessed using the EuroQol 5-Dimension 5-Level (EQ-5D-5L) Visual Analogue Scale (EQ VAS).
Scores range from 0 to 100, with higher scores indicating better perceived health status
|
Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
|
Symptoms of depression (CES-D)
Tijdsspanne: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
Depressive symptoms assessed using the 20-item Center for Epidemiologic Studies Depression Scale (CES-D).
Total scores range from 0 to 60, with higher scores indicating more depressive symptoms
|
Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
|
Symptoms of anxiety (short-form STAI)
Tijdsspanne: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
Symptoms of anxiety assessed using the 6-item short-form State-Trait Anxiety Inventory (STAI).
Total scores range from 20 to 80 after score transformation, with higher scores indicating greater anxiety symptoms
|
Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
|
Treatment satisfaction assessed using a study-specific questionnaire based on the Diabetes Treatment Satisfaction Questionnaire
Tijdsspanne: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
Diabetes risk perception assessed using the Diabetes Risk Perception Questionnaire, a validated questionnaire that evaluates perceived risk of developing diabetes
|
Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
|
Sleep quality (Pittsburgh Sleep Quality Index)
Tijdsspanne: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
Sleep quality assessed using the validated Pittsburgh Sleep Quality Index (PSQI)
|
Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
|
Food security (short-form HFSSM)
Tijdsspanne: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
Food security assessed using the short-form Household Food Security Survey Module (HFSSM).
Scores indicate the level of food security, with higher scores reflecting greater food insecurity
|
Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
|
Plasma metabolite concentrations
Tijdsspanne: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
Changes in and associations of metabolomic profiles, with cardiometabolic risk and treatment response.
Assessed using metabolomic profiling.
Blood samples will be collected at baseline and every 6 months during a 3.5-year follow-up period (study visits).
|
Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
|
Quality-adjusted life years (QALYs)
Tijdsspanne: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
Quality-adjusted life years (QALYs), calculated as the area under the curve of health-related quality of life utility values over time, where higher values indicate better health outcomes
|
Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
|
Incremental costs and incremental cost-effectiveness ratio (ICER) of semaglutide compared with placebo
Tijdsspanne: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
Incremental costs and incremental cost-effectiveness ratio (ICER) of semaglutide versus placebo
|
Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
|
Incremental healthcare costs
Tijdsspanne: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
Incremental healthcare costs associated with the intervention compared with control, calculated from collected healthcare resource utilization and unit cost data.
Currency (e.g., EUR per participant)
|
Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
Medewerkers en onderzoekers
Medewerkers
Publicaties en nuttige links
Studie record data
Bestudeer belangrijke data
Studie start (Werkelijk)
Primaire voltooiing (Geschat)
Studie voltooiing (Geschat)
Studieregistratiedata
Eerst ingediend
Eerst ingediend dat voldeed aan de QC-criteria
Eerst geplaatst (Werkelijk)
Updates van studierecords
Laatste update geplaatst (Werkelijk)
Laatste update ingediend die voldeed aan QC-criteria
Laatst geverifieerd
Meer informatie
Termen gerelateerd aan deze studie
Trefwoorden
Aanvullende relevante MeSH-voorwaarden
- Urogenitale ziekten
- Endocriene systeemziekten
- Vrouwelijke urogenitale ziekten en zwangerschapscomplicaties
- Metabole ziekten
- Zwangerschap Complicaties
- Glucosemetabolismestoornissen
- Suikerziekte
- Voedings- en stofwisselingsziekten
- Diabetes, zwangerschap
- Diabetes mellitus, type 2
- Glucagon-achtige peptide-1-receptoragonisten
- Fysiologische effecten van medicijnen
- Hypoglycemische middelen
- semaglutide
Andere studie-ID-nummers
- S66967
- 2022-502082-22-00 (Andere identificatie: EU CT number)
Plan Individuele Deelnemersgegevens (IPD)
Bent u van plan om gegevens van individuele deelnemers (IPD) te delen?
Beschrijving IPD-plan
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