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The Effect of Liraglutide on the Treatment of Coronary Artery Disease and Type 2 Diabetes (AddHope2)

Primary Purpose

Coronary Artery Disease, Diabetes Mellitus, Type 2

Status
Completed
Phase
Phase 4
Locations
Denmark
Study Type
Interventional
Intervention
Liraglutide
Placebo
Sponsored by
Haugaard, Steen Bendix, M.D., DMSc
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Coronary Artery Disease focused on measuring Coronary Artery Disease, Diabetes Mellitus, Left ventricular ejection fraction, Beta-cell function

Eligibility Criteria

18 Years - 85 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Stable CAD documented by one of the following:

    • Previous MI (a minimum of 6 weeks after an acute MI)
    • Previous coronary revascularization
    • CAD confirmed by an abnormal coronary angiography (CAG) or CT-angiography showing stenosis > 50% of any major coronary arteries.
  2. Body mass index (BMI) >/= 25,0 kg/m2
  3. Age >/= 18 years and </= 85 years
  4. Type 2 diabetes diagnosed by one of the following criteria:

    • HbA1c >/= 6.5%
    • HbA1c < 6.5 % and fasting plasma glucose >/= 7.0 mmol/l (confirmed)
    • HbA1c < 6.5 % and a 2 h plasma glucose value during OGTT >/= 11.1 mmol/l

The data for glucose metabolism are accepted provided that they have been obtained within 24 months prior to inclusion of the patient. The glucose metabolic categories are defined by ADA and WHO criteria.

Exclusion Criteria:

  • Type 1 diabetes mellitus defined as C-peptide < 450 pM
  • Previously diagnosed diabetes mellitus for more than 24 months prior to the screening procedure for this trial, except from gestational diabetes
  • Use of more than 2 types of oral antidiabetic medication and/or use of parenteral antidiabetic medication in the period of 3 months prior to the screening visit. It is accepted that the patient continues his usual antidiabetic medication after the screening visit but antidiabetic medication must be discontinued 2 weeks prior to the baseline visit.
  • Significant heart disease (NYHA > 2; Ejection Fraction < 40% and unstable angina pectoris) and known severe valve disease
  • Documented atrial fibrillation or atrial flutter within 6 weeks previous to the screening. Paroxysmal atrial fibrillation is accepted if sinus rhythm is achieved at the screening.
  • Uncontrolled arterial hypertension (> 180/100 mmHg) at the time of screening
  • Liver (transaminases greater than x 2 the upper normal level) or renal diseases (eGFR < 60 ml/min)
  • Amylase greater than x 3 the upper reference value
  • Any chronic medical condition to unduly increase risk for the potential enrollee as judged by study investigators
  • Dysregulated myxedema or hyperthyroid condition defined by a value of TSH < 0,1 and > 10,0 milli U/L
  • Anemia (< 85% of lower normal limit), leucopenia (< 85% of lower normal limit), or thrombocytopenia (< 85% of lower normal limit)
  • Pregnancy or failure to comply with contraception planning within two years, or breastfeeding
  • Abuse of alcohol or drugs, or any other co-existing condition that would make patients unsuitable to participate in the study, as judged by the investigators
  • Use of immunosuppressive therapy in the preceding 12 months
  • Chronic pancreatitis or previous acute pancreatitis
  • Known or suspected hypersensitivity to trial product(s) or related products
  • Treatment with oral glucocorticoids, calcineurin inhibitors, or dipeptidyl peptidase 4 (DPP4) inhibitors, or other GLP-1 mimetics (e.g. exenatide), which in the Investigator's opinion could interfere with glucose metabolism
  • Cancer (except basal cell skin cancer or squamous cell skin cancer) or any other clinically significant disorder, which in the Investigator's opinion could interfere with the results of the trail
  • Inflammatory bowel disease
  • Previous bowel resection
  • Clinical signs of diabetic gastroparesis
  • Plasma calcium-ion >/= 1,45 mmol/L
  • Plasma calcitonin >/= 50 ng/L
  • Subjects with personal or family history of medullary thyroid carcinoma or a personal history of multiple endocrine neoplasia type 2
  • Refusal to sign informed consent.

Sites / Locations

  • Copenhagen University Hospital, Bispebjerg

Arms of the Study

Arm 1

Arm 2

Arm Type

Placebo Comparator

Active Comparator

Arm Label

Placebo + metformin

Liraglutide + metformin

Arm Description

Outcomes

Primary Outcome Measures

Beta-cell function
Beta-cell function (disposition index) as measured during an intravenous glucose tolerance test (By Bergman Minimal Model)
LVEF
Changes in LVEF assessed by dobutamine stress echocardiography

Secondary Outcome Measures

Glucagon, incretin, glucose, NEFA, insulin and C-peptide response during meal test
Insulin sensitivity (Si), acute insulin and C-peptide response to intravenous glucose (AIRg, ACRg), glucose clearance (Kg), glucose effectiveness (Sg) and hepatic extraction of insulin (HEXi)
Insulin sensitivity (Si), acute insulin and C-peptide response to intravenous glucose (AIRg, ACRg), glucose clearance (Kg), glucose effectiveness (Sg) and hepatic extraction of insulin (HEXi) derived from a standard frequent sampling intravenous glucose tolerance test (FSIGT, Minimal model)
CRP, TNF-alfa and IL-6 in plasma and gene expression of IL6 and TNF-alfa in subcutaneous fat
Non esterified fatty acids (NEFA)
NEFA during FSIGT by use of NEFA minimal model
Heart rate variability (HRV)
HRV i.e. SDNN (standard deviation of all normal RR interval) assessed during HOLTER monitoring
Maximal velocity of the myocardium in systole (s´) and in diastole (e´)
Maximal velocity of the myocardium in systole (s´) and in diastole (e´) during the dobutamine stress test
Changes in exercise tolerance test variables: Total exercise duration (sec), time to limiting angina (sec) and time to 1 mm ST-segment depression (sec)
Changes in exercise tolerance test variables: Total exercise duration (sec), time to limiting angina (sec) and time to 1 mm ST-segment depression (sec)
ST-depression and ectopic activity
ST-depression and ectopic activity assessed during 24h HOLTER monitoring
Diurnal blood pressure
Diastolic heart function (E/E*)
Diastolic heart function (E/E*) in rest and during stress

Full Information

First Posted
May 8, 2012
Last Updated
March 4, 2017
Sponsor
Haugaard, Steen Bendix, M.D., DMSc
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1. Study Identification

Unique Protocol Identification Number
NCT01595789
Brief Title
The Effect of Liraglutide on the Treatment of Coronary Artery Disease and Type 2 Diabetes
Acronym
AddHope2
Official Title
Adding Liraglutide to the Backbone Therapy of Biguanide in Patients With Coronary Artery Disease and Newly Diagnosed Type-2 Diabetes
Study Type
Interventional

2. Study Status

Record Verification Date
March 2017
Overall Recruitment Status
Completed
Study Start Date
May 2012 (undefined)
Primary Completion Date
October 2014 (Actual)
Study Completion Date
July 2015 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Haugaard, Steen Bendix, M.D., DMSc

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to investigate the effect of combined glucagon-like-peptide-1 (GLP-1) analogue and metformin therapy on glucose metabolic and cardiovascular endpoints compared to metformin monotherapy in patients with coronary artery disease (CAD) and newly diagnosed type 2 diabetes (T2D). It is hypothesized that GLP-1 analogue added to backbone therapy of metformin in CAD patients with T2D will improve beta-cell function, left ventricular ejection fraction (LVEF), heart rate variability and lower 24h blood pressure among other selected endpoints. The present study on CAD patients with newly diagnosed T2D will address these selected endpoints during an investigator initiated, randomized, double blind, crossover, placebo-controlled 12 + 12 weeks intervention study with a 2 week wash-out period.
Detailed Description
The total study period for each patient will be 26 weeks (12 plus 12 weeks of intervention with a 2 week wash-out period). The endpoints will be evaluated at baseline (week 0), at week 12, at week 14 (following 2 weeks of wash-out) and finally at week 26.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Coronary Artery Disease, Diabetes Mellitus, Type 2
Keywords
Coronary Artery Disease, Diabetes Mellitus, Left ventricular ejection fraction, Beta-cell function

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Crossover Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
41 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Placebo + metformin
Arm Type
Placebo Comparator
Arm Title
Liraglutide + metformin
Arm Type
Active Comparator
Intervention Type
Drug
Intervention Name(s)
Liraglutide
Other Intervention Name(s)
Brand name: Victoza, Active substance: liraglutide, EMA Product number: EMEA/H/C/001026, ATC Code: A10BX07
Intervention Description
Liraglutide injection pen is administered by the participant once daily by subcutaneous injection. It is given independent of meals. The starting dose is 0.6 mg. After 2 weeks the dose will be increased to 1.2 mg. The dose will be further increased after 4 weeks to 1.8 mg. After a total of 12 weeks of treatment, a wash-out period of 2 weeks follows. Subsequently, the participant will be crossed over to a second period of 12 weeks of treatment with placebo.
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Volume-matched placebo injection pen is administered by the participant once daily by subcutaneous injection. It is given independent of meals. The starting dose is 0.6 mg volume-matched placebo. After 2 weeks the dose will be increased to 1.2 mg. The dose will be further increased after 4 weeks to 1.8 mg. After a total of 12 weeks of treatment, a wash-out period of 2 weeks follows. Subsequently, the participant will be crossed over to a second period of 12 weeks of treatment with liraglutide.
Primary Outcome Measure Information:
Title
Beta-cell function
Description
Beta-cell function (disposition index) as measured during an intravenous glucose tolerance test (By Bergman Minimal Model)
Time Frame
after 12 weeks of intervention
Title
LVEF
Description
Changes in LVEF assessed by dobutamine stress echocardiography
Time Frame
after 12 weeks of intervention
Secondary Outcome Measure Information:
Title
Glucagon, incretin, glucose, NEFA, insulin and C-peptide response during meal test
Time Frame
Baseline (week 0), week 12, week 14, week 26
Title
Insulin sensitivity (Si), acute insulin and C-peptide response to intravenous glucose (AIRg, ACRg), glucose clearance (Kg), glucose effectiveness (Sg) and hepatic extraction of insulin (HEXi)
Description
Insulin sensitivity (Si), acute insulin and C-peptide response to intravenous glucose (AIRg, ACRg), glucose clearance (Kg), glucose effectiveness (Sg) and hepatic extraction of insulin (HEXi) derived from a standard frequent sampling intravenous glucose tolerance test (FSIGT, Minimal model)
Time Frame
Baseline (week 0), week 12, week 14, week 26
Title
CRP, TNF-alfa and IL-6 in plasma and gene expression of IL6 and TNF-alfa in subcutaneous fat
Time Frame
Baseline (week 0), week 12, week 14, week 26
Title
Non esterified fatty acids (NEFA)
Description
NEFA during FSIGT by use of NEFA minimal model
Time Frame
Baseline (week 0), week 12, week 14, week 26
Title
Heart rate variability (HRV)
Description
HRV i.e. SDNN (standard deviation of all normal RR interval) assessed during HOLTER monitoring
Time Frame
Baseline (week 0), week 12, week 14, week 26
Title
Maximal velocity of the myocardium in systole (s´) and in diastole (e´)
Description
Maximal velocity of the myocardium in systole (s´) and in diastole (e´) during the dobutamine stress test
Time Frame
Baseline (week 0), week 12, week 14, week 26
Title
Changes in exercise tolerance test variables: Total exercise duration (sec), time to limiting angina (sec) and time to 1 mm ST-segment depression (sec)
Description
Changes in exercise tolerance test variables: Total exercise duration (sec), time to limiting angina (sec) and time to 1 mm ST-segment depression (sec)
Time Frame
Baseline (week 0), week 12, week 14, week 26
Title
ST-depression and ectopic activity
Description
ST-depression and ectopic activity assessed during 24h HOLTER monitoring
Time Frame
Baseline (week 0), week 12, week 14, week 26
Title
Diurnal blood pressure
Time Frame
Baseline (week 0), week 12, week 14, week 26
Title
Diastolic heart function (E/E*)
Description
Diastolic heart function (E/E*) in rest and during stress
Time Frame
Baseline (week 0), week 12, week 14, week 26

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
85 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Stable CAD documented by one of the following: Previous MI (a minimum of 6 weeks after an acute MI) Previous coronary revascularization CAD confirmed by an abnormal coronary angiography (CAG) or CT-angiography showing stenosis > 50% of any major coronary arteries. Body mass index (BMI) >/= 25,0 kg/m2 Age >/= 18 years and </= 85 years Type 2 diabetes diagnosed by one of the following criteria: HbA1c >/= 6.5% HbA1c < 6.5 % and fasting plasma glucose >/= 7.0 mmol/l (confirmed) HbA1c < 6.5 % and a 2 h plasma glucose value during OGTT >/= 11.1 mmol/l The data for glucose metabolism are accepted provided that they have been obtained within 24 months prior to inclusion of the patient. The glucose metabolic categories are defined by ADA and WHO criteria. Exclusion Criteria: Type 1 diabetes mellitus defined as C-peptide < 450 pM Previously diagnosed diabetes mellitus for more than 24 months prior to the screening procedure for this trial, except from gestational diabetes Use of more than 2 types of oral antidiabetic medication and/or use of parenteral antidiabetic medication in the period of 3 months prior to the screening visit. It is accepted that the patient continues his usual antidiabetic medication after the screening visit but antidiabetic medication must be discontinued 2 weeks prior to the baseline visit. Significant heart disease (NYHA > 2; Ejection Fraction < 40% and unstable angina pectoris) and known severe valve disease Documented atrial fibrillation or atrial flutter within 6 weeks previous to the screening. Paroxysmal atrial fibrillation is accepted if sinus rhythm is achieved at the screening. Uncontrolled arterial hypertension (> 180/100 mmHg) at the time of screening Liver (transaminases greater than x 2 the upper normal level) or renal diseases (eGFR < 60 ml/min) Amylase greater than x 3 the upper reference value Any chronic medical condition to unduly increase risk for the potential enrollee as judged by study investigators Dysregulated myxedema or hyperthyroid condition defined by a value of TSH < 0,1 and > 10,0 milli U/L Anemia (< 85% of lower normal limit), leucopenia (< 85% of lower normal limit), or thrombocytopenia (< 85% of lower normal limit) Pregnancy or failure to comply with contraception planning within two years, or breastfeeding Abuse of alcohol or drugs, or any other co-existing condition that would make patients unsuitable to participate in the study, as judged by the investigators Use of immunosuppressive therapy in the preceding 12 months Chronic pancreatitis or previous acute pancreatitis Known or suspected hypersensitivity to trial product(s) or related products Treatment with oral glucocorticoids, calcineurin inhibitors, or dipeptidyl peptidase 4 (DPP4) inhibitors, or other GLP-1 mimetics (e.g. exenatide), which in the Investigator's opinion could interfere with glucose metabolism Cancer (except basal cell skin cancer or squamous cell skin cancer) or any other clinically significant disorder, which in the Investigator's opinion could interfere with the results of the trail Inflammatory bowel disease Previous bowel resection Clinical signs of diabetic gastroparesis Plasma calcium-ion >/= 1,45 mmol/L Plasma calcitonin >/= 50 ng/L Subjects with personal or family history of medullary thyroid carcinoma or a personal history of multiple endocrine neoplasia type 2 Refusal to sign informed consent.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Steen B Haugaard, M.D., DMSc
Organizational Affiliation
Copenhagen University Hospital, Amager
Official's Role
Study Director
First Name & Middle Initial & Last Name & Degree
Ahmad Sajadieh, M.D., DMSc
Organizational Affiliation
Copenhagen University Hospital Bispebjerg
Official's Role
Principal Investigator
Facility Information:
Facility Name
Copenhagen University Hospital, Bispebjerg
City
Copenhagen
State/Province
Bispebjerg
ZIP/Postal Code
2400
Country
Denmark

12. IPD Sharing Statement

Citations:
PubMed Identifier
33413428
Citation
Kumarathurai P, Sajadieh A, Anholm C, Kristiansen OP, Haugaard SB, Nielsen OW. Effects of liraglutide on diastolic function parameters in patients with type 2 diabetes and coronary artery disease: a randomized crossover study. Cardiovasc Diabetol. 2021 Jan 7;20(1):12. doi: 10.1186/s12933-020-01205-2.
Results Reference
derived
PubMed Identifier
31164926
Citation
Anholm C, Kumarathurai P, Jurs A, Pedersen LR, Nielsen OW, Kristiansen OP, Fenger M, Holst JJ, Madsbad S, Sajadieh A, Haugaard SB. Liraglutide improves the beta-cell function without increasing insulin secretion during a mixed meal in patients, who exhibit well-controlled type 2 diabetes and coronary artery disease. Diabetol Metab Syndr. 2019 May 31;11:42. doi: 10.1186/s13098-019-0438-6. eCollection 2019.
Results Reference
derived
PubMed Identifier
28129251
Citation
Kumarathurai P, Anholm C, Fabricius-Bjerre A, Nielsen OW, Kristiansen O, Madsbad S, Haugaard SB, Sajadieh A. Effects of the glucagon-like peptide-1 receptor agonist liraglutide on 24-h ambulatory blood pressure in patients with type 2 diabetes and stable coronary artery disease: a randomized, double-blind, placebo-controlled, crossover study. J Hypertens. 2017 May;35(5):1070-1078. doi: 10.1097/HJH.0000000000001275.
Results Reference
derived
PubMed Identifier
27797930
Citation
Kumarathurai P, Anholm C, Larsen BS, Olsen RH, Madsbad S, Kristiansen O, Nielsen OW, Haugaard SB, Sajadieh A. Effects of Liraglutide on Heart Rate and Heart Rate Variability: A Randomized, Double-Blind, Placebo-Controlled Crossover Study. Diabetes Care. 2017 Jan;40(1):117-124. doi: 10.2337/dc16-1580. Epub 2016 Oct 19.
Results Reference
derived
PubMed Identifier
27455835
Citation
Kumarathurai P, Anholm C, Nielsen OW, Kristiansen OP, Molvig J, Madsbad S, Haugaard SB, Sajadieh A. Effects of the glucagon-like peptide-1 receptor agonist liraglutide on systolic function in patients with coronary artery disease and type 2 diabetes: a randomized double-blind placebo-controlled crossover study. Cardiovasc Diabetol. 2016 Jul 26;15(1):105. doi: 10.1186/s12933-016-0425-2.
Results Reference
derived
PubMed Identifier
25031198
Citation
Anholm C, Kumarathurai P, Klit MS, Kristiansen OP, Nielsen OW, Ladelund S, Madsbad S, Sajadieh A, Haugaard SB; AddHope2 Trial Study Group. Adding liraglutide to the backbone therapy of biguanide in patients with coronary artery disease and newly diagnosed type-2 diabetes (the AddHope2 study): a randomised controlled study protocol. BMJ Open. 2014 Jul 16;4(7):e005942. doi: 10.1136/bmjopen-2014-005942.
Results Reference
derived

Learn more about this trial

The Effect of Liraglutide on the Treatment of Coronary Artery Disease and Type 2 Diabetes

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