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Furosemide Pharmacodynamics and Pharmacokinetics After Subcutaneous or Oral Administration (FUROPHARM-HF)

Primary Purpose

Heart Failure

Status
Completed
Phase
Phase 1
Locations
Netherlands
Study Type
Interventional
Intervention
Furosemide injection solution for subcutaneous administration (80 mg)
Oral Furosemide tablets (80 mg)
Sponsored by
scPharmaceuticals, Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Heart Failure focused on measuring Chronic Fluid Overload

Eligibility Criteria

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

Inclusion Criteria:

  • Written informed consent obtained before any assessment is performed
  • Male and female subjects ≥18 years of age, with body weight <120 kg and body mass index (BMI) <30 kg/m2
  • Female subjects must be at least 2 years post-menopausal
  • Participant must have been on oral furosemide (40 mg oid or bid) or therapeutic equivalent (bumetanide 1 mg oid or bid) for a period 90 days before the first dose of study medication
  • History of chronic heart failure according to 2012 ESC guidelines with presence of moderate symptoms of chronic fluid overload. Chronic fluid overload is defined as presence of stable signs and symptoms of heart failure and congestion, like dyspnea at mild exertion or minimal exertion, pulmonary congestion and/or peripheral edema at the time of presentation in combination with elevated levels on natriuretic peptides (NT-proBNP > 300 ng/L)
  • In the opinion of the investigator, able to participate in the study

Exclusion Criteria:

  • Acute Decompensated Heart Failure (ADHF) or recent history of ADHF or significant worsening in their HF symptoms (within prior 2 weeks)
  • Contraindication to furosemide
  • Systolic BP (SBP) < 90 mm Hg
  • Temperature > 38°C (oral or equivalent) or sepsis or active infection requiring i.v. anti-microbial treatment
  • Serum sodium < 130 mmol/L and Serum potassium < 3.0 mmol/L
  • Current or planned (throughout the completion of study drug infusion) treatment with any i.v. therapies, including inotropic agents, vasopressors, levosimendan, nesiritide or analogues; or mechanical support (intra-aortic balloon pump, endotracheal intubation, mechanical ventilation, or any ventricular assist device)
  • History of gastric or intestinal surgery that may affect absorption of oral medication
  • Presence or need for urinary catheterization
  • Current or planned ultrafiltration, hemofiltration, or dialysis
  • Impaired renal function defined as an estimated glomerular filtration rate (eGFR) on admission < 30 mL/min/1.73 m2 will be calculated as per standard at local laboratory
  • Administration of intravenous radiographic contrast agent within 72 hours prior to screening or acute contrast-induced nephropathy at the time of screening
  • Major surgery within 30 days prior to screening
  • Administration of an investigational drug or implantation of investigational device, or participation in another trial, within 30 days before screening
  • Inability to follow instructions or comply with procedures
  • Any surgical or medical condition which in the opinion of the investigator may interfere with participation in the study or which may affect the outcome of the study

Sites / Locations

  • University Medical Center Groningen

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Group 1

Group 2

Arm Description

Furosemide injection solution for subcutaneous administration (80 mg) over 5 hours followed by Oral Furosemide tablets (80 mg) in second period.

Oral Furosemide tablets (80 mg) followed by Furosemide injection solution for subcutaneous administration (80 mg) over 5 hours in second period.

Outcomes

Primary Outcome Measures

Diuresis and natriuresis
Statistical summaries with a graphical presentation will show mean and individual diuresis and natriuresis time profiles such as time to first void, volume of first void, diuresis and natriuresis measured at 60 minute intervals up to 480 minutes following furosemide injection solution for subcutaneous administration or oral tablets. The diuretic response will be compared between therapies using t-tests or Wilcoxon test.

Secondary Outcome Measures

Body Water Content
The correlation (Pearson coefficient) between bioimpedance (body water content) and diuresis will be investigated including bioimpedance measurement of fluid overload as a predictor diuretic response.
Pharmacokinetic profiles
A graphical presentation showing mean and individual plasma furosemide concentration-time profiles for comparison between subcutaneous or oral administration. Plasma furosemide concentration-time data will be analyzed using a non-compartmental method and population PK approach (non-linear mixed-effect model). Furosemide concentrations will be summarized using descriptive statistics (including N, mean, standard deviation (SD), coefficient of variation (CV%), median, minimum and maximum) for each treatment.
Cardiac Markers (NTpro-BNP, hs-Trop T, galectin-3)
Correlation methods to investigate interaction between cardiac makers (NTpro-BNP, hs-Trop T, galectin-3) and pharmacodynamic parameters (diuresis and natriuresis).
Dypsnea Scores on Visual Analog Scale and Likert Scale
Dyspnea score (Dyspnea Visual Analog Scale and Likert Scale), the New York Heart Association (NYHA) Functional Classification and thirst distress and grading assessments by subjects in response to subcutaneous or oral administration.
Injection site reaction on Draize Scale and Visual Analog Pain Scale
Visual inspection of injection site, 5-point Draize Scale and Visual Analog pain assessment recorded during subcutaneous administration.

Full Information

First Posted
December 9, 2014
Last Updated
June 25, 2018
Sponsor
scPharmaceuticals, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT02350725
Brief Title
Furosemide Pharmacodynamics and Pharmacokinetics After Subcutaneous or Oral Administration
Acronym
FUROPHARM-HF
Official Title
A Single Center, Randomized, Open-label, Cross-over Exploratory Study to Evaluate the Pharmacodynamic and Pharmacokinetic Response to a Subcutaneous Administration or Oral Administration of Furosemide in Subjects With Heart Failure Presenting With Chronic Fluid Overload
Study Type
Interventional

2. Study Status

Record Verification Date
December 2014
Overall Recruitment Status
Completed
Study Start Date
December 2014 (undefined)
Primary Completion Date
June 2015 (Actual)
Study Completion Date
June 2015 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
scPharmaceuticals, Inc.

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The purpose of this pilot study is to investigate the pharmacodynamic and pharmacokinetic parameters of a novel furosemide formulation administered subcutaneously as compared to oral furosemide.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Heart Failure
Keywords
Chronic Fluid Overload

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Crossover Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
10 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Group 1
Arm Type
Experimental
Arm Description
Furosemide injection solution for subcutaneous administration (80 mg) over 5 hours followed by Oral Furosemide tablets (80 mg) in second period.
Arm Title
Group 2
Arm Type
Experimental
Arm Description
Oral Furosemide tablets (80 mg) followed by Furosemide injection solution for subcutaneous administration (80 mg) over 5 hours in second period.
Intervention Type
Drug
Intervention Name(s)
Furosemide injection solution for subcutaneous administration (80 mg)
Intervention Type
Drug
Intervention Name(s)
Oral Furosemide tablets (80 mg)
Primary Outcome Measure Information:
Title
Diuresis and natriuresis
Description
Statistical summaries with a graphical presentation will show mean and individual diuresis and natriuresis time profiles such as time to first void, volume of first void, diuresis and natriuresis measured at 60 minute intervals up to 480 minutes following furosemide injection solution for subcutaneous administration or oral tablets. The diuretic response will be compared between therapies using t-tests or Wilcoxon test.
Time Frame
8 hours
Secondary Outcome Measure Information:
Title
Body Water Content
Description
The correlation (Pearson coefficient) between bioimpedance (body water content) and diuresis will be investigated including bioimpedance measurement of fluid overload as a predictor diuretic response.
Time Frame
8 hours
Title
Pharmacokinetic profiles
Description
A graphical presentation showing mean and individual plasma furosemide concentration-time profiles for comparison between subcutaneous or oral administration. Plasma furosemide concentration-time data will be analyzed using a non-compartmental method and population PK approach (non-linear mixed-effect model). Furosemide concentrations will be summarized using descriptive statistics (including N, mean, standard deviation (SD), coefficient of variation (CV%), median, minimum and maximum) for each treatment.
Time Frame
8 hours
Title
Cardiac Markers (NTpro-BNP, hs-Trop T, galectin-3)
Description
Correlation methods to investigate interaction between cardiac makers (NTpro-BNP, hs-Trop T, galectin-3) and pharmacodynamic parameters (diuresis and natriuresis).
Time Frame
8 hours
Title
Dypsnea Scores on Visual Analog Scale and Likert Scale
Description
Dyspnea score (Dyspnea Visual Analog Scale and Likert Scale), the New York Heart Association (NYHA) Functional Classification and thirst distress and grading assessments by subjects in response to subcutaneous or oral administration.
Time Frame
8 hours
Title
Injection site reaction on Draize Scale and Visual Analog Pain Scale
Description
Visual inspection of injection site, 5-point Draize Scale and Visual Analog pain assessment recorded during subcutaneous administration.
Time Frame
8 hours

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Written informed consent obtained before any assessment is performed Male and female subjects ≥18 years of age, with body weight <120 kg and body mass index (BMI) <30 kg/m2 Female subjects must be at least 2 years post-menopausal Participant must have been on oral furosemide (40 mg oid or bid) or therapeutic equivalent (bumetanide 1 mg oid or bid) for a period 90 days before the first dose of study medication History of chronic heart failure according to 2012 ESC guidelines with presence of moderate symptoms of chronic fluid overload. Chronic fluid overload is defined as presence of stable signs and symptoms of heart failure and congestion, like dyspnea at mild exertion or minimal exertion, pulmonary congestion and/or peripheral edema at the time of presentation in combination with elevated levels on natriuretic peptides (NT-proBNP > 300 ng/L) In the opinion of the investigator, able to participate in the study Exclusion Criteria: Acute Decompensated Heart Failure (ADHF) or recent history of ADHF or significant worsening in their HF symptoms (within prior 2 weeks) Contraindication to furosemide Systolic BP (SBP) < 90 mm Hg Temperature > 38°C (oral or equivalent) or sepsis or active infection requiring i.v. anti-microbial treatment Serum sodium < 130 mmol/L and Serum potassium < 3.0 mmol/L Current or planned (throughout the completion of study drug infusion) treatment with any i.v. therapies, including inotropic agents, vasopressors, levosimendan, nesiritide or analogues; or mechanical support (intra-aortic balloon pump, endotracheal intubation, mechanical ventilation, or any ventricular assist device) History of gastric or intestinal surgery that may affect absorption of oral medication Presence or need for urinary catheterization Current or planned ultrafiltration, hemofiltration, or dialysis Impaired renal function defined as an estimated glomerular filtration rate (eGFR) on admission < 30 mL/min/1.73 m2 will be calculated as per standard at local laboratory Administration of intravenous radiographic contrast agent within 72 hours prior to screening or acute contrast-induced nephropathy at the time of screening Major surgery within 30 days prior to screening Administration of an investigational drug or implantation of investigational device, or participation in another trial, within 30 days before screening Inability to follow instructions or comply with procedures Any surgical or medical condition which in the opinion of the investigator may interfere with participation in the study or which may affect the outcome of the study
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Rudolf A. de Boer, MD, PhD
Organizational Affiliation
University Medical Center Groningen
Official's Role
Principal Investigator
Facility Information:
Facility Name
University Medical Center Groningen
City
Groningen
Country
Netherlands

12. IPD Sharing Statement

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Furosemide Pharmacodynamics and Pharmacokinetics After Subcutaneous or Oral Administration

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