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Treating to Reduce Albuminuria and Normalize Hemodynamic Function in Focal ScLerosis With dApagliflozin Trial Effects (TRANSLATE)

Primary Purpose

Focal Segmental Glomerulosclerosis

Status
Completed
Phase
Phase 4
Locations
Canada
Study Type
Interventional
Intervention
Dapagliflozin
Sponsored by
University Health Network, Toronto
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Focal Segmental Glomerulosclerosis focused on measuring FSGS, SGLT2, chronic kidney disease, GFR, proteinuria

Eligibility Criteria

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

Inclusion Criteria:

  • Male or female subjects diagnosed with FSGS ≥1 month prior to informed consent
  • eGFR≥45 ml/min/1.73m2
  • Age 18 years or greater
  • No history of diabetes
  • Body Mass Index (BMI) 18.5 - 45.0 kg/ m2
  • Blood pressure ≥ 100/60 at screening
  • Stable therapy with either an ACEi or angiotensin II receptor blocker or direct renin inhibitor for > 1 month
  • >30 mg/day and <6 g/day of proteinuria unless the patient is not a candidate for immunosuppressive therapy

Exclusion Criteria:

  • Leukocyte and/or nitrite positive urinalysis that is untreated;
  • History of organ transplantation, cancer, liver disease;
  • Bariatric surgery or other gastrointestinal surgeries that induce chronic malabsorption within the past two years;
  • Current treatment with systemic corticosteroids, calcineurin inhibitors, or other immunosuppressant medications;
  • Blood dyscrasias or any disorders causing hemolysis or unstable red blood cells;
  • Pre-menopausal women who are nursing, pregnant, or of child-bearing potential and not practising an acceptable method of birth control;
  • Participation in another therapeutic trial with an investigational drug within 30 days prior to informed consent;
  • Alcohol or drug abuse within three months prior to informed consent that would interfere with trial participation or any ongoing clinical condition that would jeopardize subject safety or study compliance based on investigator judgement;
  • Liver disease, defined by serum levels of alanine transaminase, aspartate transaminase, or alkaline phosphatase >3 x upper limit of normal as determined during screening;
  • Cardiac, lung or peripheral vascular disease or stroke;
  • Pancreas, pancreatic islet cells or renal transplant recipient;
  • Medical history of cancer or treatment for cancer in the last five years prior to screening;
  • History of allergy or angioedema with RAAS inhibitor exposure;
  • Kidney disease due primarily to another condition aside from FSGS;

Sites / Locations

  • Renal Physiology Laboratory, University Health Network

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Dapagliflozin (trade name Farxiga®)

Arm Description

Oral tablet, 10mg, PO, 8 weeks

Outcomes

Primary Outcome Measures

The change in Glomerular Filtration Rate (GFR) After an 8 week treatment with dapagliflozin
Glomerular Filtration Rate (GFR, based on plasma inulin clearance) will be measured at baseline and after 8 weeks of treatment.

Secondary Outcome Measures

The change in Effective Renal Plasma Flow (ERPF) After an 8 week treatment with dapagliflozin
Effective Renal Plasma Flow (ERPF, based on paraaminohippurate plasma clearance) will be measured at baseline and after 8 weeks of treatment.
The change in Blood Pressure After an 8 week treatment with dapagliflozin
The change in albuminuria after 8 weeks of treatment with dapagliflozin
The change in urinary vasoactive mediators after 8 weeks of treatment with dapagliflozin

Full Information

First Posted
October 22, 2015
Last Updated
January 11, 2018
Sponsor
University Health Network, Toronto
Collaborators
AstraZeneca, University of Toronto, Toronto General Hospital
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1. Study Identification

Unique Protocol Identification Number
NCT02585804
Brief Title
Treating to Reduce Albuminuria and Normalize Hemodynamic Function in Focal ScLerosis With dApagliflozin Trial Effects
Acronym
TRANSLATE
Official Title
Treating to Reduce Albuminuria and Normalize Hemodynamic Function in Focal ScLerosis With dApagliflozin Trial Effects: "The TRANSLATE Study"
Study Type
Interventional

2. Study Status

Record Verification Date
January 2018
Overall Recruitment Status
Completed
Study Start Date
September 2015 (undefined)
Primary Completion Date
April 24, 2017 (Actual)
Study Completion Date
April 24, 2017 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University Health Network, Toronto
Collaborators
AstraZeneca, University of Toronto, Toronto General Hospital

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
Patients with Focal Segmental Glomerulosclerosis (FSGS) constitute an increasing proportion of the total glomerulonephritis (GN) patient cohort in North America while FSGS is a risk factor for end stage renal failure. Current non-immunological FSGS therapies include the use of angiotensin converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARB), to reduce intraglomerular hypertension. Unfortunately, these agents lead to incomplete renal protection. The aim of the current study is to determine whether the addition of novel sodium glucose cotransport-2 inhibitors (SGLT2i) to standard of care leads to reduced intraglomerular pressure and suppression of proteinuria. We hypothesize that combination therapy of SGLT2i drugs and conventional RAASi results in additive renal protective effects in FSGS patients. A further goal is to examine mechanisms of SGLT2 inhibition by measuring renal hemodynamic function and sodium handling. Kidney function will be assessed in FSGS patients before and after an 8 week treatment with SGLT2i dapagliflozin.
Detailed Description
FSGS and diabetic nephropathy may have common pathogenic mechanisms, that are mediated by intraglomerular hypertension, leading to hyperfiltration and proteinuria. Given that SGLT2i corrects early hemodynamic abnormalities in patients with diabetes, our aim is to determine if a similar benefit may extend to patients with FSGS. Based on previous experimental and clinical data, we hypothesize that SGLT2i will improve renal hemodynamic abnormalities characteristic of FSGS that promote renal injury and proteinuria.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Focal Segmental Glomerulosclerosis
Keywords
FSGS, SGLT2, chronic kidney disease, GFR, proteinuria

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
10 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Dapagliflozin (trade name Farxiga®)
Arm Type
Experimental
Arm Description
Oral tablet, 10mg, PO, 8 weeks
Intervention Type
Drug
Intervention Name(s)
Dapagliflozin
Other Intervention Name(s)
Trade name Farxiga®
Intervention Description
Oral tablet, 10mg, PO, 8 weeks
Primary Outcome Measure Information:
Title
The change in Glomerular Filtration Rate (GFR) After an 8 week treatment with dapagliflozin
Description
Glomerular Filtration Rate (GFR, based on plasma inulin clearance) will be measured at baseline and after 8 weeks of treatment.
Time Frame
Before and after an 8 week treatment with dapagliflozin
Secondary Outcome Measure Information:
Title
The change in Effective Renal Plasma Flow (ERPF) After an 8 week treatment with dapagliflozin
Description
Effective Renal Plasma Flow (ERPF, based on paraaminohippurate plasma clearance) will be measured at baseline and after 8 weeks of treatment.
Time Frame
Before and after an 8 week treatment with dapagliflozin
Title
The change in Blood Pressure After an 8 week treatment with dapagliflozin
Time Frame
Before and after 8 weeks of treatment with dapagliflozin
Title
The change in albuminuria after 8 weeks of treatment with dapagliflozin
Time Frame
Before and after 8 weeks of treatment with dapagliflozin
Title
The change in urinary vasoactive mediators after 8 weeks of treatment with dapagliflozin
Time Frame
Before and after 8 weeks of treatment with dapagliflozin

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male or female subjects diagnosed with FSGS ≥1 month prior to informed consent eGFR≥45 ml/min/1.73m2 Age 18 years or greater No history of diabetes Body Mass Index (BMI) 18.5 - 45.0 kg/ m2 Blood pressure ≥ 100/60 at screening Stable therapy with either an ACEi or angiotensin II receptor blocker or direct renin inhibitor for > 1 month >30 mg/day and <6 g/day of proteinuria unless the patient is not a candidate for immunosuppressive therapy Exclusion Criteria: Leukocyte and/or nitrite positive urinalysis that is untreated; History of organ transplantation, cancer, liver disease; Bariatric surgery or other gastrointestinal surgeries that induce chronic malabsorption within the past two years; Current treatment with systemic corticosteroids, calcineurin inhibitors, or other immunosuppressant medications; Blood dyscrasias or any disorders causing hemolysis or unstable red blood cells; Pre-menopausal women who are nursing, pregnant, or of child-bearing potential and not practising an acceptable method of birth control; Participation in another therapeutic trial with an investigational drug within 30 days prior to informed consent; Alcohol or drug abuse within three months prior to informed consent that would interfere with trial participation or any ongoing clinical condition that would jeopardize subject safety or study compliance based on investigator judgement; Liver disease, defined by serum levels of alanine transaminase, aspartate transaminase, or alkaline phosphatase >3 x upper limit of normal as determined during screening; Cardiac, lung or peripheral vascular disease or stroke; Pancreas, pancreatic islet cells or renal transplant recipient; Medical history of cancer or treatment for cancer in the last five years prior to screening; History of allergy or angioedema with RAAS inhibitor exposure; Kidney disease due primarily to another condition aside from FSGS;
Facility Information:
Facility Name
Renal Physiology Laboratory, University Health Network
City
Toronto
State/Province
Ontario
ZIP/Postal Code
M5G 2N2
Country
Canada

12. IPD Sharing Statement

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Treating to Reduce Albuminuria and Normalize Hemodynamic Function in Focal ScLerosis With dApagliflozin Trial Effects

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