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Pilot Study of Aprepitant Effect on Aldosterone Secretion in Diabetic Patient (Diabetes Mellitus) With Hypertension Associated With Low Renin (APHOS-02)

Primary Purpose

Type 2 Diabetes, Hypertension

Status
Unknown status
Phase
Phase 2
Locations
France
Study Type
Interventional
Intervention
Blood sampling
Blood Pressure Measurement
electrocardiogram
orthostatic test
Administration of Aprepitant
Administration of placebo
Sponsored by
University Hospital, Rouen
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Type 2 Diabetes

Eligibility Criteria

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

Inclusion Criteria:

  • Male or menopausal female subjects;
  • Age ranging 18-30 years old;
  • Submitted to a social security regimen;
  • Agreeing to the study & Informed consent form signed;
  • Body mass index ([weight (kg)/height (m)]²) < 27;
  • No treatment received 6 weeks before inclusion;
  • No anomaly after: complete clinical examination, pulse and blood pressure measurement, ECG;
  • No biological abnormality after the following biological testing:

Hematology: white & red blood cells & platelets count, haemoglobin, hematocrit, Blood biochemistry: sodium, potassium, chloride, bicarbonate, creatinine, urea, Urinary biochemistry (24 h collection): cortisol, aldosterone, Serologies: HIV, HBV, HCV,

  • No participation in a clinical trial 3 months ago before inclusion,
  • Subscription to national social security,
  • Signed informed consent.

Exclusion Criteria:

  • Female subject potentially pregnant,
  • Subject younger than 18 year-old and older than 70 year-old,
  • Subject without diabetes condition or with diabetes but normal blood pressure (below 130/80 mmHg),
  • Subject with glycated hemoglobin HbA1c < 6.5% or >11%,
  • Subject with leuconeutropenia (neutrophils below 1700/mm3),
  • Subject with severe medical or surgical history,
  • Patients treated with drugs metabolized by CYP3A4 and CYP2C9: corticosteroids, vitamin K , hormonal contraceptives, tolbutamide, benzodiazepines, derived from ergot, antiepileptics, hypericum, macrolides, azole antifungals.
  • Patients treated with drugs interfering with the renin-angiotensin- aldosterone system : beta-blockers, diuretics , anti -aldosterone drugs , direct renin inhibitors , insulin,
  • type 2 diabetes patients with a vegetative autonomic neuropathy,
  • Patients with adrenal mass was diagnosed at imaging,
  • hepatic or renal impairment (defined respectively by secondary clinical and biological manifestations altered hepatocyte functions or estimated glomerular filtration rate less than 60 mL / min / 1.73 m2);nephrotic syndrome (defined by hypoalbuminemia less than 30 g / L associated with proteinuria at 3 grams / 24 hours);edematous syndrome (defined by the presence of edema of the lower limbs),
  • Orthostatic hypotension (defined by a decrease in systolic blood pressure of 20 mmHg and at least the diastolic blood pressure of 10 mmHg or more),
  • arrhythmias or cardiac conduction,
  • heart failure (NYHA class II minimum),
  • epilepsy,
  • serious psychiatric condition,
  • Severe allergic history, hypersensitivity to aprepitant,
  • People with hereditary problems of fructose intolerance, glucose malabsorption, galactose, or sucrase-isomaltase,
  • People with lactose intolerance,
  • subject unwilling or cannot be followed regularly. Persons deprived of their liberty by a judicial or administrative decision, those hospitalized without consent and those admitted to a health or social establishment for purposes other than research, the adults subject to a measure of legal protection or unable to consent may not be included.

Sites / Locations

  • Rouen University HospitalRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Administration of Aprepitant

Administration of placebo

Arm Description

Administration of Aprepitant 80 mg once per day during 14 days; Blood sampling, electrocardiogram, orthostatic test and Blood Pressure Measurement are done after 14 days

Administration of Placebo once per day during 14 days; Blood sampling, electrocardiogram, orthostatic test and Blood Pressure Measurement are done after 14 days

Outcomes

Primary Outcome Measures

Difference from baseline in Plasma aldosterone concentration
Plasma aldosterone concentration is analyzed

Secondary Outcome Measures

Difference from baseline in Plasma cortisol
Plasma cortisol concentration is analyzed
Difference from baseline in plasma renin
plasma renin concentration is analyzed
Difference from baseline in blood electrolytes measurement
blood electrolytes concentration is analyzed
Difference from baseline in HOMA index

Full Information

First Posted
May 25, 2016
Last Updated
August 21, 2017
Sponsor
University Hospital, Rouen
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1. Study Identification

Unique Protocol Identification Number
NCT02811055
Brief Title
Pilot Study of Aprepitant Effect on Aldosterone Secretion in Diabetic Patient (Diabetes Mellitus) With Hypertension Associated With Low Renin
Acronym
APHOS-02
Official Title
Pilot Study of Aprepitant Effect on Aldosterone Secretion in Diabetic Patient (Diabetes Mellitus) With Hypertension Associated With Low Renin
Study Type
Interventional

2. Study Status

Record Verification Date
August 2017
Overall Recruitment Status
Unknown status
Study Start Date
July 13, 2017 (Actual)
Primary Completion Date
July 2019 (Anticipated)
Study Completion Date
July 2019 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University Hospital, Rouen

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
Aldosterone regulation is mediated by hormonal control, and nervous control. Autonomic nervous system action could be mediated by neuropeptides in the adrenal gland. Therefore, in pathological conditions and especially in diabetes, low-renin hypertension with normal or high plasma aldosterone could be caused by sympathetic nervous system hypertonia. Data from the literature and previous in vitro research conducted in the investigators' laboratory (INSERM U982, University of Rouen) suggest that adrenal corticosteroid secretion might be controlled by sympathetic nervous system. This neurocrine regulation of corticosteroid secretion involves locally released neuropeptides. Among them, substance P is able to stimulate aldosterone and cortisol production via NK1 receptors. A previous clinical trial conducted at the University Hospital of Rouen, APHOS (NCT00977223) studied the effects of a NK1 receptor antagonist, aprepitant, on adrenocortical secretions in healthy volunteers. The aim of the present study is to investigate the effects of a NK1 receptor antagonist, aprepitant, on adrenocortical secretions in volunteers with diabetes associated with low-renin hypertension. Aprepitant is a drug already available for the treatment of nausea induced by chemotherapy. In the present phase II trial, plasma aldosterone and cortisol levels will be measured under treatment with aprepitant versus placebo, in both basal conditions and after activation of the adrenocortical function by upright posture. All volunteers will be given the two substances (aprepitant and placebo) in a random order during two 14 day-periods separated by a 21 day-wash-out. This study should allow to determine the role of substance P in the control of corticosteroid production in human with diabetes, associated with a low-renin hypertension.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Type 2 Diabetes, Hypertension

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Crossover Assignment
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
20 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Administration of Aprepitant
Arm Type
Experimental
Arm Description
Administration of Aprepitant 80 mg once per day during 14 days; Blood sampling, electrocardiogram, orthostatic test and Blood Pressure Measurement are done after 14 days
Arm Title
Administration of placebo
Arm Type
Placebo Comparator
Arm Description
Administration of Placebo once per day during 14 days; Blood sampling, electrocardiogram, orthostatic test and Blood Pressure Measurement are done after 14 days
Intervention Type
Biological
Intervention Name(s)
Blood sampling
Intervention Description
Blood sampling for Plasma aldosterone, Plasma cortisol, plasma renin, plasma electrolytes after before and after administration of Aprepitant 80 mg once per day during 14 days or Administration of placebo once per day during 14 days
Intervention Type
Procedure
Intervention Name(s)
Blood Pressure Measurement
Intervention Description
Blood Pressure Measurement before and after Administration of Aprepitant 80 mg once per day during 14 days or administration of placebo once per day during 14 days
Intervention Type
Device
Intervention Name(s)
electrocardiogram
Intervention Description
Electrocardiogram before and after Administration of Aprepitant 80 mg once per day during 14 days or administration of placebo once per day during 14 days
Intervention Type
Procedure
Intervention Name(s)
orthostatic test
Intervention Description
Orthostatic test after Administration of Aprepitant 80 mg once per day during 14 days or administration of placebo once per day during 14 days
Intervention Type
Drug
Intervention Name(s)
Administration of Aprepitant
Intervention Description
Administration of Aprepitant 80 mg once per day during 14 days
Intervention Type
Drug
Intervention Name(s)
Administration of placebo
Intervention Description
Administration of placebo once per day during 14 days
Primary Outcome Measure Information:
Title
Difference from baseline in Plasma aldosterone concentration
Description
Plasma aldosterone concentration is analyzed
Time Frame
Baseline and Day 14
Secondary Outcome Measure Information:
Title
Difference from baseline in Plasma cortisol
Description
Plasma cortisol concentration is analyzed
Time Frame
Baseline and Day 14
Title
Difference from baseline in plasma renin
Description
plasma renin concentration is analyzed
Time Frame
Baseline and Day 14
Title
Difference from baseline in blood electrolytes measurement
Description
blood electrolytes concentration is analyzed
Time Frame
Baseline and Day 14
Title
Difference from baseline in HOMA index
Time Frame
Baseline and Day 14

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male or menopausal female subjects; Age ranging 18-30 years old; Submitted to a social security regimen; Agreeing to the study & Informed consent form signed; Body mass index ([weight (kg)/height (m)]²) < 27; No treatment received 6 weeks before inclusion; No anomaly after: complete clinical examination, pulse and blood pressure measurement, ECG; No biological abnormality after the following biological testing: Hematology: white & red blood cells & platelets count, haemoglobin, hematocrit, Blood biochemistry: sodium, potassium, chloride, bicarbonate, creatinine, urea, Urinary biochemistry (24 h collection): cortisol, aldosterone, Serologies: HIV, HBV, HCV, No participation in a clinical trial 3 months ago before inclusion, Subscription to national social security, Signed informed consent. Exclusion Criteria: Female subject potentially pregnant, Subject younger than 18 year-old and older than 70 year-old, Subject without diabetes condition or with diabetes but normal blood pressure (below 130/80 mmHg), Subject with glycated hemoglobin HbA1c < 6.5% or >11%, Subject with leuconeutropenia (neutrophils below 1700/mm3), Subject with severe medical or surgical history, Patients treated with drugs metabolized by CYP3A4 and CYP2C9: corticosteroids, vitamin K , hormonal contraceptives, tolbutamide, benzodiazepines, derived from ergot, antiepileptics, hypericum, macrolides, azole antifungals. Patients treated with drugs interfering with the renin-angiotensin- aldosterone system : beta-blockers, diuretics , anti -aldosterone drugs , direct renin inhibitors , insulin, type 2 diabetes patients with a vegetative autonomic neuropathy, Patients with adrenal mass was diagnosed at imaging, hepatic or renal impairment (defined respectively by secondary clinical and biological manifestations altered hepatocyte functions or estimated glomerular filtration rate less than 60 mL / min / 1.73 m2);nephrotic syndrome (defined by hypoalbuminemia less than 30 g / L associated with proteinuria at 3 grams / 24 hours);edematous syndrome (defined by the presence of edema of the lower limbs), Orthostatic hypotension (defined by a decrease in systolic blood pressure of 20 mmHg and at least the diastolic blood pressure of 10 mmHg or more), arrhythmias or cardiac conduction, heart failure (NYHA class II minimum), epilepsy, serious psychiatric condition, Severe allergic history, hypersensitivity to aprepitant, People with hereditary problems of fructose intolerance, glucose malabsorption, galactose, or sucrase-isomaltase, People with lactose intolerance, subject unwilling or cannot be followed regularly. Persons deprived of their liberty by a judicial or administrative decision, those hospitalized without consent and those admitted to a health or social establishment for purposes other than research, the adults subject to a measure of legal protection or unable to consent may not be included.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Julien WILS, Pharm
Phone
+3323288
Ext
8265
Email
julien.wils@chu-rouen.fr
First Name & Middle Initial & Last Name or Official Title & Degree
Julien BLOT
Email
julien.blot@chu-rouen.fr
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Gaétan PREVOST, MD
Organizational Affiliation
Rouen University Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Rouen University Hospital
City
Rouen
Country
France
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Gaétan PREVOST, MD

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Pilot Study of Aprepitant Effect on Aldosterone Secretion in Diabetic Patient (Diabetes Mellitus) With Hypertension Associated With Low Renin

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