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Developing Oral LT3 Therapy for Heart Failure - HFpEF (DOT3HF-HFpEF)

Primary Purpose

Heart Failure With Preserved Ejection Fraction, Low Triiodothyronine Syndrome

Status
Recruiting
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
liothyronine or placebo
Sponsored by
University of Pennsylvania
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Heart Failure With Preserved Ejection Fraction focused on measuring Heart Failure, HFpEF, Low T3 Syndrome

Eligibility Criteria

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

Inclusion Criteria:

Men and women aged ≥18 years; NYHA Class I, II or III heart failure or dyspnea on exertion without a clinically identifiable alternative cause; left ventricular ejection fraction greater than or equal to 40 percent; if taking antihypertensive medications, beta-blockers, SGLT2inhibitors, sacubitril/valsartan, or aldosterone antagonists, doses must be stable for at least 30 days. Elevated filling pressures as evidenced by at least 1 of the following:

  1. Mitral E/e' ratio > 14 (either lateral or septal)
  2. Mitral E/e' ratio > 8 (either lateral or septal), with low e' velocity (septal e'<7 cm/sec or lateral e'< 10 cm/sec), in addition to one of the following:

    1. Enlarged left atrium (LA volume index >34 ml/m2)
    2. Chronic loop diuretic use for control of symptoms
    3. Elevated natriuretic peptides (BNP levels >100 ng/L or NT-proBNP levels >300 ng/L)
    4. Tricuspid regurgitation velocity >2.8 m/s
  3. Elevated invasively-determined filling pressures previously (resting LVEDP >16 mmHg or mean pulmonary capillary wedge pressure [PCWP] >12 mmHg; or PCWP/LVEDP ≥25 mmHg with exercise)
  4. Acute heart failure decompensation with radiographic evidence of pulmonary venous congestion or alveolar edema, requiring IV diuretics within the past year
  5. Probability of HFpEF>90%according to the HFpEF score,without a more likely apparent cause for symptoms as per Investigator assessment. TSH and free T4 level within the protocol specified reference range and total T3 level less than or equal to 0.94 ng/dL; if taking oral estrogen, dose must remain stable for duration of study participation.

Exclusion Criteria:

Hypertrophic or restrictive cardiomyopathy or uncorrected severe primary valvular disease; inability to perform VO2max exercise testing; severe lung disease; treatment with oral steroids within past 6 months for an exacerbation of obstructive lung disease, or the use of daytime oxygen; serum creatinine > 3.0 mg/dL; history of cirrhosis; acute coronary syndrome or coronary artery intervention or ablation therapy within past 2 months; cardiac surgery or percutaneous valve or septal defect repair within the past 6 months; heart failure hospitalization within past month; taking thyroid extract, LT4, LT3, amiodarone, or medication that affects the absorption or metabolism of thyroid hormone; gastrointestinal conditions that affect the absorption of thyroid hormone; current or planned pregnancy within the timeframe of study participation; any medical condition that, in the opinion of the investigator, will interfere with safe completion of the study.

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Sites / Locations

  • Penn MedicineRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Placebo Comparator

Arm Label

Liothyronine (LT3)

Placebo

Arm Description

Liothyronine (L-triiodothyronine or LT3) in the 5 mcg tablet dose formulation. Minimum LT3 dose will be 2.5 mcg three times daily and the maximum LT3 dose will be 12.5 mcg three times daily.

A placebo tablet matching in appearance to LT3 tablets, dosed equivalently. Minimum placebo tablet dose will be 1/2 tablet (2.5 mcg equivalent) three times daily and the maximum placebo dose will be 2 1/2 tablets (12.5 mcg equivalent) three times daily.

Outcomes

Primary Outcome Measures

Cardiac Rhythm Monitoring by 14 day Patch Rhythm Assessment
Percent increase (atrial fibrillation, ventricular tachycardia, supraventricular and ventricular) ectopy
T3 Level
Percentage of participant T3 levels above upper limit of reference range

Secondary Outcome Measures

Peak Maximal Rate of Oxygen Consumption During Exercise (VO2 Max)
Change peak rate of oxygen consumption
Measure of Quality of Life
Change Kansas City Cardiomyopathy Questionnaire, KCCQ
Actigraphy
Change in remotely sensed difference in counts per minute (CPM)
NT-proBNP Levels
Change in B-type natriuretic peptide, Pg/mL

Full Information

First Posted
September 30, 2019
Last Updated
July 11, 2023
Sponsor
University of Pennsylvania
Collaborators
National Heart, Lung, and Blood Institute (NHLBI)
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1. Study Identification

Unique Protocol Identification Number
NCT04111536
Brief Title
Developing Oral LT3 Therapy for Heart Failure - HFpEF
Acronym
DOT3HF-HFpEF
Official Title
Developing Oral LT3 Therapy For Heart Failure With Preserved Ejection Fraction
Study Type
Interventional

2. Study Status

Record Verification Date
July 2023
Overall Recruitment Status
Recruiting
Study Start Date
March 8, 2020 (Actual)
Primary Completion Date
October 31, 2023 (Anticipated)
Study Completion Date
October 31, 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Pennsylvania
Collaborators
National Heart, Lung, and Blood Institute (NHLBI)

4. Oversight

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

5. Study Description

Brief Summary
Investigation of the safety, feasibility, and preliminary efficacy of thyroid hormone therapy with Liothyronine (LT3) in individuals with heart failure with preserved ejection fraction (HFpEF) and low triiodothyronine (T3) syndrome by conducting a randomized, double-blind, placebo-controlled cross-over study with a two-week washout period between treatments.
Detailed Description
The overall goal is to determine the safety, feasibility, and preliminary efficacy of administering oral LT3 therapy in the study population of participants with Heart Failure with preserved ejection fraction (HFpEF). Each treatment period will be approximately 8 weeks in duration, with weekly titration of study drug for 4 weeks, followed by a maintenance dose for 4 weeks, then 2-week washout before crossing over to the other arm (placebo or drug). LT3 will be titrated to T3 levels.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Heart Failure With Preserved Ejection Fraction, Low Triiodothyronine Syndrome
Keywords
Heart Failure, HFpEF, Low T3 Syndrome

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Crossover Assignment
Masking
ParticipantCare ProviderInvestigator
Masking Description
Participant, Investigators and Care Providers are blinded to LT3 vs. Placebo and T3 results. There will be 1 unblinded physician in the study.
Allocation
Randomized
Enrollment
28 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Liothyronine (LT3)
Arm Type
Active Comparator
Arm Description
Liothyronine (L-triiodothyronine or LT3) in the 5 mcg tablet dose formulation. Minimum LT3 dose will be 2.5 mcg three times daily and the maximum LT3 dose will be 12.5 mcg three times daily.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
A placebo tablet matching in appearance to LT3 tablets, dosed equivalently. Minimum placebo tablet dose will be 1/2 tablet (2.5 mcg equivalent) three times daily and the maximum placebo dose will be 2 1/2 tablets (12.5 mcg equivalent) three times daily.
Intervention Type
Drug
Intervention Name(s)
liothyronine or placebo
Other Intervention Name(s)
LT3
Intervention Description
Each treatment period of liothyronine or placebo will be approximately 8 weeks in duration, with weekly titration of study drug for four weeks, followed by a maintenance dose for 4 weeks, then 2-week washout before crossing over to receive the alternate therapy - placebo or LT3.
Primary Outcome Measure Information:
Title
Cardiac Rhythm Monitoring by 14 day Patch Rhythm Assessment
Description
Percent increase (atrial fibrillation, ventricular tachycardia, supraventricular and ventricular) ectopy
Time Frame
continuous during intervention (14 days)
Title
T3 Level
Description
Percentage of participant T3 levels above upper limit of reference range
Time Frame
8 weeks
Secondary Outcome Measure Information:
Title
Peak Maximal Rate of Oxygen Consumption During Exercise (VO2 Max)
Description
Change peak rate of oxygen consumption
Time Frame
8 weeks
Title
Measure of Quality of Life
Description
Change Kansas City Cardiomyopathy Questionnaire, KCCQ
Time Frame
8 weeks
Title
Actigraphy
Description
Change in remotely sensed difference in counts per minute (CPM)
Time Frame
8 weeks
Title
NT-proBNP Levels
Description
Change in B-type natriuretic peptide, Pg/mL
Time Frame
8 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Men and women aged ≥18 years; NYHA Class I, II or III heart failure or dyspnea on exertion without a clinically identifiable alternative cause; left ventricular ejection fraction greater than or equal to 40 percent; if taking antihypertensive medications, beta-blockers, SGLT2inhibitors, sacubitril/valsartan, or aldosterone antagonists, doses must be stable for at least 30 days. Elevated filling pressures as evidenced by at least 1 of the following: Mitral E/e' ratio > 14 (either lateral or septal) Mitral E/e' ratio > 8 (either lateral or septal), with low e' velocity (septal e'<7 cm/sec or lateral e'< 10 cm/sec), in addition to one of the following: Enlarged left atrium (LA volume index >34 ml/m2) Chronic loop diuretic use for control of symptoms Elevated natriuretic peptides (BNP levels >100 ng/L or NT-proBNP levels >300 ng/L) Tricuspid regurgitation velocity >2.8 m/s Elevated invasively-determined filling pressures previously (resting LVEDP >16 mmHg or mean pulmonary capillary wedge pressure [PCWP] >12 mmHg; or PCWP/LVEDP ≥25 mmHg with exercise) Acute heart failure decompensation with radiographic evidence of pulmonary venous congestion or alveolar edema, requiring IV diuretics within the past year Probability of HFpEF>90%according to the HFpEF score,without a more likely apparent cause for symptoms as per Investigator assessment. TSH and free T4 level within the protocol specified reference range and total T3 level less than or equal to 0.94 ng/dL; if taking oral estrogen, dose must remain stable for duration of study participation. Exclusion Criteria: Hypertrophic or restrictive cardiomyopathy or uncorrected severe primary valvular disease; inability to perform VO2max exercise testing; severe lung disease; treatment with oral steroids within past 6 months for an exacerbation of obstructive lung disease, or the use of daytime oxygen; serum creatinine > 3.0 mg/dL; history of cirrhosis; acute coronary syndrome or coronary artery intervention or ablation therapy within past 2 months; cardiac surgery or percutaneous valve or septal defect repair within the past 6 months; heart failure hospitalization within past month; taking thyroid extract, LT4, LT3, amiodarone, or medication that affects the absorption or metabolism of thyroid hormone; gastrointestinal conditions that affect the absorption of thyroid hormone; current or planned pregnancy within the timeframe of study participation; any medical condition that, in the opinion of the investigator, will interfere with safe completion of the study. -
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Theresa M Scattergood, MSN
Phone
215-898-5664
Email
theresa.scattergood@pennmedicine.upenn.edu
First Name & Middle Initial & Last Name or Official Title & Degree
Anne C Holland, BA
Phone
215-746-4926
Email
anne.holland@pennmedicine.upenn.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Anne R Cappola, MD,ScM
Organizational Affiliation
University of Pennsylvania
Official's Role
Principal Investigator
Facility Information:
Facility Name
Penn Medicine
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19104
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Theresa M Scattergood, M.S.N., R.N.
Phone
215-898-5664
Email
theresa.scattergood@pennmedicine.upenn.edu
First Name & Middle Initial & Last Name & Degree
Annie C Holland, BA
Phone
215-573-0902
Email
anne.holland@pennmedicine.upenn.edu

12. IPD Sharing Statement

Plan to Share IPD
No

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