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Ambrisentan Sotagliflozin and Prevention of Renal Injury; a Randomized Evaluation (ASPIRE)

Primary Purpose

Type 1 Diabetes Mellitus With Diabetic Nephropathy

Status
Not yet recruiting
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
Sotagliflozin
Ambrisentan
Ambrisentan and Sotagliflozin
Sponsored by
University Medical Center Groningen
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Type 1 Diabetes Mellitus With Diabetic Nephropathy focused on measuring Diabetic kidney disease, sodium glucose co-transporter 2 inhibitors, endothelin receptor antagonists, Type 1 Diabetes, combination therapy

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Willing and able to sign informed consent Male or female individuals diagnosed with type 1 diabetes at least 6 months prior to informed consent WOCBP must have a negative pregnancy test at screening and must not be lactating. Male individuals must use highly effective method of contraception for the duration of the study (from the time they sign consent) and for 4 weeks after the last dose of study medication, or be able to provide proof of vasectomy. Female individuals must use highly effective method of contraception for the duration of the study (from the time they sign consent) and for 4 weeks after the last dose of study medication, provide proof of hysterectomy or sterilization, or be deemed menopausal based on a FSH-test. Age ≥18 and <65years, at the time of signing consent. Body Mass Index ≥ 21 kg/m2 Urinary albumin:creatinine ratio ≥ 50 mg/g and <3000 mg/g eGFR > 30 and <90 ml/min/1.73m2 Stable RAAS inhibition medication for at least 4 weeks prior to screening HbA1c between 6.5 and 10.5% Based on the Investigator's judgment participant must have a good understanding of his/her disease and how to manage it, and be willing and capable of performing the following study assessments (assessed before randomization): patient-led management and adjustment of insulin therapy reliable approach to insulin dose adjustment for meals, such as carbohydrate counting reliable and regular home-based blood glucose monitoring established "sick day" management regimen Exclusion Criteria: Diagnosis of type 2 diabetes Treatment with an antihyperglycaemic agent (e.g., metformin, alpha-glucosidase inhibitors, pramlintide, glucagon-like peptide receptor agonist, etc.) within 3 months Occurrence of severe hypoglycaemia involving coma/unconsciousness and/or seizure that required hospitalisation or hypoglycaemia-related treatment by an emergency physician or paramedic within 3 months Hypoglycaemia unawareness based on Investigator judgement or frequent episodes of unexplained hypoglycaemia (2 or more unexplained episodes within 3 months) Occurrence of diabetic ketoacidosis within 6 months prior to study enrolment Acute coronary syndrome (non-STEMI, STEMI and unstable angina pectoris), stroke or transient ischemic attack within 6 months Any other clinical condition that, based on Investigator's judgement, would jeopardize patient safety during trial participation or would affect the study outcome (e.g., immunocompromised patients, patients who might be at higher risk of developing urinary, genital or mycotic infections, patients with chronic viral infections, etc.) Treatment with an SGLT2i within 30 days of Visit 1 Diagnosis of severe edema (per investigator judgment) or heart failure (NYHC stage III or IV)

Sites / Locations

  • University of Colorado, Anschutz Medical Center
  • Institute de Recherches Cliniques de Montreal
  • University of Toronto
  • Steno Diabetes Center Copenhagen
  • University of Helsinki
  • Amsterdam University Academic Center
  • University Medical Center Groningen

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm 5

Arm 6

Arm Type

Experimental

Experimental

Experimental

Experimental

Experimental

Experimental

Arm Label

Treatment order 1

Treatment order 2

Treatment order 3

Treatment order 4

Treatment order 5

Treatment order 6

Arm Description

Subjects will start with 4 weeks of Ambrisentan in treatment period 1. In period 2 subjects will receive Sotagliflozin. In period 3 subjects will receive a combination of Ambrisentan and Sotagliflozin. Between treatment periods there is a 4-week wash-out.

Subjects will start with 4 weeks of Ambrisentan in treatment period 1. In period 2 subjects will receive a combination of Ambrisentan and Sotagliflozin. In period 3 subjects will receive Sotagliflozin. Between treatment periods there is a 4-week wash-out.

Subjects will start with 4 weeks of Sotagliflozine in treatment period 1. In period 2 subjects will receive a combination of Ambrisentan and Sotagliflozine. In period 3 subjects will receive Ambrisentan. Between treatment periods there is a 4-week wash-out.

Subjects will start with 4 weeks of Sotagliflozine in treatment period 1. In period 2 subjects will receive Ambrisentan. In period 3 subjects will receive a combination of Ambrisentan and Sotagliflozin. Between treatment periods there is a 4-week wash-out.

Subjects will start with 4 weeks of a combination of Ambrisentan and Sotagliflozin in period 1. In period 2 subjects will receive Ambrisentan. In period 3 subjects will receive Sotagliflozin. Between treatment periods there is a 4-week wash-out.

Subjects will start with 4 weeks of a combination of Ambrisentan and Sotagliflozin in period 1. In period 2 subjects will receive Sotagliflozin. In period 3 subjects will receive Ambrisentan. Between treatment periods there is a 4-week wash-out.

Outcomes

Primary Outcome Measures

change from baseline in Urine Albumin-Creatinine Ratio (UACR)
change from baseline in Urine Albumin-Creatinine Ratio (UACR) when treated with ambrisentan alone versus combination of sotagliflozin and ambrisentan.

Secondary Outcome Measures

change from baseline in mGFR
Glomerular Filtration Rate (GFR) using iohexol clearance techniques.
Change in biomarkers of fluid retention
Change from baseline biomarkers of fluid retention (body weight, hemoglobin, N-terminal prohormone of Brain Natriuretic Peptide (NT-proBNP))
Change in biomarkers of fluid retention
Change from baseline biomarkers of fluid retention (Body Weight)
Change in biomarkers of fluid retention
Change from baseline biomarkers of fluid retention (hemoglobin)
Change in biomarkers of fluid retention
Change from baseline biomarkers of fluid retention (N-terminal prohormone of Brain Natriuretic Peptide (NT-proBNP))
Change from baseline Extracellular Volume (ECV)
Extracellular volume (ECV) using iohexol clearance techniques and bioimpedance spectroscopy.
Change from baseline blood pressure
Change in blood pressure as measure in mmHg

Full Information

First Posted
October 2, 2023
Last Updated
October 20, 2023
Sponsor
University Medical Center Groningen
Collaborators
Juvenile Diabetes Research Foundation, Lexicon Pharmaceuticals
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1. Study Identification

Unique Protocol Identification Number
NCT06072326
Brief Title
Ambrisentan Sotagliflozin and Prevention of Renal Injury; a Randomized Evaluation
Acronym
ASPIRE
Official Title
Individual and Combined Endothelin Receptor and SGLT1/2 Antagonism in Adults With Type 1 Diabetes Mellitus and Chronic Kidney Disease: a Phase 2, Multicenter, Open-label Randomized Cross-over Trial
Study Type
Interventional

2. Study Status

Record Verification Date
October 2023
Overall Recruitment Status
Not yet recruiting
Study Start Date
March 2024 (Anticipated)
Primary Completion Date
March 2025 (Anticipated)
Study Completion Date
March 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University Medical Center Groningen
Collaborators
Juvenile Diabetes Research Foundation, Lexicon Pharmaceuticals

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The aim of this study is to test the hypothesis that sotagliflozin (SGLT1/2 inhibitor) and ambrisentan (ERA) combination therapy augments nephroprotection and mitigates fluid retention and ketogenesis in people with T1D through complementary and synergistic mechanisms of actions.
Detailed Description
A phase 2, multicenter, randomized, open-label, cross-over trial will be conducted in male or female individuals (N=36) diagnosed with type 1 diabetes at least 6 months prior to informed consent aged between 18 and 65 years, Body Mass Index (BMI) ≥ 21 kg/m2, urinary albumin:creatinine ratio ≥ 50 mg/g and < 3000 mg/g, eGFR > 30 and <90 ml/min/1.73m2 and HbA1c between 6.5 and 10.0%. Patients have to be on stable RAAS inhibition for at least 4 weeks prior to screening. The study will consist of a screening visit, a 4-week run-in phase. After the run-in phase, the participant will be randomized to treatment of ambrisentan, sotagliflozin or their combination in random order. The duration of each treatment period is 4 weeks with study visits scheduled at 2 and 4 weeks in each treatment period. At the end of each treatment period patients proceed to a 4 weeks wash-out phase to study off drug effects. The total duration of the study for each participant after randomization is thus 24 weeks Interventions Ambrisentan 2.5 mg once daily; sotagliflozin 200mg once daily; combination of ambrisentan 2.5mg once daily and sotagliflozin 200mg once daily

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Type 1 Diabetes Mellitus With Diabetic Nephropathy
Keywords
Diabetic kidney disease, sodium glucose co-transporter 2 inhibitors, endothelin receptor antagonists, Type 1 Diabetes, combination therapy

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Crossover Assignment
Model Description
Multicenter, open-label randomized cross-over trial
Masking
None (Open Label)
Allocation
Randomized
Enrollment
36 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Treatment order 1
Arm Type
Experimental
Arm Description
Subjects will start with 4 weeks of Ambrisentan in treatment period 1. In period 2 subjects will receive Sotagliflozin. In period 3 subjects will receive a combination of Ambrisentan and Sotagliflozin. Between treatment periods there is a 4-week wash-out.
Arm Title
Treatment order 2
Arm Type
Experimental
Arm Description
Subjects will start with 4 weeks of Ambrisentan in treatment period 1. In period 2 subjects will receive a combination of Ambrisentan and Sotagliflozin. In period 3 subjects will receive Sotagliflozin. Between treatment periods there is a 4-week wash-out.
Arm Title
Treatment order 3
Arm Type
Experimental
Arm Description
Subjects will start with 4 weeks of Sotagliflozine in treatment period 1. In period 2 subjects will receive a combination of Ambrisentan and Sotagliflozine. In period 3 subjects will receive Ambrisentan. Between treatment periods there is a 4-week wash-out.
Arm Title
Treatment order 4
Arm Type
Experimental
Arm Description
Subjects will start with 4 weeks of Sotagliflozine in treatment period 1. In period 2 subjects will receive Ambrisentan. In period 3 subjects will receive a combination of Ambrisentan and Sotagliflozin. Between treatment periods there is a 4-week wash-out.
Arm Title
Treatment order 5
Arm Type
Experimental
Arm Description
Subjects will start with 4 weeks of a combination of Ambrisentan and Sotagliflozin in period 1. In period 2 subjects will receive Ambrisentan. In period 3 subjects will receive Sotagliflozin. Between treatment periods there is a 4-week wash-out.
Arm Title
Treatment order 6
Arm Type
Experimental
Arm Description
Subjects will start with 4 weeks of a combination of Ambrisentan and Sotagliflozin in period 1. In period 2 subjects will receive Sotagliflozin. In period 3 subjects will receive Ambrisentan. Between treatment periods there is a 4-week wash-out.
Intervention Type
Drug
Intervention Name(s)
Sotagliflozin
Intervention Description
200 mg/day as a tablet
Intervention Type
Drug
Intervention Name(s)
Ambrisentan
Intervention Description
2.5 mg/day as a tablet
Intervention Type
Drug
Intervention Name(s)
Ambrisentan and Sotagliflozin
Intervention Description
2.5 mg/day Ambrisentan as a tablet in combination with 200 mg/day Sotagliflozin as a tablet
Primary Outcome Measure Information:
Title
change from baseline in Urine Albumin-Creatinine Ratio (UACR)
Description
change from baseline in Urine Albumin-Creatinine Ratio (UACR) when treated with ambrisentan alone versus combination of sotagliflozin and ambrisentan.
Time Frame
4 weeks
Secondary Outcome Measure Information:
Title
change from baseline in mGFR
Description
Glomerular Filtration Rate (GFR) using iohexol clearance techniques.
Time Frame
4 weeks
Title
Change in biomarkers of fluid retention
Description
Change from baseline biomarkers of fluid retention (body weight, hemoglobin, N-terminal prohormone of Brain Natriuretic Peptide (NT-proBNP))
Time Frame
4 weeks
Title
Change in biomarkers of fluid retention
Description
Change from baseline biomarkers of fluid retention (Body Weight)
Time Frame
4 weeks
Title
Change in biomarkers of fluid retention
Description
Change from baseline biomarkers of fluid retention (hemoglobin)
Time Frame
4 weeks
Title
Change in biomarkers of fluid retention
Description
Change from baseline biomarkers of fluid retention (N-terminal prohormone of Brain Natriuretic Peptide (NT-proBNP))
Time Frame
4 weeks
Title
Change from baseline Extracellular Volume (ECV)
Description
Extracellular volume (ECV) using iohexol clearance techniques and bioimpedance spectroscopy.
Time Frame
4 weeks
Title
Change from baseline blood pressure
Description
Change in blood pressure as measure in mmHg
Time Frame
4 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Willing and able to sign informed consent Male or female individuals diagnosed with type 1 diabetes at least 6 months prior to informed consent WOCBP must have a negative pregnancy test at screening and must not be lactating. Male individuals must use highly effective method of contraception for the duration of the study (from the time they sign consent) and for 4 weeks after the last dose of study medication, or be able to provide proof of vasectomy. Female individuals must use highly effective method of contraception for the duration of the study (from the time they sign consent) and for 4 weeks after the last dose of study medication, provide proof of hysterectomy or sterilization, or be deemed menopausal based on a FSH-test. Age ≥18 and <65years, at the time of signing consent. Body Mass Index ≥ 21 kg/m2 Urinary albumin:creatinine ratio ≥ 50 mg/g and <3000 mg/g eGFR > 30 and <90 ml/min/1.73m2 Stable RAAS inhibition medication for at least 4 weeks prior to screening HbA1c between 6.5 and 10.5% Based on the Investigator's judgment participant must have a good understanding of his/her disease and how to manage it, and be willing and capable of performing the following study assessments (assessed before randomization): patient-led management and adjustment of insulin therapy reliable approach to insulin dose adjustment for meals, such as carbohydrate counting reliable and regular home-based blood glucose monitoring established "sick day" management regimen Exclusion Criteria: Diagnosis of type 2 diabetes Treatment with an antihyperglycaemic agent (e.g., metformin, alpha-glucosidase inhibitors, pramlintide, glucagon-like peptide receptor agonist, etc.) within 3 months Occurrence of severe hypoglycaemia involving coma/unconsciousness and/or seizure that required hospitalisation or hypoglycaemia-related treatment by an emergency physician or paramedic within 3 months Hypoglycaemia unawareness based on Investigator judgement or frequent episodes of unexplained hypoglycaemia (2 or more unexplained episodes within 3 months) Occurrence of diabetic ketoacidosis within 6 months prior to study enrolment Acute coronary syndrome (non-STEMI, STEMI and unstable angina pectoris), stroke or transient ischemic attack within 6 months Any other clinical condition that, based on Investigator's judgement, would jeopardize patient safety during trial participation or would affect the study outcome (e.g., immunocompromised patients, patients who might be at higher risk of developing urinary, genital or mycotic infections, patients with chronic viral infections, etc.) Treatment with an SGLT2i within 30 days of Visit 1 Diagnosis of severe edema (per investigator judgment) or heart failure (NYHC stage III or IV)
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Hiddo J Lambers Heerspink, Phd, PharmD
Phone
+31-50-3617859
Email
h.j.lambers.heerspink@umcg.nl
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Hiddo J Lambers Heerspink, PhD, PharmD
Organizational Affiliation
University Medical Center Groningen
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Colorado, Anschutz Medical Center
City
Aurora
State/Province
Colorado
ZIP/Postal Code
80045
Country
United States
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Petter Bjornstad, MD
Facility Name
Institute de Recherches Cliniques de Montreal
City
Montréal
State/Province
Quebec
ZIP/Postal Code
H2W IR7
Country
Canada
Facility Name
University of Toronto
City
Toronto
ZIP/Postal Code
M5G 2N2
Country
Canada
Facility Contact:
First Name & Middle Initial & Last Name & Degree
David Cherney, MDCM, PhD
Facility Name
Steno Diabetes Center Copenhagen
City
Copenhagen
ZIP/Postal Code
2730 Herlev
Country
Denmark
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Frederik Persson, MD DMSc
Facility Name
University of Helsinki
City
Helsinki
State/Province
Uusimaa
ZIP/Postal Code
00029 HUS
Country
Finland
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Daniel Gordin, MD DMSc
Facility Name
Amsterdam University Academic Center
City
Amsterdam
State/Province
Noord Holland
ZIP/Postal Code
1081 HV
Country
Netherlands
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Daniel van Raalte, MD
Facility Name
University Medical Center Groningen
City
Groningen
ZIP/Postal Code
9700 RB
Country
Netherlands
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Peter R van Dijk, MD, PhD

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Ambrisentan Sotagliflozin and Prevention of Renal Injury; a Randomized Evaluation

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