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Effect of LIXIsenatide on the Renal System (ELIXIRS)

Primary Purpose

Diabetic Kidney Disease, Diabetic Nephropathy, Diabetes Mellitus

Status
Completed
Phase
Phase 4
Locations
Netherlands
Study Type
Interventional
Intervention
Lixisenatide
Insulin glulisine
Sponsored by
Amsterdam UMC, location VUmc
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Diabetic Kidney Disease

Eligibility Criteria

35 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Patients with type 2 diabetes (HbA1c: 6.5-10.0% or 48-86 mmol/mol)
  • Stable treatment with basal insulin glargine (dose ±20%) and metformin or basal insulin glargine (dose ±20%) alone for at least 3 months
  • Fasting plasma glucose <10 mmol/L or the use of >50 units of basal insulin glargine
  • Females must be post-menopausal
  • Caucasian
  • Age: 35 - 75 years
  • Body Mass Index: >25 kg/m2
  • Hypertension should be under control, i.e. <140/90 mmHg, and treated with an angiotensin-converting enzyme inhibitor or angiotensin-II-receptor blocker for at least 3 months.
  • Albuminuria should be treated with an angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin-II-receptor blocker (ARB) for at least 3 months.

Exclusion Criteria:

  • Current/chronic use of the following medication: thiazolidinediones, sulfonylurea derivatives, GLP-1 receptor agonists, dipeptidyl peptidase (DPP)-4 inhibitors, glucocorticoids, immune suppressants, antimicrobial agents, chemotherapeutics, antipsychotics, tricyclic antidepressants and monoamine oxidase inhibitors. Subjects on diuretics, will only be excluded when these drugs cannot be stopped for the duration of the study.
  • Chronic use of non-steroidal anti-inflammatory drugs will not be allowed, unless used as incidental medication (1-2 tablets) for non-chronic indications (i.e. sports injury, head-ache or back ache). However, no such drugs can be taken within a time-frame of 2 weeks prior to renal-testing
  • Hypoglycemia unawareness based on investigator judgment
  • History of severe hypoglycemia that required emergency hospital treatment within 3 months prior to screening
  • Estimated GFR <60 mL/min/1.73m2 (determined by the Modification of Diet in Renal Disease (MDRD) study equation)
  • Pregnancy
  • Current urinary tract infection and active nephritis
  • Recent (<6 months) history of cardiovascular disease, including: acute coronary syndrome, chronic heart failure (New York Heart Association grade II-IV), stroke or transient ischemic neurologic disorder
  • Complaints compatible with or established gastroparesis, neurogenic bladder and/or incomplete bladder emptying (as determined by ultrasonic bladder scan)
  • Active liver disease or a 3-fold elevation of liver enzymes (aspartate aminotransferase/alanine aminotransferase) at screening
  • History of or actual pancreatic disease
  • History of or actual malignancy (except basal cell carcinoma)
  • History of or actual severe mental disease
  • Substance abuse (alcohol: defined as >4 units/day)
  • Allergy to any of the agents used in the study
  • Individuals who are investigator site personnel, directly affiliated with the study, or are immediate (spouse, parent, child, or sibling, whether biological or legally adopted) family of investigator site personnel directly affiliated with the study
  • Inability to understand the study protocol or give informed consent

Sites / Locations

  • VU Universtiy Medical Center

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Lixisenatide

Insulin glulisine

Arm Description

Lixisenatide will be administered subcutaneously, once daily for 8 weeks

Insulin glulisine will be administered subcutaneously, once daily for 8 weeks

Outcomes

Primary Outcome Measures

Changes from baseline following 8-week treatment with a glucagon-like peptide(GLP)-1 receptor agonist versus insulin glulisine on renal hemodynamics, measured as glomerular filtration rate (GFR) / effective renal plasma flow (ERPF)
ml/min

Secondary Outcome Measures

Renal damage, measured by urine biomarkers
enzyme immuno assay
Renal tubular function
e.g. percentage (%)
Blood Pressure
mmHg

Full Information

First Posted
October 16, 2014
Last Updated
April 28, 2016
Sponsor
Amsterdam UMC, location VUmc
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1. Study Identification

Unique Protocol Identification Number
NCT02276196
Brief Title
Effect of LIXIsenatide on the Renal System
Acronym
ELIXIRS
Official Title
A Phase 4, Mono-center, Randomized, Open Label, Comparator-controlled, Parallel-group, Mechanistic Intervention Trial to Assess the Effect of 8-week Treatment With the Glucagon-like Peptide-1 Receptor Agonist Lixisenatide Versus Insulin Glulisine on Renal Physiology and Biomarkers in Insulin Glargine-treated Patients With Type 2 Diabetes Mellitus
Study Type
Interventional

2. Study Status

Record Verification Date
February 2016
Overall Recruitment Status
Completed
Study Start Date
September 2014 (undefined)
Primary Completion Date
April 2016 (Actual)
Study Completion Date
April 2016 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Amsterdam UMC, location VUmc

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
Based on preclinical and small-sized studies in non-diabetic individuals, incretin-based therapies, i.e. glucagon-like peptide (GLP)-1 receptor agonists and dipeptidyl peptidase-4 inhibitors, may hold promise in preventing the onset and progression of diabetic kidney disease. However, the potential renoprotective effects of these agents, that are believed to be effectuated "beyond glucose control", have not been sufficiently detailed in human diabetes. Therefore, the present study aims to explore the mechanistic and clinical effects of GLP-1 receptor agonists on renal physiology and biomarkers in patients with type 2 diabetes. Forty patients with insulin-treated type 2 diabetes will undergo an eight week intervention with lixisenatide or insulin glulisine in order to assess changes in the outcome parameters.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Diabetic Kidney Disease, Diabetic Nephropathy, Diabetes Mellitus, Glucagon-Like Peptide 1

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
40 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Lixisenatide
Arm Type
Experimental
Arm Description
Lixisenatide will be administered subcutaneously, once daily for 8 weeks
Arm Title
Insulin glulisine
Arm Type
Active Comparator
Arm Description
Insulin glulisine will be administered subcutaneously, once daily for 8 weeks
Intervention Type
Drug
Intervention Name(s)
Lixisenatide
Other Intervention Name(s)
Lyxumia
Intervention Description
GLP-1 receptor agonist
Intervention Type
Drug
Intervention Name(s)
Insulin glulisine
Other Intervention Name(s)
Apidra
Intervention Description
Insulin analogue
Primary Outcome Measure Information:
Title
Changes from baseline following 8-week treatment with a glucagon-like peptide(GLP)-1 receptor agonist versus insulin glulisine on renal hemodynamics, measured as glomerular filtration rate (GFR) / effective renal plasma flow (ERPF)
Description
ml/min
Time Frame
8 weeks
Secondary Outcome Measure Information:
Title
Renal damage, measured by urine biomarkers
Description
enzyme immuno assay
Time Frame
8 weeks
Title
Renal tubular function
Description
e.g. percentage (%)
Time Frame
8 weeks
Title
Blood Pressure
Description
mmHg
Time Frame
8 weeks
Other Pre-specified Outcome Measures:
Title
Body anthropometrics: body weight, height, body mass index, waist circumference
Description
kilogram, meters, centimeters
Time Frame
8 weeks
Title
Body fat content
Description
e.g. percentage (%)
Time Frame
8 weeks
Title
Glycemic variables
Description
e.g. mmol/l, mmol/mol
Time Frame
8 weeks
Title
Lipid spectrum
Description
e.g. mmol/l
Time Frame
8 weeks
Title
Inflammatory markers
Description
e.g. nmol/l
Time Frame
8 weeks
Title
Systemic hemodynamic variables
Description
e.g. ml/min
Time Frame
8 weeks
Title
Heart rate
Description
beat per minute
Time Frame
8 weeks
Title
Microvascular function
Description
e.g. count
Time Frame
8 weeks
Title
Arterial stiffness
Description
e.g. augmentation index
Time Frame
8 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
35 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients with type 2 diabetes (HbA1c: 6.5-10.0% or 48-86 mmol/mol) Stable treatment with basal insulin glargine (dose ±20%) and metformin or basal insulin glargine (dose ±20%) alone for at least 3 months Fasting plasma glucose <10 mmol/L or the use of >50 units of basal insulin glargine Females must be post-menopausal Caucasian Age: 35 - 75 years Body Mass Index: >25 kg/m2 Hypertension should be under control, i.e. <140/90 mmHg, and treated with an angiotensin-converting enzyme inhibitor or angiotensin-II-receptor blocker for at least 3 months. Albuminuria should be treated with an angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin-II-receptor blocker (ARB) for at least 3 months. Exclusion Criteria: Current/chronic use of the following medication: thiazolidinediones, sulfonylurea derivatives, GLP-1 receptor agonists, dipeptidyl peptidase (DPP)-4 inhibitors, glucocorticoids, immune suppressants, antimicrobial agents, chemotherapeutics, antipsychotics, tricyclic antidepressants and monoamine oxidase inhibitors. Subjects on diuretics, will only be excluded when these drugs cannot be stopped for the duration of the study. Chronic use of non-steroidal anti-inflammatory drugs will not be allowed, unless used as incidental medication (1-2 tablets) for non-chronic indications (i.e. sports injury, head-ache or back ache). However, no such drugs can be taken within a time-frame of 2 weeks prior to renal-testing Hypoglycemia unawareness based on investigator judgment History of severe hypoglycemia that required emergency hospital treatment within 3 months prior to screening Estimated GFR <60 mL/min/1.73m2 (determined by the Modification of Diet in Renal Disease (MDRD) study equation) Pregnancy Current urinary tract infection and active nephritis Recent (<6 months) history of cardiovascular disease, including: acute coronary syndrome, chronic heart failure (New York Heart Association grade II-IV), stroke or transient ischemic neurologic disorder Complaints compatible with or established gastroparesis, neurogenic bladder and/or incomplete bladder emptying (as determined by ultrasonic bladder scan) Active liver disease or a 3-fold elevation of liver enzymes (aspartate aminotransferase/alanine aminotransferase) at screening History of or actual pancreatic disease History of or actual malignancy (except basal cell carcinoma) History of or actual severe mental disease Substance abuse (alcohol: defined as >4 units/day) Allergy to any of the agents used in the study Individuals who are investigator site personnel, directly affiliated with the study, or are immediate (spouse, parent, child, or sibling, whether biological or legally adopted) family of investigator site personnel directly affiliated with the study Inability to understand the study protocol or give informed consent
Facility Information:
Facility Name
VU Universtiy Medical Center
City
Amsterdam
ZIP/Postal Code
1081 HV
Country
Netherlands

12. IPD Sharing Statement

Citations:
PubMed Identifier
28449402
Citation
Tonneijck L, Muskiet MHA, Smits MM, Hoekstra T, Kramer MHH, Danser AHJ, Diamant M, Joles JA, van Raalte DH. Postprandial renal haemodynamic effect of lixisenatide vs once-daily insulin-glulisine in patients with type 2 diabetes on insulin-glargine: An 8-week, randomised, open-label trial. Diabetes Obes Metab. 2017 Dec;19(12):1669-1680. doi: 10.1111/dom.12985. Epub 2017 Jul 25.
Results Reference
derived

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Effect of LIXIsenatide on the Renal System

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