search
Back to results

ERtugliflozin triAl in DIabetes With Preserved or Reduced ejeCtion FrAcTion mEchanistic Evaluation in Heart Failure (ERADICATE-HF)

Primary Purpose

Type 2 Diabetes Mellitus, Heart Failure

Status
Completed
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
Ertugliflozin
Placebo
Sponsored by
University Health Network, Toronto
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Type 2 Diabetes Mellitus focused on measuring SGLT2 inhibtion, Ertugliflozin, Type 2 Diabetes, Heart Failure

Eligibility Criteria

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

Inclusion Criteria:

  1. Male or female subjects diagnosed with T2D ≥12 months prior to informed consent;
  2. eGFR ≥30 ml/min/1.73m2;
  3. Age >18 years;
  4. HbA1c 6.5%-10.5%;
  5. Body Mass Index (BMI) 18.5-45.0 kg/m2;
  6. Blood pressure ≤160/110 and ≥90/60 at screening,
  7. Heart failure with New York Heart Association (NYHA) class 2-3 symptoms and ejection fraction ≥20%
  8. Stable dose of maximally tolerated ACE inhibitor, angiotensin receptor blocker or renin inhibitor for at least 30 days
  9. Stable diuretic dose for at least 30 days at the time of baseline physiological assessment
  10. BNP levels at baseline ≥100 pg/ml (no atrial fibrillation), ≥200 pg/ml if in atrial fibrillation

Exclusion Criteria:

  1. Type 1 Diabetes;
  2. Leukocyte and/or nitrite positive urinalysis that is untreated;
  3. Severe hypoglycaemia within 2 months prior to screening;
  4. History of brittle diabetes or hypoglycaemia unawareness based on investigator judgement;
  5. Unstable coronary artery disease with acute coronary syndrome, percutaneous intervention or bypass surgery within 3 months;
  6. Clinically significant valvular disease;
  7. Congestive heart failure secondary to an infiltrative cardiomyopathic process (for example amyloid) or pericardial constriction;
  8. Uncontrolled systemic hypertension (systolic blood pressure >160 mmHg and/or diastolic blood pressure >110) or systemic hypotension (systolic blood pressure < 90/60 mmHg);
  9. Bariatric surgery or other surgeries that induce chronic malabsorption;
  10. Anti-obesity drugs or diet regimen and unstable body weight three months prior to screening;
  11. Treatment with systemic corticosteroids;
  12. Blood dyscrasias or any disorders causing hemolysis or unstable red blood cells;
  13. Pre-menopausal women who are nursing, pregnant, or of child-bearing potential and not practicing an acceptable method of birth control;
  14. Participation in another trial with an investigational drug within 30 days of informed consent;
  15. 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;
  16. Liver disease, defined by serum levels of alanine transaminase, aspartate transaminase, or alkaline phosphatase >3 x upper limit of normal as determined during screening;
  17. Active malignancy at the time of screening;

Sites / Locations

  • Toronto General Hospital
  • Vanderbilt University Medical Centre
  • University Medical Center Groningen

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Ertuglifozin Treatment Arm

Placebo Arm

Arm Description

Ertugliflozin Tablets Total Dose 15mg (10mg + 5 mg) for 12 weeks

Placebo Matching Ertugliflozin Tablet for 12 weeks

Outcomes

Primary Outcome Measures

Proximal sodium reabsorption (FENa)
The difference in proximal sodium reabsorption FENa (measured using FELi) with ertugliflozin vs. placebo

Secondary Outcome Measures

Glomerular Filtration Rate (GFR)
The difference in GFR with ertugliflozin vs. placebo
Effective Renal Plasma Flow (ERPF)
The difference in ERPF with ertugliflozin vs. placebo
Systolic blood pressure (SBP)
The difference in SBP with ertugliflozin vs. placebo
Diastolic blood pressure (DBP)
The difference in DBP with ertugliflozin vs. placebo
Heart rate (HR)
The difference in HR with ertugliflozin vs. placebo
Echocardiography for markers of systolic and diastolic function, cardiac output
Arterial stiffness
Plasma volume
Plasma volume will be measured using a non-radioactive technique (indocyanine green dilution)
Extracellular water
Extracellular water will be measured non-invasively using bioimpedence spectroscopy
Cardiac output
Cardiac output will also be measured using non-invasive cardiac monitoring (NICOM)
Systemic vascular resistance
Systemic vascular resistance will also be measured using non-invasive cardiac monitoring (NICOM)
RAAS hormones
Neurohormones/biomarkers
Natriuretic peptides
Neurohormones/biomarkers
Sympathetic nervous system markers
Neurohormones/biomarkers
Urinary adenosine
Neurohormones/biomarkers

Full Information

First Posted
January 15, 2018
Last Updated
May 15, 2023
Sponsor
University Health Network, Toronto
Collaborators
University Medical Center Groningen, Merck Sharp & Dohme LLC, University of Toronto, Toronto General Hospital
search

1. Study Identification

Unique Protocol Identification Number
NCT03416270
Brief Title
ERtugliflozin triAl in DIabetes With Preserved or Reduced ejeCtion FrAcTion mEchanistic Evaluation in Heart Failure
Acronym
ERADICATE-HF
Official Title
ERtugliflozin triAl in DIabetes With Preserved or Reduced ejeCtion FrAcTion mEchanistic Evaluation in Heart Failure: "ERADICATE-HF"
Study Type
Interventional

2. Study Status

Record Verification Date
May 2023
Overall Recruitment Status
Completed
Study Start Date
June 28, 2018 (Actual)
Primary Completion Date
April 14, 2021 (Actual)
Study Completion Date
April 14, 2021 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University Health Network, Toronto
Collaborators
University Medical Center Groningen, Merck Sharp & Dohme LLC, University of Toronto, Toronto General Hospital

4. Oversight

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

5. Study Description

Brief Summary
This study aims to elucidate the mechanisms whereby the SGLT2i "ertugliflozin" modifies cardiorenal interactions that regulate fluid volume and neurohormonal activation in patients with type 2 diabetes and heart failure (T2D-HF).
Detailed Description
Newer agents called sodium glucose co-transporter-2 inhibitors (SGLT2i) have been developed to improve glycemic control and lower hemoglobin A1c by increasing glycosuria. SGLT2i also reduce blood pressure and albuminuria in T2D - possibly through natriuresis. Importantly, a landmark trial "EMPA-REG OUTCOME" demonstrated that the SGLT2i "empagliflozin" is the first anti- hyperglycemic agent to reduce mortality and HF risk, and also to decrease the risk of progressive diabetic nephropathy. Similar benefits were also recently reported in the CANVAS Program trial with canagliflozin. Despite the benefits observed in these two pivotal trials, the mechanisms responsible for beneficial effects of SGLT2i in patients with T2D with respect to the development and/or worsening of HF are not currently known. In light of the results of EMPA-REG OUTCOME, the investigators aim to elucidate the mechanisms whereby the SGLT2i "ertugliflozin" modifies cardiorenal interactions that regulate fluid volume and neurohormonal activation in patients with T2D and HF (T2D-HF). The investigators will test the hypothesis that ertugliflozin increases proximal tubular natriuresis, thereby reducing plasma volume, without inducing significant renal vasoconstriction or activation of the sympathetic nervous system (SNS) (see below, Figure 1). The systematic understanding of the effects of SGLT2i in the setting of HF will enable the design of rational physiology based strategies to decrease the burden of HF, which could have major clinical and research implications internationally.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Type 2 Diabetes Mellitus, Heart Failure
Keywords
SGLT2 inhibtion, Ertugliflozin, Type 2 Diabetes, Heart Failure

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Model Description
Patients will be randomized to 15 mg (10mg + 5mg tablets) PO ertugliflozin daily or a matched placebo.
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Masking Description
Double-blind study
Allocation
Randomized
Enrollment
34 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Ertuglifozin Treatment Arm
Arm Type
Experimental
Arm Description
Ertugliflozin Tablets Total Dose 15mg (10mg + 5 mg) for 12 weeks
Arm Title
Placebo Arm
Arm Type
Placebo Comparator
Arm Description
Placebo Matching Ertugliflozin Tablet for 12 weeks
Intervention Type
Drug
Intervention Name(s)
Ertugliflozin
Intervention Description
Ertugliflozin Tablets Total Dose 15mg (10mg + 5 mg) once daily for 12 weeks
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Placebo once daily for 12 weeks
Primary Outcome Measure Information:
Title
Proximal sodium reabsorption (FENa)
Description
The difference in proximal sodium reabsorption FENa (measured using FELi) with ertugliflozin vs. placebo
Time Frame
Outcome will be measured at 2 time points: acute (1 week) and chronic (12 weeks)
Secondary Outcome Measure Information:
Title
Glomerular Filtration Rate (GFR)
Description
The difference in GFR with ertugliflozin vs. placebo
Time Frame
Glomerular Filtration Rate (GFR, based on plasma inulin clearance) will be measured at 2 time points: acute (1 week) and chronic (12 weeks)
Title
Effective Renal Plasma Flow (ERPF)
Description
The difference in ERPF with ertugliflozin vs. placebo
Time Frame
Effective Renal Plasma Flow (ERPF, based on paraaminohippurate plasma clearance) will be measured at 2 time points: acute (1 week) and chronic (12 weeks)
Title
Systolic blood pressure (SBP)
Description
The difference in SBP with ertugliflozin vs. placebo
Time Frame
2 time points: acute (1 week) and chronic (12 weeks)
Title
Diastolic blood pressure (DBP)
Description
The difference in DBP with ertugliflozin vs. placebo
Time Frame
2 time points: acute (1 week) and chronic (12 weeks)
Title
Heart rate (HR)
Description
The difference in HR with ertugliflozin vs. placebo
Time Frame
2 time points: acute (1 week) and chronic (12 weeks)
Title
Echocardiography for markers of systolic and diastolic function, cardiac output
Time Frame
2 time points: acute (1 week) and chronic (12 weeks)
Title
Arterial stiffness
Time Frame
2 time points: acute (1 week) and chronic (12 weeks)
Title
Plasma volume
Description
Plasma volume will be measured using a non-radioactive technique (indocyanine green dilution)
Time Frame
2 time points: acute (1 week) and chronic (12 weeks)
Title
Extracellular water
Description
Extracellular water will be measured non-invasively using bioimpedence spectroscopy
Time Frame
2 time points: acute (1 week) and chronic (12 weeks)
Title
Cardiac output
Description
Cardiac output will also be measured using non-invasive cardiac monitoring (NICOM)
Time Frame
2 time points: acute (1 week) and chronic (12 weeks)
Title
Systemic vascular resistance
Description
Systemic vascular resistance will also be measured using non-invasive cardiac monitoring (NICOM)
Time Frame
2 time points: acute (1 week) and chronic (12 weeks)
Title
RAAS hormones
Description
Neurohormones/biomarkers
Time Frame
2 time points: acute (1 week) and chronic (12 weeks)
Title
Natriuretic peptides
Description
Neurohormones/biomarkers
Time Frame
2 time points: acute (1 week) and chronic (12 weeks)
Title
Sympathetic nervous system markers
Description
Neurohormones/biomarkers
Time Frame
2 time points: acute (1 week) and chronic (12 weeks)
Title
Urinary adenosine
Description
Neurohormones/biomarkers
Time Frame
2 time points: acute (1 week) and chronic (12 weeks)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
19 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male or female subjects diagnosed with T2D ≥12 months prior to informed consent; eGFR ≥30 ml/min/1.73m2; Age >18 years; HbA1c 6.5%-10.5%; Body Mass Index (BMI) 18.5-45.0 kg/m2; Blood pressure ≤160/110 and ≥90/60 at screening, Heart failure with New York Heart Association (NYHA) class 2-3 symptoms and ejection fraction ≥20% Stable dose of maximally tolerated ACE inhibitor, angiotensin receptor blocker or renin inhibitor for at least 30 days Stable diuretic dose for at least 30 days at the time of baseline physiological assessment BNP levels at baseline ≥100 pg/ml (no atrial fibrillation), ≥200 pg/ml if in atrial fibrillation Exclusion Criteria: Type 1 Diabetes; Leukocyte and/or nitrite positive urinalysis that is untreated; Severe hypoglycaemia within 2 months prior to screening; History of brittle diabetes or hypoglycaemia unawareness based on investigator judgement; Unstable coronary artery disease with acute coronary syndrome, percutaneous intervention or bypass surgery within 3 months; Clinically significant valvular disease; Congestive heart failure secondary to an infiltrative cardiomyopathic process (for example amyloid) or pericardial constriction; Uncontrolled systemic hypertension (systolic blood pressure >160 mmHg and/or diastolic blood pressure >110) or systemic hypotension (systolic blood pressure < 90/60 mmHg); Bariatric surgery or other surgeries that induce chronic malabsorption; Anti-obesity drugs or diet regimen and unstable body weight three months prior to screening; Treatment with systemic corticosteroids; 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 practicing an acceptable method of birth control; Participation in another trial with an investigational drug within 30 days of 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; Active malignancy at the time of screening;
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
David ZI Cherney, MD PhD
Organizational Affiliation
University Health Network, Toronto General Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Toronto General Hospital
City
Toronto
State/Province
Ontario
ZIP/Postal Code
M5G2N2
Country
Canada
Facility Name
Vanderbilt University Medical Centre
City
Amsterdam
State/Province
De Boelelaan
ZIP/Postal Code
1117
Country
Netherlands
Facility Name
University Medical Center Groningen
City
Groningen
Country
Netherlands

12. IPD Sharing Statement

Learn more about this trial

ERtugliflozin triAl in DIabetes With Preserved or Reduced ejeCtion FrAcTion mEchanistic Evaluation in Heart Failure

We'll reach out to this number within 24 hrs