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Impact of a Short-term Treatment With Canagliflozin (Canacardia-HF) (Canacardia)

Primary Purpose

Type2 Diabetes, Heart Failure

Status
Withdrawn
Phase
Not Applicable
Locations
Study Type
Interventional
Intervention
Canagliflozin 100mg
Placebo oral capsule
PET imaging
Sponsored by
Université de Sherbrooke
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for Type2 Diabetes

Eligibility Criteria

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

Inclusion Criteria:

  • HbA1c 7.5 -10.5%;
  • LVEF < 40%;
  • NYHA class 2 or 3;
  • NT pro-BNP level > 600 pg/mL;
  • Being on a stable-dose metformin therapy max 2500 mg/day or other hypoglycemic therapy and RAAS-blocking agents for at least 8 weeks;
  • Being on optimal and stable-doses of heart failure medication including diuretics for at least 4 weeks;

Exclusion Criteria:

  • age <18 yo;
  • NYHA class 4;
  • Treatment with a fibrate or thiazolidinedione;
  • Unstable or advanced renal failure;
  • Unstable or new medical or surgical condition within the past 3 months;
  • Heart failure caused by active inflammatory condition such as sarcoidosis or any form of myocarditis;
  • History of diabetic ketoacidosis;
  • Not on a stable regimen for at least 8 weeks before the screening visit;
  • Female of child-bearing potential who is pregnant, breast feeding or intends to become pregnant or pre-menopausal female with a positive serum pregnancy test at the time of enrollment;
  • Patients post bariatric surgery, or on weight loss medication;
  • Contraindications to metformin, including allergy or intolerance;
  • Hospitalization for heart failure within the 60 days prior to enrollment;
  • Admission for an acute coronary syndrome, percutaneous coronary intervention, or cardiac surgery within the 60 days prior to enrollment;
  • Planned cardiovascular revascularization (percutaneous intervention or surgical) or major cardiac surgery (coronary artery bypass grafting, valve replacement, ventricular assist device, cardiac transplantation, or any other surgery requiring thoracotomy) within the 90 days after enrollment;
  • Patients who are volume depleted based upon physical examination at the time of enrollment;
  • Chronic disabling illness;
  • History of substance abuse.

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm Type

    Placebo Comparator

    Experimental

    Arm Label

    Treatment 1

    Treatment 2

    Arm Description

    placebo oral capsule will be administered once daily, for 2 weeks

    Canagliflozine 100mg once daily, for 2 weeks

    Outcomes

    Primary Outcome Measures

    Change to be observed with canagliflozin on myocardial dietary fatty acid uptake
    will be assessed using oral administration of 18-fluoro-thiaheptadecanoic acid ([18F]-FTHA) with sequential dynamic. PET/CT scanning.
    Change to be observed with canagliflozin on whole-body partitioning.
    will be assessed using oral administration of 18-fluoro-thiaheptadecanoic acid ([18F]-FTHA, with static PET/CT scanning

    Secondary Outcome Measures

    myocardial and liver NEFA uptake
    using PET with [11C]-palmitate
    NEFA oxidative rate
    using PET with [11C]-acetate
    plasma NEFA turnover
    using i.v. infusion of [U-13C]-palmitate

    Full Information

    First Posted
    September 26, 2017
    Last Updated
    April 15, 2019
    Sponsor
    Université de Sherbrooke
    Collaborators
    Janssen Inc.
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    1. Study Identification

    Unique Protocol Identification Number
    NCT03298009
    Brief Title
    Impact of a Short-term Treatment With Canagliflozin (Canacardia-HF)
    Acronym
    Canacardia
    Official Title
    Subclinical Inflammation, Myocardial Function and Fatty Acid Metabolism in Patients With Type 2 Diabetes and Heart Failure: Impact of a Short-term Treatment With Canagliflozin - a Pilot Study
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    April 2019
    Overall Recruitment Status
    Withdrawn
    Why Stopped
    end of contract negociations
    Study Start Date
    November 1, 2017 (Anticipated)
    Primary Completion Date
    November 1, 2018 (Anticipated)
    Study Completion Date
    January 1, 2019 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Principal Investigator
    Name of the Sponsor
    Université de Sherbrooke
    Collaborators
    Janssen Inc.

    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
    It is a mechanistic proof-of-concept study to demonstrate how SGLT-2 inhibitors (Canagliflozin) may have a beneficial role on cardiac energetic efficiency. Patients with type 2 diabetes and with HF diagnosed for at least 3 months will be selected. The participants will be randomized to a double-blind, crossover 2-week placebo vs. Cana 100 mg once daily, an interventional trial with a one-month washout period in between. At the term of the two-week placebo and canagliflozin treatment periods (visits 2 and 4), each participant will undergo an identical postprandial metabolic study with positron emission tomography (PET) and stable isotopic tracer methods.
    Detailed Description
    Non-invasive Positron Emission Tomography (PET) imaging method allows to measure myocardial uptake and organ-specific partitioning of dietary fatty acids (DFA). It allows to study kidney, liver, skeletal muscles and adipose tissues DFA utilization, whole body fatty acid turnover and oxidation rates, myocardial oxidative metabolism and left ventricular (LV) function that are other likely targets of SGLT-2 inhibitors. Thus, the PET is ideal to verify the very interesting hypothesis that, increase in liver fatty acid utilization and/or adipose tissue dietary fatty acid uptake, may lead to reduced cardiac utilization of fatty acids and improved cardiac energetic efficiency. .

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Type2 Diabetes, Heart Failure

    7. Study Design

    Primary Purpose
    Basic Science
    Study Phase
    Not Applicable
    Interventional Study Model
    Crossover Assignment
    Model Description
    Placebo-controlled, double-blind, randomized crossover 2-week intervention study.
    Masking
    ParticipantOutcomes Assessor
    Allocation
    Randomized
    Enrollment
    0 (Actual)

    8. Arms, Groups, and Interventions

    Arm Title
    Treatment 1
    Arm Type
    Placebo Comparator
    Arm Description
    placebo oral capsule will be administered once daily, for 2 weeks
    Arm Title
    Treatment 2
    Arm Type
    Experimental
    Arm Description
    Canagliflozine 100mg once daily, for 2 weeks
    Intervention Type
    Drug
    Intervention Name(s)
    Canagliflozin 100mg
    Other Intervention Name(s)
    Invokana
    Intervention Description
    2-week intervention
    Intervention Type
    Drug
    Intervention Name(s)
    Placebo oral capsule
    Intervention Description
    2-week intervention
    Intervention Type
    Radiation
    Intervention Name(s)
    PET imaging
    Intervention Description
    1 day postprandial metabolic protocol at the end of treatment: CT scan followed by dynamic and pancorporel imaging
    Primary Outcome Measure Information:
    Title
    Change to be observed with canagliflozin on myocardial dietary fatty acid uptake
    Description
    will be assessed using oral administration of 18-fluoro-thiaheptadecanoic acid ([18F]-FTHA) with sequential dynamic. PET/CT scanning.
    Time Frame
    3 months
    Title
    Change to be observed with canagliflozin on whole-body partitioning.
    Description
    will be assessed using oral administration of 18-fluoro-thiaheptadecanoic acid ([18F]-FTHA, with static PET/CT scanning
    Time Frame
    3 months
    Secondary Outcome Measure Information:
    Title
    myocardial and liver NEFA uptake
    Description
    using PET with [11C]-palmitate
    Time Frame
    3 months
    Title
    NEFA oxidative rate
    Description
    using PET with [11C]-acetate
    Time Frame
    3 months
    Title
    plasma NEFA turnover
    Description
    using i.v. infusion of [U-13C]-palmitate
    Time Frame
    1 year
    Other Pre-specified Outcome Measures:
    Title
    Insulin sensitivity
    Description
    will be determined using the HOMA-IR (based on fasting insulin and glucose levels)
    Time Frame
    1 year
    Title
    Insulin secretion rate
    Description
    will be assessed using deconvolution of plasma C-peptide with standard Cpeptide kinetic parameters
    Time Frame
    1 year
    Title
    β-cell function
    Description
    will be assessed by calculation of the disposition index (DI) that is insulin secretion in response to the ambient insulin
    Time Frame
    1 year
    Title
    hormonal response
    Description
    will be determined using a multiplex assay system
    Time Frame
    1 year
    Title
    Biomarkers
    Description
    Assays will be performed using the BIOPLEX
    Time Frame
    1 year
    Title
    body composition
    Description
    DXA
    Time Frame
    3 months

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Maximum Age & Unit of Time
    75 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: HbA1c 7.5 -10.5%; LVEF < 40%; NYHA class 2 or 3; NT pro-BNP level > 600 pg/mL; Being on a stable-dose metformin therapy max 2500 mg/day or other hypoglycemic therapy and RAAS-blocking agents for at least 8 weeks; Being on optimal and stable-doses of heart failure medication including diuretics for at least 4 weeks; Exclusion Criteria: age <18 yo; NYHA class 4; Treatment with a fibrate or thiazolidinedione; Unstable or advanced renal failure; Unstable or new medical or surgical condition within the past 3 months; Heart failure caused by active inflammatory condition such as sarcoidosis or any form of myocarditis; History of diabetic ketoacidosis; Not on a stable regimen for at least 8 weeks before the screening visit; Female of child-bearing potential who is pregnant, breast feeding or intends to become pregnant or pre-menopausal female with a positive serum pregnancy test at the time of enrollment; Patients post bariatric surgery, or on weight loss medication; Contraindications to metformin, including allergy or intolerance; Hospitalization for heart failure within the 60 days prior to enrollment; Admission for an acute coronary syndrome, percutaneous coronary intervention, or cardiac surgery within the 60 days prior to enrollment; Planned cardiovascular revascularization (percutaneous intervention or surgical) or major cardiac surgery (coronary artery bypass grafting, valve replacement, ventricular assist device, cardiac transplantation, or any other surgery requiring thoracotomy) within the 90 days after enrollment; Patients who are volume depleted based upon physical examination at the time of enrollment; Chronic disabling illness; History of substance abuse.
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    André C. Carpentier
    Organizational Affiliation
    Université de Sherbrooke
    Official's Role
    Principal Investigator

    12. IPD Sharing Statement

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    Impact of a Short-term Treatment With Canagliflozin (Canacardia-HF)

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