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Pharmacokinetics, Pharmacodynamics, Safety and Tolerability of Dabigatran Etexilate in Patients With and Without Renal Impairment

Primary Purpose

Renal Insufficiency

Status
Completed
Phase
Phase 1
Locations
Study Type
Interventional
Intervention
Dabigatran etexilate high dose
Dabigatran etexilate low dose
Sponsored by
Boehringer Ingelheim
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Renal Insufficiency

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  • Healthy male or female subjects determined by results of screening with a creatinine clearance >80 mL/min (group 1, control group)
  • Renally impaired male or female subjects determined by results of screening with the following creatinine clearance results:

    • creatinine clearance >50 - ≤80 mL/min (group 2)
    • creatinine clearance >30 - ≤50 mL/min (group 3)
    • creatinine clearance ≤30 mL/min (group 4)
    • uraemia requiring maintenance dialysis (group 5)
    • Signed written informed consent in accordance with Good Clinical Practice (GCP) and local legislation
  • Age >=18 and <=75 years
  • BMI >=18.0 and <=32 kg/m2, at least 45 kg for females

Exclusion Criteria:

  • Any finding of the medical examination (including blood pressure, pulse rate, and electrocardiogram) deviating from normal and of clinical relevance
  • Clinically relevant gastrointestinal, hepatic, renal, respiratory, cardiovascular, metabolic, immunologic or hormonal disorders
  • Surgery of gastrointestinal tract (except appendectomy, cholecystectomy or herniotomy)
  • Clinically relevant diseases of the central nervous system
  • Relevant history of orthostatic hypotension, fainting spells or blackouts
  • Abnormal prothrombin time (PT), TT, aPTT (must be within the normal range after no more than one repeated test), thrombocytes <150000/μl (two repeats of the first test)
  • Evidence of haematuria either macroscopically detectable or microscopic on urinalysis (normal microscopic results after no more than one repeated test)
  • Evidence of blood dyscrasia, haemorrhagic diathesis, severe thrombocytopenia, cerebrovascular haemorrhage, bleeding tendencies associated with active ulceration or overt bleeding of gastrointestinal, respiratory or genitourinary tract or any disease or condition with haemorrhagic tendencies (e.g. cerebral aneurysm, dissecting aorta, central nervous system (CNS) trauma, retinopathy or nephrolithiasis)
  • Recent or contemplated diagnostic or therapeutic procedures with potential for uncontrollable bleeding (e.g. spinal puncture, lumbar block anaesthesia, surgery of CNS or eye or surgery resulting in large open surfaces) within 14 days before or after drug administration of this clinical trial
  • Chronic or relevant acute infections
  • History of allergy/hypersensitivity (including drug allergy) which is deemed relevant to the trial as judged by the investigator
  • For women with childbearing potential: no reliable contraception (accepted methods are intra uterine device, hormonal contraceptives, bilateral tubal ligation, hysterectomy, condoms) or pregnancy (known or detected by a positive pregnancy test) or breast feeding period
  • Intake of drugs with a long half-life (>24 hours) (<1 month prior to administration or during the trial)
  • Use of any drugs, within 14 days prior to administration or during the trial
  • Participation in another trial with an investigational drug (<2 months prior to drug administration or during trial)
  • Drug abuse
  • Blood donation or loss >400 mL, <1 month prior to administration or during the trial
  • Excessive physical activities <5 days prior to administration of study drug or during trial
  • Clinically relevant laboratory abnormalities

Renally impaired subjects (groups 2, 3, 4 and 5) who met any of the following criteria were not be entered into this trial:

  • Moderate and severe concurrent liver function impairment (e.g. due to hepatorenal syndrome)
  • Clinically relevant gastrointestinal, respiratory, cardiovascular, metabolic, immunologic or hormonal disorders
  • Surgery of gastrointestinal tract (except appendectomy, cholecystectomy or herniotomy)
  • Clinically relevant diseases of the central nervous system
  • Relevant history of orthostatic hypotension, fainting spells or blackouts
  • Abnormal values for PT, TT, aPTT and thrombocytes considered by the investigator or one of the co-investigators to be clinically relevant
  • Evidence of blood dyscrasia, haemorrhagic diathesis, severe thrombocytopenia, cerebrovascular haemorrhage, bleeding tendencies associated with active ulceration or overt bleeding of gastrointestinal, respiratory or genitourinary tract or any disease or condition with haemorrhagic tendencies (e.g. cerebral aneurysm, dissecting aorta, CNS trauma, retinopathy, nephrolithiasis) considered by the investigator or one of the co-investigators to be clinically relevant
  • Recent or contemplated diagnostic or therapeutic procedures with potential for uncontrollable bleeding (e.g. spinal puncture, lumbar block anaesthesia, surgery of CNS or eye or surgery resulting in large open surfaces) within 14 days before or after drug administration of this clinical trial
  • Chronic or relevant acute infections
  • History of allergy/hypersensitivity (including drug allergy) which is deemed relevant to the trial as judged by the investigator
  • For women with childbearing potential: no reliable contraception (accepted methods are intra-uterine device, hormonal contraceptives, bilateral tubal ligation, hysterectomy or condoms) or pregnancy (known or detected by a positive pregnancy test) or breast-feeding period
  • Participation in another trial with an investigational drug (<2 months prior to administration or during trial)
  • Drug abuse
  • Blood donation or loss >400 mL, <1 month prior to administration or during the trial
  • Excessive physical activities < 5 days prior to administration of study drug or during trial
  • Clinically relevant laboratory abnormalities except those values typical for renally impaired patients

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm 3

    Arm 4

    Arm 5

    Arm Type

    Experimental

    Experimental

    Experimental

    Experimental

    Experimental

    Arm Label

    Dabigatran high dose in healthy subjects

    Dabigatran high dose in mild renal impairment

    Dabigatran high dose in moderate renal impairment

    Dabigatran high dose in severe renal impairment

    Dabigatran low dose in haemodialysis patients

    Arm Description

    healthy subjects with a creatinine clearance of >80 mL/m

    patients with a creatinine clearance of >50 up to 80 mL/min

    patients with a creatinine clearance of >30 up to 50 mL/min

    patients with a creatinine clearance of up to 30 mL/min

    patients requiring haemodialysis

    Outcomes

    Primary Outcome Measures

    AUC0-infinity (area under the concentration time curve of the analyte in plasma over the time interval from 0 extrapolated to infinity)
    Cmax (maximum concentration of the analyte in plasma)
    CL/F (apparent clearance of the analyte in the plasma after extravascular administration)
    international normalized ratio (INR)
    activated partial thromboplastin time (aPTT)
    Ecarin clotting time (ECT)
    thrombin time (TT)

    Secondary Outcome Measures

    AUC0-tz (area under the concentration-time curve of the analyte in plasma over the time interval from 0 to the time of the last quantifiable data point)
    AUCt1-t2 (area under the concentration-time curve of the analyte in plasma over the time interval t1 to t2, time interval to be determined)
    tmax (time from dosing to the maximum concentration of the analyte in plasma, oral administration only)
    λz (terminal rate constant in plasma)
    t1/2 (terminal half-life of the analyte in plasma)
    MRTpo (mean residence time of the analyte in the body after p.o. administration)
    Vz/F (apparent volume of distribution during the terminal phase λz following an extravascular dose)
    Ae0-72 (amount of analyte that is eliminated in urine from the time interval 0 to 72 h)
    fe0-72 (fraction of administered drug excreted unchanged in urine from time point 0 to 72 h)
    CLR,0-72 (renal clearance of the analyte in plasma from the time point 0 h until the timepoint 72 h)
    Plasma protein binding of dabigatran
    Changes from baseline in pulse rate
    Changes from baseline in systolic and diastolic blood pressure
    Changes from baseline in ECG
    Changes from baseline in routine laboratory
    Occurrence of adverse events
    Assessment of tolerability on a 4-point scale

    Full Information

    First Posted
    July 2, 2014
    Last Updated
    July 17, 2014
    Sponsor
    Boehringer Ingelheim
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    1. Study Identification

    Unique Protocol Identification Number
    NCT02182024
    Brief Title
    Pharmacokinetics, Pharmacodynamics, Safety and Tolerability of Dabigatran Etexilate in Patients With and Without Renal Impairment
    Official Title
    Pharmacokinetics, Pharmacodynamics, Safety and Tolerability of 150 mg Dabigatran Etexilate p.o. in Patients With Different Degrees of Renal Impairment in Comparison to Subjects With Normal Renal Function in a Monocentric, Open, Parallel-group Trial
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    July 2014
    Overall Recruitment Status
    Completed
    Study Start Date
    April 2005 (undefined)
    Primary Completion Date
    March 2006 (Actual)
    Study Completion Date
    undefined (undefined)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    Boehringer Ingelheim

    4. Oversight

    5. Study Description

    Brief Summary
    To assess the effect of different degrees of renal impairment on the pharmacokinetics and pharmacodynamics of dabigatran etexilate administered orally.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Renal Insufficiency

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Phase 1
    Interventional Study Model
    Parallel Assignment
    Masking
    None (Open Label)
    Allocation
    Non-Randomized
    Enrollment
    35 (Actual)

    8. Arms, Groups, and Interventions

    Arm Title
    Dabigatran high dose in healthy subjects
    Arm Type
    Experimental
    Arm Description
    healthy subjects with a creatinine clearance of >80 mL/m
    Arm Title
    Dabigatran high dose in mild renal impairment
    Arm Type
    Experimental
    Arm Description
    patients with a creatinine clearance of >50 up to 80 mL/min
    Arm Title
    Dabigatran high dose in moderate renal impairment
    Arm Type
    Experimental
    Arm Description
    patients with a creatinine clearance of >30 up to 50 mL/min
    Arm Title
    Dabigatran high dose in severe renal impairment
    Arm Type
    Experimental
    Arm Description
    patients with a creatinine clearance of up to 30 mL/min
    Arm Title
    Dabigatran low dose in haemodialysis patients
    Arm Type
    Experimental
    Arm Description
    patients requiring haemodialysis
    Intervention Type
    Drug
    Intervention Name(s)
    Dabigatran etexilate high dose
    Intervention Type
    Drug
    Intervention Name(s)
    Dabigatran etexilate low dose
    Primary Outcome Measure Information:
    Title
    AUC0-infinity (area under the concentration time curve of the analyte in plasma over the time interval from 0 extrapolated to infinity)
    Time Frame
    pre-dose and 0.5, 1, 1.5, 2, 3, 4, 6, 8, 12, 24, 48 and 72 h after administration, additional 96 h in subjects with severe renal impairment and dialysis patients
    Title
    Cmax (maximum concentration of the analyte in plasma)
    Time Frame
    pre-dose and 0.5, 1, 1.5, 2, 3, 4, 6, 8, 12, 24, 48 and 72 h after administration, additional 96 h in subjects with severe renal impairment and dialysis patients
    Title
    CL/F (apparent clearance of the analyte in the plasma after extravascular administration)
    Time Frame
    pre-dose and 0.5, 1, 1.5, 2, 3, 4, 6, 8, 12, 24, 48 and 72 h after administration, additional 96 h in subjects with severe renal impairment and dialysis patients
    Title
    international normalized ratio (INR)
    Time Frame
    pre-dose and 0.5, 1, 1.5, 2, 3, 4, 6, 8, 12, 24, 48 and 72 h after administration, additional 96 h in subjects with severe renal impairment and dialysis patients
    Title
    activated partial thromboplastin time (aPTT)
    Time Frame
    pre-dose and 0.5, 1, 1.5, 2, 3, 4, 6, 8, 12, 24, 48 and 72 h after administration, additional 96 h in subjects with severe renal impairment and dialysis patients
    Title
    Ecarin clotting time (ECT)
    Time Frame
    pre-dose and 0.5, 1, 1.5, 2, 3, 4, 6, 8, 12, 24, 48 and 72 h after administration, additional 96 h in subjects with severe renal impairment and dialysis patients
    Title
    thrombin time (TT)
    Time Frame
    pre-dose and 0.5, 1, 1.5, 2, 3, 4, 6, 8, 12, 24, 48 and 72 h after administration, additional 96 h in subjects with severe renal impairment and dialysis patients
    Secondary Outcome Measure Information:
    Title
    AUC0-tz (area under the concentration-time curve of the analyte in plasma over the time interval from 0 to the time of the last quantifiable data point)
    Time Frame
    pre-dose and 0.5, 1, 1.5, 2, 3, 4, 6, 8, 12, 24, 48 and 72 h after administration, additional 96 h in subjects with severe renal impairment and dialysis patients
    Title
    AUCt1-t2 (area under the concentration-time curve of the analyte in plasma over the time interval t1 to t2, time interval to be determined)
    Time Frame
    pre-dose and 0.5, 1, 1.5, 2, 3, 4, 6, 8, 12, 24, 48 and 72 h after administration, additional 96 h in subjects with severe renal impairment and dialysis patients
    Title
    tmax (time from dosing to the maximum concentration of the analyte in plasma, oral administration only)
    Time Frame
    pre-dose and 0.5, 1, 1.5, 2, 3, 4, 6, 8, 12, 24, 48 and 72 h after administration, additional 96 h in subjects with severe renal impairment and dialysis patients
    Title
    λz (terminal rate constant in plasma)
    Time Frame
    pre-dose and 0.5, 1, 1.5, 2, 3, 4, 6, 8, 12, 24, 48 and 72 h after administration, additional 96 h in subjects with severe renal impairment and dialysis patients
    Title
    t1/2 (terminal half-life of the analyte in plasma)
    Time Frame
    pre-dose and 0.5, 1, 1.5, 2, 3, 4, 6, 8, 12, 24, 48 and 72 h after administration, additional 96 h in subjects with severe renal impairment and dialysis patients
    Title
    MRTpo (mean residence time of the analyte in the body after p.o. administration)
    Time Frame
    pre-dose and 0.5, 1, 1.5, 2, 3, 4, 6, 8, 12, 24, 48 and 72 h after administration, additional 96 h in subjects with severe renal impairment and dialysis patients
    Title
    Vz/F (apparent volume of distribution during the terminal phase λz following an extravascular dose)
    Time Frame
    pre-dose and 0.5, 1, 1.5, 2, 3, 4, 6, 8, 12, 24, 48 and 72 h after administration, additional 96 h in subjects with severe renal impairment and dialysis patients
    Title
    Ae0-72 (amount of analyte that is eliminated in urine from the time interval 0 to 72 h)
    Time Frame
    pre-dose over 12 hours and post dose in fractions of 0 - 12, 12 - 24, 24 - 48, and 48-72 h, additional until 96 h in subjects with severe renal impairment
    Title
    fe0-72 (fraction of administered drug excreted unchanged in urine from time point 0 to 72 h)
    Time Frame
    pre-dose over 12 hours and post dose in fractions of 0 - 12, 12 - 24, 24 - 48, and 48-72 h, additional until 96 h in subjects with severe renal impairment
    Title
    CLR,0-72 (renal clearance of the analyte in plasma from the time point 0 h until the timepoint 72 h)
    Time Frame
    pre-dose over 12 hours and post dose in fractions of 0 - 12, 12 - 24, 24 - 48, and 48-72 h, additional until 96 h in subjects with severe renal impairment
    Title
    Plasma protein binding of dabigatran
    Time Frame
    within 1 h before study drug administration
    Title
    Changes from baseline in pulse rate
    Time Frame
    Day 4, Day 5 in patients with renal impairment
    Title
    Changes from baseline in systolic and diastolic blood pressure
    Time Frame
    Day 4, Day 5 in patients with renal impairment
    Title
    Changes from baseline in ECG
    Time Frame
    Day 4, Day 5 in patients with renal impairment
    Title
    Changes from baseline in routine laboratory
    Time Frame
    Day 4, Day 5 in patients with renal impairment
    Title
    Occurrence of adverse events
    Time Frame
    up to day 4, up to day 5 in patients with renal impairment
    Title
    Assessment of tolerability on a 4-point scale
    Time Frame
    Day 4, Day 5 in patients with renal impairment

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Maximum Age & Unit of Time
    75 Years
    Accepts Healthy Volunteers
    Accepts Healthy Volunteers
    Eligibility Criteria
    Inclusion Criteria: Healthy male or female subjects determined by results of screening with a creatinine clearance >80 mL/min (group 1, control group) Renally impaired male or female subjects determined by results of screening with the following creatinine clearance results: creatinine clearance >50 - ≤80 mL/min (group 2) creatinine clearance >30 - ≤50 mL/min (group 3) creatinine clearance ≤30 mL/min (group 4) uraemia requiring maintenance dialysis (group 5) Signed written informed consent in accordance with Good Clinical Practice (GCP) and local legislation Age >=18 and <=75 years BMI >=18.0 and <=32 kg/m2, at least 45 kg for females Exclusion Criteria: Any finding of the medical examination (including blood pressure, pulse rate, and electrocardiogram) deviating from normal and of clinical relevance Clinically relevant gastrointestinal, hepatic, renal, respiratory, cardiovascular, metabolic, immunologic or hormonal disorders Surgery of gastrointestinal tract (except appendectomy, cholecystectomy or herniotomy) Clinically relevant diseases of the central nervous system Relevant history of orthostatic hypotension, fainting spells or blackouts Abnormal prothrombin time (PT), TT, aPTT (must be within the normal range after no more than one repeated test), thrombocytes <150000/μl (two repeats of the first test) Evidence of haematuria either macroscopically detectable or microscopic on urinalysis (normal microscopic results after no more than one repeated test) Evidence of blood dyscrasia, haemorrhagic diathesis, severe thrombocytopenia, cerebrovascular haemorrhage, bleeding tendencies associated with active ulceration or overt bleeding of gastrointestinal, respiratory or genitourinary tract or any disease or condition with haemorrhagic tendencies (e.g. cerebral aneurysm, dissecting aorta, central nervous system (CNS) trauma, retinopathy or nephrolithiasis) Recent or contemplated diagnostic or therapeutic procedures with potential for uncontrollable bleeding (e.g. spinal puncture, lumbar block anaesthesia, surgery of CNS or eye or surgery resulting in large open surfaces) within 14 days before or after drug administration of this clinical trial Chronic or relevant acute infections History of allergy/hypersensitivity (including drug allergy) which is deemed relevant to the trial as judged by the investigator For women with childbearing potential: no reliable contraception (accepted methods are intra uterine device, hormonal contraceptives, bilateral tubal ligation, hysterectomy, condoms) or pregnancy (known or detected by a positive pregnancy test) or breast feeding period Intake of drugs with a long half-life (>24 hours) (<1 month prior to administration or during the trial) Use of any drugs, within 14 days prior to administration or during the trial Participation in another trial with an investigational drug (<2 months prior to drug administration or during trial) Drug abuse Blood donation or loss >400 mL, <1 month prior to administration or during the trial Excessive physical activities <5 days prior to administration of study drug or during trial Clinically relevant laboratory abnormalities Renally impaired subjects (groups 2, 3, 4 and 5) who met any of the following criteria were not be entered into this trial: Moderate and severe concurrent liver function impairment (e.g. due to hepatorenal syndrome) Clinically relevant gastrointestinal, respiratory, cardiovascular, metabolic, immunologic or hormonal disorders Surgery of gastrointestinal tract (except appendectomy, cholecystectomy or herniotomy) Clinically relevant diseases of the central nervous system Relevant history of orthostatic hypotension, fainting spells or blackouts Abnormal values for PT, TT, aPTT and thrombocytes considered by the investigator or one of the co-investigators to be clinically relevant Evidence of blood dyscrasia, haemorrhagic diathesis, severe thrombocytopenia, cerebrovascular haemorrhage, bleeding tendencies associated with active ulceration or overt bleeding of gastrointestinal, respiratory or genitourinary tract or any disease or condition with haemorrhagic tendencies (e.g. cerebral aneurysm, dissecting aorta, CNS trauma, retinopathy, nephrolithiasis) considered by the investigator or one of the co-investigators to be clinically relevant Recent or contemplated diagnostic or therapeutic procedures with potential for uncontrollable bleeding (e.g. spinal puncture, lumbar block anaesthesia, surgery of CNS or eye or surgery resulting in large open surfaces) within 14 days before or after drug administration of this clinical trial Chronic or relevant acute infections History of allergy/hypersensitivity (including drug allergy) which is deemed relevant to the trial as judged by the investigator For women with childbearing potential: no reliable contraception (accepted methods are intra-uterine device, hormonal contraceptives, bilateral tubal ligation, hysterectomy or condoms) or pregnancy (known or detected by a positive pregnancy test) or breast-feeding period Participation in another trial with an investigational drug (<2 months prior to administration or during trial) Drug abuse Blood donation or loss >400 mL, <1 month prior to administration or during the trial Excessive physical activities < 5 days prior to administration of study drug or during trial Clinically relevant laboratory abnormalities except those values typical for renally impaired patients

    12. IPD Sharing Statement

    Links:
    URL
    http://trials.boehringer-ingelheim.com
    Description
    Related Info

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    Pharmacokinetics, Pharmacodynamics, Safety and Tolerability of Dabigatran Etexilate in Patients With and Without Renal Impairment

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