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Repurposing Probenecid as a Positive Inotrope for the Treatment of Heart Failure (ReProsperHF)

Primary Purpose

Systolic Heart Failure

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Probenecid 1 gr oral twice daily
Placebo
Sponsored by
University of Cincinnati
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Systolic Heart Failure focused on measuring heart failure, ejection fraction equal or less than 40%

Eligibility Criteria

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

Inclusion Criteria

  1. 18 years of age or older
  2. EF < 40% via echocardiogram within the past 12 months
  3. Stable dose of heart failure medications for > past 1 month
  4. NYHA class II - IV

Exclusion Criteria

  1. Pregnant or lactating female
  2. Receiving IV inotrope
  3. History of significant non-compliance
  4. Unwilling to adhere to the protocol
  5. Systemic systolic BP less than 90 mmHg at screening visit
  6. History of allergy to probenecid
  7. History of gout
  8. History of renal calculi
  9. Recent unstable coronary artery syndromes (USA, admission to hospital for AMI, revascularization procedure, or acute decompensated HF requiring hospitalization) within the past 3 months.
  10. Implant of CRT device within the past 3 months
  11. TIA, CVA or major surgery within the past 3 months
  12. Valvular heart disease (more than moderate stenosis or insufficiency)
  13. HOCM, myocarditis, constrictive pericarditis, congenital heart disease, 14 Active chemotherapy, significant malignancy or uncontrolled metabolic disease (untreated hyper or hypothyroidism, Cushing's disease etc.)What about uncontrolled DM?? HgA1C > etc

15. Elevated liver enzymes (> 3 times ULN), 16. Current atrial fibrillation or frequent PVCs (should we define this now) 17. End stage renal disease (dialysis dependent) or worsening renal insufficiency should define now.

18. History of gastric ulcerations, significant gastroesophageal reflux. 19. Other condition that in the opinion of the investigator, would make the subject a poor candidate for the study.

20. Co-administration of any medication that in the opinion of the investigator places the subject at increased risks due to potential adverse drug interactions.

Sites / Locations

  • University of Cincinnati

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Probenecid

placebo

Arm Description

Probenecid 1 gr oral twice daily or placebo will be given to the subject for 1 week (randomly assigned). A subsequent 1 week washout period will occur followed by the alternate therapy.

Probenecid 1 gr oral twice daily or placebo will be given to the subject for 1 week (randomly assigned). A subsequent 1 week washout period will occur followed by the alternate (placebo) therapy.

Outcomes

Primary Outcome Measures

6 minute walk test
Measure for changes in the distance that the patient can walk over 6 minutes.
shortness of breath
Measure objectively if there are changes in perceived shortness of breath using a standardized scale

Secondary Outcome Measures

Ejection fraction
We will measure via echocardiography the systolic function of the heart
beta naturietic peptide
We will measure for changes in the beta natuiretic peptide as a marker of cardiac function and dilatation.
serum electrolytes
We will measure several important electrolytes such as Na, K and Ca.

Full Information

First Posted
March 14, 2013
Last Updated
August 24, 2015
Sponsor
University of Cincinnati
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1. Study Identification

Unique Protocol Identification Number
NCT01814319
Brief Title
Repurposing Probenecid as a Positive Inotrope for the Treatment of Heart Failure
Acronym
ReProsperHF
Official Title
Initial Study on the Use of Probenecid as a Positive Inotrope for the Treatment of Systolic Heart Failure in Stable NYHA Class II to IV Patients
Study Type
Interventional

2. Study Status

Record Verification Date
August 2015
Overall Recruitment Status
Completed
Study Start Date
March 2013 (undefined)
Primary Completion Date
June 2015 (Actual)
Study Completion Date
June 2015 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Cincinnati

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Probenecid is an FDA approved drug for the treatment gout and hyperuricemia. It has been used safely in humans for decades for this and other indications. The investigators have recently discovered that this drug can also stimulate other receptors in the heart and therefore improve its function. The hypothesis of this study is that probenecid can be used to improve the function of the heart and therefore the symptoms in patients with heart failure.
Detailed Description
The investigators will test the hypothesis that oral administration of probenecid results in improved symptomatology and heart function in patients with systolic heart failure. There will be three cohorts. Cohort 1 will enroll up to 50 subjects in a double-blinded, randomized, placebo-control, cross-over study with each patient serving as his or her own control. The subjects will have stable HF, an ejection fraction of less than or equal to 40% and NYHA II to IV symptoms. Each subject will undergo 1 week of investigational product (IP), consisting of oral probenecid therapy 1 gram twice a day or placebo with weekly follow. The subjects will undergo EKGs, laboratory analysis, physical exams; dyspnea and quality of life questionnaires and a 6 minute walk test (MWT) at baseline. There will be 2 optional sub-studies one for echocardiographic data and the other biomarkers. Cohort 2 will enroll up to 50 subjects in a double-blinded, randomized, placebo-control study and will include patients admitted to the hospital with acute decompensated HF. Each subject will also receive Investigational product consisting of either 1 gram orally twice daily of probenecid or placebo during their hospitalization. They will have daily follow-up with EKG and appropriate laboratory work. In addition to the EKG, laboratory analysis, physical exams, dyspnea and quality of life questionnaires and 6 MWT data will be collected; additional data such as length of hospital stay, biomarkers, use of inotropic therapy and diuretics, and rate of diuresis will also be collected. Cohort 3 will enroll up to 50 healthy subjects in a double-blinded, randomized, placebo-control study. Each subject will also receive Investigational product consisting of either 2 grams orally of probenecid or placebo. During a 6 hour course subjects will have laboratory analysis, physical exam, telemetry, EKG and echocardiographic studies performed as measures of both safety and effect of the compound.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Systolic Heart Failure
Keywords
heart failure, ejection fraction equal or less than 40%

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Crossover Assignment
Masking
ParticipantCare ProviderInvestigator
Allocation
Randomized
Enrollment
20 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Probenecid
Arm Type
Experimental
Arm Description
Probenecid 1 gr oral twice daily or placebo will be given to the subject for 1 week (randomly assigned). A subsequent 1 week washout period will occur followed by the alternate therapy.
Arm Title
placebo
Arm Type
Placebo Comparator
Arm Description
Probenecid 1 gr oral twice daily or placebo will be given to the subject for 1 week (randomly assigned). A subsequent 1 week washout period will occur followed by the alternate (placebo) therapy.
Intervention Type
Drug
Intervention Name(s)
Probenecid 1 gr oral twice daily
Intervention Description
Probenecid 1 gram oral twice daily
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Matching placebo oral twice daily
Primary Outcome Measure Information:
Title
6 minute walk test
Description
Measure for changes in the distance that the patient can walk over 6 minutes.
Time Frame
1 week
Title
shortness of breath
Description
Measure objectively if there are changes in perceived shortness of breath using a standardized scale
Time Frame
1 week
Secondary Outcome Measure Information:
Title
Ejection fraction
Description
We will measure via echocardiography the systolic function of the heart
Time Frame
1 week
Title
beta naturietic peptide
Description
We will measure for changes in the beta natuiretic peptide as a marker of cardiac function and dilatation.
Time Frame
1 week
Title
serum electrolytes
Description
We will measure several important electrolytes such as Na, K and Ca.
Time Frame
1 week

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 18 years of age or older EF < 40% via echocardiogram within the past 12 months Stable dose of heart failure medications for > past 1 month NYHA class II - IV Exclusion Criteria Pregnant or lactating female Receiving IV inotrope History of significant non-compliance Unwilling to adhere to the protocol Systemic systolic BP less than 90 mmHg at screening visit History of allergy to probenecid History of gout History of renal calculi Recent unstable coronary artery syndromes (USA, admission to hospital for AMI, revascularization procedure, or acute decompensated HF requiring hospitalization) within the past 3 months. Implant of CRT device within the past 3 months TIA, CVA or major surgery within the past 3 months Valvular heart disease (more than moderate stenosis or insufficiency) HOCM, myocarditis, constrictive pericarditis, congenital heart disease, 14 Active chemotherapy, significant malignancy or uncontrolled metabolic disease (untreated hyper or hypothyroidism, Cushing's disease etc.)What about uncontrolled DM?? HgA1C > etc 15. Elevated liver enzymes (> 3 times ULN), 16. Current atrial fibrillation or frequent PVCs (should we define this now) 17. End stage renal disease (dialysis dependent) or worsening renal insufficiency should define now. 18. History of gastric ulcerations, significant gastroesophageal reflux. 19. Other condition that in the opinion of the investigator, would make the subject a poor candidate for the study. 20. Co-administration of any medication that in the opinion of the investigator places the subject at increased risks due to potential adverse drug interactions.
Facility Information:
Facility Name
University of Cincinnati
City
Cincinnati
State/Province
Ohio
ZIP/Postal Code
45267
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
29331959
Citation
Robbins N, Gilbert M, Kumar M, McNamara JW, Daly P, Koch SE, Conway G, Effat M, Woo JG, Sadayappan S, Rubinstein J. Probenecid Improves Cardiac Function in Patients With Heart Failure With Reduced Ejection Fraction In Vivo and Cardiomyocyte Calcium Sensitivity In Vitro. J Am Heart Assoc. 2018 Jan 13;7(2):e007148. doi: 10.1161/JAHA.117.007148.
Results Reference
derived

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Repurposing Probenecid as a Positive Inotrope for the Treatment of Heart Failure

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