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Dapagliflozin Effects on Cardiometabolic Outcomes in Patients With an Acute Heart Attack. (DAPA-MI)

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ClinicalTrials.gov Identifier: NCT04564742
Recruitment Status : Completed
First Posted : September 25, 2020
Last Update Posted : August 4, 2023
Sponsor:
Collaborator:
Uppsala University
Information provided by (Responsible Party):
AstraZeneca

Study Description
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Brief Summary:
This study will evaluate the effect of dapagliflozin versus placebo, given once daily in addition to Standard of Care (SoC) therapies for patients with myocardial infarction (MI), for hospitalisation for heart failure (HHF), cardiovascular (CV) death, and other cardiometabolic outcomes.

Condition or disease Intervention/treatment Phase
Acute Myocardial Infarction Heart Failure Drug: Dapagliflozin Drug: Placebo Phase 3

Detailed Description:
This is a multicentre, parallel group double-blind, placebo-controlled phase 3 registry-based randomised controlled trial (R-RCT) in patients without diabetes presenting with myocardial infarction (MI) (ST segment elevation myocardial infarction (STEMI) or non-ST segment elevation myocardial infarction (NSTEMI)) and evidence of impaired regional or global LV systolic function or definite evidence of Q wave MI on ECG. In the study the effect of dapagliflozin versus placebo, given once daily in addition to SoC therapy will be evaluated for the hospitalisation for HF, CV death, and other cardiometabolic outcomes.
Study Design
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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 4017 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: A Registry-based, Randomised, Double-blind, Placebo-Controlled Cardiovascular Outcomes Trial to Evaluate the Effect of Dapagliflozin on Cardiometabolic Outcomes in Patients Without Diabetes With Acute Myocardial Infarction at Increased Risk for Subsequent Development of Heart Failure
Actual Study Start Date : December 22, 2020
Actual Primary Completion Date : July 5, 2023
Actual Study Completion Date : July 5, 2023

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Arms and Interventions
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Arm Intervention/treatment
Experimental: Dapagliflozin
Patients will be randomized 1:1 to either dapagliflozin or placebo
 Drug: Dapagliflozin
Dapagliflozin 10 mg tablets given once daily, per oral use
Other Names:
  • Forxiga TM
  • Farxiga TM
Placebo Comparator: Placebo
Placebo matching dapagliflozin
 Drug: Placebo
Placebo matching dapagliflozin 10 mg tablets given once daily, per oral use


Outcome Measures
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Primary Outcome Measures :
  1. The hierarchical composite endpoint of Death (CV death followed by non-CV death), Hosp due to heart failure (adjudicated followed by investigator reported), Non-fatal MI, AF/flutter event, New onset of T2DM, last visit NYHA class, and weight loss ≥5% [ Time Frame: From randomization visit up to approximately 30 months, with a minimum follow-up time of at least 3 months for each patient ]

Secondary Outcome Measures :
  1. The hierarchical composite endpoint of Death (CV death followed by non-CV death), Hospitalisation due to heart failure (adjudicated followed by investigator reported), Non-fatal MI, AF/flutter event, New onset of T2DM, and last visit NYHA class [ Time Frame: From randomization visit up to approximately 30 months, with a minimum follow-up time of at least 3 months for each patient ]
  2. Time to the first occurrence of any of the components of this composite: • HHF • CV death [ Time Frame: From randomization visit up to approximately 30 months, with a minimum follow-up time of at least 3 months for each patient ]
  3. Time to the first occurrence of any of the components of this composite: • MI • Stroke (incl. ischaemic, haemorrhagic and undetermined stroke) • CV death [ Time Frame: From randomization visit up to approximately 30 months, with a minimum follow-up time of at least 3 months for each patient ]
  4. Time to CV death [ Time Frame: From randomization visit up to approximately 30 months, with a minimum follow-up time of at least 3 months for each patient ]
  5. Time to the first occurrence of a fatal or a non-fatal MI [ Time Frame: From randomization visit up to approximately 30 months, with a minimum follow-up time of at least 3 months for each patient ]
  6. Time to new onset of T2DM [ Time Frame: From randomization visit up to approximately 30 months, with a minimum follow-up time of at least 3 months for each patient ]
  7. Change from baseline in Body weight [ Time Frame: From randomization visit up to approximately 30 months, with a minimum follow-up time of at least 3 months for each patient ]
  8. Time to hospitalisation for any cause [ Time Frame: From randomization visit up to approximately 30 months, with a minimum follow-up time of at least 3 months for each patient ]
  9. Time to death of any cause [ Time Frame: From randomization visit up to approximately 30 months, with a minimum follow-up time of at least 3 months for each patient ]

Eligibility Criteria
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Ages Eligible for Study:   18 Years to 130 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Participant must be ≥18 at the time of signing the informed consent
  • Confirmed MI, either STEMI or NSTEMI, according to the fourth universal definition of MI (Thygesen et al 2019), within the preceding 7 days, or 10 days if earlier randomisation is not feasible
  • Evidence of impaired regional or global LV systolic function at any timepoint during current MI-related hospitalisation (established with echocardiogram, radionuclide ventriculogram, contrast angiography or cardiac MRI) or definitive evidence on ECG of Q wave MI (defined as presence of Q waves in two or more contiguous leads, excluding leads III and aVR, and meeting all the following criteria: at least 1.5 mm in depth; at least 30 ms in duration; and, if R wave present, more than 25% of the size of the subsequent R wave)
  • Hemodynamically stable at randomization (no episodes of symptomatic hypotension, or arrhythmia with haemodynamic compromise in the last 24 hours).
  • Male or female
  • Capable of giving signed informed consent which includes compliance with the requirements and restrictions listed in the informed consent form (ICF) and in the protocol
  • Provision of signed and dated, written informed consent prior to any mandatory study specific procedures, sampling, and analyses

Exclusion Criteria:

  • Known type 1 diabetes mellitus (T1DM) or T2DM at the time for admission. Patients with hyperglycaemia, but without a diagnosis of diabetes mellitus prior to the index event, are eligible at the discretion of the Investigator. Patients who present with signs and symptoms consistent with ketoacidosis, including nausea, vomiting, abdominal pain, malaise and shortness of breath should be assessed for ketoacidosis, and if ketoacidosis is confirmed the patient should not be randomized.
  • Chronic symptomatic HF with a prior HHF within the last year and known reduced ejection fraction (LVEF≤40 %), documented before the current MI hospitalization
  • Severe (eGFR <20 mL/min/1.73 m2 by local laboratory), unstable or rapidly progressing renal disease at the time of randomization
  • Severe hepatic impairment (Child-Pugh class C) at the time of inclusion into the trial
  • Active malignancy requiring treatment at the time of screening, except for basal cell- or squamous cell carcinoma of the skin, presumed possible to treat successfully
  • Any non-CV condition, eg malignancy, with a life expectancy of less than two years based on the investigator´s clinical judgement
  • Currently on treatment, or with an indication for treatment, with a sodium glucose co-transporter 2 inhibitor (SGLT2-inhibitor)
Contacts and Locations
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Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT04564742


Locations
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Sponsors and Collaborators
AstraZeneca
Uppsala University
Investigators
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Principal Investigator: Stefan James Uppsala University
Study Chair: Jonas Oldgren Uppsala University
More Information
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Responsible Party: AstraZeneca
ClinicalTrials.gov Identifier: NCT04564742    
Other Study ID Numbers: D169DC00001
2020-000664-31 ( EudraCT Number )
First Posted: September 25, 2020    Key Record Dates
Last Update Posted: August 4, 2023
Last Verified: July 2023
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes
Plan Description:

Qualified researchers can request access to anonymized individual patient-level data from AstraZeneca group of companies sponsored clinical trials via the request portal Vivli.org. All requests will be evaluated as per the AZ disclosure commitment:

https://astrazenecagrouptrials.pharmacm.com/ST/Submission/Disclosure. "Yes", indicates that AZ are accepting requests for IPD, but this does not mean all requests will be approved.
Supporting Materials: Study Protocol
Statistical Analysis Plan (SAP)
Time Frame: AstraZeneca will meet or exceed data availability as per the commitments made to the EFPIA/PhRMA Data-Sharing Principles. For details of our timelines, please refer to our disclosure commitment at https://astrazenecagrouptrials.pharmacm.com/ST/Submission/Disclosure.
Access Criteria: When a request has been approved AstraZeneca will provide access to the anonymized individual patient-level data via secure research environment Vivli.org. A Signed Data Usage Agreement (non-negotiable contract for data accessors) must be in place before accessing requested information.
URL: https://astrazenecagroup-dt.pharmacm.com/DT/Home

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: Yes
Keywords provided by AstraZeneca:
Myocardial Infarction
Cardiovascular Outcome Trial
Additional relevant MeSH terms:
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Heart Failure
Myocardial Infarction
Infarction
Heart Diseases
Cardiovascular Diseases
Ischemia
Pathologic Processes
Necrosis
 Myocardial Ischemia
Vascular Diseases
Dapagliflozin
Sodium-Glucose Transporter 2 Inhibitors
Molecular Mechanisms of Pharmacological Action
Hypoglycemic Agents
Physiological Effects of Drugs