Efficacy, Safety and Tolerability of AZD9977 and Dapagliflozin in Participants With Heart Failure and Chronic Kidney Disease (MIRACLE)
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ClinicalTrials.gov Identifier: NCT04595370 |
Recruitment Status :
Completed
First Posted : October 20, 2020
Last Update Posted : October 24, 2023
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Condition or disease | Intervention/treatment | Phase |
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Heart Failure Chronic Kidney Disease | Drug: AZD9977 Drug: Dapagliflozin | Phase 2 |
After screening, eligible participants will undergo a run-in period where all participants receive dapagliflozin for up to 7 weeks depending on pre-study use of SGLT2i or not. At the end of the run-in period, eligible participants will be randomly assigned with a 1:1:1:1 ratio to receive once daily administration of one of the following 4 study treatments group for 12 weeks. To ensure blinding, the study treatment will be administered in the form of 3 oral capsules of AZD9977 or placebo and 1 oral tablet or dapagliflozin.
- AZD9977 Dose A + dapagliflozin 10 mg
- AZD9977 Dose B + dapagliflozin 10 mg
- AZD9977 Dose C + dapagliflozin 10 mg
- Dapagliflozin 10 mg
Participants will be randomized to one of the above treatment group, according to type 2 diabetes mellitus [T2DM (yes/no)] and eGFR (≥ 20 to <30 mL/min/1.73^2; or ≥ 30 to < 45 mL/min/1.73^2; or ≥45 mL/min/1.73^2).
The total duration of participation will be approximately 22 to 24weeks.
Study Type : | Interventional (Clinical Trial) |
Actual Enrollment : | 153 participants |
Allocation: | Randomized |
Intervention Model: | Parallel Assignment |
Intervention Model Description: | Participants who meet the eligibility criteria will be randomized to one of the following treatment group:
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Masking: | Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor) |
Primary Purpose: | Treatment |
Official Title: | A Phase 2b, Randomised, Double-Blind, Active Controlled, Multi Centre Study to Evaluate the Efficacy, Safety and Tolerability of Oral AZD9977 and Dapagliflozin Treatment in Patients With Heart Failure and Chronic Kidney Disease |
Actual Study Start Date : | January 26, 2021 |
Actual Primary Completion Date : | September 22, 2023 |
Actual Study Completion Date : | September 22, 2023 |
Arm | Intervention/treatment |
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Experimental: AZD9977 Dose A + dapagliflozin 10 mg
Participants will receive once daily oral dose A of AZD9977 and 10 mg dapagliflozin for 12 weeks.
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Drug: AZD9977
Participants will receive AZD9977 as per the arms they are randomized. Drug: Dapagliflozin Participants will receive dapagliflozin as per the arms they are randomized. |
Experimental: AZD9977 Dose B + dapagliflozin 10 mg
Participants will receive once daily oral dose B of AZD9977 and 10 mg dapagliflozin for 12 weeks.
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Drug: AZD9977
Participants will receive AZD9977 as per the arms they are randomized. Drug: Dapagliflozin Participants will receive dapagliflozin as per the arms they are randomized. |
Experimental: AZD9977 Dose C + dapagliflozin 10 mg
Participants will receive once daily oral dose C of AZD9977 and 10 mg dapagliflozin for 12 weeks.
|
Drug: AZD9977
Participants will receive AZD9977 as per the arms they are randomized. Drug: Dapagliflozin Participants will receive dapagliflozin as per the arms they are randomized. |
Experimental: Dapagliflozin 10 mg
Participants will receive once daily oral dose of dapagliflozin 10 mg alone for 12 weeks.
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Drug: Dapagliflozin
Participants will receive dapagliflozin as per the arms they are randomized. |
- Percent change from baseline in UACR at 12 weeks [ Time Frame: Baseline (Day 1) until Week 12 (Day 85) ]Evaluating the effect of AZD9977 in combination with dapagliflozin compared with dapagliflozin alone on UACR.
- Percent change from baseline in UACR at 12 weeks to assess dose-response relationship [ Time Frame: Baseline (Day 1) until Week 12 (Day 85) ]Assessment of the dose-response relationship of dapagliflozin (10 mg) alone and 3 doses of AZD9977 (A, B, or C) combined with dapagliflozin (10 mg) on UACR.
- Number of participants with adverse events (AEs) and serious adverse events (SAEs) [ Time Frame: From baseline (Day 1) until Day 113 (Safety Follow-up) ]Assessment of the general safety and tolerability of AZD9977 in combination with dapagliflozin compared with dapagliflozin alone.
- Absolute value of serum potassium over time [ Time Frame: Days 1, and 3 until Day 85 ]Assessment of the effect of AZD9977 in combination with dapagliflozin compared with dapagliflozin alone on serum potassium.
- Change from baseline in serum potassium over time [ Time Frame: From baseline (Day 1), Day 3 until Day 85 ]Assessment of the effect of AZD9977 in combination with dapagliflozin compared with dapagliflozin alone on serum potassium.
- Absolute value of eGFR over time [ Time Frame: Days 1, and 3 until Day 85 ]Assessment of the effect of AZD9977 in combination with dapagliflozin compared with dapagliflozin alone on eGFR.
- Change from baseline in eGFR over time [ Time Frame: From baseline (Day 1), Day 3 until Day 85 ]Assessment of the effect of AZD9977 in combination with dapagliflozin compared with dapagliflozin alone on eGFR.
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.
Ages Eligible for Study: | 21 Years to 130 Years (Adult, Older Adult) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
Participants are included in the study if any of the following criteria apply:
- Documented diagnosis of stable symptomatic HF (New York Heart Association class II-III) at screening, and a medical history of typical symptoms and signs of HF in those who are currently receiving loop diuretic treatment
- Left ventricular ejection fraction <60% documented by the most recent echocardiogram or cardiac magnetic resonance imaging within the last 12 months prior to screening
- Stable background treatment for HF, hypertension, diabetes mellitus or renal disease according to guidelines
- N-terminal-pro-brain natriuretic peptide (NT proBNP) ≥300 pg/mL for participants with sinus rhythm at screening; and NT proBNP ≥600 pg/mL for participants with atrial fibrillation/flutter at screening
- The eGFR ≥30 and ≤60 mL/min/1.73^2 (by CKD- EPI formula) and UACR ≥30 mg/g (3 mg/mmol) and <3000 mg/g (300 mg/mmol)
- Body mass index less than 40 kg/m^2
- Serum/plasma K+ level ≥ 3.5 and < 5.0 mmol/L within 10 days prior to randomization
- Serum/ plasma Na+ level within normal reference values within 10 days prior to randomization
- Systolic blood pressure should be at protocol defined range at randomization (Visit 3), with no change to antihypertensive treatments in previous 3 weeks
- Male or female of non-childbearing potential
- All participants must follow protocol defined contraceptives procedures
Exclusion Criteria:
Participants are excluded from the study if any of the following criteria apply:
- Primary glomerulopathy, vasculitic renal disease, prior dialysis or unstable rapidly progressing renal disease, autosomal dominant or autosomal recessive polycystic kidney disease, lupus nephritis or anti-neutrophil cytoplasm antibody-associated vasculitis
- Participants with currently decompensated HF requiring hospitalization for optimization of HF treatment and are not on stable HF therapy at the time of enrollment
- HF due to cardiomyopathies
- High output HF (e.g., due to hyperthyroidism or Paget's disease)
- HF due to pericardial disease, congenital heart disease or clinically significant uncorrected primary cardiac valvular disease or planned cardiac valve repair/replacement
- Participants with uncontrolled diabetes mellitus (Glycated hemoglobin >10%)
- Participants with Type 1 diabetes mellitus
- Intermittent or persistent 2nd or 3rd degree atrioventricular block, sinus node dysfunction with clinically significant bradycardia or sinus pauses, not treated with a pacemaker
- History of any life-threatening cardiac dysrhythmia or uncontrolled ventricular rate in participants with atrial fibrillation or atrial flutter
- Acute coronary syndrome and/or elective/non-elective percutaneous cardiac interventions (within 3 months) prior to randomisation or is planned to undergo any of these procedures during the study
- Any major cardiovascular (eg, open chest, coronary artery bypass grafting or valvular repair/replacement) or major non-cardiovascular surgery within 3 months prior to randomisation or is planned to undergo any cardiovascular surgery during the study
- Heart transplantation or left ventricular assist device at any time or if these are planned
- Kidney or any organ transplantation or if these are planned
- Medical conditions associated with development of hyperkalaemia (Addison's disease )
- History or ongoing allergy/hypersensitivity, to sodium-glucose co-transporter-2 inhibitor (SGLT2i e.g., dapagliflozin, empagliflozin)
- Stroke, transient ischemic attack, carotid surgery, or carotid angioplasty within previous 3 months prior to randomisation
- Hepatic disease, including hepatitis and/or hepatic impairment (Child-Pugh class A-C), and aspartate aminotransferase or alanine transaminase or total bilirubin should be in protocol defined range at time of screening and/ or within 7 days prior to randomization
- Participants with newly detected pathological laboratory values or an ongoing disease condition
- If the participants clinical signs and symptoms consistent with COVID-19, and has been previously hospitalized with COVID-19 infection and did not fully recover their previous health status
- Previous randomization in the present study
- Prior medical treatment with an mineralocorticoid receptor antagonist where the medication was taken within 90 days prior to screening
- Current or prior treatment within 6 months prior to screening with cytotoxic therapy, immunosuppressive therapy, or other immunotherapy
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): NCT04595370
Principal Investigator: | John McMurray | University of Glasgow, United Kingdom |
Responsible Party: | AstraZeneca |
ClinicalTrials.gov Identifier: | NCT04595370 |
Other Study ID Numbers: |
D6402C00001 2020-003126-23 ( EudraCT Number ) |
First Posted: | October 20, 2020 Key Record Dates |
Last Update Posted: | October 24, 2023 |
Last Verified: | October 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. 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 shared. |
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 Pharma Data Sharing Principles. For details of our timelines, please rerefer 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 de-identified individual patient-level data in an approved sponsored tool . Signed Data Sharing Agreement (non-negotiable contract for data accessors) must be in place before accessing requested information. Additionally, all users will need to accept the terms and conditions of the SAS MSE to gain access. For additional details, please review the Disclosure Statements at https://astrazenecagrouptrials.pharmacm.com/ST/Submission/Disclosure. |
URL: | https://astrazenecagroup-dt.pharmacm.com/DT/Home |
Studies a U.S. FDA-regulated Drug Product: | Yes |
Studies a U.S. FDA-regulated Device Product: | No |
Heart Failure Type 2 diabetes mellitus Diabetic kidney disease Chronic kidney disease Mineralocorticoid receptor modulator |
Sodium-glucose co-transporter-2 inhibitor AZD9977 Dapagliflozin Urinary albumin creatinine ratio |
Kidney Diseases Renal Insufficiency, Chronic Heart Failure Heart Diseases Cardiovascular Diseases Urologic Diseases Female Urogenital Diseases Female Urogenital Diseases and Pregnancy Complications Urogenital Diseases Male Urogenital Diseases |
Renal Insufficiency Chronic Disease Disease Attributes Pathologic Processes Dapagliflozin Sodium-Glucose Transporter 2 Inhibitors Molecular Mechanisms of Pharmacological Action Hypoglycemic Agents Physiological Effects of Drugs |