A randomized, double-blind, parallel-group, cross-over, 4-period, 4 treatment, within-subject placebo-controlled study to assess the renoprotective effect of renin inhibition with Aliskiren as an alternative to irbesartan in Type 2 patients with incipient/overt diabetic nephropathy

• Register: EUCTR
• Last refreshed on: 19 March 2012
• Main ID: EUCTR2005-000362-39-DK
• Date of registration: 21/04/2005
• Prospective Registration: Yes
• Primary sponsor: Novartis Pharma Services AG
• Public title: A randomized, double-blind, parallel-group, cross-over, 4-period, 4 treatment, within-subject placebo-controlled study to assess the renoprotective effect of renin inhibition with Aliskiren as an alternative to irbesartan in Type 2 patients with incipient/overt diabetic nephropathy
• Scientific title: A randomized, double-blind, parallel-group, cross-over, 4-period, 4 treatment, within-subject placebo-controlled study to assess the renoprotective effect of renin inhibition with Aliskiren as an alternative to irbesartan in Type 2 patients with incipient/overt diabetic nephropathy
• Date of first enrolment: 22/06/2005
• Target sample size: 24
• Recruitment status: Not Recruiting
• URL: https://www.clinicaltrialsregister.eu/ctr-search/search?query=eudract_number:2005-000362-39
• Study type: Interventional clinical trial of medicinal product
• Study design: Controlled: yes Randomised: yes Open: Single blind: Double blind: yes Parallel group: yes Cross over: yes Other: yes Other trial design description: 4-period; 4 treatment, double-dummy If controlled, specify comparator, Other Medicinial Product: yes Placebo: Other:

Countries of recruitment

Denmark

Key inclusion & exclusion criteria

Inclusion criteria:
1. Male and/or female subjects between the age of 30-80 years with a diagnosis of Type 2 diabetes (defined by the WHO criteria)
2. Body mass index (BMI) must be within the range of 20 and 32. For instructions and tables see Part B, Section 8.
3. Incipient or overt diabetic nephropathy (urinary albumin excretion =100 but = 2000 mg/day). Investigator should make an effort to have two subgroups (incipient and overt nephropathy) as balance as possible, but at least 6 patients in each subgroup.
4. GFR = 40 ml/min documented in the last 4 months prior to randomization
5. To be eligible for randomization, patients must fulfill the following criteria
a) Patients on ongoing hypertensive therapy must have a blood pressure = 135/85 mm Hg but lower than 170/105 mm Hg at Visit 2 (Day -1) AND patients must be on stable antihypertensive medications for at least 8 weeks prior to Visit 2 (Run-in period)
b) Newly diagnosed hypertensive patients must have a blood pressure = 135/85 mm Hg but lower than 170/105 mm Hg at Visit 2 (Day -1)
6. Patients must be on stable hypoglycemic medications for at least 8 weeks prior to Visit 2 ( Day -1).
7. Patients must be willing and medically able to discontinue all ACEI, ARB, aldosterone receptor antagonist and potassium sparing diuretic medications for the duration of the study.
8. Female patients must be postmenopausal (i.e. must have had no regular menstrual bleeding for at least 2 years prior to inclusion) or must have had a bilateral oophorectomy or must have been surgically sterilized or hysterectomized at least 6 months prior to screening. Menopause will be confirmed by a plasma 17ß-estradiol concentration of <20 pg/mL and a plasma FSH level of >40 IU/L. Surgical sterilization procedures or hysterectomy must be supported with clinical documentation made available to the sponsor
9. Oral body temperature within the range 35.0-37.5 °C
10. Able to provide written informed consent prior to study participation.
Subject information and consent forms generated by the investigator must be approved by the sponsor prior to submission to the Ethics Committee (EC)/Institutional Review Board (IRB). A copy of the subject information and consent forms approved by the EC/IRB must be forwarded to the sponsor prior to study initiation.
11. Able to communicate well with the investigator and comply with the requirements of the study.

Are the trial subjects under 18? no
Number of subjects for this age range:
F.1.2 Adults (18-64 years) yes
F.1.2.1 Number of subjects for this age range
F.1.3 Elderly (>=65 years) yes
F.1.3.1 Number of subjects for this age range

Exclusion criteria:
Subjects meeting any of the following criteria during screening or baseline evaluations will be excluded from entry into or continuation in the study:
1. Severe Hypertension Grade 3 WHO classification (MSDBP =110 mmHg and/or MSSBP =180 mmHg)
2. ASA treatment >1g/day or regular use of NSAIDs
3. Kidney disease not caused by diabetes or hypertension
4. Serum potassium < 3.5 or > 5.1 mEq/L
5. GFR < 40 ml/min/1.73m2 as measured by the MDRD formula
6. Serum albumin < 2.0mg/dL
7. History of hypertensive encephalopathy or cerebrovascular accident in the last 12 months prior to Visit 1
8. Transient ischemic cerebral attack during the 6 months prior to Visit 1
9. Current diagnosis of heart failure (NYHA Class II-IV)
10. History of myocardial infarction, unstable angina pectoris, coronary bypass surgery, or any percutaneous coronary intervention (PCI) during the 6 months prior to Visit 1
11. Second or third degree heart block without a pacemaker
12. Concurrent potentially life threatening arrhythmia or symptomatic arrhythmia
13. Clinically significant valvular heart disease
14. Type 1 diabetes mellitus
15. Uncontrolled Type II diabetes mellitus (HbA1C >11 %)
16. History of malignancy including leukemia and lymphoma (but not basal cell skin carcinoma) within the past five years
17. Participation in any clinical investigation within 4 weeks prior to dosing or longer if required by local regulation.
18. Donation or loss of 400 mL or more of blood within 8 weeks prior to dosing.
19. Significant illness within the two weeks prior to dosing.
20. Any surgical or medical condition which might significantly alter the absorption, distribution, metabolism, or excretion of study drugs including, but not limited to, any of the following:
• History of major gastrointestinal tract surgery such as gastrectomy, gastroenterostomy, or bowel resection
• Currently active or previously active inflammatory bowel disease during the 12 months prior to Visit 1
• Currently active gastritis, duodenal or gastric ulcers, or gastrointestinal/rectal bleeding during the 3 months prior to Visit 1.
• Any history of pancreatic injury, pancreatitis or evidence of impaired pancreatic function/injury as indicated by abnormal lipase or amylase
• Evidence of hepatic disease as determined by any one of the following: SGOT/AST or SGPT/ALT values exceeding 2 x ULN at Visit 1, and Gamma GT x 3 ULN at Visit 1 a history of hepatic encephalopathy, a history of esophageal varices, or a history of portocaval shunt
• Current treatment with cholestyramine or cholestipol resins
21. History of immunocompromise, including a positive HIV (ELISA and Western blot) test result.
22. History of a positive Hepatitis B surface antigen (HBsAg) or Hepatitis C test result.
23. History of drug or alcohol abuse within the 12 months prior to dosing.
24. Persons directly involved in the execution of this protocol.
25. Any condition that in the opinion of the investigator or the Novartis medical monitor would jeopardize the evaluation of efficacy or safety
26. History of noncompliance to medical regimens or unwillingness to comply with the study protocol
27. Known or suspected contraindications to the study medications, including history of allergy to ACE inhibitors and/or to thiazide diuretics or other sulfonamide derived drug
28. Any surgical or medical condition, which in the opinion of the investigator, may place the patient at higher risk from his/her participation in the study, or is likely to prevent the pati

Age minimum:
Age maximum:
Gender:
Female: yes
Male: yes

Health Condition(s) or Problem(s) studied

Hypertension

Intervention(s)

Product Name: Aliskiren
Product Code: SPP100
Pharmaceutical Form: Film-coated tablet
INN or Proposed INN: Aliskiren
CAS Number: 173334-58-2
Concentration unit: mg milligram(s)
Concentration type: equal
Concentration number: 150-
Pharmaceutical form of the placebo: Film-coated tablet
Route of administration of the placebo: Oral use

Product Name: Aliskiren
Product Code: SPP100
Pharmaceutical Form: Film-coated tablet
INN or Proposed INN: Aliskiren
CAS Number: 173334-58-2
Concentration unit: mg milligram(s)
Concentration type: equal
Concentration number: 300-
Pharmaceutical form of the placebo: Film-coated tablet
Route of administration of the placebo: Oral use

Product Name: Irbesartan
Pharmaceutical Form: Capsule*
INN or Proposed INN: Irbesartan
CAS Number: 138402-11-6
Concentration unit: mg milligram(s)
Concentration type: equal
Concentration number: 150-
Pharmaceutical form of the placebo: Capsule*
Route of administration of the placebo: Oral use

Primary Outcome(s)

Main Objective: • To investigate whether renin-inhibition using Aliskiren 300 mg daily could be a treatment alternative to the angiotensin II receptor antagonist Irbesartan 300 mg with an equivalent potential for renoprotection

Secondary Objective: • To investigate whether combination therapy using Aliskiren 300 mg daily and Irbesartan 300 mg daily has an additive positive effect on renoprotection
• To investigate whether there is a change on biomarkers of inflammation and cardiovascular risk

Primary end point(s): Pharmacodynamic assessment whether renin-inhibition using Aliskiren 300 mg daily could be a treatment alternative to the angiotensin II receptor antagonist Irbesartan 300 mg with an equivalent potential for renoprotection

Secondary ID(s)

CSPP100A2243