A Clinical Study to Evaluate Renal Hemodynamic Responses to Aliskiren in Patients With Type 2 Diabetes Mellitus
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Purpose
The study objective was to assess the effect of single and multiple doses of aliskiren on renal plasma flow, glomerular filtration rate and to compare the effects of single and multiple doses of aliskiren versus captopril or irbesartan on renal blood flow, glomerular filtration rate, and retinal blood flow in patients with type 2 diabetes mellitus.
| Condition | Intervention | Phase |
|---|---|---|
|
Type 2 Diabetes Mellitus |
Drug: Aliskiren Drug: Irbesartan Drug: Captopril |
Phase 4 |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Endpoint Classification: Pharmacodynamics Study Intervention Model: Parallel Assignment Masking: Open Label |
| Official Title: | An Open-label, Randomized, Parallel-group Study to Evaluate the Acute and Steady-state Renal Hemodynamic Responses to Aliskiren in Patients With Type 2 Diabetes Mellitus |
- Change From Baseline in Renal Plasma Flow (RPF) After a Single Dose of Aliskiren or Irbesartan [ Time Frame: Day 2: Baseline (10 minutes and 5 minutes pre-treatment and 0 hours) and 1, 2, 3, 4 and 5 hours post-dose. ] [ Designated as safety issue: No ]
Renal plasma flow (RPF) was measured by the clearance of para-aminohippurate (PAH) by autoanalyzer methods.
The measure of the single dose effect (SDE) for aliskiren and irbesartan was calculated as Day 2 peak - Day 2 baseline RPF. Baseline RPF was determined as the median of the -10 minute, -5 minute predose and predose (0 hour) values. Peak RPF was obtained using a moving average concept.
- Change From Baseline to Steady State Trough in Renal Plasma Flow (RPF) After Aliskiren or Irbesartan [ Time Frame: Day 2 and Day 15 at Baseline (10 minutes and 5 minutes pre-treatment and 0 hours) . ] [ Designated as safety issue: No ]
Renal plasma flow (RPF) was measured by the clearance of para-aminohippurate (PAH) by autoanalyzer methods.
This multiple dose effect at steady state (MDE_SS) was calculated as Day 15 baseline - Day 2 baseline. Baseline RPF was determined as the median of the -10 minute, -5 minute predose and predose (0 hour) values.
- Change From Baseline to Steady State Peak in Renal Plasma Flow (RPF) After Aliskiren or Irbesartan [ Time Frame: Day 2: Baseline (10 minutes and 5 minutes pre-treatment and 0 hours) and Day 15: 1, 2, 3, 4 and 5 hours post-dose. ] [ Designated as safety issue: No ]
Renal plasma flow (RPF) was measured by the clearance of para-aminohippurate (PAH) by autoanalyzer methods.
This maximum multiple dose effect (MDE_Max) was calculated as Day 15 peak - Day 2 baseline. Baseline RPF was determined as the median of the -10 minute, -5 minute predose and predose (0 hour) values. Peak RPF was obtained using a moving average concept.
- Change From Single Dose Peak to Steady State Peak in Renal Plasma Flow (RPF) After Aliskiren or Irbesartan [ Time Frame: Day 2 and Day 15: 1, 2, 3, 4 and 5 hours post-dose. ] [ Designated as safety issue: No ]
Renal plasma flow (RPF) was measured by the clearance of para-aminohippurate (PAH) by autoanalyzer methods.
Accumulation of peak effect from single dose to multiple dose (MDE_Acc) was calculated as Day 15 peak - Day 2 peak. Peak RPF was obtained using a moving average concept.
- Change From Baseline in Renal Plasma Flow (RPF) After a Single Dose of Captopril [ Time Frame: Day 1: Baseline (10 minutes and 5 minutes pre-treatment and 0 hours) and 1, 2, 3, 4 and 5 hours post-dose. ] [ Designated as safety issue: No ]
Renal plasma flow (RPF) was measured by the clearance of para-aminohippurate (PAH) by autoanalyzer methods.
The measure of the single dose effect (SDE) for captopril was calculated as Day 1 peak - Day 1 baseline RPF. Baseline RPF was determined as the median of the -10 minute, -5 minute predose and predose (0 hour) values. Peak RPF was obtained using a moving average concept.
- Change From Baseline in Glomerular Filtration Rate (GFR) After a Single Dose of Captopril [ Time Frame: Day 1: Baseline (10 minutes and 5 minutes pre-treatment and 0 hours) and 1, 2, 3, 4 and 5 hours post-dose. ] [ Designated as safety issue: No ]
Glomerular filtration rate (GFR) was measured by the clearance of inulin by autoanalyzer methods.
The measure of the single dose effect (SDE) for captopril was calculated as Day 1 peak - Day 1 baseline GFR. Baseline GFR was determined as the median of the -10 minute, -5 minute predose and predose (0 hour) values. Peak GFR was obtained using a moving average concept.
- Change From Baseline in Glomerular Filtration Rate (GFR) After a Single Dose of Aliskiren or Irbesartan [ Time Frame: Day 2: Baseline (10 minutes and 5 minutes pre-treatment and 0 hours) and 1, 2, 3, 4 and 5 hours post-dose. ] [ Designated as safety issue: No ]
Glomerular filtration rate (GFR) was measured by the clearance of inulin by autoanalyzer methods.
The measure of the single dose effect (SDE) for aliskiren and irbesartan was calculated as Day 2 peak - Day 2 baseline GFR. Baseline GFR was determined as the median of the -10 minute, -5 minute predose and predose (0 hour) values. Peak GFR was obtained using a moving average concept.
- Change From Baseline to Steady State Trough in Glomerular Filtration Rate (GFR) After Aliskiren or Irbesartan [ Time Frame: Day 2 and Day 15 at Baseline (10 minutes and 5 minutes pre-treatment and 0 hours) . ] [ Designated as safety issue: No ]
Glomerular filtration rate (GFR) was measured by the clearance of inulin by autoanalyzer methods.
This multiple dose effect at steady state (MDE_SS) was calculated as Day 15 baseline - Day 2 baseline GFR. Baseline GFR was determined as the median of the -10 minute, -5 minute predose and predose (0 hour) values.
- Change From Baseline to Steady State Peak in Glomerular Filtration Rate (GFR) After Aliskiren or Irbesartan [ Time Frame: Day 2: Baseline (10 minutes and 5 minutes pre-treatment and 0 hours) and Day 15: 1, 2, 3, 4 and 5 hours post-dose. ] [ Designated as safety issue: No ]
Glomerular filtration rate (GFR) was measured by the clearance of inulin by autoanalyzer methods.
This maximum multiple dose effect (MDE_Max) was calculated as Day 15 peak - Day 2 baseline GFR. Baseline GFR was determined as the median of the -10 minute, -5 minute predose and predose (0 hour) values. Peak GFR was obtained using a moving average concept.
- Change From Single Dose Peak to Steady State Peak in Glomerular Filtration Rate (GFR) After Aliskiren or Irbesartan [ Time Frame: Day 2 and Day 15: 1, 2, 3, 4 and 5 hours post-dose. ] [ Designated as safety issue: No ]
Glomerular filtration rate (GFR) was measured by the clearance of inulin by autoanalyzer methods.
Accumulation of peak effect from single dose to multiple dose (MDE_Acc) was calculated as Day 15 peak - Day 2 peak GFR. Peak GFR was obtained using a moving average concept.
- Change in Plasma Renin Concentration (PRC) After Captopril, Aliskiren or Irbesartan [ Time Frame: Predose (Baseline) and 5 hours post dose on Days 1, 2 and 15. ] [ Designated as safety issue: No ]
The following plasma renin concentration effects were assessed:
The single dose effect (SDE) for captopril, expressed as the ratio to pre-dose measurement on Day 1, = Day 1, 5 hour / Day 1 Baseline.
SDE for aliskiren and irbesartan = Day 2, 5 hour / Day 2 Baseline.
Steady state trough effect (multiple dose effect at steady state; MDE_SS) = Day 15 Baseline / Day 2 Baseline.
Steady State peak effect (maximum multiple dose effect; MDE_Max) = Day 15, 5 hour / Day 2 Baseline.
Accumulation of peak effect from single dose to multiple dose (MDE_Acc) = Day 15, 5 hour / Day 2, 5 hour.
- Change in Plasma Pro-renin Concentration After Captopril, Aliskiren or Irbesartan [ Time Frame: Predose (Baseline) and 5 hours post dose on Days 1, 2 and 15. ] [ Designated as safety issue: No ]
The following plasma pro-renin concentration effects were assessed:
The single dose effect (SDE) for captopril, expressed as the ratio to pre-dose measurement on Day 1, = Day 1, 5 hour / Day 1 Baseline.
SDE for aliskiren and irbesartan = Day 2, 5 hour / Day 2 Baseline.
Steady state trough effect (multiple dose effect at steady state; MDE_SS) = Day 15 Baseline / Day 2 Baseline.
Steady State peak effect (maximum multiple dose effect; MDE_Max) = Day 15, 5 hour / Day 2 Baseline.
Accumulation of peak effect from single dose to multiple dose (MDE_Acc) = Day 15, 5 hour / Day 2, 5 hour.
- Change in Plasma Renin Activity (PRA) After Captopril, Aliskiren or Irbesartan [ Time Frame: Predose and 5 hours post dose on Days 1, 2 and 15. ] [ Designated as safety issue: No ]
PRA was measured by the trapping method and the following effects assessed:
The single dose effect (SDE) for captopril, expressed as the ratio to pre-dose measurement on Day 1, = Day 1, 5 hour / Day 1 baseline.
SDE for aliskiren and irbesartan = Day 2, 5 hour / Day 2 baseline.
Steady state trough effect (multiple dose effect at steady state; MDE_SS) = Day 15 baseline / Day 2 baseline.
Steady State peak effect (maximum multiple dose effect; MDE_Max) = Day 15, 5 hour / Day 2 baseline.
Accumulation of peak effect from single dose to multiple dose (MDE_Acc) = Day 15, 5 hour / Day 2, 5 hour.
- Change in Plasma Angiotensin I After Captopril, Aliskiren or Irbesartan [ Time Frame: Predose (Baseline) and 5 hours post dose on Days 1, 2 and 15. ] [ Designated as safety issue: No ]
The following angiotensin I effects were assessed:
The single dose effect (SDE) for captopril, expressed as the ratio to pre-dose measurement on Day 1, = Day 1, 5 hour / Day 1 Baseline.
SDE for aliskiren and irbesartan = Day 2, 5 hour / Day 2 Baseline.
Steady state trough effect (multiple dose effect at steady state; MDE_SS) = Day 15 Baseline / Day 2 Baseline.
Steady State peak effect (maximum multiple dose effect; MDE_Max) = Day 15, 5 hour / Day 2 Baseline.
Accumulation of peak effect from single dose to multiple dose (MDE_Acc) = Day 15, 5 hour / Day 2, 5 hour.
- Change in Plasma Angiotensin II After Captopril, Aliskiren or Irbesartan [ Time Frame: Predose (Baseline) and 5 hours post dose on Days 1, 2 and 15. ] [ Designated as safety issue: No ]
The following angiotensin II effects were assessed:
The single dose effect (SDE) for captopril, expressed as the ratio to pre-dose measurement on Day 1, = Day 1, 5 hour / Day 1 Baseline.
SDE for aliskiren and irbesartan = Day 2, 5 hour / Day 2 Baseline.
Steady state trough effect (multiple dose effect at steady state; MDE_SS) = Day 15 Baseline / Day 2 Baseline.
Steady State peak effect (maximum multiple dose effect; MDE_Max) = Day 15, 5 hour / Day 2 Baseline.
Accumulation of peak effect from single dose to multiple dose (MDE_Acc) = Day 15, 5 hour / Day 2, 5 hour.
- Change in Serum Aldosterone After Captopril, Aliskiren or Irbesartan [ Time Frame: Predose (Baseline) and 5 hours post dose on Days 1, 2 and 15. ] [ Designated as safety issue: No ]
The following serum aldosterone effects were assessed:
The single dose effect (SDE) for captopril, expressed as the ratio to pre-dose measurement on Day 1, = Day 1, 5 hour / Day 1 Baseline.
SDE for aliskiren and irbesartan = Day 2, 5 hour / Day 2 Baseline.
Steady state trough effect (multiple dose effect at steady state; MDE_SS) = Day 15 Baseline / Day 2 Baseline.
Steady State peak effect (maximum multiple dose effect; MDE_Max) = Day 15, 5 hour / Day 2 Baseline.
Accumulation of peak effect from single dose to multiple dose (MDE_Acc) = Day 15, 5 hour / Day 2, 5 hour.
- Change From Baseline in Retinal Blood Flow After Aliskiren or Irbesartan [ Time Frame: Baseline (Day 1), Day 2 and Day 15. ] [ Designated as safety issue: No ]
Retinal blood flow was assessed using the laser Doppler technique. The blood flow in the superior temporal retinal artery in one of the eyes of each study participant was determined.
The Single dose effect of aliskiren or irbesartan was measured as the change/difference between Day 2 and baseline measurements.
The Multiple dose effect of aliskiren or irbesartan wsas measured as the change/difference between Day 15 and Day 2 measurements
| Enrollment: | 45 |
| Study Start Date: | April 2008 |
| Study Completion Date: | December 2009 |
| Primary Completion Date: | December 2009 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
Experimental: Aliskiren
On Day 1 participants received a single oral dose of 25 mg captopril. Starting on Day 2 participants received aliskiren 300 mg tablets orally once a day for 14 days.
|
Drug: Aliskiren
Aliskiren 300 mg tablets
Other Name: SPP100
Drug: Captopril
Captopril 25 mg tablet
|
|
Active Comparator: Irbesartan
On Day 1 participants received a single oral dose of 25 mg captopril. Starting on Day 2 participants received irbesartan 300 mg tablets orally once a day for 14 days.
|
Drug: Irbesartan
Irbesartan 300 mg tablets
Drug: Captopril
Captopril 25 mg tablet
|
Eligibility| Ages Eligible for Study: | 18 Years to 75 Years |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Hypertensive, male and females of non-child bearing potential patients, with type 2 diabetes mellitus (T2DM) (diagnosed at least 8 weeks before Screening), with or without renal impairment; estimated glomerular filtration rate (eGFR) ≥ 40 mL/min/1.73 m^2, documented at least 3 months before the study start, aged 18-75 years with a minimum body weight of 50 kg and having an appropriate intravenous access as determined by the study staff, able to communicate well were enrolled in the study.
- Patients must be on a stable dose of hypoglycemic medications for at least 8 weeks prior to the study.
- Patients must be medically able to discontinue anti- hypertensive medications for the duration of the study.
Exclusion Criteria:
- Patients with type 1 diabetes mellitus or uncontrolled T2DM (HbA1C> 11%), eGFR <40 mL/min/1.73 m^2 (calculated by the Modification of Diet in Renal Disease (MDRD) formula), renal disease not caused by diabetes or hypertension, serum potassium < 3.5 or > 5.1 mEq/L, heart failure (New York Heart Association (NYHA) Class II-IV) or history of acute/decompensated heart failure within the 6 months prior to dosing, history of myocardial infarction, unstable angina pectoris, coronary bypass surgery, or any percutaneous coronary intervention (PCI) during the 6 months prior to the baseline visit, history of malignancy including leukemia and lymphoma within past five years, hypertensive encephalopathy any time in the past or cerebrovascular accident within the 6 months prior to the baseline visit, or with history of drug or alcohol abuse within the 12 months prior to dosing were excluded from the study.
- Patients with glaucoma, or prior ocular surgery.
- Patients with renal disease not caused by diabetes or hypertension.
- Patients with history of clinically significant drug or atopic allergy, acute or chronic respiratory disease, history of malignancy, or history of myocardial infarction, unstable angina pectoris, coronary bypass surgery, or any coronary intervention (percutaneous coronary intervention; PCI) during the 6 months prior to the study.
- Patients who had used any prescription drugs which may affect the renin-angiotensin-aldosterone system or with known effect on renal hemodynamics within 2 weeks prior to dosing and during the study, over-the-counter (OTC) medication within two (2) weeks prior to dosing,
- Any surgical or medical condition which may jeopardize the patient in case of participation in the study.
- Participation in any clinical investigation within 4 weeks prior to the study.
- Donation or loss of 400 mL or more of blood within 8 weeks prior to the study.
Other protocol-defined inclusion/exclusion criteria may apply.
Contacts and Locations More Information
No publications provided by Novartis
Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
| Responsible Party: | Novartis |
| ClinicalTrials.gov Identifier: | NCT00660309 History of Changes |
| Other Study ID Numbers: | CSPP100A2329 |
| Study First Received: | April 11, 2008 |
| Results First Received: | July 20, 2012 |
| Last Updated: | August 27, 2012 |
| Health Authority: | United States: Food and Drug Administration |
Keywords provided by Novartis:
|
Type 2 diabetes mellitus renal disease hypertension renal blood flow |
retinal blood flow aliskiren irbesartan captopril |
Additional relevant MeSH terms:
|
Diabetes Mellitus Diabetes Mellitus, Type 2 Glucose Metabolism Disorders Metabolic Diseases Endocrine System Diseases Captopril Irbesartan Angiotensin-Converting Enzyme Inhibitors Protease Inhibitors |
Enzyme Inhibitors Molecular Mechanisms of Pharmacological Action Pharmacologic Actions Antihypertensive Agents Cardiovascular Agents Therapeutic Uses Angiotensin II Type 1 Receptor Blockers Angiotensin Receptor Antagonists |
ClinicalTrials.gov processed this record on May 16, 2013