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"SALT-2 Trial" Study of Ascending Levels of Tolvaptan in Hyponatremia

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00201994
Recruitment Status : Completed
First Posted : September 20, 2005
Last Update Posted : May 3, 2012
Otsuka Pharmaceutical Co., Ltd.
Information provided by:
Otsuka Pharmaceutical Development & Commercialization, Inc.

Brief Summary:
This study's purpose is to determine whether tolvaptan can safely and effectively return the body's balance of sodium and water toward normal, and to characterize and quantify the potential clinical benefits of this treatment.

Condition or disease Intervention/treatment Phase
Hyponatremia Water Intoxication Inappropriate ADH Syndrome Water-electrolyte Imbalance Drug: Tolvaptan Phase 3

Detailed Description:

Hyponatremia is defined as a serum sodium concentration below the lower limit of normal and is the most frequently encountered electrolyte abnormality in hospitalized patients. Generally speaking, most cases of hyponatremia are mild. However, as the serum sodium falls below 130 mEq/L, the possibility of significant morbidity and mortality increases, and most clinicians will initiate corrective therapy for serum sodium values approaching 130 mEq/L and lower. The reasons for treating hyponatremia relate both to the symptoms, which may be quite disturbing to patients, as well as to potential outcomes including permanent neurological damage and death. there is also growing awareness of the association between hyponatremia and increased mortality in patients with heart failure.

A common theme underlying the occurrence of hyponatremia whether in the setting of congestive heart failure, hepatic failure with ascites, or the syndrome of inappropriate anti-diuretic hormone (SIADH) is the non-osmotic secretion of arginine vasopressin (AVP). The presence of excess AVP leads to fluid retention and hyponatremia. Agents that antagonize AVP, causing proportionally more water diuresis than solute excretion, could offer a significant treatment option for patients with hyponatremia, compared to fluid restriction alone. Treatment of hyponatremia, particularly in clinical settings such as decompensated congestive heart failure, is difficult as conventional diuretics cause neurohormonal activation and further stimulate the inappropriate release of vasopressin, leading to additional retention of free water and aggravation of hypoosmolality. Similarly, for cirrhosis with ascites and SIADH, conventional diuretics are either minimally effective or completely contraindicated. An alternative approach to symptom relief and treatment of hyponatremia may be the use of vasopressin antagonists, which increase free water clearance with proportionally less effect on sodium excretion. Tolvaptan is an oral vasopressin antagonist with relative affinity for the V2 receptor which has been shown to induce a diuresis with proportionally more free-water than sodium loss.

The current study is being undertaken in order to evaluate whether tolvaptan, an oral AVP inhibitor, will be effective in correcting mild to moderate hyponatremia, and to elucidate the effect of this correction on the subject's well-being.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 243 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double
Primary Purpose: Treatment
Official Title: Multicenter, Randomized, Double-blind, Placebo-controlled, Efficacy and Safety Study of the Effects of Titrated Oral Tolvaptan Tablets in Patients With Hyponatremia, Study 2
Study Start Date : November 2003
Actual Study Completion Date : July 2005

Resource links provided by the National Library of Medicine

Drug Information available for: Tolvaptan

Primary Outcome Measures :
  1. The average daily area under the curve of change from baseline in serum sodium level up to Day 4 within the double-blind on therapy period.
  2. and/or
  3. The average daily area under the curve of change from baseline in serum sodium level up to Day 30 within the double-blind on therapy period.

Secondary Outcome Measures :
  1. The average daily area under the curve of change from baseline in serum sodium level up to Day 4 within the double-blind on therapy period for patients with severe hyponatremia (serum sodium <130 mEq/L at baseline).
  2. The average daily area under the curve of change from baseline in serum sodium level up to Day 30 within the double-blind on therapy period for patients with severe hyponatremia (serum sodium <130 mEq/L at baseline).
  3. Percentage of patients with normalized serum sodium at Day 4.

Information from the National Library of Medicine

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.

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  1. Hyponatremia in euvolemic or hypervolemic states, defined as serum sodium <135 mEq/L prior to randomization.
  2. Able to give Informed Consent

Exclusion Criteria:

  1. Women who are breast feeding and females of childbearing potential who are not using acceptable contraceptive methods
  2. Hyponatremia in hypovolemic states.
  3. Acute and transient hyponatremia associated with head trauma or post-operative state.
  4. Hyponatremia due to uncontrolled hypothyroidism or uncontrolled adrenal insufficiency.
  5. Cardiac surgery within 30 days of potential study enrollment, excluding percutaneous coronary interventions.
  6. History of a myocardial infarction within 30 days of potential study enrollment.
  7. History of sustained ventricular tachycardia or ventricular fibrillation within 30 days, unless in the presence of an automatic implantable cardioverter defibrillator.
  8. Severe angina including angina at rest or at slight exertion and/or unstable angina.
  9. History of a cerebrovascular accident within the last 30 days.
  10. Subjects with psychogenic polydipsia may not be included, however subjects with other psychiatric illness may be included.
  11. Systolic arterial blood pressure <90 mmHg.
  12. History of hypersensitivity and/or idiosyncratic reaction to benzazepine or benzazepine derivatives (such as benazepril.).
  13. History of drug or medication abuse within the past year,or current alcohol abuse.
  14. Uncontrolled diabetes mellitus defined as fasting glucose >300mg/dL.
  15. Urinary tract obstruction except BPH if non-obstructive.
  16. Previous participation in another clinical drug trial within the past 30 days.
  17. Previous participation in this or any other tolvaptan clinical trial.
  18. Terminally ill or moribund condition with little chance of short term survival.
  19. Serum creatinine >3.5 mg/dL.
  20. Serum sodium <120 mEq/L with associated neurologic impairment, i.e. symptoms such as apathy, confusion, seizures.
  21. Patients with progressive or episodic neurologic disease such as multiple sclerosis or history of multiple strokes.
  22. Child-Pugh score greater than 10 (unless approved)
  23. Patients receiving intravenous fluids at a rate greater than KVO (Keep Vein Open).
  24. Hyponatremia due to lab artifacts
  25. Patients receiving AVP or its analogs for treatment of any condition.
  26. Patients receiving within 7 days of randomization, other medications for treatment of hyponatremia specifically: demeclocycline, lithium carbonate or urea
  27. Patients likely requiring IV saline for correction of symptomatic or asymptomatic severe hyponatremia during the course of the study.
  28. Severe pulmonary artery hypertension
  29. Hyponatremia should not be the result of any medication that can safely be withdrawn

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 identifier (NCT number): NCT00201994

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Universitatskilinikum Carl
Gustav Carus, Dresden, Germany, D-01307
Sponsors and Collaborators
Otsuka Pharmaceutical Development & Commercialization, Inc.
Otsuka Pharmaceutical Co., Ltd.
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Study Director: Frank Czerwiec, MD, Phd Otsuka Pharmaceutical Development & Commercialization, Inc.
Publications automatically indexed to this study by Identifier (NCT Number):
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Responsible Party: Frank Czerwiec, MD PhD, Otsuka Pharmaceutical Development & Commercialization, Inc. Identifier: NCT00201994    
Other Study ID Numbers: 156-03-238
First Posted: September 20, 2005    Key Record Dates
Last Update Posted: May 3, 2012
Last Verified: May 2012
Keywords provided by Otsuka Pharmaceutical Development & Commercialization, Inc.:
Additional relevant MeSH terms:
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Inappropriate ADH Syndrome
Water-Electrolyte Imbalance
Water Intoxication
Metabolic Diseases
Pituitary Diseases
Hypothalamic Diseases
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Endocrine System Diseases
Chemically-Induced Disorders
Antidiuretic Hormone Receptor Antagonists
Molecular Mechanisms of Pharmacological Action
Natriuretic Agents
Physiological Effects of Drugs