Bumetanide Versus Furosemide in Heart Failure

NCT ID: NCT00372762

Last Updated: 2014-03-27

Basic Information

• Recruitment Status: WITHDRAWN
• Clinical Phase: PHASE3
• Study Classification: INTERVENTIONAL
• Study Start Date: 2011-01-31
• Study Completion Date: 2013-06-30

Brief Summary

Patients with NYHA FC II-III heart failure will be randomized in a cross-over fashion to 8 weeks of bumetanide versus furosemide therapy (equipotent dose), to test whether bumetanide therapy has a superior effect on insulin resistance compared to furosemide. Patients will be subject to a frequently sampled intravenous glucose tolerance test (FSIGT) with minimal model (MINMOD) analysis to assess insulin resistance and to a 6-minute walk test (6MWT) to assess functional capacity; patient recruitment and retention success, as well as medication adherence, will also be assessed.

Detailed Description

Insulin resistance is common in patients with heart failure (HF) and is associated with a worse functional capacity and more severe symptoms of heart failure. The majority of HF patients take furosemide on at least a daily basis for symptom relief. Bumetanide is a loop diuretic with a similar therapeutic diuretic effect to furosemide. There is evidence from observational and small comparative trials that bumetanide has a significantly less deleterious effect on indirect measures of insulin resistance compared with furosemide. However, a formal comparison between the 2 drugs using rigorous measures of insulin resistance has never been conducted in patients with HF. If bumetanide can be demonstrated to have a similar diuretic and a superior (less deleterious) effect on insulin resistance in patients with HF, the potential exists for bumetanide to have a significantly reduced morbidity in patients with heart failure compared to furosemide. In order to prepare for such a study, the variance of the MINMOD-derived insulin resistance from the FSIGT (26), in this group of patient needs to be determined along with the feasibility of conducting such a study. Functional capacity will be determined by duplicate 6-minute walk tests.

Conditions

Heart Failure

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: CROSSOVER
• Primary Study Purpose: TREATMENT
• Blinding Strategy: QUADRUPLE

Study Groups

Furosemide

Patients will be assigned to furosemide therapy (20mg to 80mg) orally, once or twice daily for an 8-week period.

Group Type: ACTIVE_COMPARATOR

Furosemide

Intervention Type: DRUG

Current dose of furosemide will be maintained and equivalent dose bumetanide will be used following crossover

furosemide

Intervention Type: DRUG

20mg to 80mg orally once or twice daily

Bumetanide

Patients will be assigned to bumetanide therapy at an equipotent dose to furosemide therapy (1mg bumetanide is equivalent to 40mg furosemide)for an 8-week period.

Group Type: ACTIVE_COMPARATOR

Bumetanide

Intervention Type: DRUG

Equivalent dose to pre-existing furosemide will be used

bumetanide

Intervention Type: DRUG

0.5mg to 2mg orally once or twice daily

Interventions

Furosemide

Current dose of furosemide will be maintained and equivalent dose bumetanide will be used following crossover

Intervention Type: DRUG

Bumetanide

Equivalent dose to pre-existing furosemide will be used

Intervention Type: DRUG

furosemide

20mg to 80mg orally once or twice daily

Intervention Type: DRUG

bumetanide

0.5mg to 2mg orally once or twice daily

Intervention Type: DRUG

Other Intervention Names

Lasix; Bumex; Burinex; Lasix; Bumex; Burinex

Eligibility Criteria

Inclusion Criteria

1. Men and women ≥18 years of age

2. NHYA FC II or III HF AND documented LVEF ≤40% within 6 months prior to study entry

3. Taking 20 mg to 80 mg furosemide orally once or twice per day

4. No changes to cardiac medications for 3 months prior to study entry and no anticipated changes of medications for the duration of the study

5. No changes to oral anti-diabetic medications (if applicable) for 3 months prior to study entry, and no anticipated changes for the duration of the study (metformin, sulphonylurea type, glitazone type)

6. Ability to provide written consent

Exclusion Criteria

1. Known sensitivity to bumetanide

2. Myocardial infarction, coronary angioplasty, coronary artery bypass surgery, admission for HF or unstable angina within a 3 month period prior to study recruitment

3. Planned coronary intervention within 6 months

4. Patients who are taking insulin

5. Patients with chronic renal (serum creatinine ≥ 200 μmol/L) or hepatic impairment (known cirrhosis or AST or ALT > 1.5 x upper limit of normal)

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

University of Western Ontario, Canada

OTHER

Sponsor Role: collaborator

London Health Sciences Centre Research Institute OR Lawson Research Institute of St. Joseph's

OTHER

Sponsor Role: lead

Responsible Party

Neville Suskin

Principal Investigator

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Neville G Suskin, MBChB, MSc

Role: PRINCIPAL_INVESTIGATOR

LHSC, University of Western Ontario

Locations

University Hospital, London Health Sciences Centre

London, Ontario, Canada

Countries

Canada

Other Identifiers

R-06-415

Identifier Type: -

Identifier Source: org_study_id