Early Treatment With a Sodium-glucose Co-transporter 2 Inhibitor in High-risk Patients With Acute Heart Failure

NCT ID: NCT05392764

Last Updated: 2024-08-06

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

PHASE3

Total Enrollment

524 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-09-10

Study Completion Date

2027-12-31

Brief Summary

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The EMPA-AHF trial is a multicentre, randomized, double-blind, placebo-controlled trial designed to evaluate the efficacy and safety of early initiation of once-daily oral empagliflozin 10 mg in patients hospitalized for patients with acute heart failure (AHF) who are at a high risk of adverse events.

Detailed Description

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Conditions

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Acute Heart Failure

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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Empagliflozin

Patients will be randomized 1:1 to either empagliflozin or placebo.

Group Type EXPERIMENTAL

Empagliflozin 10 MG

Intervention Type DRUG

once-daily oral empagliflozin 10 mg

Placebo

Placebo matching empagliflozin

Group Type PLACEBO_COMPARATOR

Placebo

Intervention Type DRUG

Placebo matching empagliflozin 10 mg

Interventions

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Empagliflozin 10 MG

once-daily oral empagliflozin 10 mg

Intervention Type DRUG

Placebo

Placebo matching empagliflozin 10 mg

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

1. Age of ≥20 and \<90 years
2. Hospitalized with a diagnosis of acute heart failure, requiring intravenous loop diuretic therapy, and with all of the following characteristics:

i. Dyspnoea at rest or induced by slight exertion ii. At least two of the following findings: jugular venous distention, pulmonary rales, lower leg edema, and pulmonary congestion on chest X-ray iii. If the patient has a sinus rhythm at the time of admission, BNP ≥350 pg/mL or NT-proBNP ≥1400 pg/mL; if the patient has atrial fibrillation at the time of admission, BNP ≥500 pg/mL or NT-proBNP ≥2000 pg/mL. For patients taking an angiotensin receptor neprilysin inhibitor, only the reference value for NT-proBNP will be applicable.
3. At least one of the following characteristics:

i. eGFR \<60 mL/min/1.73m2, as calculated using the CKD Epidemiology Collaboration for JapaneseModification of Diet in Renal Disease formula ii. Already taking ≥40 mg of oral furosemide during the period before hospitalization. For patients on loop diuretics other than furosemide, the following conversion should be used: oral furosemide 20 mg = oral azosemide 30 mg = oral torasemide 5 mg.

iii. Urine output of \<300 mL during the 2 h following an appropriate dose of intravenous furosemide administered after hospitalization. An appropriate dose of intravenous furosemide is 20 mg for patients who have not been taking furosemide regularly before hospitalization and is the same as, or greater than, the daily oral dose for patients who have been taking furosemide regularly before hospitalization.
4. Provided written consent to participate in the study

Exclusion Criteria

1. eGFR \<20 mL/min/1.73m2 at the time of admission
2. Already taking an SGLT2i within 3 months prior to hospitalization
3. Type 1 diabetes mellitus
4. Systolic blood pressure \<90 mmHg
5. Expected to newly require treatment with thiazide, tolvaptan, or carperitide within 48 hours of study drug administration
6. Main cause of acute heart failure hospitalization is not fluid retention (e.g., persistent ventricular tachycardia, persistent atrial fibrillation/atrial flutter with a ventricular response rate of ≥130 bpm, persistent bradycardia with a ventricular response rate of \<45 bpm, an infection, severe anemia, and an acute exacerbation of COPD)
7. Acute coronary syndrome, pulmonary thromboembolism, or a cerebrovascular accident is the main cause of the present hospitalization.
8. At risk of ketoacidosis or hyperosmolar hyperglycaemia
9. On dialysis, including peritoneal dialysis, or the initiation of dialysis during hospitalization is planned
10. Pregnant or lactating women
11. Underwent the following therapeutic interventions within 30 days: cardiovascular surgery (e.g., coronary artery bypass grafting, surgery for valvular heart disease, transcatheter aortic valve implantation, percutaneous coronary intervention, percutaneous edge-to-edge mitral valve repair, and other types of surgery at the investigator's discretion) and implantation of an implantable defibrillator, cardiac resynchronization therapy defibrillator, or implantable ventricular-assist device
12. A diagnosis of acute coronary syndrome, cerebral infarction, or transient ischemic attack made within 90 days
13. Ventricular tachycardia with syncope within 90 days
14. Heart transplant recipient or listed for heart transplantation and expected to undergo transplantation during the present treatment; implanted with an implantable ventricular-assist device or expected to require an implantable ventricular-assist device during the present treatment; or expected to switch to palliative care
15. Intubated at the time of screening or expected to require intubation within within 48 hours of study drug administration
16. Severe valvular heart disease expected to be treated with thoracostomy or catheterization (a reason to exclude secondary mitral or tricuspid regurgitation due to reduced cardiac function does not exist, except for the absence of a plan to perform cardiac surgery or therapeutic catheterization)
17. A diagnosis of secondary cardiomyopathy such as amyloidosis, cardiac sarcoidosis, hemochromatosis, Fabry disease, and muscular dystrophy. Heart failure due to takotsubo cardiomyopathy, obstructive hypertrophic cardiomyopathy, complex congenital heart disease (as determined by the investigator), or pericardial constriction.
18. A diagnosis of peripartum cardiomyopathy made within 6 months
19. Active myocarditis
20. Presence of uncontrolled thyroid disease
21. Acute cardiac structural abnormalities (e.g., acute mitral regurgitation due to ruptured chordae tendineae)
23. Serious liver disorder (an increase in AST, ALT, or ALP level ≥3 times the upper limit of normal) or cirrhosis with varices or other findings suggestive of portal hypertension
24. Alcohol use disorder of at least mild severity according to the DSM-V
25. A diagnosis of active malignancy or suspected active malignancy made within 2 years
26. Coexisting diseases other than heart failure with an expected survival prognosis of ≤1 year
27. Participation in a clinical study of another drug 30 days before hospitalization
28. Patients considered to require fasting at screening.
29. Other conditions likely to interfere with the patient's safety or compliance with the protocol
30. Other patients who are considered unsuitable by the principal investigator or other investigators
Minimum Eligible Age

20 Years

Maximum Eligible Age

89 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Boehringer Ingelheim

INDUSTRY

Sponsor Role collaborator

Juntendo University

OTHER

Sponsor Role lead

Responsible Party

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Yuya Matsue

Associate Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Yuya Matsue, MD

Role: PRINCIPAL_INVESTIGATOR

Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine

Locations

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Anjo Kosei Hospital

Anjo, Aichi-ken, Japan

Site Status RECRUITING

Aichi Medical University Hospital

Nagakute, Aichi-ken, Japan

Site Status RECRUITING

Nagoya University Hospital

Nagoya, Aichi-ken, Japan

Site Status RECRUITING

Hirosaki University Hospital

Hirosaki, Aomori, Japan

Site Status RECRUITING

Hyogo Prefectural Awaji Medical Center

Sumoto, Awaji, Japan

Site Status RECRUITING

Funabashi Municipal Medical Center

Funabashi, Chiba, Japan

Site Status RECRUITING

Kameda Medical Center

Kamogawa, Chiba, Japan

Site Status RECRUITING

Juntendo University Urayasu Hospital

Urayasu, Chiba, Japan

Site Status RECRUITING

Fukuokaken Saiseikai Futsukaichi Hospital

Chikushino-shi, Fukuoka, Japan

Site Status RECRUITING

Kurume University Hospital

Kurume, Fukuoka, Japan

Site Status RECRUITING

Ogaki Municipal Hospital

Ōgaki, Gifu, Japan

Site Status RECRUITING

Gunma University Hospital

Maebashi, Gunma, Japan

Site Status RECRUITING

Kushiro-sanjikai Hospital

Kushiro, Hokkaido, Japan

Site Status RECRUITING

Medical Corporation Sapporo Heart Center

Sapporo, Hokkaido, Japan

Site Status RECRUITING

Sapporo Higashi Tokushukai Hospital

Sapporo, Hokkaido, Japan

Site Status RECRUITING

Tsuchiura Kyodo General Hospital

Tsuchiura, Ibaraki, Japan

Site Status RECRUITING

Iwate Prefectural Cyuou Hospital

Morioka, Iwate, Japan

Site Status RECRUITING

Tokai University Hospital

Isehara, Kanagawa, Japan

Site Status RECRUITING

Shonan Kamakura General Hospital

Kamakura, Kanagawa, Japan

Site Status RECRUITING

St.Marianna University School of Medicine Hospital

Kawasaki, Kanagawa, Japan

Site Status RECRUITING

Kochi Medical School Hospital

Nankoku, Kochi, Japan

Site Status RECRUITING

Nara Medical University Hospital

Kashihara, Nara, Japan

Site Status RECRUITING

Urasoe General Hospital

Urasoe, Okinawa, Japan

Site Status RECRUITING

Kindai University Hospital

Sayama, Osaka, Japan

Site Status RECRUITING

National Cerebral and Cardiovascular Center Hospital

Suita, Osaka, Japan

Site Status RECRUITING

Kasukabe Chuo General Hospital

Kasukabe, Saitama, Japan

Site Status RECRUITING

Saitama Medical Center

Kawagoe, Saitama, Japan

Site Status RECRUITING

Kawaguchi Cardiovascular and Respiratory Hospital

Kawaguchi, Saitama, Japan

Site Status RECRUITING

Soka City Hospital

Sōka, Saitama, Japan

Site Status RECRUITING

Seirei Mikatahara General Hospital

Hamamatsu, Shizuoka, Japan

Site Status RECRUITING

Juntendo University Shizuoka Hospital

Izunokuni, Shizuoka, Japan

Site Status RECRUITING

Saiseikai Utsunomiya Hospital

Utsunomiya, Tochigi, Japan

Site Status RECRUITING

Nishiarai Hospital

Adachi City, Tokyo, Japan

Site Status RECRUITING

Mitsui Memorial Hospital

Chiyoda City, Tokyo, Japan

Site Status RECRUITING

Sakakibara Heart Institute

Fuchū, Tokyo, Japan

Site Status RECRUITING

Tokyo Medical University Hachioji Medical Center

Hachiōji, Tokyo, Japan

Site Status RECRUITING

International University of Health and Welfare Mita Hospital

Minato, Tokyo, Japan

Site Status RECRUITING

Toranomon Hospital

Minato, Tokyo, Japan

Site Status NOT_YET_RECRUITING

Tokyo Women's Medical University Hospital

Shinjuku, Tokyo, Japan

Site Status RECRUITING

National Disaster Medical Center

Tachikawa, Tokyo, Japan

Site Status RECRUITING

Japanese Red Cross Fukuoka Hospital

Fukuoka, , Japan

Site Status RECRUITING

Gifu University Graduate school of Medicine

Gifu, , Japan

Site Status RECRUITING

Hiroshima City Hospital

Hiroshima, , Japan

Site Status RECRUITING

Kitasato University Hospital

Kanagawa, , Japan

Site Status RECRUITING

Chikamori Hospital

Kochi, , Japan

Site Status RECRUITING

Nara Prefecture General Medical Center

Nara, , Japan

Site Status RECRUITING

Sakakibara Heart Institute of Okayama

Okayama, , Japan

Site Status RECRUITING

Nakagami Hospital

Okinawa, , Japan

Site Status RECRUITING

Kitano Hospital

Osaka, , Japan

Site Status RECRUITING

Osaka General Medical Center

Osaka, , Japan

Site Status RECRUITING

Saitama Citizens Medical Center

Saitama, , Japan

Site Status RECRUITING

Tokushima University Hospital

Tokushima, , Japan

Site Status RECRUITING

Juntendo University Hospital

Tokyo, , Japan

Site Status RECRUITING

Juntendo University Nerima Hospital

Tokyo, , Japan

Site Status RECRUITING

Nihon University Itabashi Hospital

Tokyo, , Japan

Site Status RECRUITING

Nippon Medical School Hospital

Tokyo, , Japan

Site Status RECRUITING

St. Luke's International Hospital

Tokyo, , Japan

Site Status RECRUITING

Tokyo General Hospital

Tokyo, , Japan

Site Status RECRUITING

Tokyo Medical University

Tokyo, , Japan

Site Status RECRUITING

Tokyo Metropolitan Bokutoh Hospital

Tokyo, , Japan

Site Status RECRUITING

Yokohama City University Medical Center

Yokohama, , Japan

Site Status RECRUITING

Countries

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Japan

Central Contacts

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Yuya Matsue, MD

Role: CONTACT

81-3-3813-3111

Facility Contacts

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Yusuke Uemura

Role: primary

Tetsuya Amano

Role: primary

Takahiro Okumura

Role: primary

Yuichi Toyama

Role: primary

Koji Kuroda

Role: primary

Shinichi Okino

Role: primary

Akira Mizukami

Role: primary

Takashi Tokano

Role: primary

Ken Onitsuka

Role: primary

Tatsuhiro Shibata

Role: primary

Naoki Watanabe

Role: primary

Masaru Obokata

Role: primary

Yoshikuni Obata

Role: primary

Daisuke Hachinohe

Role: primary

Yutaro Kasai

Role: primary

Tsunekazu Kakuta

Role: primary

Masanobu Miura

Role: primary

Takeshi Ijichi

Role: primary

Shigeru Saito

Role: primary

Keisuke Kida

Role: primary

Toru Kubo

Role: primary

Kazutaka Nogi

Role: primary

Masami Abe

Role: primary

Koichiro Matsumura

Role: primary

Takeshi Kitai

Role: primary

Keisuke Nakabayashi

Role: primary

Kentaro Jujo

Role: primary

Eiichi Akiyama

Role: primary

Hiroshi Inagaki

Role: primary

Keisuke Miyajima

Role: primary

Satoru Suwa

Role: primary

Kenichiro Shimoji

Role: primary

Jujo Kentaro

Role: primary

Yu Horiuchi

Role: primary

Mamoru Nanasato

Role: primary

Nobuhiro Tanaka

Role: primary

Yuichi Tamura

Role: primary

Takahide Kodama

Role: primary

Atsushi Suzuki

Role: primary

Kazuto Hayasaka

Role: primary

Ryuichi Matsukawa

Role: primary

Hiroyuki Okura

Role: primary

Tadanao Higaki

Role: primary

Takeru Nabeta

Role: primary

Hayato Hosoda

Role: primary

Kazuma Matsubayashi

Role: primary

Atsushi Hirohata

Role: primary

Satoshi Yamaguchi

Role: primary

Shinya Ito

Role: primary

Atsushi Kikuchi

Role: primary

Tomohiro Nakamura

Role: primary

Takayuki Ise

Role: primary

Yuya Matsue

Role: primary

Kikuo Isoda

Role: primary

Daisuke Kitano

Role: primary

Yukihiro Watanabe

Role: primary

Atsushi Mizuno

Role: primary

Hideyuki Takimura

Role: primary

Masatake Kobayashi

Role: primary

Koichi Ohashi

Role: primary

Kozo Okada

Role: primary

Other Identifiers

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jRCTs031210682

Identifier Type: -

Identifier Source: org_study_id

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