Study to Investigate Efficacy, Safety, and Tolerability of Zibotentan/Dapagliflozin Compared to Dapagliflozin in Participants With Chronic Kidney Disease and High Proteinuria (ZENITH High Proteinuria)

NCT ID: NCT06087835

Last Updated: 2025-11-06

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

ACTIVE_NOT_RECRUITING

Clinical Phase

PHASE3

Total Enrollment

1835 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-11-07

Study Completion Date

2027-01-22

Brief Summary

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This is a Phase III, randomised, multicentre, double-blinded study to evaluate efficacy, safety and tolerability of treatment with zibotentan/dapagliflozin and dapagliflozin alone in participants with chronic kidney disease (CKD) and high proteinuria

Detailed Description

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Conditions

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Chronic Kidney Disease With High Proteinuria

Keywords

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Zibotentan Nephrology Dapagliflozin Sodium-glucose co-transporter 2 sodium-glucose co-transporter 2 inhibitor Kidney diseases Endothelin antagonist High Proteinuria

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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Zibotentan/Dapagliflozin dose A or Zibotentan/Dapagliflozin dose B

Drug dose (dose A or B) are determined based on eGFR values. Participants will receive daily oral dose of zibotentan/dapagliflozin in fixed dose combination.

Group Type EXPERIMENTAL

Zibotentan/Dapagliflozin

Intervention Type DRUG

Participants will receive zibotentan/dapagliflozin in fixed-dose combination as per the arms they are randomized to

Dapagliflozin alone

Participants will receive daily oral dose of dapagliflozin.

Group Type ACTIVE_COMPARATOR

Dapagliflozin

Intervention Type DRUG

Participants will receive dapagliflozin as per the arms they are randomized to

Interventions

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Zibotentan/Dapagliflozin

Participants will receive zibotentan/dapagliflozin in fixed-dose combination as per the arms they are randomized to

Intervention Type DRUG

Dapagliflozin

Participants will receive dapagliflozin as per the arms they are randomized to

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

1. Participant must be ≥ 18 years of age and of legal age of consent in the jurisdiction in which the study is taking place, at the time of signing the informed consent.
2. Diagnosis of CKD, defined as eGFR ≥ 20 and \< 90 mL/min/1.73 m2 and UACR \> 700 mg/g (\> 79 mg/mmol) or UPCR \> 1000 mg/g (\> 113 mg/mmoL).
3. All female participants must have a negative serum pregnancy test result at screening.
4. Female participants must be either

* not of child-bearing potential or
* women of child bearing potential (WOCBP) using at least one highly effective birth control method for at least 3 months prior to first dose of study intervention
5. Capable of giving signed informed consent
6. Provision of signed informed consent prior to any study specific procedure.
7. Provision of electronic informed consent prior to completion of the optional Study Participant Feedback Questionnaire (SPFQ).
8. Provision of signed and dated written Optional Genomics Initiative Research Information and Consent Form prior to collection of samples for optional genomics imitative research that supports the Genomic Initiative.
9. Receiving RAASi therapy (ACEi or ARB), and for the patient maximum tolerated labelled daily dose, that has been stable for at least 4 weeks.

Exclusion Criteria

1. Participants with NYHA class III or class IV Congestive HF at the time of enrolment.
2. Participants hospitalised for HF during the last 6 month prior to screening.
3. Evidence of rales or jugular venous distention on physical examination.
4. Participants with type 1 diabetes mellitus.
5. History of any life-threatening ventricular dysrhythmia (continuous or paroxysmal).
6. Blood pressure above 160 mmHg systolic.
7. Blood pressure below 90 mmHg systolic.
8. Participants hospitalised for heart disease or cardiac procedures or for COVID-19 during the last 3 months prior to screening.
9. History of solid organ transplantation or bone marrow transplant.
10. History or ongoing allergy/hypersensitivity, as judged by the Investigator, to SGLT2i therapy (eg, dapagliflozin, canagliflozin, empagliflozin or other SGLT2 inhibitors) or Endothelin Receptor Antagonists (eg, ambrisentan, atrasentan, bosentan, or other).
11. Any condition with a life expectancy of less than 2 years based on investigator´s clinical judgment.
12. Malignancy within the past 5 years. Exceptions to this criterion include non-melanoma skin cancer and curatively treated cervical carcinoma in situ.
13. Significant liver disease as judged by the investigator or severe hepatic impairment with AST or ALT \> 3 × ULN; or total bilirubin \> 2 × ULN at time of screening. An isolated increase in bilirubin in participants with known Gilbert's syndrome is not a reason for exclusion.
14. Known blood-borne diseases.
15. Clinically significant, unstable, or uncontrolled medical condition as assessed by the Investigator.
16. Participants on renal replacement therapy or previous kidney transplant.
17. Known history of drug or alcohol abuse within 12 months of screening.
18. Participants on treatment with strong or moderate CYP3A4 inducer.
19. Participants on systemic immunosuppression therapy other than stable maintenance therapy defined as prednisone 10 mg/day (or equivalent) or less, aziothioprine 100 mg/day or less; MMF 1000 mg/day or less for at least 3 months prior to Visit 1. Inhaled, nasal or dermatological steroids are also allowed.
20. Participants treated or expecting to be treated with tolvaptan, any other ERAs, or budesonide (where used to treat IBD or IgAN).
21. Participation in another clinical study with a study intervention administered in the last 3 months.
Minimum Eligible Age

18 Years

Maximum Eligible Age

95 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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AstraZeneca

INDUSTRY

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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Research Site

Huntsville, Alabama, United States

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Sun City West, Arizona, United States

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Bakersfield, California, United States

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Huntington Park, California, United States

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Los Alamitos, California, United States

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Los Angeles, California, United States

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Northridge, California, United States

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Oxnard, California, United States

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San Carlos, California, United States

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San Dimas, California, United States

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Tarzana, California, United States

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Victorville, California, United States

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Arvada, Colorado, United States

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Denver, Colorado, United States

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Boynton Beach, Florida, United States

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Hialeah, Florida, United States

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Hollywood, Florida, United States

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Jacksonville, Florida, United States

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Jensen Beach, Florida, United States

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Miami, Florida, United States

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Miami, Florida, United States

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Orlando, Florida, United States

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Fayetteville, Georgia, United States

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Champaign, Illinois, United States

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Chicago, Illinois, United States

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Hinsdale, Illinois, United States

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Island Lake, Illinois, United States

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Skokie, Illinois, United States

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Bowling Green, Kentucky, United States

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Shreveport, Louisiana, United States

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Silver Spring, Maryland, United States

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Flint, Michigan, United States

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Flint, Michigan, United States

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Troy, Michigan, United States

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City of Saint Peters, Missouri, United States

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Albany, New York, United States

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Middletown, New York, United States

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Orchard Park, New York, United States

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Greenville, North Carolina, United States

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Jacksonville, North Carolina, United States

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Kinston, North Carolina, United States

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New Bern, North Carolina, United States

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Statesville, North Carolina, United States

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Wilmington, North Carolina, United States

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Wilmington, North Carolina, United States

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Winston-Salem, North Carolina, United States

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Maumee, Ohio, United States

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Pottstown, Pennsylvania, United States

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East Providence, Rhode Island, United States

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Kingsport, Tennessee, United States

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Arlington, Texas, United States

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Austin, Texas, United States

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Houston, Texas, United States

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Houston, Texas, United States

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Pearland, Texas, United States

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San Antonio, Texas, United States

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San Antonio, Texas, United States

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San Antonio, Texas, United States

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Sugar Land, Texas, United States

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Salt Lake City, Utah, United States

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Alexandria, Virginia, United States

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Newport News, Virginia, United States

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Mukilteo, Washington, United States

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Spokane, Washington, United States

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Ciudad de Buenos Aires, , Argentina

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Ciudad de Buenos Aires, , Argentina

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Mar del Plata, , Argentina

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Mar del Plata, , Argentina

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Santa Fe, , Argentina

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Gosford, , Australia

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Meadowbrook, , Australia

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Perth, , Australia

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Reservoir, , Australia

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Reservoir, , Australia

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Southport, , Australia

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Feldkirch, , Austria

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Vienna, , Austria

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Belém, , Brazil

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Botucatu, , Brazil

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Joinville, , Brazil

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São José do Rio Preto, , Brazil

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São Paulo, , Brazil

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São Paulo, , Brazil

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São Paulo, , Brazil

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Dobrich, , Bulgaria

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Pleven, , Bulgaria

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Plovdiv, , Bulgaria

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Plovdiv, , Bulgaria

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Sofia, , Bulgaria

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Stara Zagora, , Bulgaria

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London, Ontario, Canada

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Waterloo, Ontario, Canada

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Greenfield Park, Quebec, Canada

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Montreal, Quebec, Canada

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Baotou, , China

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Beijing, , China

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Beijing, , China

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Changsha, , China

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Chengdu, , China

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Chengdu, , China

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Chongqing, , China

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Deyang, , China

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Foshan, , China

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Guangzhou, , China

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Guangzhou, , China

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Hangzhou, , China

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Hengyang, , China

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Linhai, , China

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Nanjing, , China

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Nanjing, , China

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Nanning, , China

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Ningbo, , China

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Pingxiang, , China

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Shanghai, , China

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Shantou, , China

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Shenzhen, , China

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Shenzhen, , China

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Wenzhou, , China

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Wuhan, , China

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Wuxi, , China

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Xi'an, , China

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Xiamen, , China

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Yantai, , China

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Yibin, , China

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Yinchuan, , China

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Zhuzhou, , China

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Zigong, , China

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Aalborg, , Denmark

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Aarhus, , Denmark

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Herlev, , Denmark

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Herning, , Denmark

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Roskilde, , Denmark

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La Tronche, , France

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Mulhouse, , France

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Nice, , France

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Nîmes, , France

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Rouen, , France

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Saint-Priest-en-Jarez, , France

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Strasbourg, , France

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Tours, , France

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Aachen, , Germany

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Bad Oeynhausen, , Germany

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Berlin, , Germany

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Dresden, , Germany

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Hanover, , Germany

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Mainz, , Germany

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München, , Germany

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Bangalore, , India

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Belagavi, , India

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Delhi, , India

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Nadiād, , India

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New Delhi, , India

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Ashkelon, , Israel

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Haifa, , Israel

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Jerusalem, , Israel

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Kfar Saba, , Israel

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Nahariya, , Israel

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Petah Tikva, , Israel

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Ramat Gan, , Israel

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Rehovot, , Israel

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Bergamo, , Italy

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Bologna, , Italy

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Foggia, , Italy

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Genoa, , Italy

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Napoli, , Italy

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Pisa, , Italy

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Roma, , Italy

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Torino, , Italy

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Chūōku, , Japan

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Fujisawa-shi, , Japan

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Fukui-shi, , Japan

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Fukuoka, , Japan

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Fukuoka, , Japan

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Fukuoka, , Japan

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Hashima-gun, , Japan

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Kamakura-shi, , Japan

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Kasuga-shi, , Japan

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Kawaguchi-shi, , Japan

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Kitakyushu-shi, , Japan

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Kitakyusyu-shi, , Japan

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Kofu, , Japan

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Kurume-shi, , Japan

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Kurume-shi, , Japan

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Kusatsu-shi, , Japan

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Kyoto, , Japan

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Matsumoto-shi, , Japan

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Meguro-ku, , Japan

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Minatoku, , Japan

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Minokamo Shi, , Japan

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Nishinomiya-Shi, , Japan

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Nishinomiya-shi, , Japan

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Okawa-shi, , Japan

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Osaka, , Japan

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Osaka, , Japan

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Oyama-shi, , Japan

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Sakushu, , Japan

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Sapporo, , Japan

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Sapporo, , Japan

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Sendai, , Japan

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Soka-shi, , Japan

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Takamatsu, , Japan

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Takasago-shi, , Japan

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Tondabayashi-shi, , Japan

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Toride-shi, , Japan

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Urayasu, , Japan

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Utsunomiya, , Japan

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Alor Star, , Malaysia

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Ipoh, , Malaysia

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Kota Kinabalu, , Malaysia

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Kuala Lumpur, , Malaysia

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Seremban, , Malaysia

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Seri Manjung, , Malaysia

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Mazatlán, , Mexico

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Amersfoort, , Netherlands

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Breda, , Netherlands

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Dordrecht, , Netherlands

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Bodø, , Norway

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Lørenskog, , Norway

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Oslo, , Norway

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Stavanger, , Norway

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Tromsø, , Norway

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Chrzanów, , Poland

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Krakow, , Poland

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Krakow, , Poland

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Lodz, , Poland

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Poznan, , Poland

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Radom, , Poland

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Rzeszów, , Poland

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Szczecin, , Poland

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Warsaw, , Poland

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Lučenec, , Slovakia

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Prešov, , Slovakia

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Púchov, , Slovakia

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Rožňava, , Slovakia

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Trebišov, , Slovakia

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Benoni, , South Africa

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Cape Town, , South Africa

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Chatsworth, , South Africa

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Durban, , South Africa

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Lenasia, , South Africa

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Midrand, , South Africa

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Parow, , South Africa

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Ansan-si, , South Korea

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Busan, , South Korea

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Cheonan-si, , South Korea

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Daegu, , South Korea

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Goyang-si, , South Korea

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Seoul, , South Korea

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Seoul, , South Korea

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Seoul, , South Korea

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Girona, , Spain

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L'Hospitalet de Llobregat, , Spain

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Lugo, , Spain

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Madrid, , Spain

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Majadahonda, , Spain

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Seville, , Spain

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Valencia, , Spain

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Gothenburg, , Sweden

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Linköping, , Sweden

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Rättvik, , Sweden

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Stockholm, , Sweden

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Uppsala, , Sweden

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Kaohsiung City, , Taiwan

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Kaohsiung City, , Taiwan

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New Taipei City, , Taiwan

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Taichung, , Taiwan

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Tainan City, , Taiwan

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Taipei, , Taiwan

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Taipei, , Taiwan

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Taipei, , Taiwan

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Taoyuan District, , Taiwan

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Bangkok, , Thailand

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Bangkok, , Thailand

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Chaingmai, , Thailand

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Hat Yai, , Thailand

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Khon Kaen, , Thailand

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Ratchathewi, , Thailand

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Adapazarı, , Turkey (Türkiye)

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Ankara, , Turkey (Türkiye)

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Bursa, , Turkey (Türkiye)

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Dinar, , Turkey (Türkiye)

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Kahramanmaraş, , Turkey (Türkiye)

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Kayseri, , Turkey (Türkiye)

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Kocaeli, , Turkey (Türkiye)

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Cardiff, , United Kingdom

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Dundee, , United Kingdom

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Glasgow, , United Kingdom

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London, , United Kingdom

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London, , United Kingdom

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London, , United Kingdom

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York, , United Kingdom

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Haiphong, , Vietnam

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Hanoi, , Vietnam

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Ho Chi Minh City, , Vietnam

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Ho Chi Minh City, , Vietnam

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Ho Chi Minh City, , Vietnam

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Countries

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Philippines United States Argentina Australia Austria Brazil Bulgaria Canada China Denmark France Germany India Israel Italy Japan Malaysia Mexico Netherlands Norway Poland Slovakia South Africa South Korea Spain Sweden Taiwan Thailand Turkey (Türkiye) United Kingdom Vietnam

References

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Smeijer JD, Wasehuus VS, Dhaun N, Gorriz JL, Soler MJ, Astrand M, Mercier AK, Greasley PJ, Ambery P, Heerspink HJL. Effects of Zibotentan Alone and in Combination with Dapagliflozin on Fluid Retention in Patients with CKD. J Am Soc Nephrol. 2024 Oct 1;35(10):1381-1390. doi: 10.1681/ASN.0000000000000436. Epub 2024 Jul 12.

Reference Type DERIVED
PMID: 39352861 (View on PubMed)

Other Identifiers

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2023-504124-26

Identifier Type: REGISTRY

Identifier Source: secondary_id

D4325C00010

Identifier Type: -

Identifier Source: org_study_id