E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
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E.1.1.1 | Medical condition in easily understood language |
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E.1.1.2 | Therapeutic area | Diseases [C] - Nutritional and Metabolic Diseases [C18] |
MedDRA Classification |
E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To investigate the impact of a single dose liraglutide on Glomerular Filtration Rate (GFR). |
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E.2.2 | Secondary objectives of the trial |
To investigate the impact of a single dose liraglutide on:
Renal blood flow, diuresis, albuminuria, kidney perfusion and oxygenation, tubular proximal sodium reabsorption, sodium clearance, potassium clearance, calcium clearance, osmolar- and free water clearance, P-angiotensin-II, P-aldosterone, P-renin, P-Atrial Natriuretic Peptide (ANP), U-angiotensinogen, adrenaline level, noradrenaline level, P-GLP-1 and P-glucagon, oxidative stress, inflammation, kidney injury markers, blood pressure and pulse. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1.
Informed consent obtained before any trial-related activities. (Trial-related activities are any procedure that would not have been performed during normal management of the subject.)
2.
Male gender
3.
T2DM, diagnosed according to international guidelines
4.
Age 20-60 years, both included
5.
Body Mass Index (BMI): 20-32 kg/m2, both included
6.
Metformin treatment
7.
Albumin/creatinine ratio < 25 mg/mmol |
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E.4 | Principal exclusion criteria |
1.
Known or suspected allergy to trial product or related products
2.
Previous participation in this trial
3.
Previous treatment with GLP-1 analogues or DPP-4 inhibitors
4.
Current treatment with any antidiabetic drug other than metformin
5.
Poorly regulated glycemic control (HbA1c > 8%)
6.
Impaired kidney function: estimated GFR < 70ml/min (estimated from creatinine concentration)
7.
Impaired liver function: liver parameters exceed 2 times or more the upper normal limit, according to the hospital lab
8.
Subjects with active malignancy
9.
Severe cardiac insufficiency classified according to NYHA III-IV
10.
Unstable angina pectoris, acute myocardial infarction (AMI) within the last 12 months
11.
Severe, uncontrolled hypertension: sitting blood pressure (BP) > 180/110 mmHg
12.
Antihypertensive treatment consisting of more than two different pharmaceutical products
13.
Symptoms related to benign prostate hyperplasia
14.
Claustrophobia
15.
Any metal body implants
16.
History of pancreatitis, type 1 diabetes, gastroparesis or multiple endocrine neoplasia syndrome type 2
17.
Personal or family history of medullary thyroid carcinoma
18.
Any diseases judged by the investigator that could affect the trial
19.
Any medication judged by the investigator that could affect the trial |
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E.5 End points |
E.5.1 | Primary end point(s) |
Single dose 51Cr-EDTA plasma clearance. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
By measuring plasma activity every 30 min for the last 1.5 hours of the 5 hours clearance period we can estimate area under the curve (AUC) by extrapolation. Clearance can be estimated as total bolus activity divided by AUC. |
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E.5.2 | Secondary end point(s) |
fMRI (Functional Magnetic Resonance Imaging ). Renal blood flow will be estimated bilaterally in the renal arteries. Using BOLD (Blood Oxygen Level Dependent) technique renal oxygenation in both cortex and medulla will be estimated. If possible (MR protocols are under development) renal perfusion in both cortex and medulla will be estimated using arterial spin labelling technique. The scans will be performed by the coordinating investigator and the data will be analyzed in collaboration with a MR physicist from Department of Nuclear Medicine, Aarhus University Hospital. The MR techniques involved are all non invasive with no exposure of radiation and no contrast injection.
Urine production (flow) in the night (21.30 – 7.30) and during the clamp period (7.30-12.30).
Measurements of urine albumin excretion during the night (21.30 – 7.30) and during the clamp period (7.30-12.30).
Electrolyte excretion (sodium, potassium, calcium and osmolal) during the night (21.30-7.30). Evaluated from the electrolyte urine concentrations from the collection at 7.30.
Lithium Clearance, Clith=Uflow*Ulith/Plith with Plith=P1-P2/(2.3*log(P1/P2)). P1 and P2 is the plasma lithium concentration at time 7.30 and 12.30. Uflow is the urine flow from 7.30 to 12.30 and Ulith is the urine lithium concentration in the urine collection at 12.30. Lithium clearance is a marker of proximal tubular sodium reabsorption.
Electrolyte clearances during clamp period: Measurements of sodium, potassium, calcium and osmolal clearance. CX= Uflow*UX/(½PX1+½PX2) where PX1 and PX2 are the plasma concentration of electrolyte X at time 7.30 and 12.30. Uflow is the urine flow from 7.30 to 12.30 and UX is the urine concentration of electrolyte X at collection time 12.30.
Hormone concentrations. Average values of P-angiotensin-II, P-aldosterone, P-renin, P-ANP and P-methanephrine, P-GLP-1 and P-glucagon measured at time 7.30 and 12.30.
Urinary excretion of adrenaline, noradrenaline and methanephrine, angiotensinogen, during clamp period (7.30-12.30).
Oxidative stress level. Urinary excretion of 8-OHdG (8-hydroxy-2’-deoxyguanosine) during the night (21.30 – 7.30) and during the clamp period (7.30-12.30). 8-OHdG is a marker of oxidative DNA damage.
Inflammatory level. Plasma values of high-sensitive C-reactive protein (P-HS-CRP) measured 7.30 and 12.30.
Markers of kidney injury. Urinary excretion of neutrophil gelatinase associated protein (NGAL) and kidney injury molecule 1 (KIM1) during the night (21.30 – 7.30) and during the clamp period (7.30-12.30).
The measurements of P-glucose and the amount of glucose and Actrapid infused in the clamp period will be recorded. |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
See secondary endpoints (E.5.2) |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | Yes |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | No |
E.6.5 | Efficacy | No |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | Yes |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | Yes |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | Yes |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | Yes |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
E.8.3 |
The trial involves single site in the Member State concerned
| Yes |
E.8.4 | The trial involves multiple sites in the Member State concerned | No |
E.8.5 | The trial involves multiple Member States | No |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.7 | Trial has a data monitoring committee | Yes |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 1 |
E.8.9.1 | In the Member State concerned months | 4 |
E.8.9.1 | In the Member State concerned days | |