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    Clinical Trial Results:
    Globifer Forte® Oral Haem and Non-haem Iron Supplementation in Heart Failure: A Randomised, DoubleBlind, Placebo Controlled, Double Dummy, Part Mechanistic Pilot Trial

    Summary
    EudraCT number
    2013-004704-19
    Trial protocol
    GB  
    Global end of trial date
    21 Dec 2020

    Results information
    Results version number
    v1(current)
    This version publication date
    23 Oct 2025
    First version publication date
    23 Oct 2025
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    GLOBIFER-HF
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    -
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    King's College London
    Sponsor organisation address
    The Strand, London, United Kingdom, WC2R 2LS
    Public contact
    Dr Darlington Okonko, King's College London, +44 207848 5017, obi.okonko@kcl.ac.uk
    Scientific contact
    Dr Darlington Okonko, King's College London, +44 207848 5017, obi.okonko@kcl.ac.uk
    Sponsor organisation name
    King's College Hospital NHS Foundation Trust
    Sponsor organisation address
    Denmark Hill, London, United Kingdom, SE5 9RS
    Public contact
    Dr Darlington Okonko, King's College London, +44 207848 5017, darlington.okonko@kcl.ac.uk
    Scientific contact
    Dr Darlington Okonko, King's College London, +44 207848 5017, darlington.okonko@kcl.ac.uk
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    21 Dec 2020
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    21 Dec 2020
    Global end of trial reached?
    Yes
    Global end of trial date
    21 Dec 2020
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To evaluate the effect of 3 months of Globifer Forte® treatment on exercise capacity, as quantified by the 6 minute walk distance (6MWD), in CHF patients with functional or absolute iron deficiency.
    Protection of trial subjects
    All participants are free to withdraw at any time from the protocol treatment without giving reasons and without prejudicing further treatment.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    21 Mar 2018
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    United Kingdom: 60
    Worldwide total number of subjects
    60
    EEA total number of subjects
    0
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    24
    From 65 to 84 years
    33
    85 years and over
    3

    Subject disposition

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    Recruitment
    Recruitment details
    -

    Pre-assignment
    Screening details
    Screening & Baseline Assessments Biochemical and haematological tests Hepcidin-25, Cytokines, NT-BNP, Symptom status (NYHA, KCCQ, VAFS) 6MWD test, Echo Iron absorption test & in-vivo iron transport

    Pre-assignment period milestones
    Number of subjects started
    60
    Number of subjects completed
    60

    Period 1
    Period 1 title
    Overall Trial (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Globifer Forte
    Arm description
    1 tablet active GF twice daily + 1 tablet placebo FeSO4 twice daily
    Arm type
    Experimental

    Investigational medicinal product name
    Globifer Forte
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    1 tablet active Globifer Forte® twice daily + 1 tablet placebo FeSO4 twice daily

    Investigational medicinal product name
    Placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    1 tablet active Globifer Forte® twice daily + 1 tablet placebo FeSO4 twice daily

    Arm title
    FeSO4
    Arm description
    1 tablet placebo Globifer Forte® twice daily + 1 tablet active FeSO4 twice daily
    Arm type
    Active comparator

    Investigational medicinal product name
    FeSO4
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    1 tablet placebo Globifer Forte® twice daily + 1 tablet active FeSO4 twice daily

    Investigational medicinal product name
    Placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    1 tablet placebo Globifer Forte® twice daily + 1 tablet active FeSO4 twice daily

    Arm title
    Placebo
    Arm description
    1 tablet placebo Globifer Forte® twice daily + 1 tablet placebo FeSO4 twice daily.
    Arm type
    Placebo

    Investigational medicinal product name
    Placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    1 tablet placebo Globifer Forte® twice daily + 1 tablet placebo FeSO4 twice daily.

    Number of subjects in period 1
    Globifer Forte FeSO4 Placebo
    Started
    24
    23
    13
    Completed
    24
    23
    13

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Globifer Forte
    Reporting group description
    1 tablet active GF twice daily + 1 tablet placebo FeSO4 twice daily

    Reporting group title
    FeSO4
    Reporting group description
    1 tablet placebo Globifer Forte® twice daily + 1 tablet active FeSO4 twice daily

    Reporting group title
    Placebo
    Reporting group description
    1 tablet placebo Globifer Forte® twice daily + 1 tablet placebo FeSO4 twice daily.

    Reporting group values
    Globifer Forte FeSO4 Placebo Total
    Number of subjects
    24 23 13 60
    Age categorical
    Units: Subjects
        In utero
    0
        Preterm newborn infants (gestational age < 37 wks)
    0
        Newborns (0-27 days)
    0
        Infants and toddlers (28 days-23 months)
    0
        Children (2-11 years)
    0
        Adolescents (12-17 years)
    0
        Adults (18-64 years)
    0
        From 65-84 years
    0
        85 years and over
    0
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    67 ( 12 ) 69 ( 14 ) 70 ( 9 ) -
    Gender categorical
    Units: Subjects
        Female
    4 5 4 13
        Male
    20 18 9 47

    End points

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    End points reporting groups
    Reporting group title
    Globifer Forte
    Reporting group description
    1 tablet active GF twice daily + 1 tablet placebo FeSO4 twice daily

    Reporting group title
    FeSO4
    Reporting group description
    1 tablet placebo Globifer Forte® twice daily + 1 tablet active FeSO4 twice daily

    Reporting group title
    Placebo
    Reporting group description
    1 tablet placebo Globifer Forte® twice daily + 1 tablet placebo FeSO4 twice daily.

    Primary: 6 minute walking distance

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    End point title
    6 minute walking distance
    End point description
    End point type
    Primary
    End point timeframe
    6 minute walk distance (6MWD) at week 12 between patients randomised to Globifer Forte® and those allocated to placebo.
    End point values
    Globifer Forte FeSO4 Placebo
    Number of subjects analysed
    20
    18
    8
    Units: metre
        arithmetic mean (standard deviation)
    383 ( 133 )
    371 ( 105 )
    430 ( 100 )
    Statistical analysis title
    Two-way Mixed Model ANCOVA Analysis at 12 weeks
    Comparison groups
    Globifer Forte v Placebo
    Number of subjects included in analysis
    28
    Analysis specification
    Pre-specified
    Analysis type
    other
    P-value
    = 0.023
    Method
    ANCOVA
    Parameter type
    Mean difference (net)
    Point estimate
    -57
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -108
         upper limit
    16

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Number and incidence of adverse events (drug tolerance) between patients randomised to Globifer Forte® and FeSO4 from baseline to 12 weeks.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    22
    Reporting groups
    Reporting group title
    Globifer Forte
    Reporting group description
    1 tablet active GF twice daily + 1 tablet placebo FeSO4 twice daily

    Reporting group title
    FeSO4
    Reporting group description
    1 tablet placebo Globifer Forte® twice daily + 1 tablet active FeSO4 twice daily

    Reporting group title
    Placebo
    Reporting group description
    1 tablet placebo Globifer Forte® twice daily + 1 tablet placebo FeSO4 twice daily.

    Serious adverse events
    Globifer Forte FeSO4 Placebo
    Total subjects affected by serious adverse events
         subjects affected / exposed
    0 / 23 (0.00%)
    1 / 24 (4.17%)
    6 / 13 (46.15%)
         number of deaths (all causes)
    0
    0
    0
         number of deaths resulting from adverse events
    0
    0
    0
    Vascular disorders
    Bowel Ischaemia
         subjects affected / exposed
    0 / 23 (0.00%)
    0 / 24 (0.00%)
    1 / 13 (7.69%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cardiac disorders
    Syncope
    Additional description: vasovagal
         subjects affected / exposed
    0 / 23 (0.00%)
    0 / 24 (0.00%)
    1 / 13 (7.69%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Congestive Heart Failure
         subjects affected / exposed
    0 / 23 (0.00%)
    0 / 24 (0.00%)
    1 / 13 (7.69%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Acute myocardial infarction
         subjects affected / exposed
    0 / 23 (0.00%)
    0 / 24 (0.00%)
    1 / 13 (7.69%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Hepatobiliary disorders
    Cholecystitis chronic
         subjects affected / exposed
    0 / 23 (0.00%)
    0 / 24 (0.00%)
    1 / 13 (7.69%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Infections and infestations
    Pneumonia
         subjects affected / exposed
    0 / 23 (0.00%)
    1 / 24 (4.17%)
    2 / 13 (15.38%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cellulitis
         subjects affected / exposed
    0 / 23 (0.00%)
    0 / 24 (0.00%)
    1 / 13 (7.69%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 1%
    Non-serious adverse events
    Globifer Forte FeSO4 Placebo
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    10 / 23 (43.48%)
    17 / 24 (70.83%)
    4 / 13 (30.77%)
    Vascular disorders
    Elective fem-fem bypass
         subjects affected / exposed
    0 / 23 (0.00%)
    0 / 24 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    0
    1
    Cardiac disorders
    Chest pain
         subjects affected / exposed
    0 / 23 (0.00%)
    1 / 24 (4.17%)
    0 / 13 (0.00%)
         occurrences all number
    0
    1
    0
    Prolonged QTc
         subjects affected / exposed
    1 / 23 (4.35%)
    0 / 24 (0.00%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    0
    General disorders and administration site conditions
    drowsiness
         subjects affected / exposed
    1 / 23 (4.35%)
    0 / 24 (0.00%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    0
    Fatigue
         subjects affected / exposed
    0 / 23 (0.00%)
    1 / 24 (4.17%)
    0 / 13 (0.00%)
         occurrences all number
    0
    1
    0
    Ear and labyrinth disorders
    loss of balance
         subjects affected / exposed
    1 / 23 (4.35%)
    0 / 24 (0.00%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    0
    Deafness
         subjects affected / exposed
    0 / 23 (0.00%)
    1 / 24 (4.17%)
    0 / 13 (0.00%)
         occurrences all number
    0
    1
    0
    Eye disorders
    blurred vision
         subjects affected / exposed
    1 / 23 (4.35%)
    0 / 24 (0.00%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    0
    Gastrointestinal disorders
    Dark stools
         subjects affected / exposed
    4 / 23 (17.39%)
    11 / 24 (45.83%)
    0 / 13 (0.00%)
         occurrences all number
    4
    11
    0
    Constipation
         subjects affected / exposed
    1 / 23 (4.35%)
    3 / 24 (12.50%)
    1 / 13 (7.69%)
         occurrences all number
    1
    3
    1
    Nausea
         subjects affected / exposed
    1 / 23 (4.35%)
    4 / 24 (16.67%)
    0 / 13 (0.00%)
         occurrences all number
    1
    4
    0
    Abdominal pain
         subjects affected / exposed
    0 / 23 (0.00%)
    1 / 24 (4.17%)
    0 / 13 (0.00%)
         occurrences all number
    0
    1
    0
    Respiratory, thoracic and mediastinal disorders
    Coryzal
         subjects affected / exposed
    0 / 23 (0.00%)
    2 / 24 (8.33%)
    1 / 13 (7.69%)
         occurrences all number
    0
    2
    1
    shortness of breath
         subjects affected / exposed
    0 / 23 (0.00%)
    1 / 24 (4.17%)
    0 / 13 (0.00%)
         occurrences all number
    0
    1
    0
    Skin and subcutaneous tissue disorders
    Rash
         subjects affected / exposed
    0 / 23 (0.00%)
    1 / 24 (4.17%)
    0 / 13 (0.00%)
         occurrences all number
    0
    1
    0
    Musculoskeletal and connective tissue disorders
    hip/knee pain
         subjects affected / exposed
    2 / 23 (8.70%)
    1 / 24 (4.17%)
    1 / 13 (7.69%)
         occurrences all number
    2
    1
    1
    swollen finger
         subjects affected / exposed
    1 / 23 (4.35%)
    0 / 24 (0.00%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    0
    Back pain
         subjects affected / exposed
    1 / 23 (4.35%)
    1 / 24 (4.17%)
    0 / 13 (0.00%)
         occurrences all number
    1
    1
    0
    Infections and infestations
    toe infection
         subjects affected / exposed
    0 / 23 (0.00%)
    1 / 24 (4.17%)
    0 / 13 (0.00%)
         occurrences all number
    0
    1
    0
    Metabolism and nutrition disorders
    Gout flare
         subjects affected / exposed
    1 / 23 (4.35%)
    0 / 24 (0.00%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    0

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    04 Jun 2018
    Protocol Version 2.2 to 3.0 (approved 05/07/2018): • Eligibility expanded to include all patients with LVEF </= 45% irrespective of degree of symptoms (NYHA class). • Removal of need to quantify mRNA levels as excessive work given that protein levels will be measured. • Change in comparison time for the iron absorption test from 2 to3 days. • Removal of ‘change in’ for the endpoints and safety evaluation and using ‘week 12’ measurements as endpoints and ‘Serum iron level at 3 hours after oral’ drug, in case of iron absorption test. • Removal of alanine transaminase from liver function test list as King’s College Hospital does not measure it routinely. • Clarification that only folate and vitamin B12 levels below the lower limit of normal were an exclusion criteria as levels above the upper limit are not physiological adverse. • Removal of cellular energetic status from the blood tests as will not be an endpoint due to it not being needed and FACS machine out of service. GLOBIFER-HF CLINICAL STUDY REPORT 10 • Clarification that chronic lung disease would only be a contraindication if patients had objective measures of severe lung disease (FEV1<50% predicted). • Removal of chronic renal impairment with eGFR <45 as an exclusion criterion, and relaxing eGFR<30 from <65 in diabetics. • Adding ‘planning to get pregnant’ to exclusion criteria. • Clarification that functional valvular disease will bot be a contraindication.
    14 Jun 2019
    Protocol Version 3.1 to 4.0 (approved 19/06/2019): • Removal of stratification of study size into groups absolute or functional iron deficiency. • Removal of testing of Haem-carrier protein 1, and haem regulatory gene 1 from the in vitro iron transporter studies. • Change total number of in vitro transporter studies to first 30 randomised patients from first 20 of each strata. • Removal of allergic disorders from the exclusion criteria. • Additional of oral haemoglobin preparations use as an exclusion criterion. • Change of compliance check telephone calls from weeks to 2 weekly • Removal of IL-10, and gamma interferon from the cytokine assay list.
    09 Jun 2020
    Protocol Version 4.0 to 5.0 (approved 07/07/2020): • Removal of soluble transferrin receptor as a baseline and end of study visit blood test • Removal of TNF receptor 1&2 from the cytokine list. • Cytokines and Hepcidin-25 ELISA measurements will be outsourced to Affinity Biomarker Labs rather than be performed in King’s College BHF Centre.

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
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    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
    As of 31 January 2023, all EU/EEA initial clinical trial applications must be submitted through CTIS . Updated EudraCT trials information and information on PIP/Art 46 trials conducted exclusively in third countries continues to be submitted through EudraCT and published on this website.

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