E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Patient with worsening chronic heart failure with left ventricular systolic dysfunction |
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E.1.1.1 | Medical condition in easily understood language |
Patient with worsening chronic heart failure |
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E.1.1.2 | Therapeutic area | Diseases [C] - Cardiovascular Diseases [C14] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.0 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10019279 |
E.1.2 | Term | Heart failure |
E.1.2 | System Organ Class | 100000004849 |
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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 |
The primary objective of the study is to investigate the efficacy (rate of decrease in N terminal pro-hormone B-type natriuretic peptide (NT-proBNP) of more than 30% from baseline to Day 28) and the safety (blood pressure changes until Day 28) of QGC001 up-titrated from 50 mg twice daily to a maximum of 500 mg twice daily. |
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E.2.2 | Secondary objectives of the trial |
Further exploratory objectives of the study are *To assess the effects of these doses on a composite endpoint of death from any cause and hospitalization for worsening heart failure (WHF) at Day 28 and after drug discontinuation up to Day 35. *To assess the effects of the respective dose levels, and of all doses combined, on changes in NT-proBNP and BNP, from baseline to Day 7, Day 14, Day 21, Day 28, and after drug discontinuation from day 28 to day 35 *To assess the changes in quality of life Minnesota Living with Heart Failure questionnaire score from randomization to day 28
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
*A signed and dated informed consent form prior to any study procedure *Adult male subjects and female subjects without childbearing potential. *Clinical diagnosis of CHF with history of NYHA class II-III for at least 3 months before randomisation. *Documented left ventricular ejection fraction (LVEF) < 40% measured by any modality within the previous 12 months in the subject’s medical history. *Subjects must also have at least one local measurement of BNP level ≥ 300 pg/mL or NT-proBNP level ≥ 1200 pg/mL (preferred assay, local laboratory) at the screening visit (maximum 7 days before randomisation). *eGFR ≥ 30 mL/min/1.73 m2 (MDRD) at screening. *Serum potassium < 5.0 mmol/L at screening. *Systolic blood pressure ≥ 110 mmHg (average of 3 consecutive measurements) at screening. *Prescribed to optimal pharmacologic therapy per “ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2016”, or based on the updated current clinical practice, unless contra-indicated or not-tolerated, and on a stable dose for at least 30 days prior to enrolment (the dosage of the drugs cannot be increased or decreased respectively by more than double or half of initial dosage). *Taking oral loop diuretics at doses < 250 mg furosemide daily (or equivalent).
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E.4 | Principal exclusion criteria |
*BMI > 45 kg.m-2. *Patients who require the use of HF IV therapy or oral furosemide > 250 mg (or equivalent) at any time during the 48 hours immediately before randomisation. *Patients with unstable angina, myocardial infarction, PTCA, coronary artery bypass graft, cerebral vascular accident, or transient ischemic attack within previous 3 months (90 days) before enrolment. *Patients whose primary cause of heart failure is mitral or aortic valve disease or congenital heart disease or hypertrophic obstructive cardiomyopathy or infiltrative cardiomyopathy (e.g. amyloidosis, sarcoidosis) or myocarditis. * Patients with “new” permanent atrial fibrillation (AF), discovered within 3 months prior to randomization. * Heart rate > 110 beats/min at screening. *Patients scheduled for Pacemaker (including ICD, CRT), Angioplasty, CABG or LVAD within the next 3 months. *Patients with severe documented chronic obstructive lung disease (COPD), defined as chronic need for oxygen therapy *eGFR < 30 mL/min/1.73 m2 (MDRD) at screening. * Decrease in eGFR greater than 20% within 3 weeks prior to the screening visit. *Serum potassium > 5.0 mmol/L at screening. *Systolic blood pressure < 110 mmHg or with signs or symptoms of hypotension. *Symptomatic hypotension or orthostatic hypotension defined by a decrease of systolic blood pressure of more than 30 mm Hg in the standing vs. sitting position at screening and at the basal SBP of the D0 (before having taken the study medication). *A marked baseline prolongation of QT/QTc interval (e.g. repeated demonstrated of a QTc interval > 450 ms) AND QRS < 100 ms. In case of QRS enlargement > 100 ms (i-e bundle branch block, pacemakers) QT does not accurately reflect repolarization and may not be calculated. * A history of additional risk factors for Torsade de Pointes (TdP) (e.g. hypokalemia, family history of long QT Syndrome). *The use of concomitant medications that prolong the QT/QTc interval. *Insulin-requiring diabetic patients (including type 1 Diabetes). *History of angioneurotic edema. *Severe liver failure at screening defined by a value of ALAT and/or ASAT≥ 5 from the normal value. *Patients involved in any interventional clinical study, patients enrolled in Registries and/or in non-interventional studies may participate. *Patients who take an investigational or non-approved treatment. *Women of childbearing potential. *Patients with a prior cardiac transplant or patients currently on the list for cardiac transplantation. * Patient with hypersensitivity to the active substance or to one of the other components of the trial preparation. * Patients in whom an allergy requiring chronic treatment is known or exists. *Patients with a history of previous illnesses of neurological or psychiatric nature that affect the Central Nervous System. *Patients with a life expectancy of less than 12 months per physician judgment. *Frail patient who, in the opinion of the investigator will not be able to follow the protocol.
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E.5 End points |
E.5.1 | Primary end point(s) |
*The Efficacy Primary endpoint will be the percentage of subjects with a relative decrease in NT proBNP (Central Lab) of more than 30% from baseline to Day 28. *The Safety Primary endpoint will be the blood pressure changes at each visit, compared to the baseline measure
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
for efficacy endpoint: at day 28 compared to Baseline for safety endpoint: at each visit, compared to the baseline |
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E.5.2 | Secondary end point(s) |
*Blood biochemistry, electrolytes, urinary osmolarity at Day 7, Day 14, Day 21, Day 28, Day 35 *Change in central lab values of NT-proBNP and BNP, at Day 7, Day 14, Day 21, Day 28, Day 35 *Death from any cause or readmission for worsening heart failure at Day 28 and Day 35 *Quality of life Minnesota Living with Heart Failure Score and D0 and Day 28.
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
at each visit compared to the baseline |
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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 | No |
E.6.3 | Therapy | No |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | Yes |
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) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
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 | No |
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
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 3 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 23 |
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 | 1 |
E.8.9.1 | In the Member State concerned days | 35 |
E.8.9.2 | In all countries concerned by the trial years | 2 |
E.8.9.2 | In all countries concerned by the trial months | 6 |
E.8.9.2 | In all countries concerned by the trial days | 35 |