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    Clinical Trial Results:
    Empagliflozin and its effect on heart failure in type 2 diabetes

    Summary
    EudraCT number
    2016-000214-30
    Trial protocol
    DE  
    Global end of trial date
    19 Nov 2020

    Results information
    Results version number
    v1(current)
    This version publication date
    25 Jan 2023
    First version publication date
    25 Jan 2023
    Other versions
    Summary report(s)
    Adverse_events_EFFORT-2

    Trial information

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    Trial identification
    Sponsor protocol code
    P000805
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    -
    WHO universal trial number (UTN)
    -
    Other trial identifiers
    DRKS: DRKS00009894
    Sponsors
    Sponsor organisation name
    Medical Center - University of Freiburg
    Sponsor organisation address
    Hugstetter Straße 55, Freiburg, Germany, 79106
    Public contact
    Coordinating Investigator, Medical Center - University of Freiburg, jochen.seufert@uniklinik-freiburg.de
    Scientific contact
    Coordinating Investigator, Medical Center - University of Freiburg, jochen.seufert@uniklinik-freiburg.de
    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
    04 Apr 2022
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    19 Nov 2020
    Global end of trial reached?
    Yes
    Global end of trial date
    19 Nov 2020
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    The primary objective of the EFFORT study is to investigate effects of empagliflozin on quality of life in diabetic patients with HFrEF or HFpEF.
    Protection of trial subjects
    Before enrolment in the clinical trial, the patient was informed that participation in the clinical trial is voluntary and that he/she may withdraw from the clinical trial at any time without having to give reasons and without penalty or loss of benefits to which the patient is otherwise entitled.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    20 Feb 2017
    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
    Germany: 63
    Worldwide total number of subjects
    63
    EEA total number of subjects
    63
    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)
    26
    From 65 to 84 years
    37
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    -

    Pre-assignment
    Screening details
    -

    Pre-assignment period milestones
    Number of subjects started
    63
    Number of subjects completed
    63

    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
    Empagliflozin
    Arm description
    -
    Arm type
    Experimental

    Investigational medicinal product name
    Empagliflozin
    Investigational medicinal product code
    Other name
    Jardiance
    Pharmaceutical forms
    Film-coated tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Dose: 25 mg/day. The tablets were to be taken in the morning, with or without food, swallowed whole with water.

    Arm title
    Placebo
    Arm description
    -
    Arm type
    Placebo

    Investigational medicinal product name
    Placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Film-coated tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Placebo was supplied as optically identical tablets to the IMP containing lactose monohydrate, microcrystalline cellulose, croscarmellose sodium, colloidal anhydrous silica, magnesium stearate, hypromellose 2910, titanium dioxide, talc, macrogol 400, iron oxide, yellow.

    Number of subjects in period 1
    Empagliflozin Placebo
    Started
    32
    31
    Completed
    32
    31

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Empagliflozin
    Reporting group description
    -

    Reporting group title
    Placebo
    Reporting group description
    -

    Reporting group values
    Empagliflozin Placebo Total
    Number of subjects
    32 31 63
    Age categorical
    Units: Subjects
        Adults (18-64 years)
    13 13 26
        From 65-84 years
    19 18 37
    Gender categorical
    Units: Subjects
        Female
    10 4 14
        Male
    22 27 49
    Subject analysis sets

    Subject analysis set title
    EFFORT-1
    Subject analysis set type
    Full analysis
    Subject analysis set description
    The primary objective of the EFFORT-1 study is to investigate effects of empagliflozin on quality of life in diabetic patients with heart failure (HF) with reduced ejection fraction (HFrEF). EFFORT-1 was planned as a confirmative study with respect to the primary endpoint, and had to be changed to an exploratory study due to slow recruitment. The primary objective is to evaluate quality of life under treatment with empagliflozin as compared to placebo in diabetic patients with HFrEF.

    Subject analysis set title
    EFFORT-2
    Subject analysis set type
    Full analysis
    Subject analysis set description
    The primary objective of the EFFORT-2 study is to investigate effects of empagliflozin on quality of life in diabetic patients with heart failure (HF) with preserved ejection fraction (HFpEF). EFFORT-2 is an exploratory hypotheses generating study. The primary objective is to evaluate quality of life under treatment with empagliflozin as compared to placebo in diabetic patients with HFpEF.

    Subject analysis sets values
    EFFORT-1 EFFORT-2
    Number of subjects
    24
    39
    Age categorical
    Units: Subjects
        Adults (18-64 years)
    13
    13
        From 65-84 years
    11
    26
    Age continuous
    Units:
        
    ( )
    ( )
    Gender categorical
    Units: Subjects
        Female
    2
    12
        Male
    22
    27

    End points

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    End points reporting groups
    Reporting group title
    Empagliflozin
    Reporting group description
    -

    Reporting group title
    Placebo
    Reporting group description
    -

    Subject analysis set title
    EFFORT-1
    Subject analysis set type
    Full analysis
    Subject analysis set description
    The primary objective of the EFFORT-1 study is to investigate effects of empagliflozin on quality of life in diabetic patients with heart failure (HF) with reduced ejection fraction (HFrEF). EFFORT-1 was planned as a confirmative study with respect to the primary endpoint, and had to be changed to an exploratory study due to slow recruitment. The primary objective is to evaluate quality of life under treatment with empagliflozin as compared to placebo in diabetic patients with HFrEF.

    Subject analysis set title
    EFFORT-2
    Subject analysis set type
    Full analysis
    Subject analysis set description
    The primary objective of the EFFORT-2 study is to investigate effects of empagliflozin on quality of life in diabetic patients with heart failure (HF) with preserved ejection fraction (HFpEF). EFFORT-2 is an exploratory hypotheses generating study. The primary objective is to evaluate quality of life under treatment with empagliflozin as compared to placebo in diabetic patients with HFpEF.

    Primary: EFFORT-1: Minnesota Living with Heart Failure Questionnaire (MLHFQ) total score

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    End point title
    EFFORT-1: Minnesota Living with Heart Failure Questionnaire (MLHFQ) total score
    End point description
    Difference of Minnesota Living with Heart Failure Questionnaire (MLHFQ) total score to baseline at 6 months after randomization. A lower MLHFQ score indicates less effect of heart failure on a patient’s quality of life. A total score accounts for all 21 items.
    End point type
    Primary
    End point timeframe
    6 months
    End point values
    Empagliflozin Placebo
    Number of subjects analysed
    12
    12
    Units: MLHFQ total score
        least squares mean (confidence interval 95%)
    2.01 (-6.31 to 10.34)
    -2.96 (-11.66 to 5.75)
    Statistical analysis title
    Mixed linear model for repeated measures (MMRM)
    Statistical analysis description
    MMRM with change from baseline of MLHFQ total score at month 1, month 3, month 6, month 9, month 12 as dependent variable and treatment, time point and interaction between treatment and time point and baseline MLHFQ as independent variables. Month 6 adjusted mean difference between treatments was estimated with 95%-confidence interval.
    Comparison groups
    Placebo v Empagliflozin
    Number of subjects included in analysis
    24
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.4
    Method
    Regression, Linear
    Parameter type
    Mean difference (final values)
    Point estimate
    4.97
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -7.09
         upper limit
    17.03

    Primary: EFFORT-2: Minnesota Living with Heart Failure Questionnaire (MLHFQ) total score

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    End point title
    EFFORT-2: Minnesota Living with Heart Failure Questionnaire (MLHFQ) total score
    End point description
    Difference of Minnesota Living with Heart Failure Questionnaire (MLHFQ) total score to baseline at 6 months after randomization. A lower MLHFQ score indicates less effect of heart failure on a patient’s quality of life. A total score accounts for all 21 items.
    End point type
    Primary
    End point timeframe
    6 months
    End point values
    Empagliflozin Placebo
    Number of subjects analysed
    20
    19
    Units: MLHFQ total score
        least squares mean (confidence interval 95%)
    -5.27 (-11.73 to 1.19)
    3.95 (-2.44 to 10.34)
    Statistical analysis title
    Mixed linear model for repeated measures (MMRM)
    Statistical analysis description
    MMRM with change from baseline of MLHFQ total score at month 1, month 3, month 6, month 9, month 12 as dependent variable and treatment, time point and interaction between treatment and time point and baseline MLHFQ as independent variables. Month 6 adjusted mean difference between treatments was estimated with 95%-confidence interval.
    Comparison groups
    Empagliflozin v Placebo
    Number of subjects included in analysis
    39
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.048
    Method
    Regression, Linear
    Parameter type
    Median difference (final values)
    Point estimate
    -9.22
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -18.35
         upper limit
    -0.09

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Complete study
    Adverse event reporting additional description
    Reported adverse events occured in the EFFORT-1 substudy. Adverse events for EFFORT-2 are attached as PDF.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    24
    Reporting groups
    Reporting group title
    Empagliflozin
    Reporting group description
    Empagliflozin

    Reporting group title
    Placebo
    Reporting group description
    Placebo

    Serious adverse events
    Empagliflozin Placebo
    Total subjects affected by serious adverse events
         subjects affected / exposed
    4 / 12 (33.33%)
    1 / 12 (8.33%)
         number of deaths (all causes)
    0
    0
         number of deaths resulting from adverse events
    0
    0
    Cardiac disorders
    Coronary artery disease
         subjects affected / exposed
    2 / 12 (16.67%)
    0 / 12 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    0 / 12 (0.00%)
    1 / 12 (8.33%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    General disorders and administration site conditions
    General physical health deterioration
         subjects affected / exposed
    0 / 12 (0.00%)
    1 / 12 (8.33%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Upper gastrointestinal haemorrhage
         subjects affected / exposed
    0 / 12 (0.00%)
    1 / 12 (8.33%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Dyspnoea
         subjects affected / exposed
    1 / 12 (8.33%)
    0 / 12 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Renal and urinary disorders
    Acute kidney injury
         subjects affected / exposed
    1 / 12 (8.33%)
    0 / 12 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infections and infestations
    Abscess limb
         subjects affected / exposed
    0 / 12 (0.00%)
    1 / 12 (8.33%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Metabolism and nutrition disorders
    Hyperkalaemia
         subjects affected / exposed
    1 / 12 (8.33%)
    0 / 12 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 0%
    Non-serious adverse events
    Empagliflozin Placebo
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    8 / 12 (66.67%)
    9 / 12 (75.00%)
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Basal cell carcinoma
         subjects affected / exposed
    0 / 12 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    1
    Surgical and medical procedures
    Finger amputation
         subjects affected / exposed
    0 / 12 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    1
    General disorders and administration site conditions
    Chest discomfort
         subjects affected / exposed
    1 / 12 (8.33%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Fatigue
         subjects affected / exposed
    2 / 12 (16.67%)
    1 / 12 (8.33%)
         occurrences all number
    2
    1
    Oedema peripheral
         subjects affected / exposed
    0 / 12 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    1
    Respiratory, thoracic and mediastinal disorders
    Chronic obstructive pulmonary disease
         subjects affected / exposed
    1 / 12 (8.33%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Cough
         subjects affected / exposed
    0 / 12 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    1
    Dyspnoea
         subjects affected / exposed
    1 / 12 (8.33%)
    1 / 12 (8.33%)
         occurrences all number
    1
    1
    Investigations
    Blood creatinine increased
         subjects affected / exposed
    0 / 12 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    1
    Gamma-glutamyltransferase increased
         subjects affected / exposed
    0 / 12 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    1
    Serum ferritin decreased
         subjects affected / exposed
    1 / 12 (8.33%)
    0 / 12 (0.00%)
         occurrences all number
    2
    0
    Injury, poisoning and procedural complications
    Contusion
         subjects affected / exposed
    1 / 12 (8.33%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Limb injury
         subjects affected / exposed
    0 / 12 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    1
    Cardiac disorders
    Atrial fibrillation
         subjects affected / exposed
    1 / 12 (8.33%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Cardiac failure congestive
         subjects affected / exposed
    0 / 12 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    1
    Coronary artery disease
         subjects affected / exposed
    1 / 12 (8.33%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Nervous system disorders
    Dizziness
         subjects affected / exposed
    2 / 12 (16.67%)
    0 / 12 (0.00%)
         occurrences all number
    2
    0
    Blood and lymphatic system disorders
    Iron deficiency anaemia
         subjects affected / exposed
    1 / 12 (8.33%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Eye disorders
    Ocular hyperaemia
         subjects affected / exposed
    1 / 12 (8.33%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Panophthalmitis
         subjects affected / exposed
    0 / 12 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    1
    Gastrointestinal disorders
    Abdominal pain
         subjects affected / exposed
    1 / 12 (8.33%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Abdominal pain upper
         subjects affected / exposed
    0 / 12 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    1
    Constipation
         subjects affected / exposed
    0 / 12 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    1
    Diarrhoea
         subjects affected / exposed
    1 / 12 (8.33%)
    1 / 12 (8.33%)
         occurrences all number
    1
    1
    Dry mouth
         subjects affected / exposed
    0 / 12 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    1
    Gastrointestinal disorder
         subjects affected / exposed
    0 / 12 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    1
    Haemorrhoidal haemorrhage
         subjects affected / exposed
    0 / 12 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    1
    Nausea
         subjects affected / exposed
    1 / 12 (8.33%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Skin and subcutaneous tissue disorders
    Dermatitis
         subjects affected / exposed
    0 / 12 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    2
    Onychoclasis
         subjects affected / exposed
    0 / 12 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    1
    Pruritus
         subjects affected / exposed
    0 / 12 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    1
    Rash
         subjects affected / exposed
    1 / 12 (8.33%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Renal and urinary disorders
    Nocturia
         subjects affected / exposed
    2 / 12 (16.67%)
    1 / 12 (8.33%)
         occurrences all number
    2
    1
    Renal pain
         subjects affected / exposed
    0 / 12 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    1
    Musculoskeletal and connective tissue disorders
    Groin pain
         subjects affected / exposed
    1 / 12 (8.33%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Tendon pain
         subjects affected / exposed
    0 / 12 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    1
    Infections and infestations
    Bronchitis
         subjects affected / exposed
    0 / 12 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    1
    Erysipelas
         subjects affected / exposed
    0 / 12 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    1
    Influenza
         subjects affected / exposed
    1 / 12 (8.33%)
    1 / 12 (8.33%)
         occurrences all number
    1
    1
    Nasopharyngitis
         subjects affected / exposed
    0 / 12 (0.00%)
    5 / 12 (41.67%)
         occurrences all number
    0
    5
    Pneumonia
         subjects affected / exposed
    1 / 12 (8.33%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Metabolism and nutrition disorders
    Hypoglycaemia
         subjects affected / exposed
    1 / 12 (8.33%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    29 Sep 2017
    • Visit 2 during the run-in phase has been omitted, as the visit was primarily implemented for controlling of patients’ compliance which will be assessed anyway at randomization visit. • Inclusion criterion 1: new: ≤ 85 years old; old: < 85 years old. • Inclusion criterion 3: new: HbA1c ≥ 6.5%; old: HbA1c > 7.0%. • Exclusion criterion 8 has been specified allowing investigators to assess individually a necessary lapse of time preceding registration for patients with implantable cardioverter-defibrillator (ICD) and pacemaker. • Exclusion criterion 16: new: active tumor disease; old: malignancies within the past 5 years (except carcinoma in situ of the cervix and non melanomatous skin cancer). • Definition of MRI compatibility has been included to optimize scheduling the cardiac MRI procedure. • Plasma volume assessment will only be performed in a subgroup of patients due to organizational issues. Patients will be assigned to this examination consecutively beginning from a certain time point in order not to compromise randomisation balance. • In addition to DNA extraction, the biobanking samples will be used for RNA extraction also. • Introduction of time range for randomisation visit. This visit may be postponed for a week due to e.g. bank holidays, patient’s medical condition or other patient’s related issues. The time range for visit 3 and visit 4 was also extended, up to 7 days. • CTP section related to adverse events of special interest was completed.
    17 Apr 2019
    Until April 2019, 54 patients have been randomized within the recruitment period of approximately 29 months since enrolment of the first patient (22 patients in EFFORT-1, 32 patients in EFFORT-2). It was decided to terminate inclusion of patients into the study by the end of 2019, last patient last visit date in January 2021. From a statistical point of view, EFFORT-1, originally planned as a confirmatory study, with a calculated necessary sample size of 200 patients, will now have, with an expected sample size of less than 50 patients, only very low power to detect a difference between treatment arms. So, EFFORT-1, in the same way as planned from the beginning for EFFORT-2, is now regarded as an exploratory hypotheses generating study.

    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.
    The most important limitation is the small number of study participants. As such, the variability of all results is high leading to large confidence intervals of effect estimates.
    For support, Contact us.
    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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