E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
type 2 diabetes |
diabete di tipo 2 |
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E.1.1.1 | Medical condition in easily understood language |
type 2 diabetes |
diabete di tipo 2 |
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E.1.1.2 | Therapeutic area | Diseases [C] - Nutritional and Metabolic Diseases [C18] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 21.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10067585 |
E.1.2 | Term | Type 2 diabetes mellitus |
E.1.2 | System Organ Class | 10027433 - Metabolism and nutrition disorders |
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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 |
To verify whether, in type 2 diabetic patients with normal 2-D ejection fraction (=50%) and without inducible myocardial ischemia at the cardiopulmonary test, the treatment with empagliflozin is associated with an improvement in left ventricular systolic function, as measured by global lungitudinal strain (GLS) through speckle tracking echography, in comparison to sitagliptin, an equally effective plasma glucose lowering agent, presumably neutral on cardiac function |
Verificare se, in pazienti diabetici di tipo 2 con normale frazione di eiezione 2-D (=50%) e senza ischemia miocardica inducibile, il trattamento con empagliflozin sia associato ad un miglioramento della funzione sistolica ventricolare sinistra, misurata mediante il global longitudinal strain (GLS) attraverso l'ecografia spekle tracking, in comparazione a sitagliptin, un agente ipoglicemizzante ugualmente efficace, ma presumibilmente neutro sulla funzione miocardica |
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E.2.2 | Secondary objectives of the trial |
¿ Changes from baseline at 6 months after treatment initiation in HbA1c; ¿ Changes from baseline at 1 and 6 months after treatment initiation in other well established parameters of cardiac function, such as 3-D ejection fraction, left atrial volume, and E/E'. ¿ Changes from baseline at 6 months after treatment initiation in VO2 max (Cardiopulmonary exercise test), an extremely clinically relevant parameter that will help in appreciating the relevance of the imaging data.
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A) Accertare l¿effetto del trattamento sui livelli di HbA1c; B) Verificare l¿effetto del trattamento su: ¿ Parametri di funzione sistolica e diastolica in ecografia 3D; ¿ Biomarcatori plasmatici orientati ai meccanismi; ¿ VO2 massima; ¿ Funzione autonomica cardiaca. C) verificare se gli effetti del trattamento differiscono nel sottogruppo di pazienti con lievi anomalie nella funzione sistolica cardiaca al baseline; D) rilevare nella intera coorte la relazione tra i cambiamenti negli indici di funzione cardiaca (global longitudinal strain o 3D) e i concomitanti cambiamenti in pressione sanguigna, peso e controllo metabolico.
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
• Male of female patients affected by type 2 diabetes mellitus (T2DM) • Subjects aged >40 and <80 years • HbA1c levels =53 and = 69 mmol/mol • Assuming stable hypoglycemic therapy since three months with: • Metformin • Metformin + basal insulin • Assuming stable cardio-active therapies since three months (anti-hypertensive drugs, diuretics, drugs for asthma, drugs for migraine) • With preserved kidney function as defined by eGFR =45 ml.min-1.1.73m2 • With preserved left ventricular function as defined by (NYHA class 1-2, and EF=50%)
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pazienti maschi o femmine affetti da diabete mellito di tipo 2 (T2DM); soggetti di età <40 e >80 anni; valori di HbA1c =53 e = 69 mmol/mol; che stiano assumendo terapia ipoglicemizzante stabile da tre mesi con metformina o metformina+insulina basale; che stiano assumendo terapie cardioattive stabili da tre mesi (farmaci anti-ipertensivi, diuretici, farmaci per l’asma, farmaci per l’emicrania); con funzione renale preservata, definita come eGFR =45 ml/min/1.1.73m2; con funzione del ventricolo sinistro preservata, definita da classe NYHA 1-2 ed EF>50%. |
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E.4 | Principal exclusion criteria |
• Refuse to give or inability to give informed consent; • Patients unlikely to comply with the protocol or unable to understand the nature, scope and possible consequences of the study; • Employees of the investigator or study centre (i.e., principal investigator, sub-investigator, study coordinators, other study staff, employees, or contractors of each), with direct involvement in the proposed study or other studies under the direction of that investigator and/or study centre, as well as family members of the employees or the investigator; • Patients with type 1 diabetes mellitus; • Pregnancy or active breast feeding; • History of acute coronary syndrome; • Respiratory insufficiency or history of clinically significant respiratory diseases (chronic obstructive pulmonary disease); • Acute or chronic inflammatory diseases; • History of active neoplastic disease within the last 5 years; • Patients with known hypersensitivity to empagliflozin and its excipients; • Volume depleted patients or those who, in the judgement of the investigator, may be at risk for dehydration (abuse of diuretics or laxatives, chronic diarrhoea etc); • History of recurrent or serious genitor-urinary infections; • Patients with known hypersensitivity to sitagliptin and its excipients; • History of acute or chronic pancreatic disease; • Patients who received any investigational new drug within the last 12 weeks; • Severe obesity (BMI=40 kg/m2); • Uncontrolled blood pressure, defined as >160/100 mmHg; • eGFR<45 ml/min/1.73 m2; • Severe hepatic insufficiency and/or significant abnormal liver function defined as aspartate aminotransferase (AST) >3x upper limit of normal (ULN) and/or alanine aminotransferase (ALT) >3x ULN or total bilirubin >2.0 mg/dL; • Cardiac arrhythmia (2nd grade AV block, atrial fibrillation, peace maker, high incidence premature beats); • Clinically relevant cardiac valvular disease; • Ejection fraction <50% or presence of regional left ventricular contraction impairment; • Poor quality of echocardiographic imaging; • Inability to perform the cardiopulmonary exercise test; • Evidence of inducible myocardial ischemia at the cardiopulmonary test
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- rifiuto o incapacità di dare il consenso informato; - pazienti che verosimilmente non si atterranno al protocollo o incapaci di comprendere la natura, lo scopo e le possibili conseguenze dello studio; - impiegati dello sperimentatore o del centro dello studio (ad esempio lo sperimentatore principale, sotto-sperimentatori, coordinatori dello studio, altri membri dello staff, impiegati o contrattisti di qualunque tipo) che abbiano un coinvolgimento diretto con lo studio proposto o in altri studi sotto la direzione di quello stesso sperimentatore e/o il centro dello studio, così come familiari degli impiegati o dello sperimentatore; - pazienti con da diabete mellito di tipo 1; - gravidanza o allattamento al seno attivo; - storia di sindrome coronarica acuta; - insufficienza respiratoria o storia di malattie respiratorie clinicamente significative (malattia ostruttiva cronica polmonare); - malattie infiammatorie acute o croniche; - storia di malattie neoplastiche attive durante gli ultimi 5 anni; pazienti con nota ipersensibilità a empagliflozin e ai suoi eccipienti; - pazienti ipovolemici o coloro che, secondo il giudizio dello sperimentatore, possano essere a rischio di disidratazione (abuso di diuretici o lassativi, diarrea cronica o altri); - storia di infezioni genitourinarie ricorrenti o gravi; - pazienti con ipersentibilità nota a sitagliptin e ai suoi eccipienti; - storia di malattie pancreatiche acute o croniche; - pazienti che abbiano assunto qualunque nuovo farmaco sperimentale durante le ultime 12 settimane; - obesità grave (BMI>=40kg/m2); - ipertensione arteriosa non controllata, definita come >160/100 mmHg; - eGFR<45 ml/min/1.73m2; insufficienza epatica severa e/o funzione epatica significativamente alterata definita come aspartato-aminotransferasi (AST) > 3x il limite superiore del normale e/o alanina-aminotransferasi (ALT) > 3x il limite superiore del normale o bilirubina totale >2,0 mg/dL; - aritmie cardiache (blocco atrioventricolare di II grado, fibrillazione atriale, pacemaker, battiti prematuri ad elevata incidenza); - valvulopatie clinicamente rilevanti; frazione di eiezione <50% o presenza di disfunzione della contrattilità regionale del ventricolo sinistro; - immagini ecocardidografiche di scarsa qualità; impossibilità di effettuare il test cardiopolmonare; evidenza di ischemia inducibile al test cardiopolmonare |
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E.5 End points |
E.5.1 | Primary end point(s) |
Changes in global longitudinal strain (GLS) from baseline to 1 month and 6 months after treatment initiation. |
Variazione in global longitudinal strain (GLS) dal basale al controllo ad un mese e a sei mesi |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
from baseline to 1 month and 6 months after treatment initiation |
dal basale al controllo ad un mese e sei mesi |
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E.5.2 | Secondary end point(s) |
- Changes from baseline at 6 months after treatment initiation in 1) HbA1c; 2) ejection fraction, left atrial volume and E/E', as measured at 3-D echocardiography; 3) VO2 max, as measured at cardiopulmonary test; 4) myocardial parietal stress plasma biomarker (BNP, NT-proBNP, proadrenomedullin), inflammation/oxidative stress plasma biomarkers (hsCRP, TNF-alpha, mieloperoxidase, uric acid) and cardiac remodeling/cytolysis (type III pro-collagene, troponine); 5) Cardiac autonomic function tests (R-R interval during Valsalva manoeuvre, deep-breathing, lying-to-standing).
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Variazioni rispetto al basale a 6 mesi dall¿inizio del trattamento in: 1) HbA1c; 2) frazione di eiezione, volume atriale sinistro ed E/E', misurati con ecocardiografia 3D; 3) VO2 max, misurata al test cardiopolmonare; 4) marcatori di stress parietale miocardico (BNP, NT-proBNP, proadrenomedullina), marcatori di infiammazione/stress ossidativo (hsCRP, TNF-alfa, mieloperossidasi, acido urico), marcatori di rimodellamento/citolisi (procollagene tipo III, troponina); 5) test di funzione autonomica cardiaca (intervallo RR durante manovra di Valsalva, respirazione profonda, clino-ortostatismo).
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
from baseline at 6 months |
rispetto al basale a 6 mesi |
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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 | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
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) | Yes |
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 | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | Yes |
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) | Yes |
E.8.2.2 | Placebo | No |
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.8.4.1 | Number of sites anticipated in Member State concerned | 1 |
E.8.5 | The trial involves multiple Member States | No |
E.8.5.1 | Number of sites anticipated in the EEA | 1 |
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 | Information not present in EudraCT |
E.8.7 | Trial has a data monitoring committee | No |
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 | 2 |
E.8.9.1 | In the Member State concerned months | 0 |
E.8.9.1 | In the Member State concerned days | 0 |
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 | 0 |
E.8.9.2 | In all countries concerned by the trial days | 0 |