E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Patients with heart failure with preserved ejection fraction ( HFpEF) and iron deficency anemia. |
Pacientes con insuficiencia cardiaca (IC) con fracción de eyección del ventrículo izquierdo (FEVI) preservada y anemia ferropénica. |
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E.1.1.1 | Medical condition in easily understood language |
Patients with heart failure with preserved ejection fraction ( HFpEF) and iron deficency anemia. |
Pacientes con insuficiencia cardiaca (IC) con fracción de eyección del ventrículo izquierdo (FEVI) preservada y anemia ferropénica. |
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E.1.1.2 | Therapeutic area | Diseases [C] - Cardiovascular Diseases [C14] |
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 |
Assess whether intravenous treatment with iron carboxymaltose or oral treatment (ferroglicina iron sulfate or liposome) in patients with HF Preserved LVEF and iron deficiency anemia, can improve functional capacity measured by the 6-minute walk (6MWT) test compared to placebo at 30 weeks after the start of treatment. |
Valorar si el tratamiento intravenoso con hierro carboximaltosa o hierro oral ( ferroglicina sulfato o hierro liposomado) en pacientes con IC con FEVI preservada y anemia ferropénica, pueden mejorar la capacidad funcional medida mediante la prueba de la marcha de 6 minutos (PM6M) en comparación con el placebo, a las 30 semanas del inicio del tratamiento. |
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E.2.2 | Secondary objectives of the trial |
To determine whether IV ferric carboxymaltose improve NYHA class and quality of life (Living with Heart Failure Minessota questionnaire), and reduce mortality and hospitalizations, in patients with HFpEF in comparison with oral iron. |
.Conocer mejor la etiología de la anemia asociada a la IC con FEVI preservada. .Valorar en que medida el tratamiento con hierro intravenoso o con hierro oral se traduce en una mejoría de la PM6M a las 6, 12 , 24 y 30 semanas. .Valorar en que medida el tratamiento con hierro intravenoso o con hierro oral se traduce en una mejoría de los síntomas de insuficiencia cardiaca a las 6, 12, 24 y 30 semanas. . Determinar si el tratamiento con hierro carboximaltosa mejora la clase funcional NYHA, la calidad de vida, y reduce la mortalidad u hospitalizaciones, en comparación con el hierro oral |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Subjects with stable chronic HF (NYHA II/IV functional class) on optimal background therapy (as determined by the investigator) for at least 4 weeks with no dose changes of heart failure drugs during the last 2 weeks (with the exception of diuretics). In general, optimal pharmacological treatment should include an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker and a beta blocker unless contraindicated or not tolerated and diuretic if indicated. 2. Left ventricular ejection fraction >45% (value within 3 months of planned date of randomization). 3. BNP >100 pg/mL and/or N-terminal-pro-BNP >400 pg/mL at the screening visit. 4. Subject must be capable of completing the 6MWT. 5. Screening serum ferritin <100 ng/mL or 100–300 ng/mL with transferrin saturation <20%. 6. At least 18 years of age. 7. Before any study-specific procedure, the appropriate written informed consent must be obtained. |
1. Pacientes hombres o mujeres con edad igual o superior a 18 años de edad, edad capaces de entender la hoja de información al paciente y otorgar su consentimiento (en caso contrario se prevé que pueda otorgar dicho consentimiento un familiar o tutor legal competente para ello). 2. Pacientes con IC crónica y FEVI preservada según los criterios de la Sociedad Europea de Cardiología en clase funcional II-IV NYHA. 3. BNP >35 pg/mL y/o N-terminal-pro-BNP >125 pg/mL en el momento de inclusión. 4.Ingreso por descompensación por lo menos en una ocasión. 5.Ferritina sérica <100ng/mL o 100–300ng/mL y IST <20% y anemia (Hb <13g/dL en hombres, 12g/dL en mujeres). 5. El paciente debe ser capaz de realizar el PM6M. 7. Los pacientes (familiar o tutor legal) deberán otorgar su consentimiento informado por escrito para participar en el estudio y antes de que se realice ninguna de las evaluaciones relacionadas con el estudio. |
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E.4 | Principal exclusion criteria |
1. Subject has known sensitivity to any of the products to be administered during dosing. 2. History of acquired iron overload. 3. History of erythropoietin-stimulating agent, i.v. iron therapy, and/or blood transfusion in previous 6 weeks prior to randomization. 4. Oral iron therapy at doses >100 mg/day in previous 1 week prior to randomization. Note: ongoing use of multivitamins containing iron <75 mg/day is permitted. 5. Body weight =/<35 kg. 6. Exercise training programme(s) in the 3 months prior to screening or planned in the next 6 months. 7. Subject at an immediate need of transfusion or haemoglobin >/= 15 g/dL. 8. Known active bacterial infection. 9. Chronic liver disease (including active hepatitis) and/or screening alanine transaminase or aspartate transaminase above three times the upper limit of the normal range. 10. Subjects with known hepatitis B surface antigen positivity and/or hepatitis C virus ribonucleic acid positivity. 11. Vitamin B12 and/or serum folate deficiency. If deficiency-corrected subject may be rescreened for inclusion. 12. Subjects with known seropositivity to human immunodeficiency virus. 13. Clinical evidence of current malignancy with exception of basal cell or squamous cell carcinoma of the skin, and cervical intraepithelial neoplasia. 14. Currently receiving systemic chemotherapy and/or radiotherapy. 15. Renal dialysis (previous, current, or planned within the next 6 months). 16. Unstable angina pectoris as judged by the investigator; severe valvular or left ventricular outflow obstruction disease needing intervention; atrial fibrillation/flutter with a mean ventricular response rate at rest >100 beats per minute. 17. Acute myocardial infarction or acute coronary syndrome, transient ischaemic attack, or stroke within the last 3 months prior to randomization. 18. Coronary artery bypass graft, percutaneous intervention (e.g. cardiac, cerebrovascular, and aortic; diagnostic catheters are allowed), or major surgery, including thoracic and cardiac surgery, within the last 3 months prior to randomization. 19. Subject currently is enrolled in or has not yet completed at least 30 days since ending other investigational device or drug study(ies), or subject is receiving other investigational agent(s). 20. Subject of childbearing potential who is pregnant (e.g. positive human chorionic gonadotropin test) or is breastfeeding. 21. Subject is not willing to use adequate contraceptive precautions during the study and for up to 5 days after the last scheduled dose of study medication. 22. Subject previously randomized to this study. Note: subjects may be rescreened if they fail any of the screening procedures. If rescreened, all tests must fall inside the maximum specified screening windows for each criterion. 23. Subject will not be available for all protocol-specified assessments. 24. Subject has any kind of disorder that compromises the ability of the subject to give written informed consent and/or to comply with study procedures. 25. Lactose intolerance. 26. Pregnant woman. |
1. Alergia o intolerancia a cualquiera de los tratamientos que se administran en el estudio. 2. Ausencia de ecocardiograma en los 6 meses previos. 3. Niveles plasmáticos de BNP < 35 pg/ml o de NT-pBNP< 125 pg/ml 4. Antecedentes de hemocromatosis, hemorragia aparente: sangrado gastrointestinal, hipermenorrea, evidencia de enfermedad inflamatoria intestinal. 5. Enfermedades neoplásicas (excepto carcinoma baso celular o escamoso de la piel y neoplasia cervical intraepitelial) que reciban o no, tratamientos quimioterápicos y/o radioterapia. 6. Antecedentes de EPO, hierro ev y/o transfusión sanguínea en las últimas 6 semanas previas a la randomización. 7. Hierro oral con dosis de >100mg/día en la última semana antes de la randomización. 8. Pacientes con necesidad inmediata de transfusión. 9. Déficit de vitamina B12 y/o déficit de folato. Si se corrige el déficit el paciente podría ser cribado de nuevo para su inclusión. 10. Pacientes con insuficiencia renal crónica en diálisis (previa, en el momento de screening o planificada en los próximos 6 meses). 11. Hipotiroidismo no tratado. 12. Enfermedad hepática crónica (incluido hepatitis activa) y/o elevación de AST o ALT > 3 veces el límite superior de la normalidad. 13. Angina inestable, valvulopatía severa u obstrucción de la salida del ventrículo izquierdo que requieran intervención. 14. Fibrilación auricular o flutter con respuesta ventricular media superior a 100lpm. 15. Infarto agudo de miocardio o síndrome coronario agudo, accidente isquémico transitorio o ictus en los últimos 3 meses previo a la randomización. 16. By-pass coronario o intervencionismo percutáneo (ej. cardíaco, cerebrovascular y aórtico), cirugía mayor, incluido cirugía torácica y cardíaca en los últimos 3 meses previo a la randomización. 17. Paciente incluido en otro estudio o que ha participado en uno en el último mes. 18. Paciente en programa de entrenamiento físico en los últimos 3 meses o planeado en los próximos 6 meses. 19. Cualquier condición que, en opinión del Investigador, pueda poner en peligro la evaluación de la eficacia o seguridad. 20. El paciente no podrá acudir a todas las evaluaciones especificadas en el protocolo. 21. El paciente presenta alguna discapacidad que compromete la capacidad para comprender y/o firmar el consentimiento y/o para cumplir los procedimientos del estudio. 22. Falta de aceptación por parte del paciente para participar en el estudio. 23. Pacientes con expectativa de vida inferior a 6 meses en el momento del ingreso no atribuible a la propia insuficiencia cardiaca. 24. Intolerancia a la lactosa. 25. Embarazo |
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E.5 End points |
E.5.1 | Primary end point(s) |
Change in 6MWT distance from baseline to Week 24 visit after the start of investigational drug. |
Cambio en la distancia PM6M desde el inicio hasta la semana 24 después de la visita de inicio del fármaco en investigación . |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
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E.5.2 | Secondary end point(s) |
- Change in NYHA class at Weeks 6, 12, 24 and 30 - Change Kansas City Cardiomyopathy questionnaire (KCCQ to to Weeks 6, 12, 24 and 30 - Rate of any, HF-related or other cardiovascular hospitalizations. - Time to the first hospitalization for any reason, for worsening of CHF, other cardiovascular-related events, or for any cardiovascular reason. |
Clase funcional de la NYHA Cuestionario de miocardiopatía de Kansas City Reducción de la hospitalización Reducción de la mortalidad |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
Weeks 6, 12, 24 and 30 |
Semanas 6,12, 24 and 30 |
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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 | No |
E.6.5 | Efficacy | No |
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) | 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 | 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 | Yes |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 4 |
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 | 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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LVLS |
Visita final último paciente. |
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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 | 6 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 1 |
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 | 0 |