E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
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E.1.1.1 | Medical condition in easily understood language |
Long-standing problem with kidney function |
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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 | 20.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10064848 |
E.1.2 | Term | Chronic kidney disease |
E.1.2 | System Organ Class | 10038359 - Renal and urinary 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 |
The main question is whether taking an empagliflozin pill once a day compared to an inactive pill (placebo) prevents worsening of kidney disease or death from heart disease in people with kidney disease.
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E.2.2 | Secondary objectives of the trial |
Secondary questions are whether taking empagliflozin pill once a day compared to an inactive pill (placebo) prevents: - hospitalization with heart failure or death from heart disease - death from any cause - hospitalization from any cause in people with kidney disease.
Other questions include the safety and tolerability of empagliflozin compared to placebo. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
Age >=18 years at Screening.
Evidence of progressive CKD at risk of kidney disease progression is defined on the basis of local laboratory results recorded at least 3 months before and at the time of the Screening visit, and requires that: (a) CKD-EPI eGFR ≥20 <45 mL/min/1.73m²; or (b) CKD-EPI eGFR ≥45 <90 mL/min/1.73m2 with urinary albumin:creatinine ratio ≥200 mg/g (or protein:creatinine ratio ≥300 mg/g)
Note: the number of participants with or without diabetes mellitus (of any type) will be at least one-third of each, and the number of participants with an eGFR >45 mL/min/1.73m2 limited to about one-third. The Steering Committee will monitor these proportions and will limit recruitment of particular categories of participant in whom sufficient numbers have already been screened or randomized.
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E.4 | Principal exclusion criteria |
None of the following must be fulfilled: (i) Currently receiving SGLT-2 or SGLT-1/2 inhibitor; (ii) Diabetes mellitus type 2 and prior atherosclerotic cardiovascular disease with an eGFR >60 mL/min/1.73m2 at Screening; (iii) Receiving combined ACEi and ARB treatment; (iv) Maintenance dialysis, functioning kidney transplant, or scheduled living donor transplant; (v) Polycystic kidney disease; (vi) Previous or scheduled bariatric surgery; (vii) Ketoacidosis in the past 5 years; (viii) Symptomatic hypotension, or systolic blood pressure <90 or >180 mmHg at Screening; (ix) ALT or AST >3x ULN at Screening; (x) Hypersensitivity to empagliflozin or other SGLT-2 inhibitor; (xi) Any immunosuppression therapy in last 3 months (except prednisolone ≤10 mg or equivalent); or anyone currently on >10 mg prednisolone (or equivalent); (xii) Use of an investigational medicinal product in the 30 days prior to Screening visit; (xiii) Known to be poorly compliant with clinic visits or prescribed medication; (xiv) Medical history that might limit the individual’s ability to take trial treatments for the duration of the study (e.g. severe respiratory disease; history of cancer or evidence of spread within last 4 years, other than non-melanoma skin cancer; or recent history of alcohol or substance misuse); (xv) Current pregnancy, lactation or women of childbearing potential (WOCBP), unless using highly-effective contraception.
In addition, individuals will be excluded at the Randomization visit if the participant: (i) Does not adhere to Run-in treatment; (ii) Is no longer willing to be randomized and followed for at least 3 years; (iii) Is considered by a local investigator not to be suitable for randomization; or (iv) Experiences ketoacidosis, heart attack, stroke, or hospitalization for heart failure, or hospitalization for urinary tract infection or acute kidney injury during Run-in.
Note that individuals who do not fulfil one or more inclusion criteria, or who fulfil one or more exclusion criteria, may be re-screened and later become eligible.
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E.5 End points |
E.5.1 | Primary end point(s) |
Time to first occurrence of: • Kidney disease progression (end-stage kidney disease, a sustained eGFR <10 mL/min/1.73m², renal death, or a sustained ≥40% decline in eGFR from randomization) or • Cardiovascular death
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
After accrual of at least 1070 primary outcome events as defined in E5.1 |
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E.5.2 | Secondary end point(s) |
a) Time to first hospitalization for heart failure or cardiovascular death; b) Occurrences of all-cause hospitalizations (first and recurrent); c) Time to death from any cause.
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
After accrual of at least 1070 primary outcome events as defined in E5.1 |
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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 | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | Yes |
E.6.11 | Pharmacogenomic | Yes |
E.6.12 | Pharmacoeconomic | Yes |
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 | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
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) | 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 | 40 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 70 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
Canada |
China |
Japan |
Malaysia |
United States |
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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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When the minimum number of required study outcomes has accrued, or the independent Data Monitoring Committee advises the trial should be stopped early, participants will be invited to Final Follow-up visits. This visit may occur earlier than their planned next 6-monthly visit. The end of the trial is then defined as the latest of the following two dates: 7 days after the last participant’s Final Follow-up visit, or the date of the last 4-week post-Final Follow-up blood draw. |
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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 | 4 |
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 | 4 |
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 |