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    Clinical Trial Results:
    Randomised, double-blind (within dose groups), placebo-controlled and parallel group trial to investigate the effects of different doses of oral BI 685509 given over 20 weeks on UACR reduction in patients with diabetic kidney disease

    Summary
    EudraCT number
    2020-002929-28
    Trial protocol
    DK   NL   PT   PL   ES  
    Global end of trial date
    27 Dec 2022

    Results information
    Results version number
    v1(current)
    This version publication date
    07 Jan 2024
    First version publication date
    07 Jan 2024
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    1366-0005
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT04750577
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Boehringer Ingelheim
    Sponsor organisation address
    Binger Strasse 173, Ingelheim am Rhein, Germany, 55216
    Public contact
    Boehringer Ingelheim, Call Center, Boehringer Ingelheim, 001 18002430127, clintriage.rdg@boehringer-ingelheim.com
    Scientific contact
    Boehringer Ingelheim, Call Center, Boehringer Ingelheim, 001 18002430127, clintriage.rdg@boehringer-ingelheim.com
    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
    06 Mar 2023
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    30 Nov 2022
    Global end of trial reached?
    Yes
    Global end of trial date
    27 Dec 2022
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    The main objectives of this trial were to demonstrate the effectiveness of BI 685509 and to characterise the dose-response relationship for BI 685509 in patients with diabetic kidney disease (DKD) by assessing 3 doses and placebo.
    Protection of trial subjects
    Only subjects that met all the study inclusion and none of the exclusion criteria were to be entered in the study. All subjects were free to withdraw from the clinical trial at any time for any reason given. Close monitoring of all subjects was adhered to throughout the trial conduct. Rescue medication was allowed for all subjects as required.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    19 May 2021
    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
    Argentina: 41
    Country: Number of subjects enrolled
    Australia: 7
    Country: Number of subjects enrolled
    Canada: 8
    Country: Number of subjects enrolled
    China: 8
    Country: Number of subjects enrolled
    Denmark: 6
    Country: Number of subjects enrolled
    Hong Kong: 11
    Country: Number of subjects enrolled
    Japan: 31
    Country: Number of subjects enrolled
    Malaysia: 9
    Country: Number of subjects enrolled
    Mexico: 10
    Country: Number of subjects enrolled
    Netherlands: 2
    Country: Number of subjects enrolled
    New Zealand: 1
    Country: Number of subjects enrolled
    Poland: 4
    Country: Number of subjects enrolled
    Portugal: 5
    Country: Number of subjects enrolled
    Spain: 31
    Country: Number of subjects enrolled
    United Kingdom: 5
    Country: Number of subjects enrolled
    United States: 64
    Worldwide total number of subjects
    243
    EEA total number of subjects
    48
    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)
    96
    From 65 to 84 years
    146
    85 years and over
    1

    Subject disposition

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    Recruitment
    Recruitment details
    This study was a phase II, randomized, double-blind (within dose groups), placebo controlled and parallel group trial in patients with diabetic kidney disease (DKD) to demonstrate the effectiveness of BI 685509 and to characterize the dose-response relationship for BI 685509 in patients with DKD by assessing 3 doses and placebo.

    Pre-assignment
    Screening details
    All subjects were screened for eligibility prior to participation in the trial. Subjects attended a specialist site which ensured that they (the subjects) strictly met all inclusion and none of the exclusion criteria. Subjects were not to be allocated to a treatment group if any of the entry criteria were violated.

    Period 1
    Period 1 title
    Overall Study (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator, Monitor, Carer, Data analyst, Assessor
    Blinding implementation details
    Patients, investigators and everyone involved in trial conduct or analysis or with any other interest except the Trial Pharmacometrician, PK programmer and Trial Bioanalyst in this double-blind trial remained blinded with regard to the randomised treatment assignments within each dose group until after the database lock. The access to the randomisation code was kept restricted until its release for analysis.

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    BI 685509 1 mg TID
    Arm description
    The patients were administered 1 milligram (mg) BI 685509 film-coated tablets 3 times a day during 20 weeks of treatment in total, with water and taken with or without food. Patients continued the treatment until undue drug toxicity, disease progression, or withdrawal of consent, whichever occurred first.
    Arm type
    Experimental

    Investigational medicinal product name
    BI 685509
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Film-coated tablet
    Routes of administration
    Oral use
    Dosage and administration details
    The patients were administered 1 milligram (mg) BI 685509 film-coated tablets 3 times a day during 20 weeks of treatment in total, with water and taken with or without food. Patients continued the treatment until undue drug toxicity, disease progression, or withdrawal of consent, whichever occurred first.

    Arm title
    BI 685509 2mg TID
    Arm description
    The patients were administered 1 milligram (mg) BI 685509 film-coated tablets 3 times a day during the first 2 weeks of treatment, If the medication was tolerated, up-titration to 2 mg TID BI 685509 occurred after 2 weeks until Week 20 of treatment. The tablets were taken with water, with or without food. Patients continued the treatment until undue drug toxicity, disease progression, or withdrawal of consent, whichever occurred first.
    Arm type
    Experimental

    Investigational medicinal product name
    BI 685509
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Film-coated tablet
    Routes of administration
    Oral use
    Dosage and administration details
    The patients were administered 1 milligram (mg) BI 685509 film-coated tablets 3 times a day during the first 2 weeks of treatment, If the medication was tolerated, up-titration to 2 mg TID BI 685509 occurred after 2 weeks until Week 20 of treatment. The tablets were taken with water, with or without food. Patients continued the treatment until undue drug toxicity, disease progression, or withdrawal of consent, whichever occurred first.

    Arm title
    BI 685509 3 mg TID
    Arm description
    The patients were administered 1 milligram (mg) BI 685509 film-coated tablets 3 times a day during the first 2 weeks of treatment, If the medication was tolerated, up-titration to 2 mg TID BI 685509 occurred after 2 weeks until Week 4 of treatment. Then if medication was tolerated, up-titration to 3 mg TID BI 685509 occurred from Week 5 until Week 20. The tablets were taken with water, with or without food. Patients continued the treatment until undue drug toxicity, disease progression, or withdrawal of consent, whichever occurred first.
    Arm type
    Experimental

    Investigational medicinal product name
    BI 685509
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Film-coated tablet
    Routes of administration
    Oral use
    Dosage and administration details
    The patients were administered 1 milligram (mg) BI 685509 film-coated tablets 3 times a day during the first 2 weeks of treatment, If the medication was tolerated, up-titration to 2 mg TID BI 685509 occurred after 2 weeks until Week 4 of treatment. Then if medication was tolerated, up-titration to 3 mg TID BI 685509 occurred from Week 5 until Week 20. The tablets were taken with water, with or without food. Patients continued the treatment until undue drug toxicity, disease progression, or withdrawal of consent, whichever occurred first.

    Arm title
    Placebo
    Arm description
    This arm comprises all placebo treated participants. Participants were randomized in the dose group in a 3:1 ratio (test treatment to placebo). Participants were administered film-coated tablets of matching placebo 3 times a day during 20 weeks of treatment. The tablets were taken with water, with or without food. Patients continued the treatment until undue drug toxicity, disease progression, or withdrawal of consent, whichever occurred first.
    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
    This arm comprises all placebo treated participants. Participants were randomized in the dose group in a 3:1 ratio (test treatment to placebo). Participants were administered film-coated tablets of matching placebo 3 times a day during 20 weeks of treatment. The tablets were taken with water, with or without food. Patients continued the treatment until undue drug toxicity, disease progression, or withdrawal of consent, whichever occurred first.

    Number of subjects in period 1
    BI 685509 1 mg TID BI 685509 2mg TID BI 685509 3 mg TID Placebo
    Started
    61
    61
    61
    60
    Treated
    61
    61
    61
    58
    Completed
    55
    46
    47
    53
    Not completed
    6
    15
    14
    7
         Adverse event, non-fatal
    2
    10
    8
    1
         Protocol deviation
    1
    1
    1
    1
         No reason available
    -
    -
    -
    2
         Burden of study procedures
    -
    2
    2
    -
         Patients prematurely discontinued
    3
    2
    2
    1
         Change of residence
    -
    -
    1
    -
         Not treated
    -
    -
    -
    2

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    BI 685509 1 mg TID
    Reporting group description
    The patients were administered 1 milligram (mg) BI 685509 film-coated tablets 3 times a day during 20 weeks of treatment in total, with water and taken with or without food. Patients continued the treatment until undue drug toxicity, disease progression, or withdrawal of consent, whichever occurred first.

    Reporting group title
    BI 685509 2mg TID
    Reporting group description
    The patients were administered 1 milligram (mg) BI 685509 film-coated tablets 3 times a day during the first 2 weeks of treatment, If the medication was tolerated, up-titration to 2 mg TID BI 685509 occurred after 2 weeks until Week 20 of treatment. The tablets were taken with water, with or without food. Patients continued the treatment until undue drug toxicity, disease progression, or withdrawal of consent, whichever occurred first.

    Reporting group title
    BI 685509 3 mg TID
    Reporting group description
    The patients were administered 1 milligram (mg) BI 685509 film-coated tablets 3 times a day during the first 2 weeks of treatment, If the medication was tolerated, up-titration to 2 mg TID BI 685509 occurred after 2 weeks until Week 4 of treatment. Then if medication was tolerated, up-titration to 3 mg TID BI 685509 occurred from Week 5 until Week 20. The tablets were taken with water, with or without food. Patients continued the treatment until undue drug toxicity, disease progression, or withdrawal of consent, whichever occurred first.

    Reporting group title
    Placebo
    Reporting group description
    This arm comprises all placebo treated participants. Participants were randomized in the dose group in a 3:1 ratio (test treatment to placebo). Participants were administered film-coated tablets of matching placebo 3 times a day during 20 weeks of treatment. The tablets were taken with water, with or without food. Patients continued the treatment until undue drug toxicity, disease progression, or withdrawal of consent, whichever occurred first.

    Reporting group values
    BI 685509 1 mg TID BI 685509 2mg TID BI 685509 3 mg TID Placebo Total
    Number of subjects
    61 61 61 60 243
    Age categorical
    Randomised Set (RS): This patient set includes all entered and randomised patients.
    Units: Subjects
        In utero
    0 0 0 0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0 0 0 0
        Newborns (0-27 days)
    0 0 0 0 0
        Infants and toddlers (28 days-23 months)
    0 0 0 0 0
        Children (2-11 years)
    0 0 0 0 0
        Adolescents (12-17 years)
    0 0 0 0 0
        Adults (18-64 years)
    28 28 21 19 96
        From 65-84 years
    33 32 40 41 146
        85 years and over
    0 1 0 0 1
    Age Continuous
    Randomised Set (RS): This patient set includes all entered and randomised patients.
    Units: years
        arithmetic mean (standard deviation)
    65.2 ( 9.3 ) 64.8 ( 11.0 ) 65.2 ( 8.8 ) 67.6 ( 8.7 ) -
    Sex: Female, Male
    Randomised Set (RS): This patient set includes all entered and randomised patients.
    Units: Participants
        Female
    16 14 13 16 59
        Male
    45 47 48 44 184
    Race (NIH/OMB)
    Randomised Set (RS): This patient set includes all entered and randomised patients.
    Units: Subjects
        American Indian or Alaska Native
    1 3 3 2 9
        Asian
    23 16 16 16 71
        Native Hawaiian or Other Pacific Islander
    1 0 0 0 1
        Black or African American
    6 11 10 6 33
        White
    30 31 32 34 127
        More than one race
    0 0 0 2 2
        Unknown or Not Reported
    0 0 0 0 0
    Ethnicity (NIH/OMB)
    Randomised Set (RS): This patient set includes all entered and randomised patients.
    Units: Subjects
        Hispanic or Latino
    16 21 23 21 81
        Not Hispanic or Latino
    45 40 38 39 162
        Unknown or Not Reported
    0 0 0 0 0
    Urine Albumin Creatinine Ratio (UACR) FMV
    Urine Albumin Creatinine Ratio (UACR) at baseline. The first morning void (FMV) is the first urination after the patient wakes up at their usual time to start their day. Baseline is defined as the mean of all available samples prior to Visit 2 up to and including those prior to the first intake of trial medication.
    Units: Milligram/gram (mg/g)
        arithmetic mean (standard deviation)
    991.7 ( 889.0 ) 1033 ( 760.4 ) 818.4 ( 686.9 ) 866.1 ( 658.1 ) -
    Urine Albumin Creatinine Ratio (UACR) - 10 Hour
    Urine Albumin Creatinine Ratio (UACR) at baseline. For 10-hour urine. Baseline was defined as the mean of all non-missing assessments from visit 2 until prior to the first intake of trial medication. As soon as the First Morning Void sample was collected the clock starts for the 10-hour urine collection. During the 10-hour period every time the patient urinates, they collected their urine into a provided container. An aliquot of this urine was taken and used as the 10-hour UACR sample.
    Units: milligram/gram (mg/g)
        arithmetic mean (standard deviation)
    1093.5 ( 980.3 ) 1090.7 ( 794.4 ) 880.8 ( 722.4 ) 913.1 ( 657.3 ) -

    End points

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    End points reporting groups
    Reporting group title
    BI 685509 1 mg TID
    Reporting group description
    The patients were administered 1 milligram (mg) BI 685509 film-coated tablets 3 times a day during 20 weeks of treatment in total, with water and taken with or without food. Patients continued the treatment until undue drug toxicity, disease progression, or withdrawal of consent, whichever occurred first.

    Reporting group title
    BI 685509 2mg TID
    Reporting group description
    The patients were administered 1 milligram (mg) BI 685509 film-coated tablets 3 times a day during the first 2 weeks of treatment, If the medication was tolerated, up-titration to 2 mg TID BI 685509 occurred after 2 weeks until Week 20 of treatment. The tablets were taken with water, with or without food. Patients continued the treatment until undue drug toxicity, disease progression, or withdrawal of consent, whichever occurred first.

    Reporting group title
    BI 685509 3 mg TID
    Reporting group description
    The patients were administered 1 milligram (mg) BI 685509 film-coated tablets 3 times a day during the first 2 weeks of treatment, If the medication was tolerated, up-titration to 2 mg TID BI 685509 occurred after 2 weeks until Week 4 of treatment. Then if medication was tolerated, up-titration to 3 mg TID BI 685509 occurred from Week 5 until Week 20. The tablets were taken with water, with or without food. Patients continued the treatment until undue drug toxicity, disease progression, or withdrawal of consent, whichever occurred first.

    Reporting group title
    Placebo
    Reporting group description
    This arm comprises all placebo treated participants. Participants were randomized in the dose group in a 3:1 ratio (test treatment to placebo). Participants were administered film-coated tablets of matching placebo 3 times a day during 20 weeks of treatment. The tablets were taken with water, with or without food. Patients continued the treatment until undue drug toxicity, disease progression, or withdrawal of consent, whichever occurred first.

    Primary: Change from baseline in log transformed Urine Albumin Creatinine Ratio (UACR) measured in 10-hour urine after 20 weeks of trial treatment

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    End point title
    Change from baseline in log transformed Urine Albumin Creatinine Ratio (UACR) measured in 10-hour urine after 20 weeks of trial treatment
    End point description
    Change from baseline in log transformed Urine Albumin Creatinine Ratio (UACR) after 20 weeks is reported. As soon as the First Morning Void sample was collected the clock starts for the 10-hour urine collection. During the 10-hour period every time the patient urinates, they collected their urine into a provided container. An aliquot of this urine was taken and used as the 10-hour UACR sample. Least Square Means and Standard error were estimated by restricted maximum likelihood based Mixed-effect Model for Repeated Measures ((REML)−based MMRM) including the fixed, categorical effects of treatment at each visit (baseline, Week 6, Week 12 and Week 20), and the continuous effect of baseline at each visit (Week 6, Week 12 and Week 20) as well as random effects of patient. The Least Squares Mean (Standard error) at Week 20 is reported.
    End point type
    Primary
    End point timeframe
    Baseline (Week -2 and Week -1) and Week 6, Week 12 and Week 20.
    End point values
    BI 685509 1 mg TID BI 685509 2mg TID BI 685509 3 mg TID Placebo
    Number of subjects analysed
    57
    52
    56
    56
    Units: milligram/gram (mg/g)
        least squares mean (standard error)
    -0.069 ( 0.074 )
    -0.029 ( 0.079 )
    -0.217 ( 0.076 )
    0.034 ( 0.073 )
    Statistical analysis title
    Statistical analysis 2
    Statistical analysis description
    A flat vs. non-flat dose-response relationship across the 3 doses of BI 685509 and placebo was tested using the Multiple Comparison Procedure - Modelling (MCP-Mod) approach which evaluated simultaneously 5 different plausible dose-response patterns (linear, exponential, quadratic, Emax and Sigmoid Emax) while protecting the overall probability of type I error (one-sided alpha of 0.050). The total daily dose was considered for MCP-Mod analysis (placebo, active BI 685509 3 mg, 6 mg, and 9 mg).
    Comparison groups
    BI 685509 1 mg TID v BI 685509 2mg TID v BI 685509 3 mg TID v Placebo
    Number of subjects included in analysis
    221
    Analysis specification
    Pre-specified
    Analysis type
    other [1]
    P-value
    = 0.0294
    Method
    MCP-Mod linear model fit
    Confidence interval
    Notes
    [1] - Mixed Model Repeated Measures (MMRM) estimates were used as input for the MCP-Mod. ncluding the fixed, categorical effects of treatment at each visit (baseline, Week 6, Week 12 and Week 20), and the continuous effect of baseline at each visit (Week 6, Week 12 and Week 20) as well as random effects of patient. Linear: No assumption was needed.
    Statistical analysis title
    Statistical analysis 3
    Statistical analysis description
    Quadratic assumption: 50 % of the maximum effect is achieved at a dose of 3 mg. 90 % of the maximum effect is achieved at a dose of 6 mg.
    Comparison groups
    BI 685509 1 mg TID v BI 685509 2mg TID v BI 685509 3 mg TID v Placebo
    Number of subjects included in analysis
    221
    Analysis specification
    Pre-specified
    Analysis type
    other [2]
    P-value
    = 0.0468 [3]
    Method
    MCP-Mod quadratic model fit
    Confidence interval
    Notes
    [2] - A flat vs. non-flat dose-response relationship across the 3 doses of BI 685509 and placebo was tested using the Multiple Comparison Procedure - Modelling (MCP-Mod) approach which evaluated simultaneously 5 different plausible dose-response patterns (linear, exponential, quadratic, Emax and Sigmoid Emax) while protecting the overall probability of type I error (one-sided alpha of 0.050). The total daily dose was considered for MCP-Mod analysis (placebo, active BI 685509 3 mg, 6 mg, and 9 mg).
    [3] - Mixed Model Repeated Measures (MMRM) estimates were used as input for the MCP-Mod. Including the fixed, categorical effects of treatment at each visit, and the continuous effect of baseline at each visit, as well as random effects of patient
    Statistical analysis title
    Statistical analysis 4
    Statistical analysis description
    A flat vs. non-flat dose-response relationship across the 3 doses of BI 685509 and placebo was tested using the Multiple Comparison Procedure - Modelling (MCP-Mod) approach which evaluated simultaneously 5 different plausible dose-response patterns (linear, exponential, quadratic, Emax and Sigmoid Emax) while protecting the overall probability of type I error (one-sided alpha of 0.050). The total daily dose was considered for MCP-Mod analysis (placebo, active BI 685509 3 mg, 6 mg, and 9 mg).
    Comparison groups
    BI 685509 1 mg TID v BI 685509 2mg TID v BI 685509 3 mg TID v Placebo
    Number of subjects included in analysis
    221
    Analysis specification
    Pre-specified
    Analysis type
    other [4]
    P-value
    = 0.0586
    Method
    MCP-Mod Emax model fit
    Confidence interval
    Notes
    [4] - Mixed Model Repeated Measures (MMRM) estimates were used as input for the MCP-Mod. ncluding the fixed, categorical effects of treatment at each visit (baseline, Week 6, Week 12 and Week 20), and the continuous effect of baseline at each visit (Week 6, Week 12 and Week 20) as well as random effects of patient. Emax assumption: 80% of the maximum effect is achieved at 6 mg.
    Statistical analysis title
    Statistical analysis 1
    Statistical analysis description
    A flat vs. non-flat dose-response relationship across the 3 doses of BI 685509 and placebo was tested using the Multiple Comparison Procedure - Modelling (MCP-Mod) approach which evaluated simultaneously 5 different plausible dose-response patterns (linear, exponential, quadratic, Emax and Sigmoid Emax) while protecting the overall probability of type I error (one-sided alpha of 0.050). The total daily dose was considered for MCP-Mod analysis (placebo, active BI 685509 3 mg, 6 mg, and 9 mg).
    Comparison groups
    BI 685509 1 mg TID v BI 685509 2mg TID v BI 685509 3 mg TID v Placebo
    Number of subjects included in analysis
    221
    Analysis specification
    Pre-specified
    Analysis type
    other [5]
    P-value
    = 0.0245
    Method
    MCP-Mod exponential model fit
    Confidence interval
    Notes
    [5] - Mixed Model Repeated Measures (MMRM) estimates were used as input for the MCP-Mod. ncluding the fixed, categorical effects of treatment at each visit (baseline, Week 6, Week 12 and Week 20), and the continuous effect of baseline at each visit (Week 6, Week 12 and Week 20) as well as random effects of patient. Exponential: 20% of the maximum effect is achieved at 3 mg.
    Statistical analysis title
    Statistical analysis 5
    Statistical analysis description
    A flat vs. non-flat dose-response relationship across the 3 doses of BI 685509 and placebo was tested using the Multiple Comparison Procedure - Modelling (MCP-Mod) approach which evaluated simultaneously 5 different plausible dose-response patterns (linear, exponential, quadratic, Emax and Sigmoid Emax) while protecting the overall probability of type I error (one-sided alpha of 0.050). The total daily dose was considered for MCP-Mod analysis (placebo, active BI 685509 3 mg, 6 mg, and 9 mg).
    Comparison groups
    BI 685509 1 mg TID v BI 685509 2mg TID v BI 685509 3 mg TID v Placebo
    Number of subjects included in analysis
    221
    Analysis specification
    Pre-specified
    Analysis type
    other [6]
    P-value
    = 0.0659
    Method
    MCP-Mod Sigmoid emax model fit
    Confidence interval
    Notes
    [6] - Mixed Model Repeated Measures (MMRM) estimates were used as input for the MCP-Mod. ncluding the fixed, categorical effects of treatment at each visit (baseline, Week 6, Week 12 and Week 20), and the continuous effect of baseline at each visit (Week 6, Week 12 and Week 20) as well as random effects of patient. Sigmoid Emax assumption:Sigmoid emax: 30 % of the maximum effect is achieved at a dose of 3 mg. 90 % of the maximum effect is achieved at a dose of 6 mg.
    Statistical analysis title
    Statistical analysis 6
    Statistical analysis description
    Least Square Means difference and 95% confidence interval were estimated by restricted maximum likelihood based Mixed-effect Model for Repeated Measures ((REML)−based MMRM) including the fixed, categorical effects of treatment at each visit (baseline, Week 6, Week 12 and Week 20), and the continuous effect of baseline at each visit (Week 6, Week 12 and Week 20) as well as random effects of patient.
    Comparison groups
    BI 685509 1 mg TID v Placebo
    Number of subjects included in analysis
    113
    Analysis specification
    Pre-specified
    Analysis type
    other [7]
    P-value
    = 0.3224
    Method
    Mixed-effect Model Repeat Measurement
    Parameter type
    Mean difference (net)
    Point estimate
    -0.103
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.309
         upper limit
    0.102
    Notes
    [7] - Least Squares Mean of 1 mg BI 685509 TID"- Least Squares Mean of Placebo
    Statistical analysis title
    Statistical analysis 7
    Statistical analysis description
    Least Square Means difference and 95% confidence interval were estimated by restricted maximum likelihood based Mixed-effect Model for Repeated Measures ((REML)−based MMRM) including the fixed, categorical effects of treatment at each visit (baseline, Week 6, Week 12 and Week 20), and the continuous effect of baseline at each visit (Week 6, Week 12 and Week 20) as well as random effects of patient.
    Comparison groups
    BI 685509 2mg TID v Placebo
    Number of subjects included in analysis
    108
    Analysis specification
    Pre-specified
    Analysis type
    other [8]
    P-value
    = 0.5616
    Method
    Mixed-effect Model Repeat Measurement
    Parameter type
    Mean difference (net)
    Point estimate
    -0.063
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.275
         upper limit
    0.15
    Notes
    [8] - Least Squares Mean of "2 mg BI 685509 TID"- Least Squares Mean of "Placebo"
    Statistical analysis title
    Statistical analysis 8
    Statistical analysis description
    Least Square Means difference and 95% confidence interval were estimated by restricted maximum likelihood based Mixed-effect Model for Repeated Measures ((REML)−based MMRM) including the fixed, categorical effects of treatment at each visit (baseline, Week 6, Week 12 and Week 20), and the continuous effect of baseline at each visit (Week 6, Week 12 and Week 20) as well as random effects of patient.
    Comparison groups
    BI 685509 3 mg TID v Placebo
    Number of subjects included in analysis
    112
    Analysis specification
    Pre-specified
    Analysis type
    other [9]
    P-value
    = 0.0183
    Method
    Mixed-effect Model Repeat Measurement
    Parameter type
    Mean difference (net)
    Point estimate
    -0.251
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.459
         upper limit
    -0.043
    Notes
    [9] - Least Squares Mean of "3 mg BI 685509 TID"- Least Squares Mean of "Placebo"

    Secondary: Change from baseline in log transformed Urine Albumin Creatinine Ratio (UACR) measured in First Morning Void urine after 20 weeks of trial treatment

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    End point title
    Change from baseline in log transformed Urine Albumin Creatinine Ratio (UACR) measured in First Morning Void urine after 20 weeks of trial treatment
    End point description
    Change from baseline in log transformed Urine Albumin Creatinine Ratio (UACR) measured in First Morning Void urine after 20 weeks of trial treatment is reported. The first morning void (FMV) was the first urination after the patient woke up at their usual time to start their day. Least Square Means and Standard error were estimated by restricted maximum likelihood based Mixed-effect Model for Repeated Measures ((REML)−based MMRM) including the fixed, categorical effects of treatment at each visit (baseline, Week 6, Week 12 and Week 20), and the continuous effect of baseline at each visit (Week 6, Week 12 and Week 20) as well as random effects of patient. The Least Squares Mean (Standard error) at Week 20 is reported.
    End point type
    Secondary
    End point timeframe
    Baseline (Week -2 and Week -1) and Week 6, Week 12 and Week 20
    End point values
    BI 685509 1 mg TID BI 685509 2mg TID BI 685509 3 mg TID Placebo
    Number of subjects analysed
    56
    53
    55
    56
    Units: milligram/gram (mg/g)
        least squares mean (standard error)
    -0.112 ( 0.072 )
    -0.020 ( 0.076 )
    -0.258 ( 0.074 )
    0.099 ( 0.072 )
    Statistical analysis title
    Statistical analysis 9
    Statistical analysis description
    Least Square Means difference and 95% confidence interval were estimated by restricted maximum likelihood based Mixed-effect Model for Repeated Measures ((REML)−based MMRM) including the fixed, categorical effects of treatment at each visit (baseline, Week 6, Week 12 and Week 20), and the continuous effect of baseline at each visit (Week 6, Week 12 and Week 20) as well as random effects of patient.
    Comparison groups
    BI 685509 1 mg TID v Placebo
    Number of subjects included in analysis
    112
    Analysis specification
    Pre-specified
    Analysis type
    other [10]
    P-value
    = 0.0396
    Method
    Mixed models analysis
    Parameter type
    Mean difference (net)
    Point estimate
    -0.211
    Confidence interval
         level
    0.95%
         sides
    2-sided
         lower limit
    -0.413
         upper limit
    -0.01
    Notes
    [10] - Least Squares Mean of "1 mg BI 685509 TID"- Least Squares Mean of "Placebo"
    Statistical analysis title
    Statistical analysis 11
    Statistical analysis description
    Least Square Means difference and 95% confidence interval were estimated by restricted maximum likelihood based Mixed-effect Model for Repeated Measures ((REML)−based MMRM) including the fixed, categorical effects of treatment at each visit (baseline, Week 6, Week 12 and Week 20), and the continuous effect of baseline at each visit (Week 6, Week 12 and Week 20) as well as random effects of patient.
    Comparison groups
    BI 685509 3 mg TID v Placebo
    Number of subjects included in analysis
    111
    Analysis specification
    Pre-specified
    Analysis type
    other [11]
    P-value
    = 0.0006
    Method
    Mixed models analysis
    Parameter type
    Mean difference (net)
    Point estimate
    -0.357
    Confidence interval
         level
    0.95%
         sides
    2-sided
         lower limit
    -0.56
         upper limit
    -0.154
    Notes
    [11] - Least Squares Mean of "3 mg BI 685509 TID"- Least Squares Mean of "Placebo"
    Statistical analysis title
    Statistical analysis 10
    Statistical analysis description
    Least Square Means difference and 95% confidence interval were estimated by restricted maximum likelihood based Mixed-effect Model for Repeated Measures ((REML)−based MMRM) including the fixed, categorical effects of treatment at each visit (baseline, Week 6, Week 12 and Week 20), and the continuous effect of baseline at each visit (Week 6, Week 12 and Week 20) as well as random effects of patient.
    Comparison groups
    BI 685509 2mg TID v Placebo
    Number of subjects included in analysis
    109
    Analysis specification
    Pre-specified
    Analysis type
    other [12]
    P-value
    = 0.2568
    Method
    Mixed models analysis
    Parameter type
    Mean difference (net)
    Point estimate
    -0.12
    Confidence interval
         level
    0.95%
         sides
    2-sided
         lower limit
    -0.327
         upper limit
    0.088
    Notes
    [12] - Least Squares Mean of "2 mg BI 685509 TID"- Least Squares Mean of "Placebo"

    Secondary: Number of patients achieving UACR decreases in 10-hour urine of at least 20% from baseline after 20 weeks of trial treatment

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    End point title
    Number of patients achieving UACR decreases in 10-hour urine of at least 20% from baseline after 20 weeks of trial treatment
    End point description
    Number of patients achieving Urine Albumin Creatinine Ratio (UACR) decreases in 10-hour urine of at least 20% from baseline after 20 weeks of trial treatment is reported. As soon as the First Morning Void sample was collected the clock starts for the 10-hour urine collection. During the 10-hour period every time the patient urinates, they collected their urine into a provided container. An aliquot of this urine was taken and used as the 10-hour UACR sample.
    End point type
    Secondary
    End point timeframe
    Baseline (day -14 and -7) and week 20 (day 141)
    End point values
    BI 685509 1 mg TID BI 685509 2mg TID BI 685509 3 mg TID Placebo
    Number of subjects analysed
    57
    53
    56
    56
    Units: Participants
    23
    16
    26
    13
    Statistical analysis title
    Statistical analysis 12
    Statistical analysis description
    Treatment, sodium-Glucose co-Transporter-2 Inhibitor (SGLT2i) use at baseline, and type of diabetes were used as covariates in the logistic regression model.
    Comparison groups
    BI 685509 1 mg TID v Placebo
    Number of subjects included in analysis
    113
    Analysis specification
    Pre-specified
    Analysis type
    other [13]
    P-value
    = 0.0519
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    2.25
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.99
         upper limit
    5.1
    Notes
    [13] - Odds Ratio was calculated as BI 685509/ Placebo.
    Statistical analysis title
    Statistical analysis 13
    Statistical analysis description
    Treatment, sodium-Glucose co-Transporter-2 Inhibitor (SGLT2i) use at baseline, and type of diabetes were used as covariates in the logistic regression model.
    Comparison groups
    BI 685509 2mg TID v Placebo
    Number of subjects included in analysis
    109
    Analysis specification
    Pre-specified
    Analysis type
    other [14]
    P-value
    = 0.4159
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.43
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.61
         upper limit
    3.36
    Notes
    [14] - Odds Ratio was calculated as BI 685509/ Placebo.
    Statistical analysis title
    Statistical analysis 14
    Statistical analysis description
    Treatment, sodium-Glucose co-Transporter-2 Inhibitor (SGLT2i) use at baseline, and type of diabetes were used as covariates in the logistic regression model.
    Comparison groups
    BI 685509 3 mg TID v Placebo
    Number of subjects included in analysis
    112
    Analysis specification
    Pre-specified
    Analysis type
    other [15]
    P-value
    = 0.0106
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    2.9
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    1.28
         upper limit
    6.55
    Notes
    [15] - Odds Ratio was calculated as BI 685509/ Placebo

    Secondary: Number of patients achieving UACR decreases in First Morning Void urine of at least 20% from baseline after 20 weeks of trial treatment

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    End point title
    Number of patients achieving UACR decreases in First Morning Void urine of at least 20% from baseline after 20 weeks of trial treatment
    End point description
    Number of patients achieving Albumin Creatinine Ratio (UACR) decreases in First Morning Void urine of at least 20% from baseline after 20 weeks of trial treatment. is reported. The first morning void (FMV) was the first urination after the patient woke up at their usual time to start their day.
    End point type
    Secondary
    End point timeframe
    Baseline (day -14 and -7) and week 20 (day 141)
    End point values
    BI 685509 1 mg TID BI 685509 2mg TID BI 685509 3 mg TID Placebo
    Number of subjects analysed
    57
    53
    56
    56
    Units: Participants
    23
    13
    29
    11
    Statistical analysis title
    Statistical analysis 15
    Statistical analysis description
    Treatment, sodium-Glucose co-Transporter-2 Inhibitor (SGLT2i) use at baseline, and type of diabetes were used as covariates in the logistic regression model.
    Comparison groups
    BI 685509 1 mg TID v Placebo
    Number of subjects included in analysis
    113
    Analysis specification
    Pre-specified
    Analysis type
    other [16]
    P-value
    = 0.0176
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    2.79
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    1.2
         upper limit
    6.53
    Notes
    [16] - Odds Ratio was calculated as BI 685509/ Placebo.
    Statistical analysis title
    Statistical analysis 16
    Statistical analysis description
    Treatment, sodium-Glucose co-Transporter-2 Inhibitor (SGLT2i) use at baseline, and type of diabetes were used as covariates in the logistic regression model.
    Comparison groups
    BI 685509 2mg TID v Placebo
    Number of subjects included in analysis
    109
    Analysis specification
    Pre-specified
    Analysis type
    other [17]
    P-value
    = 0.5467
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.32
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.53
         upper limit
    3.29
    Notes
    [17] - Odds Ratio was calculated as BI 685509/ Placebo
    Statistical analysis title
    Statistical analysis 17
    Statistical analysis description
    Treatment, sodium-Glucose co-Transporter-2 Inhibitor (SGLT2i) use at baseline, and type of diabetes were used as covariates in the logistic regression model.
    Comparison groups
    BI 685509 3 mg TID v Placebo
    Number of subjects included in analysis
    112
    Analysis specification
    Pre-specified
    Analysis type
    other [18]
    P-value
    = 0.0005
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    4.46
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    1.91
         upper limit
    10.39
    Notes
    [18] - Odds Ratio was calculated as BI 685509/ Placebo

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    From first BI 685509 intake until last BI 685509 intake or patient’s trial termination date, whichever occurs earlier + 7 days of Residual effect period (REP), up to 148 days.
    Adverse event reporting additional description
    Treated Set (TS): This set included all patients who were dispensed trial medication (BI 685509) and were documented to have taken at least 1 dose of open-label trial medication (BI 685509).
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    25.1
    Reporting groups
    Reporting group title
    BI 685509 1mg TID
    Reporting group description
    The patients were administered 1 milligram (mg) BI 685509 film-coated tablets 3 times a day during 20 weeks of treatment in total, with water and taken with or without food. Patients continued the treatment until undue drug toxicity, disease progression, or withdrawal of consent, whichever occurred first.

    Reporting group title
    Placebo
    Reporting group description
    This arm comprises all placebo treated participants. Participants were randomized in the dose group in a 3:1 ratio (test treatment to placebo). Participants were administered film-coated tablets of matching placebo 3 times a day during 20 weeks of treatment. The tablets were taken with water, with or without food. Patients continued the treatment until undue drug toxicity, disease progression, or withdrawal of consent, whichever occurred first.

    Reporting group title
    BI 685509 3mg TID
    Reporting group description
    The patients were administered 1 milligram (mg) BI 685509 film-coated tablets 3 times a day during the first 2 weeks of treatment, If the medication was tolerated, up-titration to 2 mg TID BI 685509 occurred after 2 weeks until Week 4 of treatment. Then if medication was tolerated, up-titration to 3 mg TID BI 685509 occurred from Week 5 until Week 20. The tablets were taken with water, with or without food. Patients continued the treatment until undue drug toxicity, disease progression, or withdrawal of consent, whichever occurred first.

    Reporting group title
    BI 685509 2mg TID
    Reporting group description
    The patients were administered 1 milligram (mg) BI 685509 film-coated tablets 3 times a day during the first 2 weeks of treatment, If the medication was tolerated, up-titration to 2 mg TID BI 685509 occurred after 2 weeks until Week 20 of treatment. The tablets were taken with water, with or without food. Patients continued the treatment until undue drug toxicity, disease progression, or withdrawal of consent, whichever occurred first.

    Serious adverse events
    BI 685509 1mg TID Placebo BI 685509 3mg TID BI 685509 2mg TID
    Total subjects affected by serious adverse events
         subjects affected / exposed
    4 / 61 (6.56%)
    4 / 58 (6.90%)
    7 / 61 (11.48%)
    8 / 61 (13.11%)
         number of deaths (all causes)
    0
    0
    2
    1
         number of deaths resulting from adverse events
    0
    0
    0
    0
    Vascular disorders
    Extremity necrosis
         subjects affected / exposed
    0 / 61 (0.00%)
    0 / 58 (0.00%)
    0 / 61 (0.00%)
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    General disorders and administration site conditions
    Peripheral swelling
         subjects affected / exposed
    0 / 61 (0.00%)
    0 / 58 (0.00%)
    0 / 61 (0.00%)
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Psychiatric disorders
    Schizophrenia
         subjects affected / exposed
    0 / 61 (0.00%)
    0 / 58 (0.00%)
    1 / 61 (1.64%)
    0 / 61 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Investigations
    Protein urine present
         subjects affected / exposed
    1 / 61 (1.64%)
    0 / 58 (0.00%)
    0 / 61 (0.00%)
    0 / 61 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Injury, poisoning and procedural complications
    Procedural haemorrhage
         subjects affected / exposed
    0 / 61 (0.00%)
    0 / 58 (0.00%)
    0 / 61 (0.00%)
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Cardiac disorders
    Atrial fibrillation
         subjects affected / exposed
    0 / 61 (0.00%)
    0 / 58 (0.00%)
    1 / 61 (1.64%)
    0 / 61 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Cardiac failure
         subjects affected / exposed
    0 / 61 (0.00%)
    0 / 58 (0.00%)
    1 / 61 (1.64%)
    0 / 61 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Acute myocardial infarction
         subjects affected / exposed
    1 / 61 (1.64%)
    1 / 58 (1.72%)
    1 / 61 (1.64%)
    0 / 61 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    0 / 0
    Angina unstable
         subjects affected / exposed
    0 / 61 (0.00%)
    0 / 58 (0.00%)
    1 / 61 (1.64%)
    0 / 61 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Nodal rhythm
         subjects affected / exposed
    0 / 61 (0.00%)
    1 / 58 (1.72%)
    0 / 61 (0.00%)
    0 / 61 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Myocardial ischaemia
         subjects affected / exposed
    0 / 61 (0.00%)
    0 / 58 (0.00%)
    0 / 61 (0.00%)
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Cardiac failure congestive
         subjects affected / exposed
    1 / 61 (1.64%)
    0 / 58 (0.00%)
    0 / 61 (0.00%)
    0 / 61 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Nervous system disorders
    Normal pressure hydrocephalus
         subjects affected / exposed
    0 / 61 (0.00%)
    0 / 58 (0.00%)
    0 / 61 (0.00%)
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Transient ischaemic attack
         subjects affected / exposed
    0 / 61 (0.00%)
    0 / 58 (0.00%)
    1 / 61 (1.64%)
    0 / 61 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Intestinal obstruction
         subjects affected / exposed
    1 / 61 (1.64%)
    0 / 58 (0.00%)
    0 / 61 (0.00%)
    0 / 61 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Epiploic appendagitis
         subjects affected / exposed
    0 / 61 (0.00%)
    1 / 58 (1.72%)
    0 / 61 (0.00%)
    0 / 61 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Hepatobiliary disorders
    Cholecystitis
         subjects affected / exposed
    0 / 61 (0.00%)
    0 / 58 (0.00%)
    0 / 61 (0.00%)
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Skin and subcutaneous tissue disorders
    Diabetic foot
         subjects affected / exposed
    0 / 61 (0.00%)
    0 / 58 (0.00%)
    0 / 61 (0.00%)
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Diabetic bullosis
         subjects affected / exposed
    0 / 61 (0.00%)
    0 / 58 (0.00%)
    0 / 61 (0.00%)
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Renal and urinary disorders
    Renal mass
         subjects affected / exposed
    0 / 61 (0.00%)
    0 / 58 (0.00%)
    0 / 61 (0.00%)
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Chronic kidney disease
         subjects affected / exposed
    0 / 61 (0.00%)
    0 / 58 (0.00%)
    1 / 61 (1.64%)
    0 / 61 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Acute kidney injury
         subjects affected / exposed
    1 / 61 (1.64%)
    0 / 58 (0.00%)
    0 / 61 (0.00%)
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Infections and infestations
    Gastroenteritis
         subjects affected / exposed
    1 / 61 (1.64%)
    0 / 58 (0.00%)
    0 / 61 (0.00%)
    0 / 61 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Cellulitis
         subjects affected / exposed
    0 / 61 (0.00%)
    0 / 58 (0.00%)
    1 / 61 (1.64%)
    0 / 61 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Influenza
         subjects affected / exposed
    0 / 61 (0.00%)
    0 / 58 (0.00%)
    0 / 61 (0.00%)
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Pneumonia bacterial
         subjects affected / exposed
    1 / 61 (1.64%)
    0 / 58 (0.00%)
    0 / 61 (0.00%)
    0 / 61 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Osteomyelitis
         subjects affected / exposed
    0 / 61 (0.00%)
    0 / 58 (0.00%)
    0 / 61 (0.00%)
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Metabolism and nutrition disorders
    Hypoglycaemia
         subjects affected / exposed
    0 / 61 (0.00%)
    1 / 58 (1.72%)
    0 / 61 (0.00%)
    0 / 61 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    BI 685509 1mg TID Placebo BI 685509 3mg TID BI 685509 2mg TID
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    13 / 61 (21.31%)
    14 / 58 (24.14%)
    15 / 61 (24.59%)
    15 / 61 (24.59%)
    Vascular disorders
    Hypertension
         subjects affected / exposed
    3 / 61 (4.92%)
    6 / 58 (10.34%)
    3 / 61 (4.92%)
    2 / 61 (3.28%)
         occurrences all number
    3
    8
    4
    2
    Hypotension
         subjects affected / exposed
    3 / 61 (4.92%)
    0 / 58 (0.00%)
    5 / 61 (8.20%)
    6 / 61 (9.84%)
         occurrences all number
    3
    0
    8
    6
    General disorders and administration site conditions
    Oedema peripheral
         subjects affected / exposed
    2 / 61 (3.28%)
    1 / 58 (1.72%)
    5 / 61 (8.20%)
    5 / 61 (8.20%)
         occurrences all number
    2
    1
    6
    5
    Gastrointestinal disorders
    Diarrhoea
         subjects affected / exposed
    4 / 61 (6.56%)
    4 / 58 (6.90%)
    1 / 61 (1.64%)
    1 / 61 (1.64%)
         occurrences all number
    4
    4
    1
    1
    Infections and infestations
    COVID-19
         subjects affected / exposed
    2 / 61 (3.28%)
    3 / 58 (5.17%)
    3 / 61 (4.92%)
    3 / 61 (4.92%)
         occurrences all number
    2
    4
    3
    3

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    15 Dec 2020
    Global Amendment 1: Version 2.0 is considered to be the initial version of the CTP and included some modifications after version 1.0 has been archived. The original version 1.0 of this protocol was not submitted to any authorities, ethics committees or institutional review board for approval of the clinical trial.
    29 Jul 2021
    Global Amendment 2: -The column header “Post dose” and a cross to indicate post dose ECG at Visit 3 were added to the flow chart.-Extended the maximum time before randomisation from 28 to 35 days throughout the protocol.-Further requirement to inclusion criterion #3 was added: eGFR must remain ≥20 mL/min/1.73 m2 after Visit 1 up to the start of Visit 3, measured by central or any local laboratory analysis.-Adverse events to be summarized by the treatment to which the subject was randomised, and the treatment at the onset of AE for the drug-related AE rather than the treatment at end of the up-titration period as was before.
    13 Oct 2021
    Global Amendment 3: Addition of ECGs at visits where there were previously no ECGs: three ECGs at visits 4, 5 and one ECG at Visits 7 and 8. At Visits 3 and 6 an additional ECG to be done to the two already performed. -eGFR has been added as a test that patients can be pre-screened for if consent is given.Potential QT-interval prolongation was added as a risk along with the summary of data, rationale for the risk and the mitigation strategy.-Exclusion criteria 11) Removal of lactose monohydrate as an example of an excipient.Addition of the following exclusion criteria:17. QTcF -interval >450 ms in men or >470 ms in women at any time from screening (Visit 1) until start of treatment. 18. A family history of long QT syndrome. 19. Concomitant use of therapies with a known risk of Torsade de Pointes at screening (Visit 1) and throughout screening and baseline run-in or planned initiation of such therapies during the trial.The following was added to Discontinuation of Trial Treatment: Patients with a QT or QTcF interval >500 ms, or an increase of QT or QTcF of >60 ms from the pre-dosevalue at Visit 3 (baseline). Such cases must be reported as AEs.-Text was added to state that ECGs were to be performed prior to blood draws and after the patient has been in the supine position for 5 min.
    14 Mar 2022
    Global Amendment 4: Exclusion criterion #1 was changed to: Treatment with Renin Angiotensin Aldosterone System (RAAS) interventions (apart from either ACEi or ARB), phosphodiesterase-5 inhibitors, non-specific phosphodiesterase inhibitors (such as dipyridamole and theophylline), NO donors including nitrates, sGCstimulators/activators (other than trial treatment) or any other restricted medication (including OATP1B1/3 inhibitors, UGT inhibitors/inducers) as provided in the Investigator Site File (ISF) within 4 weeks prior to Visit 1 and throughout screening and baseline run-in. Patients who must or wish to continue the intake of restricted medications or any drug considered likely to interfere with the safe conduct of the trial are also excluded.
    14 Mar 2022
    Global Amendment 4: Patients who must or wish to continue the intake of restricted medications (see section 4.2.2.1) or any drug considered likely to interfere with the safe conduct of the trial are also excluded. 3.3.4.1 Discontinuation of trial treatment: The patient experiences a severe infection e.g. with SARSCoV- 2, as determined by the Investigator. Was changed to: The patient experiences a severe infection, e.g. with SARSCoV-2 that precludes their safe participation in the trial, as determined by the Investigator. 4.2.2.1 Restrictions regarding concomitant treatment: Phosphodiesterase inhibitors Nitrates in table 4.2.2.1:1 replaced with: Phosphodiesterase-5 inhibitors, non-specific phosphodiesterase inhibitors (such as dipyridamole and theophylline). 7.2.1: The TS is used for safety analyses as well as demographics and baseline characteristics. was replaced with: The TS is used for safety analyses and exposure.

    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.
    None reported
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