E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Iron deficiency in patients with chronic heart failure and mild cognitive impairment |
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E.1.1.1 | Medical condition in easily understood language |
Iron deficiency in patients with chronic heart failure and mild cognitive impairment |
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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 |
The primary objective of the study is to evaluate the effect of iron repletion with intravenous Ferric Derisomaltose on cognitive function as assessed using a composite score of cognitive function, in patients with stable chronic heart failure (NYHA class II-III, left ventricular ejection fraction ≤ 40 %) and iron deficiency. |
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E.2.2 | Secondary objectives of the trial |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. The Patient is willing and able to participate and provides written informed consent; 2. Age ≥ 18 years and < 85; 3. NYHA II-III functional class due to stable symptomatic chronic HF and all of the following; 4. Three months without cardiac hospitalization; 5. Patients in NYHA II: acute care admission or emergency room visit for worsening HF at least once within 24 months prior to start of treatment, but not in the last three months; 6. Appropriate dose of medical therapy for HF (such as ACEi, ARB, ß-blocker, oral diuretics, MRA, ARNI, ivabradine) consistent with prevailing local and international CV guidelines. 7. No dose changes of HF drugs during the last 2 weeks (exception for diuretics); 8. No introduction of a new HF drug class during the last 4 weeks; 9. LVEF ≤ 40 % for both groups of NYHA functional classes; documented within the last 12 months prior to screening; 10. At screening or Visit 1, significantly raised plasma levels of natriuretic peptides (NT-proBNP ≥ 600 pg/ml or BNP ≥ 150 pg/ml) or if they have been hospitalized for HF within the previous 12 months, a NT-proBNP ≥ 400 pg/ml or BNP of at least 100 pg/ml or by patients with atrial fibrillation and HF, a NT-proBNP ≥ 900 pg/ml; 11. Screening ferritin < 100 ng/ml OR ferritin 100-299 ng/ml if TSAT < 20 %; 12. Hb: ≥10 < 15.0 g/dl 13. Patient must be able to perform the 6 minute walking distance und handgrip strength measurements according to investigator judgment; 14. Mild cognitive impairment according to MoCA Test.
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E.4 | Principal exclusion criteria |
1. Clinical signs and symptoms of infection or C-reactive protein > 20 mg/l; 2. Clinically significant bleeding and subject at an immediate need of transfusion; 3. Active malignancy with exception of basal cell or squamous cell carcinoma of the skin, and cervical intraepithelial neoplasia; 4. History of erythropoetin, IV or oral iron therapy, and blood transfusion in previous 4 weeks; 5. Chronic liver disease and/or screening alanine transaminase (ALT) or aspartate transaminase (AST) above three times the upper limit of the normal range; 6. Vitamin B12 and/or serum folate deficiency. If deficiency is corrected, patients may be re-screened for inclusion; 7. Haemolytic anaemia and other forms of anaemia not based on ID (e.g. other microcytic anaemia, pernicious anaemia); 8. Known HIV/AIDS; 9. Currently receiving systemic chemotherapy and/or radiotherapy; 10. Renal replacement therapy (previous, current or planned within the next 6 month) or haemodialysis; 11. Severe valvular or left ventricular outflow obstruction disease, obstructive cardiomyopathy; 12. Atrial fibrillation/flutter with a mean ventricular response rate in rest > 100 bpm; 13. Uncontrolled hypertension with blood pressure > 160/100 mmHg; 14. Acute coronary syndrome (STEMI, NSTEMI or unstable angina pectoris), transient ischaemic attack or stroke within the last 3 months; 15. Coronary-artery bypass graft, percutaneous intervention (cardiac, cerebrovascular, aortic; diagnostic catheters are allowed) or major surgery, including thoracic and cardiac surgery, within the last 3 months or planned during the study; 16. Implantation of CRT/ICD within the past 3 months or planned during the study; 17. Subject is pregnant (e.g., positive ß-hCG test) or is breast feeding; 18. Women in childbearing age and not using medically acceptable effective contraception refer to CTFG*; 19. History of acquired iron overload or hemochromatosis (or a first relative with hemochromatosis); 20. Hypersensitivity to the active substance, to FDI or any of its excipients; 21. Earlier hypersensitivity to parental iron preparations or a history of allergic disorders; 22. History of severe asthma, eczema or other atopic allergy; 23. History of immune or inflammatory conditions (e.g. systemic lupus erythematosus, rheumatoid arthritis); 24. Concurrent immunosuppressive therapy; 25. Psychosis or dementia (latter assessed by DemTect); 26. Prescribed anti-dementia medication 27. Diagnosed current severe depressive episode (according to ICD-10-GM).
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E.5 End points |
E.5.1 | Primary end point(s) |
Changes in cognitive performance at week 12, compared to baseline, as assessed by a global composite score of cognitive function. This score constitutes the average of z-standardized results of the Digit Symbol Substitution Test, Stroop Color Word Interference Task, Trailmaking-Test, CERAD-Wordlist, Digit Span Backwards Test, and Digit Span Forwards Test. |
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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) |
1. Changes in cognitive performance at week 24, compared to baseline, as assessed by the global composite score of cognitive function. 2. Changes in single measures of cognitive performance at week 12 and 24 compared to baseline, as assessed by the MoCA Test, Digit Symbol Substitution Test, Stroop Color Word Interference Task, Trailmaking-Test, CERAD-Wordlist, Digit Span Backwards Test, and Digit Span Forwards Test. 3. Reduction in depression from baseline to week 12 and 24, as assessed by HADS. 4. Reduction in general anxiety and heart-focused anxiety from baseline to week 12 and 24, as assessed by HADS and HAF-17 and CAQ. 5. Changes in self-reported quality of life, as assessed by The Kansas City Cardiomyopathy Questionnaire (for HF specific quality of life) and EQ-5D (for general psychological and physical quality of life) from baseline to week 12 and 24.
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
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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) | 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 | 2 |
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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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 | 7 |