Zibotentan and Dapagliflozin for the Treatment of CKD (ZENITH-CKD Trial)

Sponsor
AstraZeneca (Industry)
Overall Status
Recruiting
CT.gov ID
NCT04724837
Collaborator
(none)
495
251
3
22.4
2
0.1

Study Details

Study Description

Brief Summary

The purpose of the study is to assess efficacy, safety and tolerability of treatment with zibotentan and dapagliflozin in combination and dapagliflozin 10 mg as monotherapy in participants with chronic kidney disease (CKD) with estimated glomerular filtration rate (eGFR) ≥ 20 mL/min/1.73 m^2, and urinary albumin to creatinine ratio (UACR) ≥ 150 mg/g and ≤ 5000 mg/g.

Condition or Disease Intervention/Treatment Phase
Phase 2

Detailed Description

The study will be conducted in approximately 220 sites in North America, South America, Africa, Asia/Pacific, and European countries.

Participants will be randomized to 12 weeks of treatment plus 2 weeks follow-up.

After screening, eligible participants will be stratified by diabetes (diabetic kidney disease [DKD] versus non-diabetes mellitus [non-DM] CKD) and baseline eGFR (below or equal versus above 45 mL/min/1.73m^2).

A total of 495 participants will be randomised into this study, including participants randomised under the earlier study design. Four hundred and fifteen (415) participants will be randomised to have 166 participants in zibotentan Dose A/dapagliflozin 10 mg combination arm and dapagliflozin 10 mg monotherapy arm, and 83 participants in the zibotentan Dose B/dapagliflozin 10 mg combination arm.

  • Zibotentan Dose A + Dapagliflozin 10 mg once daily.

  • Zibotentan Dose B + Dapagliflozin 10 mg once daily.

  • Dapagliflozin 10 mg + Placebo once daily.

Participants who were previously randomised cannot be re-randomised.

Study Design

Study Type:
Interventional
Anticipated Enrollment :
495 participants
Allocation:
Randomized
Intervention Model:
Parallel Assignment
Masking:
Triple (Participant, Care Provider, Investigator)
Primary Purpose:
Treatment
Official Title:
A Phase 2b Multicentre, Randomised, Double-Blind, Active-Controlled, Parallel Group Dose-Ranging Study to Assess the Efficacy, Safety and Tolerability of Zibotentan and Dapagliflozin in Patients With Chronic Kidney Disease With Estimated Glomerular Filtration Rate (eGFR) ≥ 20 mL/Min/1.73 m^2
Actual Study Start Date :
Apr 28, 2021
Anticipated Primary Completion Date :
Mar 10, 2023
Anticipated Study Completion Date :
Mar 10, 2023

Arms and Interventions

Arm Intervention/Treatment
Experimental: Zibotentan Dose A + Dapagliflozin

Participants will receive once daily oral dose A of zibotentan and 10 mg dapagliflozin for 12 weeks.

Drug: Zibotentan
Participants will receive zibotentan as per the arms they are randomized.

Drug: Dapagliflozin
Participants will receive dapagliflozin as per the arms they are randomized.

Experimental: Zibotentan Dose B + Dapagliflozin

Participants will receive once daily oral dose B of zibotentan and 10 mg dapagliflozin for 12 weeks.

Drug: Zibotentan
Participants will receive zibotentan as per the arms they are randomized.

Drug: Dapagliflozin
Participants will receive dapagliflozin as per the arms they are randomized.

Experimental: Dapagliflozin + Placebo

Participants will receive once daily oral dose of dapagliflozin 10 mg and placebo for 12 weeks.

Drug: Dapagliflozin
Participants will receive dapagliflozin as per the arms they are randomized.

Drug: Placebo
Participants will receive placebo as per the arms they are randomized to.

Outcome Measures

Primary Outcome Measures

  1. Change in Log-transformed Urinary Albumin to Creatinine Ratio (UACR) from baseline to Week 12 [From baseline (Week 0 [Day 1]) until Week 12 (Day 84)]

    The effect of zibotentan Dose B/dapagliflozin 10 mg versus dapagliflozin 10 mg on UACR will be assessed.

Secondary Outcome Measures

  1. Change in Log-transformed UACR from baseline to Week 12 [From baseline (Week 0 [Day 1]) until Week 12 (Day 84)]

    The effect of zibotentan dose A/dapagliflozin 10 mg versus dapagliflozin 10 mg monotherapy on UACR will be assessed.

  2. Change in Blood Pressure from baseline to Week 12 [From baseline (Week 0 [Day 1]) until Week 12 (Day 84)]

    The change in office systolic and diastolic blood pressure (BP) for doses of zibotentan combined with dapagliflozin 10 mg versus dapagliflozin 10 mg monotherapy will be assessed.

  3. Least Squares Mean Change of UACR at Week 12 from the zibotentan/dapagliflozin dose arms and the dapagliflozin monotherapy arm [From baseline until Week 12 (Day 84)]

    The assessment of dose-response and relationship across different dose of zibotentan/dapagliflozin and dapagliflozin alone on UACR reduction.

  4. Change in eGFR from Baseline to Week 1, Week 12 and Week 14 [From baseline (Week 0 [Day 1]) until Week 1, Week 12, and Week 14]

    The effect of different doses of zibotentan and dapagliflozin 10 mg in combination versus dapagliflozin 10 mg monotherapy on eGFR will be assessed.

  5. Change in eGFR from Week 1 to Week 12 [From Week 1 (Day 8) until Week 12 (Day 84)]

    The effect of different doses of zibotentan and dapagliflozin 10 mg in combination versus dapagliflozin 10 mg monotherapy on eGFR will be assessed.

  6. Number of Participants Experiencing Adverse events [From Week 0 (Day 1) until Follow-up visit (Week 14 [Day 98])]

    The safety and tolerability of all doses of zibotentan combined with dapagliflozin 10 mg and dapagliflozin 10 mg monotherapy will be assessed.

Eligibility Criteria

Criteria

Ages Eligible for Study:
18 Years to 130 Years
Sexes Eligible for Study:
All
Accepts Healthy Volunteers:
No
Inclusion Criteria:

Participants are eligible to be included in the study only if all of the following criteria apply:

  • Diagnosis of CKD, defined as:

(a) eGFR chronic kidney disease epidemiology collaboration (CKD-EPI) ≥ 20 mL/min/1.73 m^2, and (b) UACR ≥ 150 and ≤ 5000 mg albumin/g creatinine, based on a single first morning void spot urine sample at screening.

  • No current or prior (within 1 month of screening) medical treatment with an SGLT2i (sodium-glucose co-transporter 2 inhibitor) or any fixed dose combination with SGLT2i

  • If ACEi and/or ARB and/or mineralocorticoid receptor agonist (MRA) are prescribed, the dose must be stable ≥ 4 weeks before screening. Participants who have been deemed unable to tolerate ACEi or ARB therapy due to allergy or complications can be enrolled

  • No current or prior treatment within 6 months prior to screening with cytotoxic therapy, immunosuppressive therapy or other immunotherapy for primary or secondary kidney disease

  • Body mass index (BMI) ≤ 40 kg/m^2

  • All participants should follow protocol defined contraceptives procedures

Exclusion Criteria:
Participants are excluded from the study if any of the following criteria apply:
  • Minimal change disease, unstable rapidly progressing renal disease, and/or renal disease requiring significant immunosuppression, autosomal dominant or autosomal recessive polycystic kidney disease

  • Participants with New York Heart Association classification functional heart failure (HF) class III or IV

  • Acute coronary syndrome events within 3 months prior to screening

  • Participants with a B-type natriuretic peptide (BNP) ≥ 200 pg/mL or NT-proBNP ≥ 600 pg/mL (BNP ≥ 400 pg/mL or NT-proBNP ≥ 1200 pg/mL, respectively, if associated with atrial fibrillation) measured by local laboratory at screening (Visit 1)

  • Participants with unstable HF requiring hospitalisation for optimisation of HF treatment and/or who have not been stable on HF therapy within 6 months prior to screening

  • Heart failure due to cardiomyopathies that would primarily require other specific treatment: eg, cardiomyopathy due to pericardial disease, amyloidosis or other infiltrative diseases, cardiomyopathy related to congenital heart disease, primary hypertrophic cardiomyopathy, cardiomyopathy related to toxic or infective conditions

  • High output HF

  • Heart failure due to primary cardiac valvular disease/dysfunction, severe functional mitral or tricuspid valve insufficiency, or planned cardiac valve repair/replacement

  • Participants with uncontrolled diabetes mellitus (HbA1c > 12%), and with T1DM

  • Intermittent or persistent second or third degree atrioventricular block after sinus node dysfunction, with clinically significant bradycardia or sinus pause when not treated with pacemaker

  • History of any life-threatening cardiac dysrhythmia

  • Cardiac surgery or non-elective percutaneous coronary interventions (within 3 months) or open chest coronary artery bypass grafting or valvular repair/replacement (within 12 months) prior to screening or is planned to undergo any of these procedures after randomisation

  • Heart transplantation or left ventricular assist device at any time

  • History or ongoing allergy/hypersensitivity, as judged by the investigator, to SGLT2i or drugs with a similar chemical structure to zibotentan

  • Any clinically significant disease or disorder, which might put the participant at risk because of participation in the study, or probable alternative primary reason for participant's symptoms in judgment of investigator, including but not limited to:

  • Isolated pulmonary arterial hypertension (defined as mean PAP ≥ 25 mmHg at rest) or right ventricular failure; in the absence of left-sided HF

  • Anaemia defined as haemoglobin (Hb) level < 100 g/L or 10 g/dL at screening (Visit 1)

  • Severe chronic obstructive pulmonary disease or other lung disease including but not limited to pulmonary fibrosis requiring chronic oxygen therapy, regular nebuliser use, or oral steroid therapy

  • Stroke, transient ischemic attack, carotid surgery, or carotid angioplasty within previous 3 months prior to screening Severe hepatic impairment (Child-Pugh class C Hepatic impairment), aspartate transaminase or alanine transaminase > 2x the upper limit of normal [ULN]; or total bilirubin > 2x ULN at time of screening

  • Participants with newly detected pathological laboratory values or an ongoing disease condition requiring investigation and/or initiation or adjustment of current treatment

  • Positive hepatitis C antibody, or hepatitis B virus, surface antigen at screening

  • Participants treated with strong or moderate CYP3A4 inhibitor or inducer

  • Confirmation of corona virus disease- 2019 (COVID-19) infection:

  • Participant has a positive test result for severe acute respiratory syndrome coronavirus 2 during screening. Participants who are not hospitalised for COVID-19 infections can be re screened 4 weeks after they have recovered

  • Participant has been previously hospitalised with COVID-19 infection

  • Ejection fraction < 50% measured by echocardiogram at screening

Contacts and Locations

Locations

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Sponsors and Collaborators

  • AstraZeneca

Investigators

  • Principal Investigator: David C Wheeler, MB ChB, MD, FRCP, Centre for Nephrology Royal Free Campus University College London Rowland Hill Street London NW3 2PF United Kingdom
  • Principal Investigator: Jamie P. Dwyer, M.D., Nephrology Clinical Trials Center Nephrology and Hypertension Vanderbilt University Medical Center Nashville TN United States of America

Study Documents (Full-Text)

None provided.

More Information

Publications

None provided.
Responsible Party:
AstraZeneca
ClinicalTrials.gov Identifier:
NCT04724837
Other Study ID Numbers:
  • D4325C00001
  • 2020-004101-32
First Posted:
Jan 26, 2021
Last Update Posted:
Aug 4, 2022
Last Verified:
Aug 1, 2022
Individual Participant Data (IPD) Sharing Statement:
Yes
Plan to Share IPD:
Yes
Studies a U.S. FDA-regulated Drug Product:
Yes
Studies a U.S. FDA-regulated Device Product:
No
Keywords provided by AstraZeneca
Additional relevant MeSH terms:

Study Results

No Results Posted as of Aug 4, 2022