SNOW: Comparison of Eplerenone Versus Spironolactone in Heart Failure Patients With Glucose Intolerance or Type 2 Diabetes

Sponsor

Montreal Heart Institute (Other)

Overall Status

Unknown status

CT.gov ID

NCT01586442

Collaborator

Pfizer (Industry)

Enrollment

Location

Arms

Duration (Months)

0.9

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

In this proposal,the investigators will examine whether the selectivity of eplerenone for the MR will translate into a better glucose and metabolic profile compare to spironolactone in patients with HF with glucose intolerance or type 2 diabetes. In addition, the investigators will also compare the impact of these two agents on changes of concentrations of established prognostic biomarkers of neurohormonal activation and extracellular matrix turnover.

Condition or Disease	Intervention/Treatment	Phase
Heart Failure Type 2 Diabetes Glucose Intolerance	Drug: Eplerenone Drug: Spironolactone	Phase 3

Study Design

Study Type:

Interventional

Actual Enrollment :

62 participants

Allocation:

Randomized

Intervention Model:

Parallel Assignment

Masking:

Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)

Primary Purpose:

Treatment

Official Title:

A Comparison of the Effects of Selective and Non Selective Mineralocorticoid Antagonism on Glucose Homeostasis and Lipid Profile of Heart Failure Patients With Glucose Intolerance or Type 2 Diabetes.

Study Start Date :

Mar 1, 2012

Actual Primary Completion Date :

Mar 1, 2015

Anticipated Study Completion Date :

Mar 1, 2018

Arms and Interventions

Arm	Intervention/Treatment
Active Comparator: Spironolactone spironolactone 12.5mg once daily titrated to 25mg once daily	Drug: Spironolactone Spironolactone 12,5mg daily titrated to 25mg once daily for 16 weeks Other Names: Aldactone
Experimental: Eplerenone Eplerenone 25mg once daily titrated to 50mg once daily	Drug: Eplerenone Eplerenone 25mg once daily titrated to 50 mg once daily for 4 months Other Names: Inspra

Arm

Intervention/Treatment

Active Comparator: Spironolactone

spironolactone 12.5mg once daily titrated to 25mg once daily

Drug: Spironolactone

Spironolactone 12,5mg daily titrated to 25mg once daily for 16 weeks

Other Names:

Aldactone

Experimental: Eplerenone

Eplerenone 25mg once daily titrated to 50mg once daily

Drug: Eplerenone

Eplerenone 25mg once daily titrated to 50 mg once daily for 4 months

Other Names:

Inspra

Outcome Measures

Primary Outcome Measures

Glycated hemoglobin [4 months]
Change in glycated hemoglobin
Fasting glucose and lipid profile [4 months]
Plasma insulin [4 months]
Cortisol [4 months]
Adiponectin [4 months]
NT-proBNP [4 months]
PIIINP [4 months]

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

Male or female at least 18 years old.
Symptomatic HF corresponding to NYHA class II-IV symptoms for at least 4 weeks prior randomization.
A diagnosis of 1) impaired glucose tolerance described as overnight fasting between blood glucose 5.6 and 6.9 mmol/L on two occasions; or 2) type 2 diabetes defined as overnight fasting between blood glucose of 7.0 mmol/L or more on two occasions; a HbA1c equal to or higher than 6.5% or more on two occasions; or as a history of type II diabetes treated with hypoglycemic agents.
LVEF equal to or lower than 40% documented by, contrast ventriculography, magnetic resonance imaging, radionuclide ventriculography or quantitative echocardiography within the previous 12 months if no cardiac event occurred since the measurement of the LVEF. The most recent measurements should be used.
Treatment with an optimal and stable dose of ACE inhibitor (or ARB) for at least 4 weeks prior to enrolment in the study. In addition, patients should be treated with a stable dose of beta-blockers for at least 4 weeks prior enrolment in the study. Patients incapable to tolerate bisoprolol, carvedilol or metoprolol will be allowed within the trial.
Informed consent must be obtained before any study specific procedures are performed

Exclusion Criteria:

Current treatment with a combination of an ARB, an ACE or a renin inhibitor.
Type 1 diabetes
Known intolerance or allergy to eplerenone or spironolactone, including gynecomastia with spironolactone.
Estimated GFR < 30 mL/min/1.73 m2 as calculated using the MDRD equation (Appendix 1).
Current serum potassium higher than 5.0 mmol/L (higher than 5.0 mEq/L).
Current symptomatic hypotension and/or systolic B.P. < 90 mmHg.
Persistent systolic or diastolic hypertension (systolic > 170 mmHg or diastolic > 100 mmHg despite use of antihypertensive therapy).
HF secondary to any of the following conditions: hemodynamically significant primary stenotic valvular cardiomyopathy, isolated right sided CHF, non cardiac disease (e.g. uncorrected thyroid disease), pericardial disease, complex congenital heart disease, myocarditis.
Decompensated heart failure described as hospitalization or I.V. administration of medication in emergency room or heart failure clinic within 4 weeks (ex.: diuretics, inotropes, vasodilatators)
Current treatment with insulin
Stroke, acute coronary syndrome, PCI within the last 4 weeks before randomization.
Cardiac surgery within 3 months.
Significant liver disease (ALT x 3 times limit of normal).
Planned cardiac surgery expected to be performed within the next 6 months.
Previous heart transplant or heart transplant expected to be performed within the next 6 months.
Presence of any non-cardiac diseases likely to significantly shorten life expectancy to < 1 year.
Pregnant or lactating women or women of childbearing potential who are not protected from pregnancy by an accepted method of contraception, such as the oral contraceptive pill, an intrauterine device or surgical sterilization (all women of childbearing potential must have a negative pregnancy test before randomization).
Any condition that in the opinion of the investigator would jeopardize the evaluation on efficacy or safety or be associated with poor adherence to the protocol.
Treatment with any investigational agent or device within 4 weeks of randomization.