A Method Validation Study for Evaluation of Novel Treatments Limiting Pulmonary Oedema in Cardiac Failure

NCT02135861 | Completed Phase 1 Results

• 1 other identifier: 201137
• Study Type: interventional
• Target: 41
• Locations: 1 country
• Sites: 1

Brief Summary

Transient receptor potential vanilloid 4 (TRPV4) channel blockade may be promising in the treatment of pulmonary oedema and dyspnoea in heart failure (HF) and acute decompensated heart failure (ADHF) patients by re-establishing the alveolar septal barrier. Dynamic contrast enhanced (DCE) Magnetic Resonance Imaging (MRI) is an established technique for assessing changes in vascular permeability and interstitial water volume. The aim of this study is to establish the potential utility of DCE-MRI as a novel endpoint for dose ranging and proof of mechanism studies of TRPV4 blockers. The DCE-MRI markers of vascular permeability and pulmonary oedema will be measured in subjects with HF (group 2) and healthy volunteers (HV) (group 1) at rest to determine if there is a difference between the two populations. Apart from this, exercise induced changes relative to rest in interstitial volume and exchange rate will be evaluated in both HV and subjects with HF. Additionally, the capability of DCE-MRI to detect changes in interstitial lung fluid in patients with acute decompensated heart failure (ADHF) (group 3) will be investigated. DCE-MRI markers of pulmonary oedema will be assessed when patients are initially hospitalized with ADHF and subsequently after receiving standard of care treatment to determine whether differences can be detected by this methodology.This study will enrol a sufficient number of subjects to have at least 24 subjects in Group 1 and 2 (group 1:12 HV and group 2: 12 subjects with HF) and atleast 5 subjects in Group 3. For each subject, the MRI data must be of sufficient quality to enable DCE-MRI modelling from 2 Sessions. For group 1 and 2, the subjects will have screening visit and 3 MRI sessions. For the first scanning session, subjects will undergo the baseline procedure. The second imaging session will occur approximately one week later to measure within subject variability. A third imaging session (which will be conducted in 2 visits) will incorporate a bicycle exercise challenge prior to the MRI scan, and this third scan will be performed approximately one to three days after the second imaging session. For group 3: Screening will occur during hospitalization for eligibility. Session 1of MRI will be conducted while the subject is still hospitalized. Session 2 will be conducted within 4 weeks of the first scan, when the signs of pulmonary oedema are considered to be resolved. If a subject's pulmonary oedema has not resolved at Session 2, then the subject will be not be scanned by MRI at Session 2 and will be brought back for Session 3 up to 4 weeks after Session 2 for their second MRI.

Conditions

Heart Failure, Congestive

Keywords

Acute decompensated heart failure; heart failure; MRI; trpV4 channel inhibitors; pulmonary oedema

Outcome Measures

Primary Outcomes (6)

• Interstitial Volume (ve) in Heart Failure Participants and Healthy Volunteers at Baseline

  Interstitial volume (ve) was measured by DCE-MRI. ve for total lung, left lung, right lung, left lung apical, left lung basal, right lung apical, right lung basal has been presented. Session 1 values were considered as Baseline values.

  Day 1

• Exchange Rate (Ktrans) in Heart Failure Participants and Healthy Volunteers at Baseline

  Exchange rate (Ktrans) was measured by DCE-MRI. Ktrans for total lung, left lung, right lung, left lung apical, left lung basal, right lung apical, right lung basal has been presented. Session 1 values were considered as Baseline values.

  Day 1

• Interstitial Volume (ve) in Heart Failure Participants and Healthy Volunteers Before and Following Exercise

  Interstitial volume (ve) was measured by DCE-MRI. ve for total lung, left lung, right lung, left lung apical, left lung basal, right lung apical, right lung basal before and following exercise has been presented.

  Day 11

• Exchange Rate (Ktrans) in Heart Failure Participants and Healthy Volunteers Before and Following Exercise

  Exchange rate (Ktrans) was measured by DCE-MRI. Ktrans for total lung, left lung, right lung, left lung apical, left lung basal, right lung apical, right lung basal before and following exercise has been presented.

  Day 11

• Change in Interstitial Volume (ve) in ADHF Participants

  Interstitial volume (ve) was measured by DCE-MRI. Three participants underwent 3 DCE-MRI scans. The data has been presented for individual participant in each session. The data presented below is only for total lung.

  Up to Week 8

• Change in Exchange Rate (Ktrans) in ADHF Participants

  Exchange rate (Ktrans) was measured by DCE-MRI. Three participants underwent 3 DCE-MRI scans. The data has been presented for individual participant in each session. The data presented below is only for total lung.

  Up to Week 8

Secondary Outcomes (2)

• Assessment of Intra-subject Variability in Ve Between Session 1 and Session 2 of DCE-MRI

  Day 1 (Session 1) and Day 9 (Session 2)

• Assessment of Intra-subject Variability in Ktrans Between Session 1 and Session 2 of DCE-MRI

  Day 1 (Session 1) and Day 9 (Session 2)

Study Arms (3)

Healthy volunteers

EXPERIMENTAL

All subjects will undergo MRI scanning conducted by experienced radiographers and radiologists in the nominated scanning sites, using a 1.5 Tesla (T) system.

Procedure: DCE-MRI scans; Other: Gadobutrol

Heart failure patients

EXPERIMENTAL

All subjects will undergo DCE-MRI scanning conducted by experienced radiographers and radiologists in the nominated scanning sites, using a 1.5 T system.

Procedure: DCE-MRI scans; Other: Gadobutrol

Acute decompensated heart failure

EXPERIMENTAL

All subjects will undergo DCE-MRI scanning conducted by experienced radiographers and radiologists in the nominated scanning sites, using a 1.5 T system

Procedure: DCE-MRI scans; Other: Gadobutrol

Interventions

DCE-MRI scans PROCEDURE

Subjects will be placed supine in the scanner and will be prepared for intravenous contrast agent administration. The contrast agent is administered using a power injector before imaging.

Acute decompensated heart failure; Healthy volunteers; Heart failure patients

Gadobutrol OTHER

Gadobutrol at a dose less than or equal to 0.1 millimoles per kilogram (mmol/kg) will be given intravenously as a bolus using a power injector.

Acute decompensated heart failure; Healthy volunteers; Heart failure patients

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Male or females over 18 years of age at the time of signing the informed consent.
• Body weight \>=50 kilogram (kg) and Body Mass Index (BMI) within the range 18.0-40.0 kilogram/square meter (kg/m\^2) (inclusive).
• Able to understand and comply with protocol requirements, instructions and protocol stated restrictions and is willing to take part in the imaging sessions.
• Capable of giving written informed consent, which includes compliance with the requirements and restrictions listed in the consent form.
• \- Healthy as determined by a responsible and experienced physician, based on a medical evaluation including medical history, brief physical examination, clinical laboratory tests, and Electrocardiogram (ECG).
• Male subjects OR female subjects of non reproductive potential as defined as pre-menopausal females with a documented tubal ligation or hysterectomy, or post-menopausal defined as 12 months of spontaneous amenorrhea \[in questionable cases a blood sample with simultaneous follicle stimulating hormone (FSH) \> 40 million international units (MIU)/millilitre (mL) and oestradiol \< 40picogram (pg)/mL (\< 140 pmol/L) is confirmatory.
• years of age or over at the time of signing the informed consent
• Hospitalized for the management of acute decompensated HF
• Presence of dyspnoea at rest or with minimal activity
• Presence of at least one of the following signs: Tachypnea with respiratory rate \>=20 breaths/min or Rales or crackles audible on auscultation
• Chest x-ray with evidence of pulmonary congestion/oedema performed approximately within the last 48 hours (if not available - an additional research CXR may be requested)
• Have received at least one treatment with an intravenous diuretic prior to the first MRI scan
• Body weight \>= 50kg and BMI within the range 18-40 kg/m\^2 (inclusive)
• Able to understand and comply with protocol requirements, instructions and protocol-stated restrictions and is willing to take part in the imaging sessions
• Capable of giving written informed consent, which includes compliance with the requirements and restrictions listed in the consent form

You may not qualify if:

• History of known primary pulmonary disease requiring current medication or other therapy.
• Orthopnoea of sufficient severity to preclude supine scanning as determined at screening.
• Unstable angina within the past 3 months.
• Uncontrolled hypertension (resting systolic Blood Pressure (BP) \>160 millimeters of mercury (mmHg) or resting diastolic BP \>100 mmHg).
• Current smoker, defined as having smoked in the preceding 6 months.
• Contraindication for MRI scanning (as assessed by local MRI safety questionnaire) which includes but not limited to: Intracranial aneurysm clips or other metallic objects; Intra-orbital metal fragments that have not been removed ; Pacemakers or other implanted cardiac rhythm management devices and non-MRI compatible heart valves; Inner ear implants; and History of claustrophobia.
• Pregnant females as determined by positive urine human chorionic gonadotropin (HCG) test at screening or any scanning session.
• Positive test for drugs of abuse, not due to current prescription drugs as determined by the GSK Medical Monitor and principal investigator (PI), and alcohol screen.
• Estimated Creatinine Clearance (Cockcroft-Gault) \<60 millilitre (mL)/minute.
• End-stage heart failure defined as requiring left ventricular assist devices, intra-aortic balloon pump or any type of mechanical support
• Chronic or intermittent renal support therapy (hemodialysis, ultrafiltration, or peritoneal dialysis)
• Ongoing or planned intravenous diuretic treatment within 1 hour of MRI scan appointment
• History of known primary pulmonary disease requiring current medication or other therapy
• Orthopnoea of sufficient severity to preclude supine scanning (as determined by a 15-minute test of lying supine with or without the use of oxygen)
• Contraindication for MRI scanning (as assessed by local MRI safety questionnaire), which includes but is not limited to: Intracranial aneurysm clips (except Sugita) or other metallic objects OR intra-orbital metal fragments that have not been removed OR pacemakers or other implanted cardiac rhythm management devices and non-MRI compatible heart valves OR inner ear implants OR history of claustrophobia

Sponsors & Collaborators

• GlaxoSmithKline: lead

Study Sites (1)

GSK Investigational Site

Cambridge, CB2 2GG, United Kingdom

Location

MeSH Terms

Conditions

Heart Failure; Pulmonary Edema

Interventions

gadobutrol

Condition Hierarchy (Ancestors)

Heart Diseases; Cardiovascular Diseases; Lung Diseases; Respiratory Tract Diseases

Results Point of Contact

• Title: GSK Response Center
• Organization: GlaxoSmithKline

GSKClinicalSupportHD@gsk.com

866-435-7343

Study Officials

• GSK Clinical Trials

  GlaxoSmithKline

  STUDY DIRECTOR

Publication Agreements

• PI is Sponsor Employee: No
• Restriction Type: OTHER
• Restrictive Agreement: Yes

Study Design

• Study Type: interventional
• Phase: phase 1
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: BASIC SCIENCE
• Intervention Model: SINGLE GROUP
• Sponsor Type: INDUSTRY
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: April 24, 2014
• First Posted: May 12, 2014
• Study Start: July 30, 2014
• Primary Completion: February 22, 2017
• Study Completion: February 22, 2017
• Last Updated: February 27, 2019
• Results First Posted: February 27, 2019

Record last verified: 2018-07

Locations

GB (1)