Efficacy of Pioglitazone on Macrovascular Outcome in Patients With Type 2 Diabetes (PROactive)
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Purpose
The purpose of this study is to determine whether pioglitazone, once daily (QD), can delay the time to death, heart attack, acute coronary syndrome, heart bypass surgery, stroke, leg bypass surgery or amputation in patients with type 2 diabetes.
| Condition | Intervention | Phase |
|---|---|---|
|
Diabetes Mellitus |
Drug: Pioglitazone Drug: Placebo |
Phase 3 |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Endpoint Classification: Safety Study Intervention Model: Parallel Assignment Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor) Primary Purpose: Treatment |
| Official Title: | PROspective PioglitAzone Clinical Trial In MacroVascular Events: A Macrovascular Outcome Study in Type 2 Diabetic Patients Comparing Pioglitazone With Placebo in Addition to Existing Therapy |
- Time to the Composite of All Cause Mortality, Non-Fatal Myocardial Infarction, Stroke, Acute Coronary Syndrome, Major Leg Amputation, Cardiac Intervention, Bypass Surgery or Leg Revascularization. [ Time Frame: At First Occurrence ] [ Designated as safety issue: Yes ]
- Time to All Cause Mortality. [ Time Frame: At occurrence ] [ Designated as safety issue: Yes ]
- Time to Non-Fatal Myocardial Infarction. [ Time Frame: At occurrence ] [ Designated as safety issue: Yes ]
- Time to Acute Coronary Syndrome. [ Time Frame: At occurrence ] [ Designated as safety issue: Yes ]
- Time to Cardiac Intervention (including coronary artery bypass graft or percutaneous coronary intervention). [ Time Frame: At occurrence ] [ Designated as safety issue: Yes ]
- Time to Stroke. [ Time Frame: At occurrence ] [ Designated as safety issue: Yes ]
- Time to Major Leg Amputation (above the ankle). [ Time Frame: At occurrence ] [ Designated as safety issue: Yes ]
- Time to Bypass Surgery [ Time Frame: At occurrence ] [ Designated as safety issue: Yes ]
- Time to Revascularization of the Leg. [ Time Frame: At occurrence ] [ Designated as safety issue: Yes ]
- Time to Cardiovascular Mortality. [ Time Frame: At occurrence ] [ Designated as safety issue: Yes ]
| Enrollment: | 4373 |
| Study Start Date: | May 2001 |
| Study Completion Date: | January 2005 |
| Primary Completion Date: | January 2005 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
| Experimental: Pioglitazone QD |
Drug: Pioglitazone
Pioglitazone 15 mg to 45 mg, tablets, orally, once daily for up to 48 months.
Other Names:
|
| Placebo Comparator: Placebo QD |
Drug: Placebo
Pioglitazone placebo-matching tablets, orally, once daily for up to 48 months
|
Detailed Description:
Diabetes mellitus is one of the most common non-communicable diseases worldwide. More than 22 million persons have been diagnosed with diabetes in the European region of the International Diabetes Federation. Complications of diabetes involving both microvascular and macrovascular systems contribute to increased disability and reduced life expectancy. Damage to the coronary, cerebral (brain), and peripheral vascular beds as a consequence of diabetes is responsible for the increased macrovascular illness and death associated with the disease.
Insulin resistance is common to the genesis of both atherosclerosis and type 2 diabetes mellitus. In diabetes, insulin resistance is coupled to receptor dysfunction. In atherosclerosis, insulin resistance may have both direct effects on the cardiovascular system as well as indirect effects provoked by imbalances in blood glucose, lipids, clotting factors, endothelial function, and other factors. Considerable indirect evidence suggests that peroxisome proliferator-activated receptor agonists may favorably influence macrovascular outcome, either through modification of risk factors (such as blood lipids) or through effects on the vessel wall.
Pioglitazone, a thiazolidinedione compound discovered by Takeda Pharmaceutical Company, Ltd, functions as a peroxisome proliferator-activated receptor agonist as its mode of action.
This study is designed to assess whether pioglitazone in combination with other medications administered for glycemic management of type 2 diabetes might reduce the incidence of macrovascular events associated with this disease compared with placebo. Individuals who participate in this study will provide written informed consent and will be required to commit to screening and randomization visits and approximately 17 additional visits (1 every 2 months for the first year and every 3 months thereafter) at the study center. Study participation is anticipated to be about 40 months (or approximately 3 years and 4 months). Multiple procedures will occur at each visit which may include fasting, blood collection, physical examinations and electrocardiograms.
Eligibility| Ages Eligible for Study: | 35 Years to 75 Years |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria
- Type 2 diabetes mellitus
- Glycosylated hemoglobin above the upper limit of normal (ie, the local equivalent of 6.5% for)
-
Established history of macrovascular disease, defined as 1 or more of:
- Myocardial infarction at least 6 months before entry into the study.
- Stroke at least 6 months before entry into the study
- Percutaneous coronary intervention or coronary artery bypass graft at least 6 months before entry into the study.
- Acute coronary syndrome at least 3 months before entry into the study.
- Objective evidence of coronary artery disease.
- Peripheral arterial obstructive disease
Exclusion Criteria
- Signs of type 1 diabetes.
- Patients prescribed insulin as sole therapy for glycemic control of diabetes for 2 weeks or more at any time in the previous 3 months.
- Myocardial infarction, stroke, coronary artery bypass graft, or percutaneous cardiac intervention in the 6 months prior to enrolment.
- Acute coronary syndrome in the 3 months prior to enrolment.
- Heart failure at entry defined as patient having a New York Heart Association functional score of II or above.
- Had an appointment for a coronary angiogram or endovascular or surgical intervention.
- Leg ulcers, gangrene, or ischemic rest pain.
- Had an appointment for an angiogram or endovascular or surgical intervention for leg ischemia.
- Had undergone a major operation (defined as a surgical procedure lasting for more than 30 minutes) at any time in the previous 4 weeks.
- Significantly impaired hepatic function, defined as alanine aminotransferase greater than 2.5 times the upper limit of normal.
- Familial polyposis coli.
- Required dialysis.
- History of alcohol or drug abuse.
- Any other intercurrent disease believed to be likely to have a significant impact on the patient's life expectancy during the course of the study (eg, cancer).
- Patient was undergoing follow-up as part of another clinical trial or less than 3 months had elapsed since the last dose of an investigational drug or procedure.
- Hypersensitivity to pioglitazone or other TZD.
- Current use of pioglitazone or other TZD.
- Patient was known to be infected with human immunodeficiency virus or was known to have viral hepatitis.
- Women who were any of the following: pregnant, breast feeding, wished to become pregnant during the course of the study or of childbearing potential and not planning to use a reliable method of contraception throughout the study.
Contacts and LocationsPlease refer to this study by its ClinicalTrials.gov identifier: NCT00174993
Show 19 Study Locations
| Study Director: | European Development Director | Takeda |
More Information
Additional Information:
Publications:
Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
| Responsible Party: | Takeda |
| ClinicalTrials.gov Identifier: | NCT00174993 History of Changes |
| Other Study ID Numbers: | AD4833/EC444, U1111-1114-2854 |
| Study First Received: | September 9, 2005 |
| Last Updated: | February 27, 2012 |
| Health Authority: | United Kingdom: Medicines and Healthcare Products Regulatory Agency France: Afssaps - Agence française de sécurité sanitaire des produits de santé (Saint-Denis) Germany: Federal Institute for Drugs and Medical Devices Italy: The Italian Medicines Agency Austria: Federal Ministry for Health and Women Switzerland: Swissmedic Belgium: The Federal Public Service (FPS) Health, Food Chain Safety and Environment Denmark: Danish Medicines Agency Sweden: Medical Products Agency Finland: Finnish Medicines Agency Norway: Norwegian Medicines Agency Netherlands: Medicines Evaluation Board (MEB) Poland: Office for Registration of Medicinal Products, Medical Devices and Biocidal Products Hungary: National Institute of Pharmacy Slovakia: State Institute for Drug Control Czech Republic: State Institute for Drug Control Latvia: State Agency of Medicines Lithuania: State Medicine Control Agency - Ministry of Health Estonia: The State Agency of Medicine |
Keywords provided by Takeda:
|
Glucose Metabolism Disorder Dysmetabolic Syndrome Type II Diabetes; Diabetes Mellitus |
Lipoatrophic Dyslipidemia Drug Therapy |
Additional relevant MeSH terms:
|
Pioglitazone Hypoglycemic Agents Pharmacologic Actions Physiological Effects of Drugs |
ClinicalTrials.gov processed this record on March 03, 2015