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Changes in NT-proBNP and Outcomes, Safety, and Tolerability in HFpEF Patients With Acute Decompensated Heart Failure (ADHF) Who Have Been Stabilized During Hospitalization and Initiated In-hospital or Within 30 Days Post-discharge (PARAGLIDE-HF)

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ClinicalTrials.gov Identifier: NCT03988634
Recruitment Status : Recruiting
First Posted : June 17, 2019
Last Update Posted : September 17, 2020
Sponsor:
Information provided by (Responsible Party):
Novartis ( Novartis Pharmaceuticals )

Brief Summary:
The purpose of this study is to assess the effect of sacubitril/valsartan (LCZ696) vs. valsartan on changes in NT-proBNP and outcomes, safety and tolerability in patients with HFpEF (left ventricular ejection fraction (LVEF) > 40%) who have been stabilized during hospitalization for acute decompensated heart failure and initiated in-hospital or within 30 days post discharge.

Condition or disease Intervention/treatment Phase
Heart Failure With Preserved Ejection Fraction (HFpEF) Drug: sacubitril/valsartan Drug: valsartan Phase 3

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 800 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary Purpose: Treatment
Official Title: A Multicenter, Randomized, Double-blind, Double-dummy, Parallel Group, Active Controlled Study to Evaluate the Effect of Sacubitril/Valsartan (LCZ696) Versus Valsartan on Changes in NT-proBNP and Outcomes, Safety, and Tolerability in HFpEF Patients With Acute Decompensated Heart Failure (ADHF) Who Have Been Stabilized During Hospitalization and Initiated In-hospital or Within 30 Days Post-discharge (PARAGLIDE-HF)
Actual Study Start Date : June 27, 2019
Estimated Primary Completion Date : March 21, 2022
Estimated Study Completion Date : March 21, 2022

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: sacubitril/valsartan

randomized in a 1:1 ratio: sacubitril/valsartan to valsartan for up to approximately 20 months of double-blind treatment.

Initial dose for patients randomized to sacubitril/valsartan (LCZ696) will be determined by patient's previous dose of ACEi/ARB immediately prior to hospital admission for acute decompensated heart failure. Study treatment will be titrated to the target dose of sacubitril/valsartan (LCZ696) 97/103 mg twice daily (Dose Level 3).

Patients will be required to take a total of two tablets twice daily (one tablet of active sacubitril/valsartan and one tablet of valsartan matching placebo pack).

Drug: sacubitril/valsartan

Sacubitril/valsartan (LCZ696) is available as 24/26 mg, 49/51 mg, and 97/103 mg in tablet form to be taken orally, twice daily, for the double-blind period.

Valsartan matching placebo is available as 40 mg, 80 mg, and 160 mg in tablet form to be taken orally, twice daily, for the double-blind period.

Other Name: LCZ696

Active Comparator: valsartan

randomized in a 1:1 ratio: sacubitril/valsartan to valsartan for up to approximately 20 months of double-blind treatment.

Initial dose at randomization will be based on patient's previous dose of or lack of ACEi/ARB immediately prior to current hospital admission for ADHF, or at the time of out-of-hospital randomization.

Study treatment will be titrated to the target dose of valsartan 160 mg twice daily (Dose Level 3).

Patients will be required to take a total of two tablets twice daily (one tablet of active valsartan and one tablet of sacubitril/valsartan (LCZ696) matching placebo pack).

Drug: valsartan

Valsartan is available as 40 mg, 80 mg, and 160 mg in tablet form to be taken orally, twice daily, for the double-blind period.

Sacubitril/valsartan (LCZ696) matching placebo is available as 24/26 mg, 49/51 mg, and 97/103 mg in tablet form to be taken orally, twice daily, for the double-blind period.





Primary Outcome Measures :
  1. Proportional change in NT-proBNP from baseline to the average of weeks 4 and 8 [ Time Frame: Baseline to weeks 4 and 8 ]
    To demonstrate the effect of sacubitril/valsartan vs. valsartan on time-averaged proportional change in NT-proBNP from baseline to Weeks 4 and 8 in patients with HFpEF who have been stabilized during hospitalization for acute decompensated heart failure and initiated in-hospital or within 30 days post-discharge


Secondary Outcome Measures :
  1. Composite hierarchical outcome [ Time Frame: Baseline to Weeks 4 and 8 ]
    To determine the effect of sacubitril/valsartan vs. valsartan on the composite hierarchical outcome consisting of: a) time to CV death, b) total HF hospitalizations, c) total urgent HF visits, and d) time-averaged proportional change in NT-proBNP (from baseline to Weeks 4 and 8) using win ratio methodology

  2. Cumulative number of recurrent composite overtime [ Time Frame: Overtime ]
    To assess the effect of sacubitril/valsartan vs. valsartan on total composite events based on CV death, HF hospitalizations, and urgent HF visits

  3. Incidences of a composite endpoint of worsening renal function [ Time Frame: Overtime ]
    To assess the effect of sacubitril/valsartan vs. valsartan on the incidences of a composite endpoint of worsening renal function (renal death, reaching ESRD, or decline in eGFR >/= 50%)

  4. Proportional change in NT-proBNP from baseline to Week 8 [ Time Frame: Baseline to week 8 ]
    To assess the effect of sacubitril/valsartan vs. valsartan on change in NT-proBNP from baseline to Week 8

  5. Proportional change from baseline in hs-Troponin (high sensitivity) at Weeks 4 and 8 [ Time Frame: Baseline to weeks 4 and 8 ]
    To assess the effect of sacubitril/valsartan vs. valsartan on change from baseline in hs-Troponin (high sensitivity) at Weeks 4 and 8



Information from the National Library of Medicine

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Ages Eligible for Study:   40 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria

  1. Signed informed consent must be obtained prior to participation in the study
  2. Patients ≥40 years of age, male or female
  3. Currently hospitalized for or within 30 days following discharge of an acute decompensated HFpEF admission. Patients with a diagnosis of acute heart failure had to have symptoms and signs of fluid overload (i.e. jugular venous distention, edema or rales on auscultation or pulmonary congestion on chest x-ray). Eligible patients will be randomized no earlier than 36 hours and within 30 days post-discharge after presentation with acute HFpEF decompensation and meeting the following definitions of hemodynamic stability:

    In-hospital randomized patients will have been hemodynamically stable defined in this study as:

    1. SBP≥100mmHg for the preceding 6 hours prior to randomization; no symptomatic hypotension
    2. No increase (intensification) in i.v. diuretic dose within last 6 hours prior to randomization
    3. No i.v. inotropic drugs for 24 hours prior to randomization
    4. No i.v. vasodilators including nitrates within last 6 hours prior to randomization

    Out-of-hospital randomization patients will have been hemodynamically stabilized defined in this study as:

    1. SBP ≥100mmHg; no symptomatic hypotension
    2. No increase (intensification and/or change to IV) in diuretic dose within last 24 hours prior to randomization
    3. No i.v. inotropic drugs for 24 hours prior to randomization
  4. HFpEF with most recent LVEF >40% (within past 3 months)
  5. Elevated NT-proBNP or BNP at the time of screening (and within 72 hours from inhospital screening to out-of-hospital randomization, if applicable)

    1. Patients not in AF at the time of biomarker assessment: NT-proBNP ≥ 500pg/mL or BNP ≥ 150 pg/mL; patients in AF at the time of biomarker assessment: NT-proBNP ≥ 1000pg/mL or BNP ≥ 300 pg/mL
    2. Patients recruited in-hospital will be randomized based on the qualifying local lab value in-hospital NT-proBNP or BNP value. In-hospital is the preferred method of enrollment.
    3. Patients enrolled out-of-hospital can be randomized based on their NT-proBNP or BNP value in the following way:

    if enrolling in out-of-hospital setting then need eligible screening/local NTproBNP/BNP within 72 hours of randomization. The test value could be from recent hospitalization if within 72 hours or would require (re)drawing NT-proBNP or BNP labs in out-of-hospital setting if the lab value is not already available within the last 72 hours

  6. Has not taken an ACEi for 36 hours prior to randomization

Exclusion Criteria

  1. Any clinical event within the 90 days prior to randomization that could have reduced the LVEF (i.e., MI, CABG), unless an echo measurement was performed after the event confirming the LVEF to be >40%
  2. Currently taking Entresto™ (sacubitril/valsartan) or any prior use
  3. eGFR < 20ml/min/1.73 m2 as measured by the simplified Modification of Diet in Renal Disease (MDRD) formula at most recent assessment prior to randomization and within 24 hours prior to randomization
  4. Serum potassium > 5.2 mEq/L at most recent assessment prior to randomization and within 24 hours prior to randomization
  5. Acute coronary syndrome, stroke, transient ischemic attack; cardiac, carotid or other major CV surgery; percutaneous coronary intervention (PCI) or carotid angioplasty, within 30 days prior to randomization
  6. Probable alternative diagnoses that in the opinion of the investigator could account for the patient's HF symptoms (i.e. dyspnea, fatigue) such as significant pulmonary disease (including primary pulmonary HTN), anemia or obesity. Specifically, patients with the following are excluded:

    1. Severe pulmonary disease including chronic obstructive pulmonary disease (COPD) (i.e. requiring home oxygen, oral steroid therapy) or
    2. Hemoglobin (Hgb) < 9.5 g/dL males and < 9 g/dL females or
    3. Body mass index (BMI) > 50 kg/m2 at randomization
  7. Isolated right HF in the absence of left-sided structural heart disease
  8. History of hypersensitivity (i.e. including angioedema), known or suspected contraindications, or intolerance to any of the study drugs including ARNIs (i.e.sacubitril/valsartan), and/or ARBs
  9. Patients with a known history of angioedema due to any etiology
  10. Patients with a history of heart transplant or LVAD, currently on the transplant list, or with planned intent to implant LVAD or CRT device within the initial three months of enrollment during the trial
  11. A cardiac or non-cardiac medical condition other than HF with an estimated life expectancy of < 12 months
  12. Known pericardial constriction, genetic hypertrophic cardiomyopathy, or infiltrative cardiomyopathy including amyloid heart disease (amyloidosis)
  13. Life-threatening or uncontrolled dysrhythmia, including symptomatic or sustained ventricular tachycardia and atrial fibrillation or flutter with a resting ventricular rate >110 bpm
  14. Clinically significant congenital heart disease felt to be the cause of the patient's symptoms and signs of HF
  15. Coronary or carotid artery disease or valvular heart disease likely to require surgical or percutaneous intervention within the duration of the trial
  16. Any surgical or medical condition, which in the opinion of the investigator, may place the patient at higher risk from his/her participation in the study, or is likely to prevent the patient from complying with the requirements of the study or completing the study
  17. Known hepatic impairment (as evidenced by total bilirubin > 3 mg/dL, or increased ammonia levels, if performed), or history of cirrhosis with evidence of portal hypertension such as varices
  18. Participation in any other clinical trial involving investigational agents or devices within the past 30 days
  19. Pregnant or nursing women; women of childbearing potential that are not using a highly effective method of contraception until 1 week following last dose
  20. Women of childbearing potential, defined as all women physiologically capable of becoming pregnant, unless they are using basic methods of contraception during dosing of study treatment

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03988634


Contacts
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Contact: Novartis Pharmaceuticals 1-888-669-6682 novartis.email@novartis.com
Contact: Novartis Pharmaceuticals +41613241111

Locations
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Sponsors and Collaborators
Novartis Pharmaceuticals
Investigators
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Study Director: Novartis Pharmaceuticals Novartis Pharmaceuticals
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Responsible Party: Novartis Pharmaceuticals
ClinicalTrials.gov Identifier: NCT03988634    
Other Study ID Numbers: CLCZ696DUS01
First Posted: June 17, 2019    Key Record Dates
Last Update Posted: September 17, 2020
Last Verified: September 2020
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes
Plan Description: Novartis is committed to sharing with qualified external researchers, access to patient-level data and supporting clinical documents from eligible studies. These requests are reviewed and approved by an independent review panel on the basis of scientific merit. All data provided is anonymized to respect the privacy of the patients who have participated in the trial in line with applicable laws and regulations. This trial data availability is according to criteria and process described on www.clinicalstudydatarequest.com

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Novartis ( Novartis Pharmaceuticals ):
Heart failure with preserved ejection fraction (HFpEF)
Heart failure hospitalization
NYHA
NT-proBNP
Acute decompensated heart failure
Sacubitril/valsartan
Global evaluation of treatment effectiveness (GETE)
Additional relevant MeSH terms:
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Heart Failure
Heart Diseases
Cardiovascular Diseases
Valsartan
LCZ 696
Antihypertensive Agents
Angiotensin II Type 1 Receptor Blockers
Angiotensin Receptor Antagonists
Molecular Mechanisms of Pharmacological Action