SGLT2 Inhibitors in ATTR

• Status: Not yet recruiting
• Trial end date: 2023-03-01
• Target enrollment: 0
• Participant gender: All

Summary

This is a single center, single arm, prospective, 12 week open label pilot trial of the sodium-glucose cotransporter 2 inhibitor (SGLT2i), empagliflozin 10 mg oral daily, in patients with transthyretin amyloid cardiomyopathy (ATTR-CM). The target population for enrollment will be subjects with ATTR-CM and either non-insulin dependent diabetes mellitus or chronic kidney disease. The primary aim will be to assess the safety and tolerability of empagliflozin 10 mg oral daily in subjects with heart failure secondary to ATTR, which remain unexplored. The accrual target is 15 subjects. Consented subjects will be evaluated for safety and tolerability of study drug, empagliflozin 10 mg oral daily, over a period of 12 weeks. Subjects will undergo a total of 6 study visits: 3 in-person and 3 telephone follow-ups.

• Phase: Phase 4
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: Columbia University
• Treatments: Empagliflozin

Criteria

Inclusion Criteria:

• Every participant must meet all of the following inclusion criteria to be eligible for enrollment in this study:

1. Age ≥ 18 years old

2. Diagnosis of TTR cardiac amyloidosis (wild type or variant), confirmed by the presence of amyloid deposits on analysis of biopsy specimens obtained from cardiac and noncardiac sites (e.g. fat aspirate, gastrointestinal sites, salivary glands, or bone marrow), technetium-99m pyrophosphate cardiac scintigraphy, or mass spectrometry

3. Normal serum free light chain ratio and the absence of abnormal monoclonal band on serum and urine immunofixation

4. Subjects will have at least 1 of the indications below for an SGLT2i, and meet package-insert criteria for drug initiation: non-insulin dependent diabetes mellitus with hemoglobin A1c ranging from 6.5-9.9 OR chronic kidney disease (defined as an estimated glomerular filtration rate of 25-75 ml/minute/1.73 m2 of body-surface area)

5. On stable oral diuretics (defined as no more than a 50% increase from baseline diuretic dose established during a sustained 2 week period) within 2 weeks before enrollment

6. Able to understand and sign the informed consent document after the nature of the study has been fully explained

Exclusion Criteria:

• The presence of any of the following excludes eligibility for enrollment in this study:

1. Prior liver or heart transplantation

2. Active malignancy or non-amyloid disease with expected survival of less than 1 year

3. Heart failure, in the opinion of the investigator, primarily caused by severe left-sided valve disease. Note: if valve was repaired, subject may be considered as no longer with severe valve disease

4. Heart failure, in the opinion of the investigator, primarily caused by ischemic heart disease

5. Ventricular assist device or anticipated within the next 6 months

6. Pacemaker or implantable cardioverter defibrillator incompatible with magnetic resonance technology

7. Absolute contraindication for quantitative magnetic resonance (e.g. aneurysmal clips, metal objects)

8. Impairment from stroke, injury or other medical disorder that precludes participation in the study

9. Myocardial infarction, cardiovascular surgery, stroke or transient ischemic attack within the prior 90 days

10. Disabling dementia or other mental or behavioral disease

11. Enrollment in a clinical trial not approved for co-enrollment

12. Expected use of continuous intravenous inotropic therapy in the next 6 months

13. High risk for non-adherence as determined by screening evaluation

14. Inability or unwillingness to comply with the study requirements

15. Chronic kidney disease with estimated glomerular filtration rate (eGFR) <15 mL/min/1.73 m2 or end-stage renal disease

16. Current or prior SGLT2i use

17. Type 1 diabetes mellitus or insulin-dependent diabetes mellitus

18. N-terminal (NT)-pro hormone BNP (NT-proBNP) < 300 pg/mL or < 900 pg/mL if concomitant diagnosis of atrial fibrillation

19. History of ketoacidosis

20. History of complex urinary tract or genital infections

21. History of kidney stone

22. Systolic blood pressure < 90 mmHg and symptomatic hypotension

23. Systolic blood pressure ≥ 180 mmg Hg

24. Chronic obstructive pulmonary disease

25. Major surgery in the 90 days before or after screening

26. Chronic alcohol or drug abuse

27. Nursing home resident

28. Other reason that would make the subject inappropriate for entry into this study