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Cardiovascular Risk FactorPhase 2DAPA-SWEETNCT04258371

DAPAgliflozin Sodium Water glucosE EffecTs in Patients at High Cardiovascular Risk

A Phase 2 study testing Dapagliflozin 10 MG in people with Cardiovascular Risk Factor, run by University Health Network, Toronto at 1 site in Canada.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

This study aims to elucidate the impact of SGLT2 inhibition on peripheral vascular function, renal function, fluid volume, neurohormonal activation and inflammatory/fibrotic pathways in patients with T2D at high cardiovascular risk and non-T2D patients. Read more about this study

Who is it for?
Ages 50 years and older
Conditions the study is for
Cardiovascular Risk Factor
What is being tested?
Dapagliflozin 10 MG
Type of treatment
Pill or oral medicine
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
50 participants
Where
1 siteCanada
Study dates
10 Feb 2020to Dec 2023
Phase
Phase 2
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 50 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • eGFR ≥30 ml/min/1.73m2
  • In patients with type 2 diabetes, HbA1c <12.0%
  • Body Mass Index (BMI) 18.5-45.0 kg/m2
  • Blood pressure < or = 160/100 at screening (sitting)
  • Stable dose of maximally tolerated ACE inhibitor, angiotensin receptor blocker or renin inhibitor for at least 30 days
  • Stable diuretic dose for at least 14 days prior to baseline study Visit
  • High cardiovascular risk: an age of 50 years or more with at least one cardiovascular coexisting condition (coronary heart disease, cerebrovascular disease, peripheral vascular disease, chronic kidney disease of stage 3 or greater, or chronic heart failure of New York Heart Association class II or III) OR an age of 60 years or more with at least one cardiovascular risk factor, as determined by the investigator (microalbuminuria or proteinuria, hypertension and left ventricular hypertrophy, left ventricular systolic or diastolic dysfunction, or an ankle-brachial index [the ratio of the systolic blood pressure at the ankle to the systolic blood pressure in the arm] of less than 0.9).

Who cannot join

  • Type 1 Diabetes
  • Iodine intolerance
  • Hypersensitivity or allergy to dapagliflozin
  • Use of an SGLT2 inhibitor within 30 days
  • Leukocyte and/or nitrite positive urinalysis that is untreated
  • Severe hypoglycaemia within 1 month prior to screening
Show all 20Show fewer
  • Unstable coronary artery disease with acute coronary syndrome, percutaneous intervention or bypass surgery within 3 months
  • Clinically significant valvular disease in the opinion of the investigator
  • Congestive heart failure secondary to an infiltrative cardiomyopathic process (for example amyloid) or pericardial constriction
  • Bariatric surgery or other surgeries that induce chronic malabsorption within 1 year;
  • Anti-obesity drugs or diet regimen and unstable body weight three months prior to screening;
  • Treatment with systemic corticosteroids
  • Blood dyscrasias or any disorders causing hemolysis or unstable red blood cells
  • Pre-menopausal women who are nursing, pregnant, or of child-bearing potential and not practicing an acceptable method of birth control
  • Participation in another trial with an investigational drug within 30 days of informed consent
  • Alcohol or drug abuse within three months prior to informed consent that would interfere with trial participation or any ongoing clinical condition that would jeopardize subject safety or study compliance based on investigator judgement
  • Liver disease, defined by serum levels of alanine transaminase, aspartate transaminase, or alkaline phosphatase >3 x upper limit of normal as determined during screening
  • Medical history of cancer or treatment for cancer in the last five years prior to screening, aside from uncomplicated basal cell or squamous cell carcinoma;
  • Unstable or rapidly progressive renal disease as per investigator judgement
  • Intolerance or sensitivity to SGLT2 inhibitors

Trial locations and contacts

1 site in 1 country.

Yuliya Lytvyn, PhD contact

julia.lytvyn@mail.utoronto.ca

Canada1 site, 1 recruiting
  • Renal Physiology Laboratory

    Toronto

    Vesta Lai, RN, 416-340-4800 ext. 8508, vesta.lai@uhn.ca

    Yuliya Lytvyn, PhD, julia.lytvyn@mail.utoronto.ca

    Recruiting

Other trials in Canada

About this study

This study aims to elucidate the impact of SGLT2 inhibition on peripheral vascular function, renal function, fluid volume, neurohormonal activation and inflammatory/fibrotic pathways in patients with T2D at high cardiovascular risk and non-T2D patients.

Read the detailed description

In light of EMPA-REG OUTCOME, CANVAS Program and DECLARE trials, we aim to elucidate the impact of SGLT2 inhibition on peripheral vascular function while also exploring the effects of this therapy on renal function, fluid volume, neurohormonal activation and inflammatory/fibrotic pathways in patients with T2D at high cardiovascular risk to best replicate the patient populations in recent cardiovascular outcome trials (CVOT), who are also participating in ongoing CVOTs such as VERTIS (ertugliflozin), as well as non-T2D patients in other ongoing trials examining cardiorenal effects of these therapies. We will test the hypothesis that in a high- risk population, regardless of T2D status, SGLT2 inhibition will improve markers of arterial stiffness (decreases in pulse wave velocity and augmentation index) in the study cohort - a surrogate marker of cardiovascular risk independent of glucose lowering. In addition, dapagliflozin will improve endothelial function ("flow-mediated vasodilatation" - FMD) and increase natriuresis (fractional excretion of sodium or FENa+), thereby reducing blood pressure, without inducing renal vasoconstriction or activation of the sympathetic nervous system (SNS). Based on extensive experimental literature, we also hypothesize that SGLT2 inhibition will suppress levels of pro-inflammatory/fibrotic mediators (see below) that have been linked with progression of cardiovascular and renal disease. The systematic understanding of the effects of SGLT2 inhibitors in the setting of patients at high cardiovascular risk will enable the design of rational physiology-based strategies to decrease the burden of cardiorenal disease, which could have important clinical and research implications. Data from DAPA-SWEET will also be valuable to better understand the results of trials that include patients using SGLT2 inhibitors as primary prevention strategies, such as in DECLARE TIMI-58.

Being tested
Dapagliflozin 10 MG, Placebo oral tablet
Keywords
SGLT2 inhibition, Cardiovascular risk, Dapagliflozin

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Dapagliflozin 10 MGDrug

    Dapagliflozin Tablets Total Dose 10mg daily for 12 weeks

  • Placebo oral tabletDrug

    Placebo once daily for 12 weeks

Study groups in NCT04258371
Study groupRoleWhat they receive
Dapagliflozin Treatment ArmExperimentalDapagliflozin Tablets Total Dose 10mg daily for 12 weeks
Receives: Drug: Dapagliflozin 10 MG
Placebo ArmPlacebo comparatorPlacebo Matching Dapagliflozin Tablet for 12 weeks
Receives: Drug: Placebo oral tablet

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Arterial stiffness

    Measured using a Sphygmocor device

    Measured: Acute (1 week)

  2. Arterial stiffness

    Measured using a Sphygmocor device

    Measured: Chronic (12 weeks)

Secondary outcomes (28)
  1. Glomerular filtration rate

    GFR

    Measured: Glomerular Filtration Rate (GFR, based on plasma iohexol clearance) will be measured at 2 time points: acute (1 week) and chronic (12 weeks)

  2. Flow mediated dilation

    FMD

    Measured: Outcome will remeasured at 2 time points: acute (1 week) and chronic (12 weeks)

  3. Nitroglycerin mediated dilation

    Measured: Outcome will remeasured at 2 time points: acute (1 week) and chronic (12 weeks)

  4. Systolic blood pressure

    Measured: Outcome will remeasured at 2 time points: acute (1 week) and chronic (12 weeks)

  5. Diastolic blood pressure

    Measured: Outcome will remeasured at 2 time points: acute (1 week) and chronic (12 weeks)

  6. Heart rate

    Measured: Outcome will remeasured at 2 time points: acute (1 week) and chronic (12 weeks)

  7. Echocardiography

    Changes to systolic and diastolic function

    Measured: Outcome will remeasured at 2 time points: acute (1 week) and chronic (12 weeks)

  8. Non-Invasive Cardiac Output Monitoring (Measured using a NICOM device)

    Cardiac output and systemic vascular resistance

    Measured: Outcome will remeasured at 2 time points: acute (1 week) and chronic (12 weeks)

  9. Bioimpedence spectroscopy

    Measure of extracellular water

    Measured: Outcome will remeasured at 2 time points: acute (1 week) and chronic (12 weeks)

  10. Plasma concentration of natriuretic peptides

    Measured: Outcome will remeasured at 2 time points: acute (1 week) and chronic (12 weeks)

  11. Plasma concentration of the renin-angiotensin aldosterone system (RAAS) hormones

    Measured: Outcome will remeasured at 2 time points: acute (1 week) and chronic (12 weeks)

  12. Nitric oxide

    Measured: Outcome will remeasured at 2 time points: acute (1 week) and chronic (12 weeks)

  13. Fractional excretion of sodium, using lithium clearance as a surrogate for proximal tubular sodium handling

    Measured: Outcome will remeasured at 2 time points: acute (1 week) and chronic (12 weeks)

  14. Urinary concentration of the renin-angiotensin aldosterone system (RAAS) markers

    Measured: Outcome will remeasured at 2 time points: acute (1 week) and chronic (12 weeks)

  15. Urinary adenosine

    Measured: Outcome will remeasured at 2 time points: acute (1 week) and chronic (12 weeks)

  16. mRNA expression of monocyte chemoattractant protein-1(MCP-1)

    Measured in urine and skin biopsy samples

    Measured: Outcome will remeasured at 2 time points: acute (1 week) and chronic (12 weeks)

  17. mRNA expression of intercellular adhesion molecule-1(ICAM-1)

    Measured in urine and skin biopsy samples

    Measured: Outcome will remeasured at 2 time points: acute (1 week) and chronic (12 weeks)

  18. mRNA expression of plasminogen activator inhibitor-1(PAI-1)

    Measured in urine and skin biopsy samples

    Measured: Outcome will remeasured at 2 time points: acute (1 week) and chronic (12 weeks)

  19. mRNA expression of transforming growth factor-beta (TGF-beta)

    Measured in urine and skin biopsy samples

    Measured: Outcome will remeasured at 2 time points: acute (1 week) and chronic (12 weeks)

  20. mRNA expression of connective tissue growth factor (CTGF)

    Measured in urine and skin biopsy samples

    Measured: Outcome will remeasured at 2 time points: acute (1 week) and chronic (12 weeks)

  21. mRNA expression of interleukins (IL-1beta, IL-6)

    Measured in urine and skin biopsy samples

    Measured: Outcome will remeasured at 2 time points: acute (1 week) and chronic (12 weeks)

  22. mRNA expression of tumour necrosis factor-alpha (TNF-alpha)

    Measured in urine and skin biopsy samples

    Measured: Outcome will remeasured at 2 time points: acute (1 week) and chronic (12 weeks)

  23. mRNA expression of matrix metalloproteinases 2 (MMP2)

    Measured in urine and skin biopsy samples

    Measured: Outcome will remeasured at 2 time points: acute (1 week) and chronic (12 weeks)

  24. mRNA expression of matrix metalloproteinases 9 (MMP9)

    Measured in urine and skin biopsy samples

    Measured: Outcome will remeasured at 2 time points: acute (1 week) and chronic (12 weeks)

  25. mRNA expression of advances glycation end-product (AGE)

    Measured in urine and skin biopsy samples

    Measured: Outcome will remeasured at 2 time points: acute (1 week) and chronic (12 weeks)

  26. mRNA expression of receptor for AGE (RAGE)

    Measured in urine and skin biopsy samples

    Measured: Outcome will remeasured at 2 time points: acute (1 week) and chronic (12 weeks)

  27. Urinary thiobarbituric acid reactive substances (TBARS)

    Measured: Outcome will remeasured at 2 time points: acute (1 week) and chronic (12 weeks)

  28. Urinary 8-hydroxydeoxyguanosine (8-OHdG)

    Measured: Outcome will remeasured at 2 time points: acute (1 week) and chronic (12 weeks)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted6 Feb 2020
  2. Study start10 Feb 2020
  3. Primary completionDec 2023 (estimated)
  4. Study completionDec 2023 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
Patients will be randomized to 10mg PO dapagliflozin daily or matching placebo.
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
50 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04258371
Sponsor's protocol ID
18-5597
Acronym
DAPA-SWEET
Status last verified
May 2023
First submitted
23 Jan 2020
Last updated
17 May 2023
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No

Publications

  • Sridhar VS, Kugathasan L, Lytvyn Y, Deng Y, Liu H, Lovblom LE, Tse J, Nardone M, Floras JS, Osuntokun T, Tobushi T, Lam RCY, Lam B, Stevens J, Burger D, Touw DJ, Heerspink HJL, Lovshin JA, Perkins BA, Cherney DZI. Cardiovascular-Kidney Effects of Dapagliflozin in Patients at Cardiovascular Risk With or Without Type 2 Diabetes: Results of a Randomized, Double-Blind, Placebo-Controlled Trial. Hypertension. 2026 Feb;83(2):e25955. doi: 10.1161/HYPERTENSIONAHA.125.25955. Epub 2025 Dec 5.

    PubMed 41347301

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Dapagliflozin 10 MG in people with Cardiovascular Risk Factor, run by University Health Network, Toronto at 1 site in Canada.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 7 inclusion and 20 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 17 May 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Canada. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

Contact Vesta Lai, RN (416-340-4800 ext. 8508, vesta.lai@uhn.ca), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Arterial stiffness (time frame: Acute (1 week)). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04258371, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 17 May 2023.

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