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Diabetic Nephropathy Type 2Phase 3NCT05487755

Investigational and Comparative Study in the Management of Diabetic Nephropathy

A Phase 3 study testing Tadalafil 20Mg Oral Tablet and Pentoxifylline 400 MG Oral Tablet in people with Diabetic Nephropathy Type 2, run by Tanta University at 1 site in Egypt.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The objective of this study is to investigate and compare the safety and efficacy of selective (PDE5) enzyme inhibitor; tadalafil and non selective (PDE) inhibitor; pentoxifylline in diabetic nephropathy to improve glucose metabolism, lipid profile and decrease albuminuria. Read more about this study

Who is it for?
Ages 35 to 70 years
Conditions the study is for
Diabetic Nephropathy Type 2
What is being tested?
Tadalafil 20Mg Oral Tablet and Pentoxifylline 400 MG Oral Tablet
Type of treatment
Pill or oral medicine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
90 participants
Where
1 siteEgypt
Study dates
1 Feb 2022to 1 Sep 2023
Phase
Phase 3
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 35 to 70 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • A confirmed with clinical diagnosis of T2DM with duration at least 7 years to ensure established of micro-vascular complication (DKD).
  • females (post-menopause), males with sufficient erectile function.
  • Patients on stage 3 DN with evidence of persistent micro-albuminuria. All Abnormal tests of (UACR) must be confirmed in two out of three samples collected over a 6 month period before enrolled in the study.
  • (urinary ACR≥30-300mg/g) in 3 consecutive measurements in 6 months period despite treatment with RAAS blockade(ramipril 10 mg ) ACEI or for at least 6 months period before enrollment in the study at maximum recommended tolerated dose.
  • Exclusion Criteria:Cardiovascular disease: angina, arrhythmias, myocardial Infarction, heart failure (NYHA II -IV), uncontrolled hypertension > (170 \100 mm Hg) severe hypotension < (90\50 mm Hg), Hearing problem, vision defect, previous episodes of retinal / cerebral hemorrhage, psychiatric disease, thyroid disorders, alcohol abuse, smoking, Hepatic insufficiency (child -Pugh class C), (ALT or AST>3N), cholestasis, history of chronic inflammatory, immunologic or malignant disease. Acute inflammation or infectious disease in the previous 3 months, taking immunosuppressive treatment, Known allergy to tadalafil or methylxanthine, Use alpha one blockers, use of anti-oxidant drugs three months before enrollment in the study ,medications strongly alter CYP3A4 inducer or inhibitor, use of nitrates, other PDEI drugs, - Renal disease (acute kidney injury, recent exposure to radio- contrast media, creatinine clearance <30 ml/ min /1.73 m2 , bleeding disorders, peptic ulcer, and stroke, Pregnancy, lactation.

Who cannot join

None listed.

Trial locations and contacts

1 site in 1 country.

Egypt1 site
  • Faculty of pharmacy

    Tanta

Other trials in Egypt

About this study

Official title: Investigational and Comparative Study to Assess Safety and Effectiveness of Tadalafil and Pentoxifyllin in the Management of Diabetic Nephropathy

The objective of this study is to investigate and compare the safety and efficacy of selective (PDE5) enzyme inhibitor; tadalafil and non selective (PDE) inhibitor; pentoxifylline in diabetic nephropathy to improve glucose metabolism, lipid profile and decrease albuminuria.

Read the detailed description

Diabetic nephropathy(DN) is one of the major micro- vascular complications of diabetes mellitus and the leading cause of end-stage renal disease (ESRD) that require renal replacement therapies.

The average incidence of diabetic nephropathy is 3% per year during the first 10 to 20 years after diabetes onset. Diabetic nephropathy occurs in 20-40% of all diabetic patients.

Pathogenesis of diabetic nephropathy is complex and multi-factorial in which diabetes mellitus has more than pathway for initiation and progression of the disease.

  • Metabolic pathway: result in formation of advanced glycation end products (AGEs).
  • Inflammatory pathway: result in increase serum level of tumor necrosis factor-α(TNF .
  • Hemodynamic pathway: result in increase serum level of endothelin-1 which result in glomerular hypertension and hyper filtration.

Tadalafil is a phosphodiesterase type 5 enzyme (PDE5) inhibitor used mainly in erectile dysfunction and pulmonary hypertension by a mechanism involving increase(NO-cGMP-PKG) signaling pathway.

Tadalafil is a powerful pleiotropic drug that it can be used in DN as it can target more than pathway involved in pathogenesis of DN include hyperglycemia and endothelial dysfunction through increase (NO-cGMP) signaling pathway as well as hyperlipidemia. Animal studies reported that tadalafil increase significantly total antioxidant capacity(TAC),decrease significantly serum level of inflammatory marker (TNF- α), blood glucose level, serum creatinine ,serum urea and urinary albumin excretion all result in decrease renal inflammation, injury, necrosis and apoptosis.

Pentoxifylline is a methyl xanthine derivative, non selective phosphodiesterase enzyme inhibitor used mainly to treat peripheral vascular diseases by improve blood flow, increase red blood cell flexibility and inhibit platelet aggregation.

Pentoxifylline have been recently widely used in many animal studies and clinical trials to evaluate its efficacy in management of DN and the results were so promising.(14)

Pentoxifylline can slow the decrease in eGFR, and significantly reduce albuminuria in which it can be effective alternative to ACEI in reducing albuminuria as proved by clinical trial.(15) The powerful effect of pentoxifylline in DN as it can affect several pathways implicated in pathogenesis of DN; it has hypoglycemic effect by decrease Significantly blood glucose, HbA1c and serum triglyceride, it also decrease pro inflammatory cytokines (TNF-α, IL-1, IL-6), reduce plasma level of malondialdehyde and increase glutathione level.(16)

Neutrophil Gelatinase-Associated Lipocalin (NGAL): is a 25-kDa protein belong to lipocalin superfamily. The urinary concentration of NGAL increase in renal tubular damage as a result of both diminished reabsorption and increased release from renal tubules into urine indicating both proximal and distal tubular damage respectively.(17) NGAL is not considered a marker of renal function but a marker of structural damage of renal tubules, its level can quantify the degree of tubular damage.(18) NGAL can be used as a precocious marker of therapeutic response by application of NGAL measurement in monitoring the effectiveness of a particular treatment and predicting different clinical outcomes in the course of renal diseases

Being tested
Tadalafil 20Mg Oral Tablet, Pentoxifylline 400 MG Oral Tablet

What participants receive

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

  • Tadalafil 20Mg Oral TabletDrug

    Also called cialong

    Tadalafil is a phosphodiesterase type 5 enzyme (PDE5) inhibitor used mainly in erectile dysfunction and pulmonary hypertension by a mechanism involving increase(NO-cGMP-PKG) signaling pathway.(8) Tadalafil is a powerful pleiotropic drug that it can be used in DN as it can target more than pathway involved in pathogenesis of DN include hyperglycemia and endothelial dysfunction through increase (NO-cGMP) signaling pathway as well as hyperlipidemia

  • Pentoxifylline 400 MG Oral TabletDrug

    Also called Pental SR

    Pentoxifylline is a methyl xanthine derivative, non selective phosphodiesterase enzyme inhibitor used mainly to treat peripheral vascular diseases by improve blood flow

Study groups in NCT05487755
Study groupRoleWhat they receive
control groupNo intervention: (n=30) control group will receive traditional therapy blood glucose lowering agent +RAAS blockade ACEI or ARBs for six months.
Tadalafil groupExperimental:( n=30) will receive traditional therapy +tadalafil PO 20 mg every other day for six months
Receives: Drug: Tadalafil 20Mg Oral Tablet
pentoxifylline groupExperimental:( n=30) will receive traditional therapy+ pentoxifylline PO 400 mg twice daily for six months.
Receives: Drug: Pentoxifylline 400 MG Oral Tablet

What is being measured

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

  1. Change in Urinary albumin/creatinine ratio (ACR)

    Measurement of urine albumin to creatinne ratio by measurement of urine albumin using Turbidimetric immunoassay method and measurement of urine creatinnie by standard by enzymatic colorimetric methods

    Measured: Change between baseline and six months after

  2. Change in Hemoglobin A1c (HbA1c).

    Measurement of Hemoglobin A1C using (HPLC: ion exchange chromatography)

    Measured: Change between baseline and six months after

  3. Change in Fasting blood glucose.

    Measurement of Fasting blood glucose by using standard enzymatic colorimetric methods

    Measured: Change between baseline and six months after

  4. Change in Sr Cr

    Measurement of serum creatinine using colorimetric technique

    Measured: Change between baseline and six months after

  5. Change in Creatinine clearance

    Creatinine clearance was calculated by (Cockcroft-Gault Formula)

    Measured: Change between baseline and six months after

  6. change in 2- Hours Postprandial blood glucose

    Measurement 2- Hours Postprandial blood glucose in blood using standard enzymatic colorimetric methods

    Measured: Change between baseline and six months after

Secondary outcomes (4)
  1. Change in serum ((TNF-α).

    Measurement of serum level of (TNF-α) by Enzyme linked immunosorbent assay (ELISA).

    Measured: Change between baseline and six months after

  2. Change in Urinary NGAL (uNGAL).

    Measurement of urinary Neutrophil Gelatinase-Associated Lipocalin (NGAL)using by Enzyme linked immunosorbent assay ELISA technique:

    Measured: Change between baseline and six months after

  3. Change in Lipid profile (TG, LDL, and HDL).

    Measurement of serum lipid profile (TC,TG,HDL,LDL)using Enzymatic Colorimetric Method

    Measured: Change between baseline and six months after

  4. Change in serum malondialdehyde (MDA) .

    Meaurement of serum malondialdehyde by Enzyme linked immunosorbent assay (ELISA) .

    Measured: Change between baseline and six months after

Timeline

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

  1. First posted4 Aug 2022
  2. Study start1 Feb 2022
  3. Primary completion1 Mar 2023
  4. Study completion1 Sep 2023

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 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
* This is a randomized, controlled, prospective study. * Ninety diabetic nephropathy patients at stage 3(micro-albuminuria) will be divided into three groups as follow -Group 1: (n=30) control group will receive traditional therapy blood glucose lowering agent +RAAS blockade ACEI or ARBs for six months. * Group 2 :( n=30) will receive traditional therapy +tadalafil PO 20 mg every other day for six months. Group 3 :( n=30) will receive traditional therapy+ pentoxifylline PO 400 mg twice daily for six months.
Masking
None (open label)
Enrolment
90 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05487755
Sponsor's protocol ID
DN mangement
Status last verified
May 2024
First submitted
22 Jul 2022
Last updated
14 May 2024
Results posted
No
FDA-regulated drug
No
FDA-regulated device
No

Publications

  • Rivero A, Mora C, Muros M, Garcia J, Herrera H, Navarro-Gonzalez JF. Pathogenic perspectives for the role of inflammation in diabetic nephropathy. Clin Sci (Lond). 2009 Mar;116(6):479-92. doi: 10.1042/CS20080394.

    PubMed 19200057
  • Wada J, Makino H. Inflammation and the pathogenesis of diabetic nephropathy. Clin Sci (Lond). 2013 Feb;124(3):139-52. doi: 10.1042/CS20120198.

    PubMed 23075333
  • Hegazy SK, Amaar WA, Hegab WSM. Tadalafil versus pentoxifylline in the management of diabetic kidney disease: a randomized clinical trial. Diabetol Metab Syndr. 2024 Jun 24;16(1):138. doi: 10.1186/s13098-024-01363-3.

    PubMed 38915115

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Tadalafil 20Mg Oral Tablet and Pentoxifylline 400 MG Oral Tablet in people with Diabetic Nephropathy Type 2, run by Tanta University at 1 site in Egypt.

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 5 inclusion and 0 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: finished, as of the sponsor's last update on 14 May 2024. 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 Egypt. 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. 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 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

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

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

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

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change in Urinary albumin/creatinine ratio (ACR) (time frame: Change between baseline and six months after). The study lists 6 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 NCT05487755, which also lists 3 linked publications.

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 14 May 2024.

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