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Randomized Controlled Trial
. 2016 Apr 4:15:57.
doi: 10.1186/s12933-016-0381-x.

Rationale and design of a randomized trial to test the safety and non-inferiority of canagliflozin in patients with diabetes with chronic heart failure: the CANDLE trial

Atsushi Tanaka  1 , Teruo Inoue  2 , Masafumi Kitakaze  3 , Jun-Ichi Oyama  4 , Masataka Sata  5 , Isao Taguchi  6 , Wataru Shimizu  7 , Hirotaka Watada  8 , Hirofumi Tomiyama  9 , Junya Ako  10 , Yasushi Sakata  11 , Toshihisa Anzai  12 , Masaaki Uematsu  13 , Makoto Suzuki  14 , Kazuo Eguchi  15 , Akira Yamashina  9 , Yoshihiko Saito  16 , Yasunori Sato  17 , Shinichiro Ueda  18 , Toyoaki Murohara  19 , Koichi Node  20
Affiliations
Randomized Controlled Trial

Rationale and design of a randomized trial to test the safety and non-inferiority of canagliflozin in patients with diabetes with chronic heart failure: the CANDLE trial

Atsushi Tanaka et al. Cardiovasc Diabetol. .

Abstract

Background: Because type 2 diabetes mellitus is associated strongly with an increased risk of cardiovascular diseases, the number of patients with diabetes with chronic heart failure is increasing steadily. However, clinical evidence of therapeutic strategies in such patients is still lacking. A recent randomized, placebo-controlled trial in patients with type 2 diabetes with high cardiovascular risk demonstrated that the SGLT2 inhibitor, empagliflozin, reduced the incidence of hospitalization for heart failure. Because SGLT2 inhibitors cause a reduction in body weight and blood pressure in addition to improving glycemic control, they have the potential to exert beneficial effects on the clinical pathophysiology of heart failure. The aim of the ongoing CANDLE trial is to test the safety and non-inferiority of canagliflozin, another SGLT2 inhibitor, compared with glimepiride, a sulfonylurea agent, in patients with type 2 diabetes mellitus and chronic heart failure.

Methods: A total of 250 patients with type 2 diabetes who are drug-naïve or taking any anti-diabetic agents and suffering from chronic heart failure with a New York Heart Association classification I to III will be randomized centrally into either canagliflozin or glimepiride groups (1: 1) using the dynamic allocation method stratified by age (<65, ≥65 year), HbA1c level (<6.5, ≥6.5 %), and left ventricular ejection fraction (<40, ≥40 %). After randomization, all the participants will be given the add-on study drug for 24 weeks in addition to their background therapy. The primary endpoint is the percentage change from baseline in NT-proBNP after 24 weeks of treatment. The key secondary endpoints after 24 weeks of treatment are the change from baseline in glycemic control, blood pressure, body weight, lipid profile, quality of life score related to heart failure, and cardiac and renal function.

Discussion: The CANDLE trial is the first to assess the safety and non-inferiority of canagliflozin in comparison with glimepiride in patients with type 2 diabetes with chronic heart failure. This trial has the potential to evaluate the clinical safety and efficacy of canagliflozin on heart failure. Trial registration Unique trial Number, UMIN000017669.

Keywords: Canagliflozin; Chronic heart failure; Glimepiride; NT-proBNP; Non-inferiority; SGLT2 inhibitor; Safety; Type 2 diabetes mellitus.

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Figures

Fig. 1
Fig. 1
Trial concept. Conventional diuretics are well established agents for CHF. On the other hand, SGLT2 inhibitors are new anti-diabetic agents with multiple favorable effects such as improving glycemic and metabolic parameters. In addition, empagliflozin has recently been reported to reduce the risk of CV events asterisk [13]. However, the beneficial effects of SGLT2 inhibitors in T2DM patients with CHF have yet to be established. BP blood pressure, BW body weight, CHF chronic heart failure, CV cardiovascular, SGLT2 sodium glucose cotransporter 2, T2DM type 2 diabetes mellitus
Fig. 2
Fig. 2
Trial outline
See this image and copyright information in PMC

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