Heart Failure
Conditions
Brief summary
The purpose of this study is to determine the superiority of the effectiveness of canagliflozin 100 milligram (mg) daily versus placebo in participants with symptomatic heart failure (HF) in improving the overall Kansas City Cardiomyopathy Questionnaire (KCCQ) Total Symptom Score (TSS).
Interventions
Participants will receive 100 mg immediate-release, over-encapsulated tablets (as a capsule) orally once daily.
Participants will receive matching placebo capsules orally once daily.
Sponsors
Study design
Eligibility
Inclusion criteria
\- Have clinically stable symptomatic heart failure (HF) (heart failure with reduced ejection fraction \[HFrEF\] and heart failure with preserved ejection fraction \[HFpEF\]): (A) For HFrEF: (a) ejection fraction (EF) less than or equal to (\<=) 40 percent (%) and (b) a primary diagnosis of HF OR 2 medical visits (including virtual) with a HF diagnosis code in any position in the past 18 months (B) For HFpEF: (a) EF greater than (\>) 40%; (b) a primary diagnosis of HF OR 2 medical visits (including virtual) with a HF diagnosis code in any position in the past 18 months, AND; (C) on a loop diuretic or spironolactone or eplerenone (mineralocorticoid receptor antagonists), in the past 18 months * Have a baseline Kansas City Cardiomyopathy Questionnaire (KCCQ) score of less than or equal to (\<=) 80 prior to randomization * Be able to read and understand English * Possess and have sole use (example: not shared with other users) of smartphone compatible with the Fitbit device * Willing/able to wear the Fitbit device on a regular basis for the 9-month study period
Exclusion criteria
* Currently taking a sodium-glucose co-transporter 2 inhibitor (SGLT2i) or within the last 3 months * History of diabetic ketoacidosis or have type 1 diabetes mellitus (T1DM) * Have acute decompensated HF (exacerbation of symptomatic HF) requiring intravenous diuretics, inotropes, or vasodilators within the last 4 weeks * Have stage 4 or 5 Chronic Kidney Disease (that is, estimated glomerular filtration rate \[eGFR\] \<30 milliliter per minute \[ml/min\] on dialysis) from the most recent assessment * Have a diagnosis of hypotension within 30 days
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change From Baseline in Kansas City Cardiomyopathy Questionnaire-Total Symptom Score (KCCQ-TSS) at Week 12 | Baseline, Week 12 | Change from baseline in KCCQ-TSS was reported. KCCQ was a 23-item, self-administered questionnaire that measure the participant's perception of their health status, including their heart failure (HF) symptoms, impact on physical and social function and how their HF impacts the quality of life. KCCQ quantifies 7 domains: physical limitations (6 items), symptom stability (1 item), symptom frequency (4 items), symptom burden (3 items), self-efficacy (2 items), quality of life (3 items) and social limitations (4 items). Scores were generated for each domain and scaled from 0 to 100, with 0 denoting the worst and 100 the best possible status. KCCQ-TSS was average of domains- symptom frequency and symptom burden, and transformed to a single score which ranged from 0 (worst) to 100 (the best possible status), where the higher score reflected better health status. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change From Baseline in Total Daily Step Count at Week 12 | Baseline, Week 12 | Change from baseline in total daily step count at Week 12 was reported in this outcome measure. The number of steps taken per day was measured using a step activity monitor at baseline and throughout the study. Step count was measured from the Fitbit device data. The Fitbit app on the participant's phone collected all data from the Fitbit device. A negative change from baseline indicated a decrease in the number of daily steps. |
| Change From Baseline in KCCQ Individual Domain Scores (Physical Limitation and Quality of Life) at Week 12 | Baseline, Week 12 | Change from baseline in KCCQ physical limitation score and KCCQ quality of life score were reported. KCCQ was a 23-item, self-administered questionnaire that measure the participant's perception of their health status, including their heart failure (HF) symptoms, impact on physical and social function and how their HF impacts the quality of life. KCCQ quantifies 7 domains: physical limitations (6 items), symptom stability (1 item), symptom frequency (4 items), symptom burden (3 items), self-efficacy (2 items), quality of life (3 items) and social limitations (4 items). Scores were generated for each domain and scaled from 0 to 100, with 0 (worst) and 100 (the best possible status), where the higher score reflected better health status. |
| Change From Baseline in KCCQ Clinical Summary Score at Week 12 | Baseline, Week 12 | Change from baseline in KCCQ-clinical summary score was reported. KCCQ was a 23-item, self-administered questionnaire that measure the participant's perception of their health status, including their heart failure (HF) symptoms, impact on physical and social function and how their HF impacts the quality of life. KCCQ quantifies 7 domains: physical limitations (6 items), symptom stability (1 item), symptom frequency (4 items), symptom burden (3 items), self-efficacy (2 items), quality of life (3 items) and social limitations (4 items). Scores were generated for each domain and scaled from 0 to 100, with 0 denoting the worst and 100 the best possible status. KCCQ-clinical summary score was average of domains- physical limitation and total symptoms (average of symptom frequency and symptom burden), and transformed to a single score which ranged from 0 (worst) -100 (the best possible status), where the higher score reflected better health status. |
| Change From Baseline in KCCQ Overall Summary Score at Week 12 | Baseline, Week 12 | Change from baseline in KCCQ-overall summary score was reported. KCCQ was a 23-item, self-administered questionnaire that measure the participant's perception of their health status, including their heart failure (HF) symptoms, impact on physical and social function and how their HF impacts the quality of life. KCCQ quantifies 7 domains: physical limitations (6 items), symptom stability (1 item), symptom frequency (4 items), symptom burden (3 items), self-efficacy (2 items), quality of life (3 items) and social limitations (4 items). Scores were generated for each domain and scaled from 0 to 100, with 0 denoting the worst and 100 the best possible status. KCCQ- overall summary score was average of domains- physical limitation, total symptoms (average of symptom frequency and symptom burden), quality of life, and social limitation, and transformed to a single score which ranged from 0 (worst) -100 (the best possible status), where the higher score reflected better health status. |
Countries
United States
Participant flow
Pre-assignment details
A total of 1,333 participants were screened. Of which, 476 participants were randomized in the study.
Participants by arm
| Arm | Count |
|---|---|
| Placebo Participants received placebo (matched to canagliflozin) capsule orally once daily for 12 weeks. | 231 |
| Canagliflozin 100 mg Participants received canagliflozin 100 milligrams (mg) immediate-release, over-encapsulated tablet (as capsule) orally once daily for 12 weeks. | 224 |
| Total | 455 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Death | 5 | 3 |
| Overall Study | Lost to Follow-up | 4 | 6 |
| Overall Study | Protocol Violation | 3 | 4 |
| Overall Study | Withdrawal by Subject | 19 | 16 |
Baseline characteristics
| Characteristic | Canagliflozin 100 mg | Total | Placebo |
|---|---|---|---|
| Age, Continuous | 62.9 Years STANDARD_DEVIATION 13.15 | 63.4 Years STANDARD_DEVIATION 13.32 | 63.8 Years STANDARD_DEVIATION 13.5 |
| Race/Ethnicity, Customized Asian | 1 Participants | 2 Participants | 1 Participants |
| Race/Ethnicity, Customized Black or African American | 35 Participants | 65 Participants | 30 Participants |
| Race/Ethnicity, Customized Other | 4 Participants | 5 Participants | 1 Participants |
| Race/Ethnicity, Customized White | 184 Participants | 383 Participants | 199 Participants |
| Sex: Female, Male Female | 105 Participants | 204 Participants | 99 Participants |
| Sex: Female, Male Male | 119 Participants | 251 Participants | 132 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 5 / 231 | 3 / 224 |
| other Total, other adverse events | 0 / 231 | 0 / 224 |
| serious Total, serious adverse events | 36 / 231 | 33 / 224 |
Outcome results
Change From Baseline in Kansas City Cardiomyopathy Questionnaire-Total Symptom Score (KCCQ-TSS) at Week 12
Change from baseline in KCCQ-TSS was reported. KCCQ was a 23-item, self-administered questionnaire that measure the participant's perception of their health status, including their heart failure (HF) symptoms, impact on physical and social function and how their HF impacts the quality of life. KCCQ quantifies 7 domains: physical limitations (6 items), symptom stability (1 item), symptom frequency (4 items), symptom burden (3 items), self-efficacy (2 items), quality of life (3 items) and social limitations (4 items). Scores were generated for each domain and scaled from 0 to 100, with 0 denoting the worst and 100 the best possible status. KCCQ-TSS was average of domains- symptom frequency and symptom burden, and transformed to a single score which ranged from 0 (worst) to 100 (the best possible status), where the higher score reflected better health status.
Time frame: Baseline, Week 12
Population: Full analysis set (FAS) included all randomized participants who had received at least one dose of study intervention/medication and had at least one post-baseline KCCQ measurement. Here, N (Overall number of participants analyzed) signifies participants evaluable for this outcome measure.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Placebo | Change From Baseline in Kansas City Cardiomyopathy Questionnaire-Total Symptom Score (KCCQ-TSS) at Week 12 | 4.9 Score on a scale | Standard Error 1.27 |
| Canagliflozin 100 mg | Change From Baseline in Kansas City Cardiomyopathy Questionnaire-Total Symptom Score (KCCQ-TSS) at Week 12 | 9.2 Score on a scale | Standard Error 1.27 |
Change From Baseline in KCCQ Clinical Summary Score at Week 12
Change from baseline in KCCQ-clinical summary score was reported. KCCQ was a 23-item, self-administered questionnaire that measure the participant's perception of their health status, including their heart failure (HF) symptoms, impact on physical and social function and how their HF impacts the quality of life. KCCQ quantifies 7 domains: physical limitations (6 items), symptom stability (1 item), symptom frequency (4 items), symptom burden (3 items), self-efficacy (2 items), quality of life (3 items) and social limitations (4 items). Scores were generated for each domain and scaled from 0 to 100, with 0 denoting the worst and 100 the best possible status. KCCQ-clinical summary score was average of domains- physical limitation and total symptoms (average of symptom frequency and symptom burden), and transformed to a single score which ranged from 0 (worst) -100 (the best possible status), where the higher score reflected better health status.
Time frame: Baseline, Week 12
Population: FAS included all randomized participants who had received at least one dose of study intervention/medication and had at least one post-baseline KCCQ measurement. Here, N (Overall number of participants analyzed) signifies participants evaluable for this outcome measure.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Placebo | Change From Baseline in KCCQ Clinical Summary Score at Week 12 | 4.7 Score on a scale | Standard Error 1.16 |
| Canagliflozin 100 mg | Change From Baseline in KCCQ Clinical Summary Score at Week 12 | 8.5 Score on a scale | Standard Error 1.17 |
Change From Baseline in KCCQ Individual Domain Scores (Physical Limitation and Quality of Life) at Week 12
Change from baseline in KCCQ physical limitation score and KCCQ quality of life score were reported. KCCQ was a 23-item, self-administered questionnaire that measure the participant's perception of their health status, including their heart failure (HF) symptoms, impact on physical and social function and how their HF impacts the quality of life. KCCQ quantifies 7 domains: physical limitations (6 items), symptom stability (1 item), symptom frequency (4 items), symptom burden (3 items), self-efficacy (2 items), quality of life (3 items) and social limitations (4 items). Scores were generated for each domain and scaled from 0 to 100, with 0 (worst) and 100 (the best possible status), where the higher score reflected better health status.
Time frame: Baseline, Week 12
Population: FAS included all randomized participants who had received at least one dose of study intervention/medication and had at least one post-baseline KCCQ measurement. Here, N (Overall number of participants analyzed) signifies participants evaluable for this outcome measure. Here, 'n' (number analyzed) signifies participants with available data for each specified category.
| Arm | Measure | Group | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|---|
| Placebo | Change From Baseline in KCCQ Individual Domain Scores (Physical Limitation and Quality of Life) at Week 12 | KCCQ-Physical Limitation | 4.8 Score on a scale | Standard Error 1.26 |
| Placebo | Change From Baseline in KCCQ Individual Domain Scores (Physical Limitation and Quality of Life) at Week 12 | KCCQ-Quality of Life | 9.1 Score on a scale | Standard Error 1.4 |
| Canagliflozin 100 mg | Change From Baseline in KCCQ Individual Domain Scores (Physical Limitation and Quality of Life) at Week 12 | KCCQ-Physical Limitation | 7.8 Score on a scale | Standard Error 1.27 |
| Canagliflozin 100 mg | Change From Baseline in KCCQ Individual Domain Scores (Physical Limitation and Quality of Life) at Week 12 | KCCQ-Quality of Life | 12.4 Score on a scale | Standard Error 1.41 |
Change From Baseline in KCCQ Overall Summary Score at Week 12
Change from baseline in KCCQ-overall summary score was reported. KCCQ was a 23-item, self-administered questionnaire that measure the participant's perception of their health status, including their heart failure (HF) symptoms, impact on physical and social function and how their HF impacts the quality of life. KCCQ quantifies 7 domains: physical limitations (6 items), symptom stability (1 item), symptom frequency (4 items), symptom burden (3 items), self-efficacy (2 items), quality of life (3 items) and social limitations (4 items). Scores were generated for each domain and scaled from 0 to 100, with 0 denoting the worst and 100 the best possible status. KCCQ- overall summary score was average of domains- physical limitation, total symptoms (average of symptom frequency and symptom burden), quality of life, and social limitation, and transformed to a single score which ranged from 0 (worst) -100 (the best possible status), where the higher score reflected better health status.
Time frame: Baseline, Week 12
Population: FAS included all randomized participants who had received at least one dose of study intervention/medication and had at least one post-baseline KCCQ measurement. Here, N (Overall number of participants analyzed) signifies participants evaluable for this outcome measure.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Placebo | Change From Baseline in KCCQ Overall Summary Score at Week 12 | 6.2 Score on a scale | Standard Error 1.18 |
| Canagliflozin 100 mg | Change From Baseline in KCCQ Overall Summary Score at Week 12 | 9.5 Score on a scale | Standard Error 1.18 |
Change From Baseline in Total Daily Step Count at Week 12
Change from baseline in total daily step count at Week 12 was reported in this outcome measure. The number of steps taken per day was measured using a step activity monitor at baseline and throughout the study. Step count was measured from the Fitbit device data. The Fitbit app on the participant's phone collected all data from the Fitbit device. A negative change from baseline indicated a decrease in the number of daily steps.
Time frame: Baseline, Week 12
Population: FAS included all randomized participants who had received at least one dose of study intervention/medication and had at least one post-baseline KCCQ measurement. Here, N (Overall number of participants analyzed) signifies participants evaluated for this outcome measure.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Placebo | Change From Baseline in Total Daily Step Count at Week 12 | -74.9 Daily step count | Standard Error 112.85 |
| Canagliflozin 100 mg | Change From Baseline in Total Daily Step Count at Week 12 | -45.1 Daily step count | Standard Error 113.78 |