Trial Outcomes & Findings for Aldosterone Breakthrough During Diovan, Tekturna, and Combination Therapy in Patients With Proteinuric Kidney Disease (NCT NCT01129557)

NCT ID: NCT01129557

Last Updated: 2014-05-15

Results Overview

The primary outcome of this study is the 9-month cumulative incidence of aldosterone breakthrough, defined as a sustained increase in 24-hour urine aldosterone above baseline, in each treatment arm.

Recruitment status

TERMINATED

Study phase

PHASE4

Target enrollment

46 participants

Primary outcome timeframe

9 months

Results posted on

2014-05-15

Participant Flow

Participant milestones

Participant milestones
Measure
Diovan
Diovan (Valsartan), an angiotensin receptor blocker (ARB) 320 mg by mouth once daily for 9 months
Tekturna
Tekturna (Aliskiren), a direct renin inhibitor (DRI) 300 mg by mouth once daily for 9 months
Tekturna + Diovan
Tekturna (Aliskiren), a direct renin inhibitor (DRI) 150 mg by mouth once daily for 9 months \& Diovan (Valsartan), an angiotensin receptor blocker (ARB) 160 mg by mouth once daily for 9 months
Overall Study
STARTED
15
17
14
Overall Study
COMPLETED
11
12
10
Overall Study
NOT COMPLETED
4
5
4

Reasons for withdrawal

Reasons for withdrawal
Measure
Diovan
Diovan (Valsartan), an angiotensin receptor blocker (ARB) 320 mg by mouth once daily for 9 months
Tekturna
Tekturna (Aliskiren), a direct renin inhibitor (DRI) 300 mg by mouth once daily for 9 months
Tekturna + Diovan
Tekturna (Aliskiren), a direct renin inhibitor (DRI) 150 mg by mouth once daily for 9 months \& Diovan (Valsartan), an angiotensin receptor blocker (ARB) 160 mg by mouth once daily for 9 months
Overall Study
Adverse Event
1
2
2
Overall Study
Novartis terminated study early
3
3
2

Baseline Characteristics

Aldosterone Breakthrough During Diovan, Tekturna, and Combination Therapy in Patients With Proteinuric Kidney Disease

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Diovan
n=15 Participants
Diovan (Valsartan), an angiotensin receptor blocker (ARB) 320 mg by mouth once daily for 9 months
Tekturna
n=17 Participants
Tekturna (Aliskiren), a direct renin inhibitor (DRI) 300 mg by mouth once daily for 9 months
Tekturna+Diovan
n=14 Participants
Tekturna (Aliskiren), a direct renin inhibitor (DRI) 150 mg by mouth once daily for 9 months \& Diovan (Valsartan), an angiotensin receptor blocker (ARB) 160 mg by mouth once daily for 9 months
Total
n=46 Participants
Total of all reporting groups
Age, Categorical
<=18 years
0 Participants
n=99 Participants
0 Participants
n=107 Participants
0 Participants
n=206 Participants
0 Participants
n=7 Participants
Age, Categorical
Between 18 and 65 years
15 Participants
n=99 Participants
17 Participants
n=107 Participants
12 Participants
n=206 Participants
44 Participants
n=7 Participants
Age, Categorical
>=65 years
0 Participants
n=99 Participants
0 Participants
n=107 Participants
2 Participants
n=206 Participants
2 Participants
n=7 Participants
Sex: Female, Male
Female
4 Participants
n=99 Participants
6 Participants
n=107 Participants
4 Participants
n=206 Participants
14 Participants
n=7 Participants
Sex: Female, Male
Male
11 Participants
n=99 Participants
11 Participants
n=107 Participants
10 Participants
n=206 Participants
32 Participants
n=7 Participants
Race/Ethnicity, Customized
American Indian or Alaska Native
0 Participants
n=99 Participants
0 Participants
n=107 Participants
0 Participants
n=206 Participants
0 Participants
n=7 Participants
Race/Ethnicity, Customized
Asian
2 Participants
n=99 Participants
3 Participants
n=107 Participants
1 Participants
n=206 Participants
6 Participants
n=7 Participants
Race/Ethnicity, Customized
Native Hawaiian or Other Pacific Islander
0 Participants
n=99 Participants
0 Participants
n=107 Participants
0 Participants
n=206 Participants
0 Participants
n=7 Participants
Race/Ethnicity, Customized
Black or African American
1 Participants
n=99 Participants
1 Participants
n=107 Participants
1 Participants
n=206 Participants
3 Participants
n=7 Participants
Race/Ethnicity, Customized
White
8 Participants
n=99 Participants
8 Participants
n=107 Participants
9 Participants
n=206 Participants
25 Participants
n=7 Participants
Race/Ethnicity, Customized
More than one race
4 Participants
n=99 Participants
4 Participants
n=107 Participants
2 Participants
n=206 Participants
10 Participants
n=7 Participants
Race/Ethnicity, Customized
Unknown or Not Reported
0 Participants
n=99 Participants
1 Participants
n=107 Participants
1 Participants
n=206 Participants
2 Participants
n=7 Participants

PRIMARY outcome

Timeframe: 9 months

The primary outcome of this study is the 9-month cumulative incidence of aldosterone breakthrough, defined as a sustained increase in 24-hour urine aldosterone above baseline, in each treatment arm.

Outcome measures

Outcome measures
Measure
Diovan
n=11 Participants
valsartan \[angiotensin receptor blocker (ARB)\] : Diovan 320 mg PO once daily for 9 months
Tekturna
n=12 Participants
aliskiren \[direct renin inhibitor (DRI)\] : Tekturna 300 mg PO once daily for 9 months
Tekturna + Diovan
n=10 Participants
aliskiren + valsartan (DRI + ARB) : Tekturna 150 mg PO once daily + Diovan 160 mg PO once daily for 9 months
9 Months: Subjects Without Aldosterone Breakthrough
Baseline: Subjects With Aldosterone Breakthrough
3 Months: Subjects With Aldosterone Breakthrough
6 Months: Subjects With Aldosterone Breakthrough
9 Months: Subjects With Aldosterone Breakthrough
Cumulative Incidence of Aldosterone Breakthrough in Subjects Who Completed the 9-month Study Protocol.
3 participants
3 participants
3 participants

SECONDARY outcome

Timeframe: Baseline, 3-, 6-, and 9-months

Mean serum aldosterone at baseline, 3-, 6-, and 9-months.

Outcome measures

Outcome measures
Measure
Diovan
n=24 Participants
valsartan \[angiotensin receptor blocker (ARB)\] : Diovan 320 mg PO once daily for 9 months
Tekturna
n=24 Participants
aliskiren \[direct renin inhibitor (DRI)\] : Tekturna 300 mg PO once daily for 9 months
Tekturna + Diovan
n=24 Participants
aliskiren + valsartan (DRI + ARB) : Tekturna 150 mg PO once daily + Diovan 160 mg PO once daily for 9 months
9 Months: Subjects Without Aldosterone Breakthrough
n=24 Participants
Baseline: Subjects With Aldosterone Breakthrough
n=9 Participants
3 Months: Subjects With Aldosterone Breakthrough
n=9 Participants
6 Months: Subjects With Aldosterone Breakthrough
n=9 Participants
9 Months: Subjects With Aldosterone Breakthrough
n=9 Participants
Serum Aldosterone Over Time During 9-month Treatment Course in Subjects With and Without Aldosterone Breakthrough.
9.1 ng/dL
Standard Deviation 5.2
4.8 ng/dL
Standard Deviation 3.1
4.9 ng/dL
Standard Deviation 3.6
4.9 ng/dL
Standard Deviation 3.8
7.3 ng/dL
Standard Deviation 4.5
8.5 ng/dL
Standard Deviation 4.3
11.7 ng/dL
Standard Deviation 5.6
11.7 ng/dL
Standard Deviation 7.5

SECONDARY outcome

Timeframe: Baseline, 3-, 6-, and 9-months

Mean urine aldosterone at baseline, 3-, 6-, and 9-months.

Outcome measures

Outcome measures
Measure
Diovan
n=24 Participants
valsartan \[angiotensin receptor blocker (ARB)\] : Diovan 320 mg PO once daily for 9 months
Tekturna
n=24 Participants
aliskiren \[direct renin inhibitor (DRI)\] : Tekturna 300 mg PO once daily for 9 months
Tekturna + Diovan
n=24 Participants
aliskiren + valsartan (DRI + ARB) : Tekturna 150 mg PO once daily + Diovan 160 mg PO once daily for 9 months
9 Months: Subjects Without Aldosterone Breakthrough
n=24 Participants
Baseline: Subjects With Aldosterone Breakthrough
n=9 Participants
3 Months: Subjects With Aldosterone Breakthrough
n=9 Participants
6 Months: Subjects With Aldosterone Breakthrough
n=9 Participants
9 Months: Subjects With Aldosterone Breakthrough
n=9 Participants
Urine Aldosterone Over Time During 9-month Treatment Course in Subjects With and Without Aldosterone Breakthrough.
10.9 ug/day
Standard Deviation 9.4
4.4 ug/day
Standard Deviation 3.3
5.5 ug/day
Standard Deviation 4.3
4.3 ug/day
Standard Deviation 2.3
7.4 ug/day
Standard Deviation 4.5
11.0 ug/day
Standard Deviation 6.2
14.4 ug/day
Standard Deviation 8.2
12.8 ug/day
Standard Deviation 5.2

SECONDARY outcome

Timeframe: Baseline, 3-, 6-, and 9-months

Mean serum potassium at baseline, 3-, 6-, and 9-months. (given as reference to interpret contemporaneous plasma \& urine aldosterone measurements.)

Outcome measures

Outcome measures
Measure
Diovan
n=24 Participants
valsartan \[angiotensin receptor blocker (ARB)\] : Diovan 320 mg PO once daily for 9 months
Tekturna
n=24 Participants
aliskiren \[direct renin inhibitor (DRI)\] : Tekturna 300 mg PO once daily for 9 months
Tekturna + Diovan
n=24 Participants
aliskiren + valsartan (DRI + ARB) : Tekturna 150 mg PO once daily + Diovan 160 mg PO once daily for 9 months
9 Months: Subjects Without Aldosterone Breakthrough
n=24 Participants
Baseline: Subjects With Aldosterone Breakthrough
n=9 Participants
3 Months: Subjects With Aldosterone Breakthrough
n=9 Participants
6 Months: Subjects With Aldosterone Breakthrough
n=9 Participants
9 Months: Subjects With Aldosterone Breakthrough
n=9 Participants
Serum Potassium Over Time During 9-month Treatment Course in Subjects With and Without Aldosterone Breakthrough.
4.2 mmol/L
Standard Deviation 0.5
4.4 mmol/L
Standard Deviation 0.5
4.4 mmol/L
Standard Deviation 0.4
4.4 mmol/L
Standard Deviation 0.4
4.3 mmol/L
Standard Deviation 0.2
4.2 mmol/L
Standard Deviation 0.2
4.3 mmol/L
Standard Deviation 0.2
4.4 mmol/L
Standard Deviation 0.4

SECONDARY outcome

Timeframe: Baseline, 3-, 6-, and 9-months

Mean 24-hour urine sodium (mmol/day) at baseline, 3-, 6-, and 9-months. (given as reference to interpret contemporaneous plasma \& urine aldosterone measurements.)

Outcome measures

Outcome measures
Measure
Diovan
n=24 Participants
valsartan \[angiotensin receptor blocker (ARB)\] : Diovan 320 mg PO once daily for 9 months
Tekturna
n=24 Participants
aliskiren \[direct renin inhibitor (DRI)\] : Tekturna 300 mg PO once daily for 9 months
Tekturna + Diovan
n=24 Participants
aliskiren + valsartan (DRI + ARB) : Tekturna 150 mg PO once daily + Diovan 160 mg PO once daily for 9 months
9 Months: Subjects Without Aldosterone Breakthrough
n=24 Participants
Baseline: Subjects With Aldosterone Breakthrough
n=9 Participants
3 Months: Subjects With Aldosterone Breakthrough
n=9 Participants
6 Months: Subjects With Aldosterone Breakthrough
n=9 Participants
9 Months: Subjects With Aldosterone Breakthrough
n=9 Participants
Mean 24-hour Urine Sodium Over Time During 9-month Treatment Course in Subjects With and Without Aldosterone Breakthrough.
158 mmol/day
Standard Deviation 67
180 mmol/day
Standard Deviation 81
188 mmol/day
Standard Deviation 66
169 mmol/day
Standard Deviation 70
258 mmol/day
Standard Deviation 98
220 mmol/day
Standard Deviation 65
250 mmol/day
Standard Deviation 102
200 mmol/day
Standard Deviation 54

SECONDARY outcome

Timeframe: Baseline and Final (9 month)

Compares baseline and final (9 month) blood pressure for subjects with and without aldosterone breakthrough

Outcome measures

Outcome measures
Measure
Diovan
n=24 Participants
valsartan \[angiotensin receptor blocker (ARB)\] : Diovan 320 mg PO once daily for 9 months
Tekturna
n=24 Participants
aliskiren \[direct renin inhibitor (DRI)\] : Tekturna 300 mg PO once daily for 9 months
Tekturna + Diovan
n=9 Participants
aliskiren + valsartan (DRI + ARB) : Tekturna 150 mg PO once daily + Diovan 160 mg PO once daily for 9 months
9 Months: Subjects Without Aldosterone Breakthrough
n=9 Participants
Baseline: Subjects With Aldosterone Breakthrough
3 Months: Subjects With Aldosterone Breakthrough
6 Months: Subjects With Aldosterone Breakthrough
9 Months: Subjects With Aldosterone Breakthrough
Pre- and Post-treatment Blood Pressure in Subjects With and Without Aldosterone Breakthrough.
Office systolic Blood Pressure
134.0 mm Hg
Standard Deviation 10.9
122.0 mm Hg
Standard Deviation 12.0
136.3 mm Hg
Standard Deviation 9.8
127.9 mm Hg
Standard Deviation 10.8
Pre- and Post-treatment Blood Pressure in Subjects With and Without Aldosterone Breakthrough.
Office diastolic Blood Pressure
83.7 mm Hg
Standard Deviation 8.9
74.0 mm Hg
Standard Deviation 9.3
87.7 mm Hg
Standard Deviation 6.6
81.6 mm Hg
Standard Deviation 10.2

SECONDARY outcome

Timeframe: Baseline and Final (9 month)

Compares baseline and final (9 month) serum creatinine for subjects with and without aldosterone breakthrough

Outcome measures

Outcome measures
Measure
Diovan
n=24 Participants
valsartan \[angiotensin receptor blocker (ARB)\] : Diovan 320 mg PO once daily for 9 months
Tekturna
n=24 Participants
aliskiren \[direct renin inhibitor (DRI)\] : Tekturna 300 mg PO once daily for 9 months
Tekturna + Diovan
n=9 Participants
aliskiren + valsartan (DRI + ARB) : Tekturna 150 mg PO once daily + Diovan 160 mg PO once daily for 9 months
9 Months: Subjects Without Aldosterone Breakthrough
n=9 Participants
Baseline: Subjects With Aldosterone Breakthrough
3 Months: Subjects With Aldosterone Breakthrough
6 Months: Subjects With Aldosterone Breakthrough
9 Months: Subjects With Aldosterone Breakthrough
Pre- and Post-treatment Serum Creatinine in Subjects With and Without Aldosterone Breakthrough.
1.2 mg/dL
Standard Deviation 0.3
1.3 mg/dL
Standard Deviation 0.4
1.2 mg/dL
Standard Deviation 0.5
1.4 mg/dL
Standard Deviation 1.1

SECONDARY outcome

Timeframe: Baseline and Final (9 month)

Compares baseline and final (9 month) serum potassium for subjects with and without aldosterone breakthrough

Outcome measures

Outcome measures
Measure
Diovan
n=24 Participants
valsartan \[angiotensin receptor blocker (ARB)\] : Diovan 320 mg PO once daily for 9 months
Tekturna
n=24 Participants
aliskiren \[direct renin inhibitor (DRI)\] : Tekturna 300 mg PO once daily for 9 months
Tekturna + Diovan
n=9 Participants
aliskiren + valsartan (DRI + ARB) : Tekturna 150 mg PO once daily + Diovan 160 mg PO once daily for 9 months
9 Months: Subjects Without Aldosterone Breakthrough
n=9 Participants
Baseline: Subjects With Aldosterone Breakthrough
3 Months: Subjects With Aldosterone Breakthrough
6 Months: Subjects With Aldosterone Breakthrough
9 Months: Subjects With Aldosterone Breakthrough
Pre- and Post-treatment Serum Potassium in Subjects With and Without Aldosterone Breakthrough.
4.2 (mmol/L)
Standard Deviation 0.5
4.4 (mmol/L)
Standard Deviation 0.4
4.3 (mmol/L)
Standard Deviation 0.2
4.4 (mmol/L)
Standard Deviation 0.4

SECONDARY outcome

Timeframe: Baseline and Final (9 month)

Compares baseline and final (9 month) 24-hour urine protein for subjects with and without aldosterone breakthrough

Outcome measures

Outcome measures
Measure
Diovan
n=24 Participants
valsartan \[angiotensin receptor blocker (ARB)\] : Diovan 320 mg PO once daily for 9 months
Tekturna
n=24 Participants
aliskiren \[direct renin inhibitor (DRI)\] : Tekturna 300 mg PO once daily for 9 months
Tekturna + Diovan
n=9 Participants
aliskiren + valsartan (DRI + ARB) : Tekturna 150 mg PO once daily + Diovan 160 mg PO once daily for 9 months
9 Months: Subjects Without Aldosterone Breakthrough
n=9 Participants
Baseline: Subjects With Aldosterone Breakthrough
3 Months: Subjects With Aldosterone Breakthrough
6 Months: Subjects With Aldosterone Breakthrough
9 Months: Subjects With Aldosterone Breakthrough
Pre- and Post-treatment 24-hour Urine Protein in Subjects With and Without Aldosterone Breakthrough.
2827 (mg/day)
Standard Deviation 2736
1911 (mg/day)
Standard Deviation 2958
3844 (mg/day)
Standard Deviation 3502
2681 (mg/day)
Standard Deviation 2967

SECONDARY outcome

Timeframe: Baseline and Final (9 month)

Compares baseline and final (9 month) 24-hour urine sodium for subjects with and without aldosterone breakthrough

Outcome measures

Outcome measures
Measure
Diovan
n=24 Participants
valsartan \[angiotensin receptor blocker (ARB)\] : Diovan 320 mg PO once daily for 9 months
Tekturna
n=24 Participants
aliskiren \[direct renin inhibitor (DRI)\] : Tekturna 300 mg PO once daily for 9 months
Tekturna + Diovan
n=9 Participants
aliskiren + valsartan (DRI + ARB) : Tekturna 150 mg PO once daily + Diovan 160 mg PO once daily for 9 months
9 Months: Subjects Without Aldosterone Breakthrough
n=9 Participants
Baseline: Subjects With Aldosterone Breakthrough
3 Months: Subjects With Aldosterone Breakthrough
6 Months: Subjects With Aldosterone Breakthrough
9 Months: Subjects With Aldosterone Breakthrough
Pre- and Post-treatment 24-hour Urine Sodium in Subjects With and Without Aldosterone Breakthrough.
158 (mmol/day)
Standard Deviation 67
169 (mmol/day)
Standard Deviation 70
258 (mmol/day)
Standard Deviation 98
200 (mmol/day)
Standard Deviation 54

SECONDARY outcome

Timeframe: Baseline and Final (9 month)

Compares baseline and final (9 month) 24-hour urine aldosterone for subjects with and without aldosterone breakthrough

Outcome measures

Outcome measures
Measure
Diovan
n=24 Participants
valsartan \[angiotensin receptor blocker (ARB)\] : Diovan 320 mg PO once daily for 9 months
Tekturna
n=24 Participants
aliskiren \[direct renin inhibitor (DRI)\] : Tekturna 300 mg PO once daily for 9 months
Tekturna + Diovan
n=9 Participants
aliskiren + valsartan (DRI + ARB) : Tekturna 150 mg PO once daily + Diovan 160 mg PO once daily for 9 months
9 Months: Subjects Without Aldosterone Breakthrough
n=9 Participants
Baseline: Subjects With Aldosterone Breakthrough
3 Months: Subjects With Aldosterone Breakthrough
6 Months: Subjects With Aldosterone Breakthrough
9 Months: Subjects With Aldosterone Breakthrough
Pre- and Post-treatment 24-urine Aldosterone in Subjects With and Without Aldosterone Breakthrough.
10.9 (ug/day)
Standard Deviation 9.4
4.3 (ug/day)
Standard Deviation 2.3
7.4 (ug/day)
Standard Deviation 4.5
12.8 (ug/day)
Standard Deviation 5.2

SECONDARY outcome

Timeframe: Baseline and Final (9 month)

Compares baseline and final (9 month) serum aldosterone for subjects with and without aldosterone breakthrough

Outcome measures

Outcome measures
Measure
Diovan
n=24 Participants
valsartan \[angiotensin receptor blocker (ARB)\] : Diovan 320 mg PO once daily for 9 months
Tekturna
n=24 Participants
aliskiren \[direct renin inhibitor (DRI)\] : Tekturna 300 mg PO once daily for 9 months
Tekturna + Diovan
n=9 Participants
aliskiren + valsartan (DRI + ARB) : Tekturna 150 mg PO once daily + Diovan 160 mg PO once daily for 9 months
9 Months: Subjects Without Aldosterone Breakthrough
n=9 Participants
Baseline: Subjects With Aldosterone Breakthrough
3 Months: Subjects With Aldosterone Breakthrough
6 Months: Subjects With Aldosterone Breakthrough
9 Months: Subjects With Aldosterone Breakthrough
Pre- and Post-treatment Serum Aldosterone in Subjects With and Without Aldosterone Breakthrough.
9.1 (ng/dL)
Standard Deviation 5.2
4.9 (ng/dL)
Standard Deviation 3.8
7.3 (ng/dL)
Standard Deviation 4.6
11.7 (ng/dL)
Standard Deviation 7.5

Adverse Events

Tekturna

Serious events: 0 serious events
Other events: 2 other events
Deaths: 0 deaths

Diovan

Serious events: 0 serious events
Other events: 1 other events
Deaths: 0 deaths

Tekturna + Diovan

Serious events: 0 serious events
Other events: 2 other events
Deaths: 0 deaths

Serious adverse events

Adverse event data not reported

Other adverse events

Other adverse events
Measure
Tekturna
n=17 participants at risk
Tekturna (Aliskiren), a direct renin inhibitor (DRI) 300 mg by mouth once daily for 9 months
Diovan
n=15 participants at risk
Diovan (Valsartan), an angiotensin receptor blocker (ARB) 320 mg by mouth once daily for 9 months
Tekturna + Diovan
n=14 participants at risk
Tekturna (Aliskiren), a direct renin inhibitor (DRI) 150 mg by mouth once daily for 9 months \& Diovan (Valsartan), an angiotensin receptor blocker (ARB) 160 mg by mouth once daily for 9 months
Renal and urinary disorders
>25% increase in creatinine
0.00%
0/17
6.7%
1/15 • Number of events 1
0.00%
0/14
General disorders
Hypotension
5.9%
1/17 • Number of events 1
0.00%
0/15
7.1%
1/14 • Number of events 1
Skin and subcutaneous tissue disorders
Rash
0.00%
0/17
0.00%
0/15
7.1%
1/14 • Number of events 1
Nervous system disorders
Headache
5.9%
1/17 • Number of events 1
0.00%
0/15
0.00%
0/14

Additional Information

Andrew Bomback, MD

Columbia University Medical Center, Division of Nephrology

Phone: 212-305-5020

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place