研究疾病:
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糖尿病肾病
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研究疾病代码:
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Target disease:
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diabetic nephropathy
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Target disease code:
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研究类型:
Study type:
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干预性研究
Interventional study
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研究设计:
Study design:
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随机平行对照
randomized controlled trial(parallel group design)
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研究所处阶段:
Study phase:
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上市后药物
Post-marketing clinical trial
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研究目的:
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观察与达格列净比较,雷公藤多苷治疗中晚期糖尿病肾病的疗效和安全性。包括有效剂量、使用疗程与不良反应、心血管安全性等。
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Objectives of Study:
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To observe the efficacy and safety of Tripterygium wilfordii polyglycoside in the treatment of advanced diabetic nephropathy compared with dagaglizin. Including effective dose, course of use and adverse reactions, cardiovascular safety, etc.
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药物成份或治疗方案详述:
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Description for medicine or protocol of treatment in detail:
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纳入标准:
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1.自愿在与本试验相关的活动开始前签署知情同意书,并能够理解本试验的程序和方法,愿意严格遵守临床试验方案完成本试验;
2.符合糖尿病肾病的诊断标准,6月内曾接受肾活检,病理诊断符合 DN或虽未行肾活检,但临床诊断符合DN;
3.筛选时5%≤HbA1c≤9.5%;随机入组时5%≤HbA1c≤9.0%
4.随机入组时100≤SBP<160mmHg且60≤DBP<100mmHg;
5.筛选和随机时eGFR大于等于30ml/min/1.73m2。eGFR计算使用CDK-EPI公式;其中CKD3期与CKD2+1期随机比例为60%:40%。
6.筛选前和随机时尿蛋白定量≥0.5g/24h或ACR≥300mg/g;
7.筛选前已接受厄贝沙坦基础治疗,≥0.15g/d或达到最大耐受剂量并保持稳定至少4周,对于不足0.15g的要说明不能耐受的原因,比如是血压过低还是药物副作用过大,或eGFR下降的速率:4周内下降超过30%。
8.筛选前4周内未服用任何肾脏治疗药物,包括:百令胶囊,黄葵胶囊,金水保,怡开,达格列净,雷公藤,及为使用其他免疫抑制药物,如来氟米特,羟氯喹,糖皮质激素制剂。
9..筛选时性别不限,年龄 30~80岁
10.筛选时BMI:19-35kgm2(包括两端)
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Inclusion criteria
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1. Voluntarily sign the informed consent before the start of the activities related to this trial, understand the procedures and methods of this trial, and be willing to strictly abide by the clinical trial protocol to complete this trial;
2. They met the diagnostic criteria of diabetic nephropathy. They had received renal biopsy within 6 months, and the pathological diagnosis was consistent with DN, or the clinical diagnosis was consistent with DN although they did not receive renal biopsy;
3. 5% ≤ HbA1c ≤ 9.5% at screening and 5% ≤ HbA1c ≤ 9.0% at random
4. 100 ≤ SBP < 160mmhg and 60 ≤ DBP < 100mmhg at random;
5. The EGFR was greater than or equal to 30ml / min / 1.73m 2 at screening and random. EGFR was calculated by cdk-epi formula, and the random proportion of CKD3 and CKD2+1 was 60% : 40%.
6. Urine routine PRO+ or above before screening and at randomization ,Urinary protein ≥ 0.5g/24h or ACR ≥ 300mg / g before screening and at random;
7. Prior to screening, irbesartan basal treatment was ≥0.15g/d or reached the maximum tolerated dose and remained stable for at least 4 weeks. For less than 0.15g, the reason for intolerance should be explained, such as hypotension or excessive side effects of the drug, or eGFR decline rate: over 30% within 4 weeks.
8.Did not take any renal therapy drugs during the 4 weeks prior to screening, including: Bellingcapsule, Huangkui capsule, Jinshuibao, Iicai, dagalizin, tripterygium wilfordii, and other immunosuppressive drugs, such as leflunomide, hydroxychloroquine, and glucocorticoid preparations.
9. There was no gender limit in the screening, the age was 30-80 years old;
10. Screening BMI:19-35kgm2 (including both ends)
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排除标准:
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1、2周内使用过SGLT2抑制剂类降糖药;
2、3个月内参加任何药物或医疗器械的临床试验,且接受过研究药
物或器械干预;
3、研究者怀疑受试者可能对研究药物过敏或不耐受。
4.随机前有以下任何一种疾病的病史或证据:
1)既往病史或临床证据提示非糖尿病性肾脏疾病;
2)需要免疫抑制治疗的肾脏疾病或慢性透析或肾移植病史;
3)3个月内出现过急性糖尿病并发症(糖尿病酮症酸中毒、乳酸性酸中毒、高渗性非酮症糖尿病昏迷);
4)3个月内出现过失代偿性心力衰竭(NYHA分级ⅣV级)、不稳定性心绞痛、脑血管意外、心肌梗死、严重心律失常、进行过冠状动脉旁路移植术或经皮腔内冠状动脉成形术;
5)3个月内进行重大手术或尚未从手术中完全恢复;
6)5年内发生过任何器官系统恶性肿瘤(局部皮肤基底细胞癌除外),或恶性肿瘤发生于筛选前5年前,但目前疾病处于活动期
7)人免疫缺陷病毒(HIV)抗体阳性史及乙肝(大三阳、小三阳)阳性病史;
8)已知重大肝脏疾病(急慢性肝炎、肝硬化);
9)合并风湿免疫性疾病,且正接受免疫调节或抑制药物治疗;
10)有尿路感染症状,或尿LEU2+及以上。
5.筛选时有任何一项实验室检查指标符合下列标准
1)谷丙转氨酶或谷草转氨酶>3.0×UNL或总胆红素>2.0×UNL
2)血钾>5.5mmol/L;
3)白蛋白<25g/L;
4)Hb 小于90g;
5)尿常规提示LEU 2+及以上。
6. 儿童、育龄期有孕育要求者(一年以内)、孕妇和哺乳期妇女。
受试者为研究中心员工或与参与本研究实施的研究中心员工有从属关系(现行法定配偶、父母、子女、亲兄弟姐妹)
7.研究者认为患者具有任何可能影响本研究的疗效和安全性评价或导致者不能成功参与研究的因素(医疗、心理、社会或地理性因素)。
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Exclusion criteria:
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1. SGLT2 inhibitors were used within 2 weeks;
2. Participated in the clinical trials of any drug or medical device within 3 months, and received the research drug
Intervention of objects or devices;
3. The researchers suspected that the subjects might be allergic or intolerant to the study drug.
4. History or evidence of any of the following diseases before randomization:
1) Previous medical history or clinical evidence suggest non-diabetic kidney disease;
2) History of kidney disease or chronic dialysis or kidney transplantation requiring immunosuppressive therapy;
3) Acute diabetic complications (diabetic ketoacidosis, lactic acidosis, hypertonic nonketotic diabetic coma) occurred within 3 months;
4) Within 3 months, the patients had decompensated heart failure (NYHA grade IV V), unstable angina pectoris, cerebrovascular accident, myocardial infarction, severe arrhythmia, coronary artery bypass grafting or percutaneous transluminal coronary angioplasty;
5) Major operation or incomplete recovery within 3 months;
6) Malignant tumor of any organ system (except local skin basal cell carcinoma) occurred within 5 years, or malignant tumor occurred 5 years before screening, but the disease is in active stage at present
7) Positive history of HIV antibody and positive history of hepatitis B (big three positive, small three positive);
8) Major liver diseases (acute and chronic hepatitis, cirrhosis) are known;
9) He was complicated with rheumatic immune diseases and was receiving immunomodulatory or suppressive drugs;
10) Urinary tract infection symptoms, or urinary leu2 + and above.
5. Any one of the laboratory indexes met the following criteria
1) Alanine aminotransferase or aspartate aminotransferase > 3.0 × unl or total bilirubin > 2.0 × unl
2) Blood potassium > 5.5mmol/l;
3) Albumin < 25g / L;
4) Hb is less than 90g;
5) Urine routine examination showed Leu 2 + and above.
6. Children, those of childbearing age who have pregnancy requirements (within one year), pregnant women and lactating women.
The subjects are employees of the research center or have affiliation with the employees of the research center participating in the implementation of this study (current legal spouse, parents, children, siblings)
7. The researcher believes that the patient has any factors (medical, psychological, social or geographical factors) that may affect the efficacy and safety evaluation of the study or cause the patient to fail to participate in the study.
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研究实施时间:
Study execute time:
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从From
2022-02-08
至To
2024-02-08
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征募观察对象时间:
Recruiting time:
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从From
2022-02-25
至To
2024-02-08
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