NCT05004363: LIFT

Lokelma for RAAS Maximisation in CKD & Heart Failure.

Status unknown Phase 3 Last updated 18 May 2023

What this trial tests

Phase 3 trial testing Lokelma Oral Product in Chronic Kidney Diseases in 130 participants. Status unknown.

Timeline

19 January 2022

Primary endpoint
31 December 2023

31 December 2023

Quick facts

Lead sponsor	St George's, University of London
Phase	Phase 3
Status	Status unknown
Study type	INTERVENTIONAL
Allocation	randomized
Design	parallel
Masking	quadruple
Primary purpose	treatment
Enrollment	130
Start date	19 January 2022
Primary completion	31 December 2023
Estimated completion	31 December 2023
Sites	1 location across United Kingdom

Drugs / interventions tested

• Lokelma Oral Product — full drug profile →

Conditions studied

• Chronic Kidney Diseases — all drugs for Chronic Kidney Diseases →
• Heart Failure With Reduced Ejection Fraction — all drugs for Heart Failure With Reduced Ejection Fraction →
• Hyperkalemia — all drugs for Hyperkalemia →
• ACE Inhibitor Induced Hyperkalaemia — all drugs for ACE Inhibitor Induced Hyperkalaemia →

Sponsor

St George's, University of London

Who can join

18 and older, any sex, with Chronic Kidney Diseases or Heart Failure With Reduced Ejection Fraction. Patients with the condition only — healthy volunteers not accepted.

Sponsor's own description

Background: CKD in patients with heart failure (HF) is common and associated with poor prognosis. Despite evidence of benefit with Renin-Angiotensin-Aldosterone-System inhibitor (RAASi) agents, they are avoided due to fear of hyperkalaemia. New potassium binders, e.g. Sodium Zirconium Cyclosilicate (SZC), reduce incidence of hyperkalaemia in CKD-HF patients and hence may help RAASi maximisation, which has not been investigated in an RCT.

Purpose: The proposed study will randomise HFrEF patients with stable CKD 3-5 and serum potassium 5-5.0 mmol/L, to receive SZC or placebo while RAASi therapy is maximised. The aim of the study is to examine if SZC is superior to placebo in achieving maximal doses of ACEi/ARB, e.g. Ramipril 10 mg, Candesartan 32 mg; and mineralocorticoid receptor antagonist, e.g. Epleronone 50 mg or Spironolactone 50 mg, avoiding hyperkalaemia.

Methods: Eligible patients with eGFR\<60 mL/min/1.73m2, heart failure (EF\<40%) on none/submaximal dose of RAASi will be randomised to receive 10g TDS of investigational medicinal product (IMP), either SZC or placebo, for 48 hours and in 10 or 5g OD guided by laboratory serum potassium (K+). Every two weeks the RAASi dose will be increased and IMP adjusted according to a strict protocol and guided by laboratory potassium and creatinine. The primary endpoint of the study is achievement of maximal dose of RAASi in randomised patients avoiding hyperkalaemia, i.e. K+≤5.6 mmol/L. Patients will be allowed to continue with RAASi maximisation to K+\<6.0mmol/L. Patients will be tested at baseline and follow-up visits for hyperkalaemia, AKI, symptomatic hypotension and QT prolongation on ECG.

Results: The study results will show if SZC is superior to placebo for RAASi maximisation in CKD-HF patients while maintaining safe levels of serum potassium without any adverse impact on quality of life. The study will demonstrate if SZC allows higher RAASi dose and more dose escalations than placebo. It will also examine the impact of RAASi escalation on creatinine, proteinuria, and cardiac blood biomarkers.

Conclusion: If positive, the results of this study will demonstrate that SZC enables RAASi up titration in CKD-HF patients, which potentially can help achieve optimal treatment and improve quality of life of the patient.

Publications & conference data

2 peer-reviewed publications reference this trial (live from Europe PMC):

1. Steroidal or non-steroidal MRAs: should we still enable RAASi use through K binders?
   Gregg LP, Navaneethan SD. · · 2023 · cited 12× · PMID 36264349 · DOI 10.1093/ndt/gfac284
2. Evolving therapeutic strategies for patients hospitalized with new or worsening heart failure across the spectrum of left ventricular ejection fraction.
   Ostrominski JW, Vaduganathan M. · · 2022 · cited 7× · PMID 35789014 · DOI 10.1002/clc.23849