Bumetanide Injection for Heart Failure

(MsDR Trial)

Overseen By Veena Rao

Age: 18+

Sex: Any

Trial Phase: Phase 1

Sponsor: Yale University

Must not be taking: Non-loop diuretics

Disqualifiers: Low GFR, Flash pulmonary edema, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 5

Duration: 9 days

75 Participants Needed

Trial Summary

What is the purpose of this trial?

This study will employ a randomized order, double-blind, repeated measures dose ranging design. This design was chosen in order to generate multiple within-subject serial loop diuretic dose response exposures. The overall study schema will include 75 heart failure (HF) patients.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop all current medications, but you cannot use non-loop diuretics in the 14 days before the study, except for low-dose aldosterone antagonists like spironolactone or eplerenone at 50 mg or less.

What data supports the effectiveness of the drug Bumetanide Injection for heart failure?

While the specific effectiveness of Bumetanide Injection for heart failure isn't directly addressed, diuretics (drugs that help remove excess fluid from the body) like Bumetanide are commonly used to manage symptoms in heart failure patients. They help reduce fluid buildup, which can ease symptoms such as swelling and shortness of breath. ^{1 2 3 4 5}

How is Bumetanide Injection unique for treating heart failure?

Bumetanide Injection is unique for treating heart failure because it is a loop diuretic (a type of medication that helps remove excess fluid from the body) administered via injection, which can provide rapid relief from fluid overload compared to oral diuretics. This can be particularly beneficial in acute settings where quick action is needed to reduce symptoms like swelling and shortness of breath. ^{6 7 8 9 10}

Research Team

Jeffrey Testani, MD

Principal Investigator

Yale University

Eligibility Criteria

This trial is for adults over 18 with heart failure who are stable on their current medications and haven't been hospitalized in the last 3 months. They should not have severe kidney issues, be using certain diuretics, or have conditions like restrictive cardiomyopathy. Pregnant or breastfeeding individuals and those unable to follow the study plan are excluded.

Inclusion Criteria

I am older than 18 years.

I am not planning to change my heart failure treatments during the study.

I have been diagnosed with heart failure.

Exclusion Criteria

I have chronic issues with holding urine that would prevent me from doing certain tests.

Your hemoglobin level is less than 8 grams per deciliter.

I haven't taken any water pills except for low-dose spironolactone or eplerenone in the last 2 weeks.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

1 week

1 visit (in-person)

Pre-study Diet

Participants follow a study diet provided by the metabolic kitchen to decrease variability in diuretic response

5 days

Treatment

Participants receive randomized doses of bumetanide and undergo bio-specimen collection

9 days

4 visits (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

Treatment Details

Interventions

• Bumetanide Injection

Trial Overview The study tests how well different doses of Bumetanide Injection work in patients with heart failure. It's a controlled experiment where each patient receives multiple doses in random order without knowing which dose they're getting at any time.

Participant Groups

Group I: Bumetanide 2.5 mg Active Control 1 Intervention

2.5 mg Randomized to doses 10 mg, 5 mg, 2.5 mg, 1.25 mg

Group II: Bumetanide 1.25 mg Active Control 1 Intervention

1.25 mg Randomized to doses 10 mg, 5 mg, 2.5 mg, 1.25 mg

Group III: Bumetanide 10 mg Active Control 1 Intervention

Randomized to doses 10 mg, 5 mg, 2.5 mg, 1.25 mg

Group IV: Bumetanide 5 mg Active Control 1 Intervention

5 mg Randomized to doses 10 mg, 5 mg, 2.5 mg, 1.25 mg

Who Is Running the Clinical Trial?

Yale University

Lead Sponsor

Trials

1,963

Recruited

3,046,000+

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

Collaborator

Trials

2,513

Recruited

4,366,000+

Findings from Research

In a study involving 7605 outpatients with heart failure and reduced left ventricular ejection fraction, a performance improvement intervention led to a significant increase in the use of target doses of β-blockers, improving from 36.1% to 45.9% over 24 months.

The intervention did not result in similar increases for ACE inhibitors/ARBs or aldosterone antagonists, indicating a need for further research to understand barriers to achieving target doses for these medications.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Medication dosing in outpatients with heart failure after implementation of a practice-based performance improvement intervention: findings from IMPROVE HF. Gheorghiade, M., Albert, NM., Curtis, AB., et al.[2022]

Patients with heart failure and reduced ejection fraction benefit from various medications, including ACE inhibitors, beta blockers, and newer drug classes like angiotensin receptor blocker/neprilysin inhibitors, which have been shown to improve survival rates.

For those hospitalized due to heart failure, implementing disease management programs and telemonitoring can significantly lower the chances of readmission and improve overall survival.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Heart Failure Due to Reduced Ejection Fraction: Medical Management. Chavey, WE., Hogikyan, RV., Van Harrison, R., et al.[2017]

In a study of 8399 patients with heart failure, the angiotensin-neprilysin inhibitor LCZ696 was found to significantly reduce the need for intensified treatment and emergency visits for worsening heart failure compared to the angiotensin-converting enzyme inhibitor enalapril.

Patients treated with LCZ696 experienced 23% fewer hospitalizations for heart failure and showed early and sustained improvements in biomarkers indicating heart stress and injury, suggesting it is more effective in preventing clinical deterioration in heart failure patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Angiotensin receptor neprilysin inhibition compared with enalapril on the risk of clinical progression in surviving patients with heart failure. Packer, M., McMurray, JJ., Desai, AS., et al.[2022]

Recent large-scale studies have shown that vasodilators and ACE inhibitors can significantly improve survival rates in patients with congestive heart failure (CHF), highlighting their importance in treatment plans.

Ongoing trials are investigating the effects of these treatments on patients with asymptomatic left ventricular dysfunction, suggesting a potential for early intervention in preventing CHF progression.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effect of treatment on survival in congestive heart failure. Pitt, B., Cohn, JN., Francis, GS., et al.[2019]

Drug therapy for heart failure due to left ventricular dysfunction is proven to improve patient prognosis and is both safe and cost-effective, highlighting its importance in treatment plans.

This paper is the first in a series that will focus on the most relevant and applicable evidence regarding drug therapies for chronic heart failure, specifically targeting left ventricular systolic dysfunction.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Drug therapy for chronic heart failure due to left ventricular systolic dysfunction: a scientific review. I. Introduction. Carneiro, AV.[2008]

Intranasal injections of a form of prednisolone (Hydeltra(R) TBA) provided significant relief from nasal obstruction in 78% of patients suffering from conditions like seasonal allergic rhinitis and sinusitis-related nasal edema.

The treatment was well-tolerated, with minimal side effects, primarily a small amount of bleeding during injection, allowing for effective local anti-inflammatory action without systemic effects.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Intranasal injection of corticosteroids. SIMMONS, MW.[2018]

OnabotulinumtoxinA injections are a safe and effective second-line treatment for adults with refractory overactive bladder, showing improvement in 60%-65% of patients compared to placebo.

The optimal dose of 100 U, approved by the FDA, provides symptom relief for 6 to 12 months, with a low risk of urinary retention at around 6%.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

OnabotulinumtoxinA for the treatment of overactive bladder. Cox, L., Cameron, AP.[2023]

In a study of 187 women receiving a 100 U injection of onabotulinumtoxinA (BnTA) for urgency urinary incontinence, 10% experienced urinary retention, with 8% having symptomatic retention and 2% having asymptomatic retention.

Women with a history of anti-stress urinary incontinence procedures were more likely to experience urinary retention, indicating that prior surgical interventions may increase the risk of retention after BnTA treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The First Injection: Rates of Urinary Retention in Women With Urgency Incontinence Treated With Intravesical OnabotulinumtoxinA Injection. Squires, NA., Mueller, MG., Lewicky-Gaupp, C., et al.[2021]

A transvaginal ultrasound-guided injection of botulinum toxin A (BoNT-A) in 12 women significantly improved symptoms of lower urinary tract syndrome, as shown by better scores in the international prostate symptom score (IPSS) and patient perception of bladder condition (PPBC) after the procedure.

The technique was found to be safe, with only one patient experiencing new urge urinary incontinence, and it also reduced the need for clean intermittent catheterization (CIC) in patients requiring it.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Efficacy of Transvaginal Ultrasound-Guided BoNT-A External Sphincter Injection in Female Patients with Underactive Bladder. Tsai, CY., Yeh, YH., Tsai, LH., et al.[2023]

Ultrasound-assisted intravesical delivery of botulinum toxin A (BTX-A) using microbubbles significantly reduced bladder hyperactivity in a rat model, demonstrating its potential as a non-injection treatment method.

This method led to increased cleavage of SNAP-25 and reduced release of calcitonin gene-related peptide (CGRP), indicating a mechanism by which BTX-A can effectively alleviate symptoms of overactive bladder.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Ultrasound-assisted intravesical botulinum toxin A delivery attenuates acetic acid-induced bladder hyperactivity in rats. Liu, Q., Gao, Y., Cong, H., et al.[2023]

References

1. United States pubmed.ncbi.nlm.nih.gov

Medication dosing in outpatients with heart failure after implementation of a practice-based performance improvement intervention: findings from IMPROVE HF. [2022]

2. United States pubmed.ncbi.nlm.nih.gov

Heart Failure Due to Reduced Ejection Fraction: Medical Management. [2017]

3. United States pubmed.ncbi.nlm.nih.gov

Angiotensin receptor neprilysin inhibition compared with enalapril on the risk of clinical progression in surviving patients with heart failure. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

The effect of treatment on survival in congestive heart failure. [2019]

5. Portugal pubmed.ncbi.nlm.nih.gov

Drug therapy for chronic heart failure due to left ventricular systolic dysfunction: a scientific review. I. Introduction. [2008]

6. United States pubmed.ncbi.nlm.nih.gov

Intranasal injection of corticosteroids. [2018]

7. England pubmed.ncbi.nlm.nih.gov

OnabotulinumtoxinA for the treatment of overactive bladder. [2023]

8. United States pubmed.ncbi.nlm.nih.gov

The First Injection: Rates of Urinary Retention in Women With Urgency Incontinence Treated With Intravesical OnabotulinumtoxinA Injection. [2021]

9. Switzerland pubmed.ncbi.nlm.nih.gov

The Efficacy of Transvaginal Ultrasound-Guided BoNT-A External Sphincter Injection in Female Patients with Underactive Bladder. [2023]

10. Switzerland pubmed.ncbi.nlm.nih.gov

Ultrasound-assisted intravesical botulinum toxin A delivery attenuates acetic acid-induced bladder hyperactivity in rats. [2023]