A Phase 2 interventional study of AZD5718 and Dapagliflozin 10 mg in Chronic Kidney Disease, sponsored by AstraZeneca. Terminated at 111 sites in 11 countries. Open to participants aged 18 Years to 130 Years. Per ClinicalTrials.gov, last updated 2024-12-20.
Sponsored by AstraZeneca · Phase 2, Interventional, and Treatment
The purpose of the study is to evaluate the dose-response efficacy, safety, and pharmacokinetics (PK) of AZD5718 in participants with proteinuric chronic kidney disease.
The study will be conducted in approximately 118 study centers across 12 countries. The overall study period will be around 28 weeks. Approximately 632 participants comprising of 67% diabetic kidney disease (DKD) and 33% non-DKD participants will be enrolled. After a screening period of up to 4 weeks, the participants will be randomised in a 1:1:1:1 ratio to receive one of the doses of AZD5718 and/or placebo for the first 12 weeks (Day 85 [treatment period 1]), with an add-on therapy of 8 weeks of dapagliflozin for all participants from Week 12 to 20 (Day 85 to 141 [treatment period 2]). Only participants still taking their assigned treatment from treatment period 1 will progress to treatment period 2. Any participant with urine albumin to creatinine ratio (ACR) \< 30 mg/g at Week 12 will be excluded from treatment period 2. The eligibility check to enter treatment period 2 will be done at Visit 7 (Week 12) using the last available urine ACR result. The final analysis will be done after all participants have completed follow-up period of up to 4 weeks. The expected total study duration, including the Screening Period, for each participant will be at least 28 weeks.
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Participants with proteinuric CKD defined as:
Exclusion Criteria:
Any of the following concomitant conditions or diseases at Screening Visit 1:
Participants will receive once daily oral dose 1 of AZD5718 for 12 weeks, thereafter add-on therapy of 10 mg dapagliflozin for 8 weeks.
Drug: AZD5718 · Drug: Dapagliflozin 10 mg
Participants will receive once daily oral dose 2 of AZD5718 for 12 weeks, thereafter add-on therapy of 10 mg dapagliflozin for 8 weeks.
Drug: AZD5718 · Drug: Dapagliflozin 10 mg
Participants will receive once daily oral dose 3 of AZD5718 for 12 weeks, thereafter add-on therapy of 10 mg dapagliflozin for 8 weeks.
Drug: AZD5718 · Drug: Dapagliflozin 10 mg
Participants will receive once daily oral dose of placebo matched to AZD5718 for 12 weeks, thereafter add-on therapy of 10 mg dapagliflozin for 8 weeks.
Drug: Dapagliflozin 10 mg · Drug: Placebo
Participants will receive once daily oral dose of AZD5718 as per the arms they are randomised, and will continue until Week 20.
Participants will receive once daily oral dose of 10 mg dapagliflozin for 8 weeks as an add-on therapy.
Participants will receive once daily oral dose of placebo matched to AZD5718, and will continue until Week 20.
Change From Baseline in Reduction of Urine Albumin to Creatinine Ratio (ACR) to Week 20
The dose response effect of AZD5718 on urine ACR at 20 weeks was evaluated. Values less than 1 indicate improvement from baseline.
Time frame: Week 1 (Baseline) to Week 20
Change From Baseline in Reduction of Urine ACR to Week 12
The dose response effect of AZD5718 on urine ACR at 12 weeks was evaluated. Values less than 1 indicate improvement from baseline.
Time frame: Week 1 (Baseline) to Week 12
Number of Participants With Adverse Events and Serious Adverse Events
The safety and tolerability profile of AZD5718 treatment was assessed
Time frame: From Screening (Week -4 to 0) to Week 24
Change From Baseline in 24-hours Mean Systolic Blood Pressure to Week 12
The effect of AZD5718 on ambulatory blood pressure was assessed
Time frame: Week 1 (Baseline) to Week 12
Plasma Concentrations of AZD5718
The PK of AZD5718 after repeated oral dosing for 20 weeks was evaluated
Time frame: From Week 2 to Week 20
Change From Baseline in Estimated Glomerular Filtration Rate (eGFR) to Week 12
The effect of AZD5718 on renal function was evaluated
Time frame: Week 1 (Baseline), Week 2, Week 4, Week 8, and Week 12
Participants were enrolled in this study from 01 October 2020 to 06 September 2022. The study was terminated early on 01 July 2022 due to lack of efficacy.
| Milestone | AZD5718 Dose 1 + Dapagliflozin 10 mg | AZD5718 Dose 2 + Dapagliflozin 10 mg | AZD5718 Dose 3 + Dapagliflozin 10 mg | Placebo + Dapagliflozin 10 mg |
|---|---|---|---|---|
| Started | 154 | 153 | 153 | 153 |
| Completed | 72 | 82 | 82 | 82 |
| Not completed | 82 | 71 | 71 | 71 |
| Withdrew: Adverse event | 7 | 2 | 3 | 0 |
| Withdrew: Death | 0 | 0 | 0 | 1 |
| Withdrew: Lost to follow-up | 0 | 1 | 0 | 1 |
| Withdrew: Physician decision | 0 | 3 | 1 | 1 |
| Withdrew: Withdrawal by subject | 6 | 6 | 0 | 3 |
| Withdrew: Development of study specific withdrawal criteria | 3 | 1 | 2 | 2 |
| Withdrew: Due to covid-19 pandemic | 7 | 3 | 7 | 6 |
| Withdrew: Failure to meet randomisation criteria | 2 | 3 | 4 | 2 |
| Withdrew: Early termination from the study | 54 | 51 | 50 | 50 |
| Withdrew: Missing | 3 | 0 | 0 | 5 |
| Withdrew: Participants who did not receive treatment | 0 | 1 | 4 | 0 |
The dose response effect of AZD5718 on urine ACR at 20 weeks was evaluated. Values less than 1 indicate improvement from baseline.
| milligram/gram (mg/g) | AZD5718 Dose 1 + Dapagliflozin 10 mg | AZD5718 Dose 2 + Dapagliflozin 10 mg | AZD5718 Dose 3 + Dapagliflozin 10 mg | Placebo + Dapagliflozin 10 mg |
|---|---|---|---|---|
| Change From Baseline in Reduction of Urine Albumin to Creatinine Ratio (ACR) to Week 20 | 0.79 (0.69 to 0.90) | 0.81 (0.70 to 0.92) | 0.77 (0.67 to 0.87) | 0.84 (0.73 to 0.95) |
The dose response effect of AZD5718 on urine ACR at 12 weeks was evaluated. Values less than 1 indicate improvement from baseline.
| mg/g | AZD5718 Dose 1 + Dapagliflozin 10 mg | AZD5718 Dose 2 + Dapagliflozin 10 mg | AZD5718 Dose 3 + Dapagliflozin 10 mg | Placebo + Dapagliflozin 10 mg |
|---|---|---|---|---|
| Change From Baseline in Reduction of Urine ACR to Week 12 | 0.94 (0.84 to 1.04) | 1.03 (0.92 to 1.15) | 0.96 (0.86 to 1.06) | 1.10 (0.99 to 1.22) |
The safety and tolerability profile of AZD5718 treatment was assessed
| Participants | AZD5718 Dose 1 + Dapagliflozin 10 mg | AZD5718 Dose 2 + Dapagliflozin 10 mg | AZD5718 Dose 3 + Dapagliflozin 10 mg | Placebo + Dapagliflozin 10 mg |
|---|---|---|---|---|
| Any AE | 82 | 81 | 104 | 80 |
| Any AE with outcome = death | 0 | 0 | 0 | 1 |
| Any SAE (including events with outcome = death) | 12 | 8 | 11 | 6 |
| Any AE leading to discontinuation of study treatment | 12 | 2 | 3 | 6 |
| Any AE leading to dose interruption | 7 | 6 | 5 | 10 |
| Any AE leading to withdrawal from study | 7 | 0 | 1 | 1 |
| Any AE possibly related to study treatment as assessed by investigator | 14 | 12 | 8 | 14 |
The effect of AZD5718 on ambulatory blood pressure was assessed
| millimeter mercury (mm Hg) | AZD5718 Dose 1 + Dapagliflozin 10 mg | AZD5718 Dose 2 + Dapagliflozin 10 mg | AZD5718 Dose 3 + Dapagliflozin 10 mg | Placebo + Dapagliflozin 10 mg |
|---|---|---|---|---|
| Change From Baseline in 24-hours Mean Systolic Blood Pressure to Week 12 | -2.06 ± 10.782 | 1.56 ± 11.407 | -1.83 ± 9.986 | 3.76 ± 11.779 |
The PK of AZD5718 after repeated oral dosing for 20 weeks was evaluated
| nanomoles per liter (nmol/L) | AZD5718 Dose 1 + Dapagliflozin 10 mg | AZD5718 Dose 2 + Dapagliflozin 10 mg | AZD5718 Dose 3 + Dapagliflozin 10 mg |
|---|---|---|---|
| Week 2 (pre-dose) | 4.771 ± 113.047 | 12.181 ± 116.038 | 37.346 ± 138.565 |
| Week 4 (pre-dose) | 3.975 ± 85.449 | 11.207 ± 111.951 | 37.525 ± 127.660 |
| Week 8 (pre-dose) | 3.947 ± 77.097 | 11.579 ± 113.404 | 35.903 ± 116.207 |
| Week 12 (pre-dose) | 4.107 ± 79.068 | 11.041 ± 81.967 | 33.568 ± 127.405 |
| Week 16 (pre-dose) | 4.115 ± 76.378 | 10.006 ± 97.216 | 35.662 ± 130.148 |
| Week 20 (pre-dose) | 3.813 ± 65.605 | 10.200 ± 122.277 | 33.063 ± 100.320 |
| Week 4 (post-dose, 1-2 hours) | 16.321 ± 115.673 | 71.279 ± 128.551 | 340.794 ± 147.394 |
| Week 4 (post-dose, 2-5 hours) | 18.376 ± 77.409 | 86.464 ± 103.733 | 464.721 ± 79.567 |
| Week 4 (post-dose, 5-8 hours) | 16.713 ± 65.648 | 76.834 ± 59.503 | 343.531 ± 90.628 |
| Week 4 (post dose, 8-12 hours) | 14.434 ± 52.414 | 53.706 ± 68.160 | 234.913 ± 97.174 |
The effect of AZD5718 on renal function was evaluated
| milliliter/minute/1.73m^2 | AZD5718 Dose 1 + Dapagliflozin 10 mg | AZD5718 Dose 2 + Dapagliflozin 10 mg | AZD5718 Dose 3 + Dapagliflozin 10 mg | Placebo + Dapagliflozin 10 mg |
|---|---|---|---|---|
| Week 2 | -0.470 ± 6.3936 | -0.140 ± 5.2801 | -0.429 ± 5.7175 | 0.547 ± 5.7124 |
| Week 4 | -0.735 ± 6.5764 | 0.140 ± 5.2628 | -0.817 ± 6.1986 | 0.058 ± 6.3583 |
| Week 8 | -0.760 ± 6.0304 | -0.535 ± 5.8865 | -1.144 ± 6.5142 | -0.068 ± 5.3729 |
| Week 12 | -0.612 ± 6.2138 | -1.149 ± 6.1783 | -0.394 ± 6.4678 | -0.257 ± 6.4508 |
Collected over From Screening (Week -4 to 0) to Week 24. Non-serious events are listed at a 5% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| AZD5718 Dose 1 + Dapagliflozin 10 mg | 0/154 (0%) | 12/154 (7.8%) | 16/154 (10.4%) |
| AZD5718 Dose 2 + Dapagliflozin 10 mg | 0/152 (0%) | 8/152 (5.3%) | 8/152 (5.3%) |
| AZD5718 Dose 3 + Dapagliflozin 10 mg | 0/149 (0%) | 11/149 (7.4%) | 9/149 (6%) |
| Placebo + Dapagliflozin 10 mg | 1/153 (0.7%) | 6/153 (3.9%) | 8/153 (5.2%) |
| Event | AZD5718 Dose 1 + Dapagliflozin 10 mg | AZD5718 Dose 2 + Dapagliflozin 10 mg | AZD5718 Dose 3 + Dapagliflozin 10 mg | Placebo + Dapagliflozin 10 mg |
|---|---|---|---|---|
| PneumoniaInfections and infestations | 1/154 | 0/152 | 2/149 | 0/153 |
| Urinary tract infectionInfections and infestations | 1/154 | 0/152 | 1/149 | 0/153 |
| COVID-19 pneumoniaInfections and infestations | 0/154 | 0/152 | 1/149 | 0/153 |
| Septic shockInfections and infestations | 0/154 | 0/152 | 1/149 | 0/153 |
| Pituitary apoplexyEndocrine disorders | 0/154 | 0/152 | 1/149 | 0/153 |
| Diabetes mellitusMetabolism and nutrition disorders | 0/154 | 0/152 | 1/149 | 0/153 |
| Coronary artery diseaseCardiac disorders | 0/154 | 0/152 | 1/149 | 0/153 |
| Diabetic nephropathyRenal and urinary disorders | 0/154 | 0/152 | 1/149 | 0/153 |
| Chest painGeneral disorders | 0/154 | 0/152 | 1/149 | 0/153 |
| Hand fractureInjury, poisoning and procedural complications | 0/154 | 0/152 | 1/149 | 0/153 |
| Event | AZD5718 Dose 1 + Dapagliflozin 10 mg | AZD5718 Dose 2 + Dapagliflozin 10 mg | AZD5718 Dose 3 + Dapagliflozin 10 mg | Placebo + Dapagliflozin 10 mg |
|---|---|---|---|---|
| HyperkalaemiaMetabolism and nutrition disorders | 6/154 | 7/152 | 9/149 | 6/153 |
| Urinary tract infectionInfections and infestations | 8/154 | 8/152 | 1/149 | 6/153 |
| Glomerular filtration rate decreasedInvestigations | 8/154 | 3/152 | 5/149 | 8/153 |
All participants who were randomised and received any study treatment were included in the Full Analysis Set (FAS).
| Age, Continuous(Years) | AZD5718 Dose 1 + Dapagliflozin 10 mg | AZD5718 Dose 2 + Dapagliflozin 10 mg | AZD5718 Dose 3 + Dapagliflozin 10 mg | Placebo + Dapagliflozin 10 mg | Total |
|---|---|---|---|---|---|
| Mean | 64.9 ± 10.70 | 63.7 ± 10.63 | 65.1 ± 9.39 | 64.3 ± 10.71 | 64.5 ± 10.37 |
| Sex: Female, Male(Participants) | AZD5718 Dose 1 + Dapagliflozin 10 mg | AZD5718 Dose 2 + Dapagliflozin 10 mg | AZD5718 Dose 3 + Dapagliflozin 10 mg | Placebo + Dapagliflozin 10 mg | Total |
|---|---|---|---|---|---|
| Female | 57 | 53 | 45 | 53 | 208 |
| Male | 97 | 99 | 104 | 100 | 400 |
| Ethnicity (NIH/OMB)(Participants) | AZD5718 Dose 1 + Dapagliflozin 10 mg | AZD5718 Dose 2 + Dapagliflozin 10 mg | AZD5718 Dose 3 + Dapagliflozin 10 mg | Placebo + Dapagliflozin 10 mg | Total |
|---|---|---|---|---|---|
| Hispanic or Latino | 32 | 37 | 28 | 32 | 129 |
| Not Hispanic or Latino | 122 | 115 | 121 | 121 | 479 |
| Unknown or Not Reported | 0 | 0 | 0 | 0 | 0 |
| Race (NIH/OMB)(Participants) | AZD5718 Dose 1 + Dapagliflozin 10 mg | AZD5718 Dose 2 + Dapagliflozin 10 mg | AZD5718 Dose 3 + Dapagliflozin 10 mg | Placebo + Dapagliflozin 10 mg | Total |
|---|---|---|---|---|---|
| American Indian or Alaska Native | 0 | 0 | 0 | 0 | 0 |
| Asian | 54 | 55 | 56 | 52 | 217 |
| Native Hawaiian or Other Pacific Islander | 0 | 0 | 0 | 0 | 0 |
| Black or African American | 20 | 16 | 15 | 15 | 66 |
| White | 68 | 73 | 67 | 77 | 285 |
| More than one race | 0 | 0 | 0 | 0 | 0 |
| Unknown or Not Reported | 12 | 8 | 11 | 9 | 40 |
Showing the first 100 of 111 sites across 11 countries.
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Plan to share: Yes — Qualified researchers can request access to anonymized individual patient-level data from AstraZeneca group of companies sponsored clinical trials via the request portal. All requests will be evaluated as per the AZ disclosure commitment: https://astrazenecagrouptrials.pharmacm.com/ST/Submission/Disclosure. Yes, indicates that AZ are accepting requests for IPD, but this does not mean all requests will be shared.
Supporting information: Study protocol, Sap
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