Zibotentan and Dapagliflozin in Patients With Type 2 Diabetes and Elevated Albuminuria

Prior treatment

• Women of childbearing potential (WOCBP). WOCBP is defined as women who have experienced menarche and who have not undergone successful surgical sterilization (hysterectomy, bilateral tubal ligation, or bilateral oophorectomy) or who are not post-menopausal
• Participation in any clinical investigation within 3 months prior to initial dosing.
• Donation or loss of 400 ml or more of blood within 8 weeks prior to initial dosing.
• History of drug or alcohol abuse within the 12 months prior to dosing, or according to investigator's assessment.

Other illness

• Diagnosis of type 1 diabetes
• Minimal change disease, unstable rapidly progressing renal disease, and/or renal disease requiring significant immunosuppression, autosomal dominant or autosomal recessive polycystic kidney disease
• Heart Failure NYHA Class III or IV
• Acute coronary syndrome event within the preceding 6 months
• Active malignancy aside from treated squamous cell or basal cell carcinoma of the skin within the last 5 years.
• Severe hepatic impairment
• History of epilepsy syndrome
• History of severe hypersensitivity or contraindications to dapagliflozin
• History of hypersensitivity or contraindications to iodinated contrast media
• History of noncompliance to medical regimens or unwillingness to comply with the study protocol.
• Any surgical or medical condition, which in the opinion of the investigator, may place the patient at higher risk from his/her participation in the study, or is likely to prevent the patient from complying with the requirements of the study or completing the study.

Lab values

• Hba1c \> 12.5%
• Hemoglobin \<9g/dL
• Any medication, surgical or medical condition which might significantly alter the absorption, distribution, metabolism, or excretion of medications including, but not limited to any of the following:
  • History of active inflammatory bowel disease within the last six months;
  • Major gastrointestinal tract surgery such as gastrectomy, gastroenterostomy, or bowel resection;
  • Gastro-intestinal ulcers and/or gastrointestinal or rectal bleeding within last six months;
  • Pancreatic injury or pancreatitis within the last six months;
  • Evidence of hepatic disease as determined by any one of the following: ALT or AST values exceeding 3x ULN at the screening visit, a history of hepatic encephalopathy, a history of esophageal varices, or a history of portocaval shunt;
  • Evidence of urinary obstruction or difficulty in voiding at screening

Other

• Urinary protein excretion \> 3500 mg/day
• NT-proBNP \> 600 pg/ml
• Severe peripheral edema according to investigators opinion
• Pregnancy or breastfeeding
• Indication for immunosuppressants according to Investigator's opinion
• Use of the co-interventional treatments (outlined in section 5.2) within 6 weeks of screening.
• Subject who, in the assessment of the investigator, may be at risk for dehydration or volume depletion that may affect the interpretation of efficacy or safety data

• Age ≥18 and ≤75 years
• Urinary albumin:creatinine ratio \> 100 mg/g and ≤ 3500 mg/g in a first morning void urine collection
• eGFR ≥ 30 mL/min/1.73m2
• On a stable dose of an ACEi or ARB for at least 4 weeks prior to randomization
• Willing to sign informed consent