Impact of Perioperative Exenatide Infusion on Quality of Life in Cardiac Surgery Patients

Condition(s) targeted: Quality of Life

Intervention: Exenatide (Drug); Insulin (Drug)

Phase: Phase 2/Phase 3

Status: Recruiting

Sponsored by: Centre Hospitalier Universitaire de Besancon

Official(s) and/or principal investigator(s):
Guillaume BESCH, M.D., Principal Investigator, Affiliation: CHRU Besançon
Sebastien PILI-FLOURY, M.D., PhD, Study Director, Affiliation: CHRU Besançon

Overall contact:
Guillaume BESCH, M.D., Phone: +33381218958, Email: gbesch@chu-besancon.fr

A diminution of quality of life is often reported by patients after coronary artery bypass graft (CABG) surgery. A part of this diminution could be explain by postoperative left ventricular (LV) dysfunction. Exenatide (Byetta®) is an incretin mimetic, characterized by an anti-hyperglycemic effect that depends on the blood glucose level. Recent data have suggested that exenatide could improve LV function by an inotropic effect in patients suffering from cardiogenic shock or from congestive heart failure. Moreover, patients suffering from congestive heart failure reported a better quality of life when they were treated with exenatide compared to placebo. The investigators hypothesize that perioperative exenatide infusion could improve postoperative quality of life in CABG surgery patients.

Official title: Impact of Intravenous Exenatide Versus Insulin on Quality of Life in Cardiac Surgery Patients: an Ancillary Study of the ExSTRESS Phase II/III Clinical Trial

Study design: Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment

Primary outcome: Variation of the SF-36 score value at 3-months

Secondary outcome:

Variation of the SF-36 score value at 1-month

Variation of the SF-36 score value at 6-months

Variation of the SF-36 score value at 12-months

1-month mortality

3-months mortality

6-months mortality

12-months mortality

Postoperative left ventricular function

Detailed description: The ExeQOL study is an ancillary study of the ExSTRESS trial (www. clinicaltrials. gov identifier: NCT01969149). The ExSTRESS trial is a phase II/III randomized-controlled trial that aim at assessing intravenous exenatide versus insulin for perioperative glycemic control in CABG surgery. The phase II of the ExStress trial will assess the safety and the efficacy of a continuous intravenous infusion of exenatide for the management of post operative stress hyperglycemia after planned coronary artery graft bypass (CABG) surgery. The aim of the phase III of the ExSTRESS trial is to compare the efficacy of a continuous intravenous infusion of exenatide to the gold standard treatment, i. e the intravenous infusion of short-acting insulin, for the management of post operative stress hyperglycemia after planned CABG surgery.

Minimum age: 18 Years. Maximum age: N/A. Gender(s): Both.

Criteria:

Inclusion Criteria:

- Age over 18.

- Patient consent.

- Non insulin requiring type 2 diabetic patients.

- Non diabetic patients.

- Planned coronary artery bypass graft (CABG) surgery.

- ASA (American Society of Anesthesiologists) score 1, 2, or 3.

Exclusion Criteria:

- Pregnancy and breast feeding.

- Pancreatectomy.

- Acute pancreatitis.

- Chronic pancreatitis.

- Type 1 diabetic patients.

- Insulin requiring type 2 patients.

- HbA1c>8%

- Ketoacidosis.

- Hyperosmolar coma.

- Preoperative blood glucose level above 300 mg/dl [21].

- Insulin or exenatide contraindication.

- History of renal transplantation or currently receiving renal dialysis or creatinine

clearance below 60 ml/min.

- Emergency surgery.

- Planned non CABG cardiac surgery.

Guillaume BESCH, M.D., Phone: +33381218958, Email: gbesch@chu-besancon.fr

Post operative intensive care unit of the cardiac surgery department, Besançon 25030, France; Recruiting
Guillaume Besch, MD, Email: gbesch@chu-besancon.fr

Link to ExStress Study protocol

Related publications:

Goldberg PA, Sakharova OV, Barrett PW, Falko LN, Roussel MG, Bak L, Blake-Holmes D, Marieb NJ, Inzucchi SE. Improving glycemic control in the cardiothoracic intensive care unit: clinical experience in two hospital settings. J Cardiothorac Vasc Anesth. 2004 Dec;18(6):690-7.

Studer C, Sankou W, Penfornis A, Pili-Floury S, Puyraveau M, Cordier A, Etievent JP, Samain E. Efficacy and safety of an insulin infusion protocol during and after cardiac surgery. Diabetes Metab. 2010 Feb;36(1):71-8. doi: 10.1016/j.diabet.2009.05.008. Epub 2010 Jan 25.

Perneger TV, Leplège A, Etter JF, Rougemont A. Validation of a French-language version of the MOS 36-Item Short Form Health Survey (SF-36) in young healthy adults. J Clin Epidemiol. 1995 Aug;48(8):1051-60.

Sokos GG, Nikolaidis LA, Mankad S, Elahi D, Shannon RP. Glucagon-like peptide-1 infusion improves left ventricular ejection fraction and functional status in patients with chronic heart failure. J Card Fail. 2006 Dec;12(9):694-9.

Sokos GG, Bolukoglu H, German J, Hentosz T, Magovern GJ Jr, Maher TD, Dean DA, Bailey SH, Marrone G, Benckart DH, Elahi D, Shannon RP. Effect of glucagon-like peptide-1 (GLP-1) on glycemic control and left ventricular function in patients undergoing coronary artery bypass grafting. Am J Cardiol. 2007 Sep 1;100(5):824-9. Epub 2007 Jun 14.

Starting date: May 2015
Last updated: May 7, 2015