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Trial details imported from ClinicalTrials.gov

For full trial details, please see the original record at https://clinicaltrials.gov/ct2/show/NCT04518293




Registration number
NCT04518293
Ethics application status
Date submitted
15/08/2020
Date registered
19/08/2020
Date last updated
25/04/2024

Titles & IDs
Public title
Efficacy and Safety of GMRx2 Compared to Dual Combinations for the Treatment of Hypertension
Scientific title
Efficacy and Safety of GMRx2 (a Single Pill Combination Containing Telmisartan/Amlodipine/Indapamide) Compared to Dual Combinations for the Treatment of Hypertension
Secondary ID [1] 0 0
GMRx2-HTN-2020-ACT1
Universal Trial Number (UTN)
Trial acronym
GMRx2_ACT
Linked study record

Health condition
Health condition(s) or problem(s) studied:
Hypertension 0 0
Condition category
Condition code
Cardiovascular 0 0 0 0
Hypertension

Intervention/exposure
Study type
Interventional
Description of intervention(s) / exposure
Treatment: Drugs - Telmisartan 20 mg/amlodipine 2.5 mg/indapamide 1.25 mg
Treatment: Drugs - telmisartan 40 mg/amlodipine 5 mg/indapamide 2.5 mg
Treatment: Drugs - Telmisartan 20 mg/amlodipine 2.5 mg .
Treatment: Drugs - telmisartan 40 mg/amlodipine 5 mg
Treatment: Drugs - Telmisartan 20 mg/indapamide 1.25 mg
Treatment: Drugs - telmisartan 40 mg/indapamide 2.5 mg
Treatment: Drugs - Amlodipine 2.5 mg/indapamide 1.25 mg
Treatment: Drugs - amlodipine 5 mg/indapamide 2.5 mg

Experimental: Triple - TAI - Telmisartan 20 mg/amlodipine 2.5 mg/indapamide 1.25 mg. At week 6 visit, forced up-titration to telmisartan 40 mg/amlodipine 5 mg/indapamide 2.5 mg

Active Comparator: Dual - TA - Telmisartan 20 mg/amlodipine 2.5 mg . At week 6 visit, forced up-titration to telmisartan 40 mg/amlodipine 5 mg

Active Comparator: Dual - TI - Telmisartan 20 mg/indapamide 1.25 mg. At week 6 visit, forced up-titration to telmisartan 40 mg/indapamide 2.5 mg

Active Comparator: Dual - AI - Amlodipine 2.5 mg/indapamide 1.25 mg. At week 6 visit, forced up-titration to amlodipine 5 mg/indapamide 2.5 mg


Treatment: Drugs: Telmisartan 20 mg/amlodipine 2.5 mg/indapamide 1.25 mg
Single pill

Treatment: Drugs: telmisartan 40 mg/amlodipine 5 mg/indapamide 2.5 mg
Signle pill

Treatment: Drugs: Telmisartan 20 mg/amlodipine 2.5 mg .
oral tablet

Treatment: Drugs: telmisartan 40 mg/amlodipine 5 mg
oral tablet

Treatment: Drugs: Telmisartan 20 mg/indapamide 1.25 mg
oral tablet

Treatment: Drugs: telmisartan 40 mg/indapamide 2.5 mg
oral tablet

Treatment: Drugs: Amlodipine 2.5 mg/indapamide 1.25 mg
oral tablet

Treatment: Drugs: amlodipine 5 mg/indapamide 2.5 mg
oral tablet
Intervention code [1] 0 0
Treatment: Drugs
Comparator / control treatment
Control group

Outcomes
Primary outcome [1] 0 0
Difference in change in home SBP from baseline to week 12
Timepoint [1] 0 0
12 weeks
Secondary outcome [1] 0 0
Difference in change in clinic seated mean SBP from baseline to Week 12
Timepoint [1] 0 0
12 weeks
Secondary outcome [2] 0 0
Difference in change in clinic seated mean SBP from baseline to Week 6
Timepoint [2] 0 0
6 weeks
Secondary outcome [3] 0 0
Difference in change in clinic seated mean DBP from baseline to Week 12
Timepoint [3] 0 0
12 weeks
Secondary outcome [4] 0 0
Difference in change in clinic seated mean DBP from baseline to Week 6
Timepoint [4] 0 0
6 weeks
Secondary outcome [5] 0 0
Percentage of participants with clinic seated mean SBP <140 and DBP <90 mmHg at Week 12
Timepoint [5] 0 0
12 weeks
Secondary outcome [6] 0 0
Percentage of participants with clinic seated mean SBP <140 and DBP <90 mmHg at Week 6
Timepoint [6] 0 0
6 weeks
Secondary outcome [7] 0 0
Percentage of participants with clinic seated mean SBP <130 and DBP <80 mmHg at Week 12
Timepoint [7] 0 0
12 weeks
Secondary outcome [8] 0 0
Percentage of participants with clinic seated mean SBP <130 and DBP <80 mmHg at Week 6
Timepoint [8] 0 0
6 weeks
Secondary outcome [9] 0 0
Difference in change in home seated mean SBP from baseline to Week 6
Timepoint [9] 0 0
6 weeks
Secondary outcome [10] 0 0
Difference in change in home seated mean DBP from baseline to Week 12
Timepoint [10] 0 0
12 weeks
Secondary outcome [11] 0 0
Difference in change in home seated mean DBP from baseline to Week 6
Timepoint [11] 0 0
6 weeks
Secondary outcome [12] 0 0
Difference in change in trough home seated mean SBP from baseline to week 12
Timepoint [12] 0 0
12 weeks
Secondary outcome [13] 0 0
Difference in change in trough home seated mean SBP from baseline to Week 6
Timepoint [13] 0 0
6 weeks
Secondary outcome [14] 0 0
Percentage of participants with home seated mean SBP <135 and DBP <85 mmHg at Week 12
Timepoint [14] 0 0
12 weeks
Secondary outcome [15] 0 0
Percentage of participants with home seated mean SBP <135 and DBP <85 mmHg at Week 6
Timepoint [15] 0 0
6 weeks
Secondary outcome [16] 0 0
Percentage of participants with home seated mean SBP <130 and DBP <80 mmHg at Week 12
Timepoint [16] 0 0
12 weeks
Secondary outcome [17] 0 0
Percentage of participants with home seated mean SBP <130 and DBP <80 mmHg at Week 6
Timepoint [17] 0 0
6 weeks

Eligibility
Key inclusion criteria
At screening visit

1. Provided signed consent to participate in the trial.

2. Adult of age =18 years.

3. Attended automated clinic seated mean SBP (average of last 2 measurements calculated
by the device):

140-179 mmHg on 0 blood pressure (BP)-lowering drugs, or 130-170 mmHg on 1 BP-lowering
drug, or 120-160 mmHg on 2 BP-lowering drugs, or 110-150 mmHg on 3 BP-lowering drugs.

At randomization visit

1. Home seated mean SBP 110-154 mmHg in the week prior to the randomization visit .

2. Adherence of 80-120% to run-in medication.

3. Tolerated run-in medication.

4. Adherence to home BP monitoring schedule: =3 days in the week before the randomization
visit and =1 day per week during the preceding weeks, , with =2 measures in the
specified morning and evening time periods on each day (i.e. accepting measures
outside of the recommended 0600-1000 and 1800-2200 periods as long as they are in the
am or pm, respectively).

At week 12 (for optional open-label extension)

1. Provided signed informed consent.

2. completed randomized treatment and willing to continue GMRx2-based regimen for up to
12 months.
Minimum age
18 Years
Maximum age
No limit
Sex
Both males and females
Can healthy volunteers participate?
No
Key exclusion criteria
At screening visit

1. Receiving 4 or more BP-lowering drugs.

2. receiving any BP lowering drugs for indications other than hypertension e.g. heart
failure

3. Pregnant or had a positive pregnancy test or unwilling to undertake a pregnancy test
during the trial and up to 30 days after the discontinuation of the trial medication
or breastfeeding or of childbearing age and not using an acceptable method of
contraception. Acceptable methods of birth control include hormonal prescription oral
contraceptives, contraceptive injections, contraceptive patch, intrauterine device,
double-barrier method (e.g. condoms, diaphragm, or cervical cap with spermicidal foam,
cream, or gel), or male partner sterilization. Contraception should be used for at
least 1 month before the screening visit and until the end of trial participation.

4. Not suitable for participation in a clinical trial according to local ethical or
regulatory requirements related to severe acute respiratory syndrome coronavirus-2
(SARS-CoV-2).

5. Contraindication, including hypersensitivity (e.g. anaphylaxis or angioedema), to the
active run-in treatment or to any of the trial medication options in the four
randomized groups.

6. Current/history of transient ischemic attack, stroke, or hypertensive encephalopathy.

7. Current/history of acute coronary syndrome, unstable angina, myocardial infarction,
percutaneous transluminal coronary revascularization, or coronary artery bypass graft.

8. Current atrial fibrillation. Patients with a history of paroxysmal atrial fibrillation
are potentially eligible as long as there has been no episode in the last 3 months,
while patient with a history of persistent or permanent atrial fibrillation are not
eligible.

9. Current/history of New York Heart Association class III and IV congestive heart
failure.

10. Current/history of a known secondary cause of hypertension, such as primary
aldosteronism, renal artery stenosis, pheochromocytoma, or Cushing's syndrome.

11. Current/history of substantially uncontrolled diabetes (HbA1c > 11.0%) within last
three months.

12. Current/history of end-stage renal disease or anuria or estimated glomerular
filtration rate (eGFR) <60 ml/min/1.73m2.

13. Electrolyte levels that would be regarded as contraindications for any of the
potential treatment arms e.g. serum sodium <132mmol/l or >148mmol/l serum potassium
<3.1 mmol/l or >5.6 mmol/l.

14. Current/history of aspartate aminotransferase (AST) or alanine aminotransferase (ALT)
>3 times the upper limit of normal range within 6 months.

15. Current concomitant illness or physical impairment or mental condition that in the
judgment of the investigator could interfere with the effective conduct of the trial
or constitutes a significant risk to the participants' well-being.

16. Arm circumference that is too large (>55 cm) or too small (<20 cm) to allow accurate
measurement of BP.

17. Currently taking or might need during the trial, a concomitant treatment which is
known to interact with one or more of the trial medications: digoxin, lithium,
diabetics receiving aliskiren, moderate and strong CYP3A4 inhibitors (e.g. ritonavir,
ketoconazole, diltiazem], simvastatin >20 mg/day, immunosuppressants.

18. Might need treatment with drugs that are prohibited during the trial: other
antihypertensive drugs, endothelin receptor antagonists, neprilysin inhibitors, or
other drugs that may affect BP (see Appendix 5).

19. Current surgical or medical condition that might significantly alter the absorption,
distribution, metabolism, or excretion of trial drugs such as prior major
gastrointestinal tract surgery (e.g. gastrectomy, lap band, or bowel resection) or
acute flare of inflammatory bowel disease within one year.

20. Individuals working >2 nightshifts per week.

21. Participated in any investigative drug or device trial within the previous 30 days.

22. History of alcohol or drug abuse within 12 months.

At randomization visit

1. Unable to adhere to the trial procedures during the run-in treatment period.

2. Any of the following which in the investigator's judgment may compromise the safety of
the participant if randomized to the trial medications:

1. High or low clinic BP levels even in the light of the values for home BP that are
available for that participant. The exact levels of BP are not specified, since
there is clinical uncertainty as to the relevance of BP levels which are high or
low in clinic only; for example, the clinical relevance of 'whitecoat
hypertension' is uncertain.

2. High or low home diastolic BP (DBP) levels. The exact levels of DBP is not
specified, reflecting clinical uncertainty of the implications of isolated
diastolic hypertension. However, home DBP values of >99 mmHg may typically be
considered as requiring treatment intensification, and such participants would
not be suitable for randomization.

3. Any abnormal laboratory value which in the judgment of the investigator could
interfere with the effective conduct of the trial or constitutes a significant risk to
the participants' well-being.

4. Fulfilling any of the exclusion criteria mentioned for the screening visit, when
verified again at randomization visit.

Study design
Purpose of the study
Treatment
Allocation to intervention
Randomised controlled trial
Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Masking / blinding
Blinded (masking used)
Who is / are masked / blinded?
The people receiving the treatment/s
The people administering the treatment/s
The people assessing the outcomes
The people analysing the results/data
Intervention assignment
Parallel
Other design features
Phase
Phase 3
Type of endpoint/s
Statistical methods / analysis

Recruitment
Recruitment status
Completed
Data analysis
Reason for early stopping/withdrawal
Other reasons
Date of first participant enrolment
Anticipated
Actual
26/06/2021
Date of last participant enrolment
Anticipated
Actual
Date of last data collection
Anticipated
Actual
1/09/2023
Sample size
Target
Accrual to date
Final
1385
Recruitment in Australia
Recruitment state(s)
NSW,QLD,VIC,WA
Recruitment hospital [1] 0 0
Castle Hill Medical Centre - Castle Hill
Recruitment hospital [2] 0 0
Princess Alexandra Hospital - Hypertension Unit - Brisbane
Recruitment hospital [3] 0 0
Hudson Institute of Medical Research - Clayton
Recruitment hospital [4] 0 0
Barwon Health, Geelong University Hospital - Geelong
Recruitment hospital [5] 0 0
Curtin University - Bentley
Recruitment hospital [6] 0 0
Royal Perth Hospital - Perth
Recruitment postcode(s) [1] 0 0
2154 - Castle Hill
Recruitment postcode(s) [2] 0 0
4102 - Brisbane
Recruitment postcode(s) [3] 0 0
3168 - Clayton
Recruitment postcode(s) [4] 0 0
3220 - Geelong
Recruitment postcode(s) [5] 0 0
6102 - Bentley
Recruitment postcode(s) [6] 0 0
6000 - Perth
Recruitment outside Australia
Country [1] 0 0
United States of America
State/province [1] 0 0
Arizona
Country [2] 0 0
United States of America
State/province [2] 0 0
California
Country [3] 0 0
United States of America
State/province [3] 0 0
Florida
Country [4] 0 0
United States of America
State/province [4] 0 0
Georgia
Country [5] 0 0
United States of America
State/province [5] 0 0
Illinois
Country [6] 0 0
United States of America
State/province [6] 0 0
Louisiana
Country [7] 0 0
United States of America
State/province [7] 0 0
New York
Country [8] 0 0
United States of America
State/province [8] 0 0
North Carolina
Country [9] 0 0
United States of America
State/province [9] 0 0
Tennessee
Country [10] 0 0
United States of America
State/province [10] 0 0
Texas
Country [11] 0 0
United States of America
State/province [11] 0 0
Virginia
Country [12] 0 0
Czechia
State/province [12] 0 0
Kralovehradsky
Country [13] 0 0
Czechia
State/province [13] 0 0
Stredocesky
Country [14] 0 0
New Zealand
State/province [14] 0 0
Auckland
Country [15] 0 0
New Zealand
State/province [15] 0 0
Gisborne
Country [16] 0 0
Poland
State/province [16] 0 0
Gdansk
Country [17] 0 0
Poland
State/province [17] 0 0
Wroclaw
Country [18] 0 0
Poland
State/province [18] 0 0
Katowice
Country [19] 0 0
Poland
State/province [19] 0 0
Nowy Dwór Mazowiecki
Country [20] 0 0
Poland
State/province [20] 0 0
Poznan
Country [21] 0 0
Poland
State/province [21] 0 0
Skierniewice
Country [22] 0 0
Poland
State/province [22] 0 0
Warsaw
Country [23] 0 0
Sri Lanka
State/province [23] 0 0
Colombo
Country [24] 0 0
Sri Lanka
State/province [24] 0 0
Dehiwala
Country [25] 0 0
Sri Lanka
State/province [25] 0 0
Galle
Country [26] 0 0
Sri Lanka
State/province [26] 0 0
Jaffna
Country [27] 0 0
Sri Lanka
State/province [27] 0 0
Kandy
Country [28] 0 0
Sri Lanka
State/province [28] 0 0
Kurunegala
Country [29] 0 0
Sri Lanka
State/province [29] 0 0
Negombo
Country [30] 0 0
Sri Lanka
State/province [30] 0 0
Nugegoda
Country [31] 0 0
Sri Lanka
State/province [31] 0 0
Ragama
Country [32] 0 0
United Kingdom
State/province [32] 0 0
Cambridgeshire
Country [33] 0 0
United Kingdom
State/province [33] 0 0
Cheshire
Country [34] 0 0
United Kingdom
State/province [34] 0 0
Cornwall
Country [35] 0 0
United Kingdom
State/province [35] 0 0
Derbyshire
Country [36] 0 0
United Kingdom
State/province [36] 0 0
Durham
Country [37] 0 0
United Kingdom
State/province [37] 0 0
East Midlands
Country [38] 0 0
United Kingdom
State/province [38] 0 0
Herts.
Country [39] 0 0
United Kingdom
State/province [39] 0 0
Lancashire
Country [40] 0 0
United Kingdom
State/province [40] 0 0
Leicestershire
Country [41] 0 0
United Kingdom
State/province [41] 0 0
London
Country [42] 0 0
United Kingdom
State/province [42] 0 0
Poole
Country [43] 0 0
United Kingdom
State/province [43] 0 0
Somerset
Country [44] 0 0
United Kingdom
State/province [44] 0 0
South Yorkshire
Country [45] 0 0
United Kingdom
State/province [45] 0 0
Wales
Country [46] 0 0
United Kingdom
State/province [46] 0 0
Warwickshire
Country [47] 0 0
United Kingdom
State/province [47] 0 0
West Midlands
Country [48] 0 0
United Kingdom
State/province [48] 0 0
Wiltshire
Country [49] 0 0
United Kingdom
State/province [49] 0 0
Sheffield

Funding & Sponsors
Primary sponsor type
Commercial sector/Industry
Name
George Medicines PTY Limited
Address
Country

Ethics approval
Ethics application status

Summary
Brief summary
Recent hypertension guidelines recommend combination therapy as initial treatment for many or
most patients. Several trials suggest triple low-dose combination therapy may be highly
effective in terms of achieving blood pressure control without increasing adverse effects.
This trial is designed to investigate the efficacy and safety of GMRx2 in participants with
high blood pressure compared to dual combinations.
Trial website
https://clinicaltrials.gov/ct2/show/NCT04518293
Trial related presentations / publications
Public notes

Contacts
Principal investigator
Name 0 0
Anthony Rodgers, Professor
Address 0 0
The George Institute
Country 0 0
Phone 0 0
Fax 0 0
Email 0 0
Contact person for public queries
Name 0 0
Address 0 0
Country 0 0
Phone 0 0
Fax 0 0
Email 0 0
Contact person for scientific queries