A Research Study to See How Semaglutide Works Compared to Placebo in People With Type 2 Diabetes and Chronic Kidney Disease

Study Overview
=================
Brief Summary
-----------------
The researchers are doing this study to see if semaglutide can slow down the growth and worsening of chronic kidney disease in people with type 2 diabetes. Participants will get semaglutide (active medicine) or placebo ('dummy medicine'). This is known as participants' study medicine - which treatment participants get is decided by chance. Semaglutide is a medicine, doctors can prescribe in some countries for the treatment of type 2 diabetes. Participants will get the study medicine in a pen. Participants will use the pen to inject the medicine in a skin fold once a week. The study will close when there is enough information collected to show clear result of the study. The total time participants will be in this study is about 3 to 5 years, but it could be longer.

Official Title
-----------------
Effect of Semaglutide Versus Placebo on the Progression of Renal Impairment in Subjects With Type 2 Diabetes and Chronic Kidney Disease

Conditions
-----------------
Diabetes Mellitus, Type 2

Intervention / Treatment
-----------------
* Drug: Semaglutide
* Drug: Placebo (semaglutide)


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Male or female, age above or equal to 18 years at the time of signing informed consent. Japan: Male or female, age above or equal to 20 years at the time of signing informed consent Diagnosed with type 2 diabetes mellitus HbA1c less than or equal to 10% (less than or equal to 86 mmol/mol) Renal impairment defined either by: serum creatinine-based eGFR greater than or equal to 50 and less than or equal to 75 mL/min/1.73 m^2 (CKD-EPI) and UACR greater than 300 and less than 5000 mg/g or serum creatinine-based eGFR greater than or equal to 25 and less than 50 mL/min/1.73 m^2 (CKD-EPI) and UACR greater than 100 and less than 5000 mg/g Treatment with maximum labelled or tolerated dose of a renin-angiotensin-aldosterone system (RAAS) blocking agent including an angiotensin converting enzyme (ACE) inhibitor or an angiotensin II receptor blocker (ARB), unless such treatment is contraindicated or not tolerated. Treatment dose must be stable for at least 4 weeks prior to the date of the laboratory assessments used for determination of the inclusion criteria for renal impairment and kept stable until screening Exclusion Criteria: Congenital or hereditary kidney diseases including polycystic kidney disease, autoimmune kidney diseases including glomerulonephritis or congenital urinary tract malformations Use of any glucagon-like peptide-1 (GLP-1) receptor agonist within 30 days prior to screening Myocardial infarction, stroke, hospitalisation for unstable angina pectoris or transient ischaemic attack within 60 days prior to the day of screening Presently classified as being in New York Heart Association (NYHA) Class IV heart failure Planned coronary, carotid or peripheral artery revascularisation Current (or within 90 days) chronic or intermittent haemodialysis or peritoneal dialysis Uncontrolled and potentially unstable diabetic retinopathy or maculopathy. Verified by a fundus examination performed within the past 90 days prior to screening or in the period between screening and randomisation. Pharmacological pupil-dilation is a requirement unless using a digital fundus photography camera specified for non-dilated examination

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Semaglutide<br>Participants are to receive semglutide for up to 5 years or more (event driven). The trial is event driven with a pre-defined minimum number of renal endpoint events for the primary endpoint. | Drug: Semaglutide<br>* Participants are to inject semaglutide with a needle in the stomach, thigh or upper arm. Participants will use a pen to inject semaglutide under their skin. Participants will inject semaglutide 1 time a week on the same day of the week. Participants' dose of semaglutide will be changed over time. Participants start by taking a smaller amount (0.25 mg). After 4 weeks the dose will be increased to 0.5 mg. It will be increased more (to 1 mg) at 8 weeks. Participants will then stay on the same dose for the rest of the study.<br>|
| Placebo Comparator: Placebo<br>Participants are to receive placebo (semglutide) for up to 5 years or more (event driven). The trial is event driven with a pre-defined minimum number of renal endpoint events for the primary endpoint. | Drug: Placebo (semaglutide)<br>* Participants are to inject placebo (semaglutide) with a needle in the stomach, thigh or upper arm. Participants will use a pen to inject placebo (semaglutide) under their skin. Participants will inject placebo (semaglutide) 1 time a week on the same day of the week. Participants' dose of placebo (semaglutide) will be changed over time. Participants start by taking a smaller amount (0.25 mg). After 4 weeks the dose will be increased to 0.5 mg. It will be increased more (to 1 mg) at 8 weeks. Participants will then stay on the same dose for the rest of the study.<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time to first occurrence of a composite primary outcome event defined as persistent eGFR decline of greater than or equal to 50 percentage from trial start, reaching ESRD, death from kidney disease or death from cardiovascular disease | Measured in month(s). End Stage Renal Disease (ESRD) is defined as the following individual components: Persistent estimated glomerular filtration rate (eGFR) less than 15 mL/min/1.73m^2 or, Chronic dialysis treatment or receiving a kidney transplantation. | Week 0 to month 61 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Annual rate of change in eGFR (chronic kidney disease - epidemiology collaboration (CKD-EPI)) (total eGFR slope) | Measured in (mL/min/1.73 m^2)/year. | Week 0 to month 61 | 
| Time to first occurrence of a composite cardiovascular major adverse cardiovascular event (MACE) endpoint consisting of: Non-fatal myocardial infarction, non-fatal stroke, and cardiovascular (CV) death | Measured in month(s). | Week 0 to month 61 | 
| Time to occurrence of all-cause death | Measured in month(s). | Week 0 to month 61 | 
| Time to occurrence of each of the individual components of the primary composite endpoint and of the confirmatory secondary MACE endpoint | Measured in month(s). | Week 0 to month 61 | 
| Time to first occurrence of major adverse limb events (MALE), a composite endpoint consisting of: Acute limb ischemia hospitalisation and chronic limb ischemia hospitalisation | Measured in month(s). | Week 0 to month 61 | 
| Annual rate of change in eGFR (CKD-EPI) (chronic eGFR slope) | Measured in (mL/min/1.73 m^2)/year. | Week 12 to month 61 | 
| Change in eGFR (CKD-EPI) | Measured in mL/min/1.73 m^2. | Week 0, Week 12 | 
| Change in eGFR (cystatin C CKD-EPI) | Measured in mL/min/1.73 m^2. | Week 0, Year 3 | 
| Relative change in urinary albumin-to-creatinine ratio (UACR) | Measured in percentage. | Week 0, Year 3 | 
| Change in body weight | Measured in kilogram. | Week 0, Year 3 | 
| Change in glycosylated haemoglobin (HbA1c) | Measured in percentage point. | Week 0, Year 3 | 
| Change in systolic blood pressure | Measured in mmHg. | Week 0, Year 3 | 
| Change in diastolic blood pressure | Measured in mmHg. | Week 0, Year 3 | 
| Number of severe hypoglycaemic episodes | Number of events. | Week 0 to month 61 |