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Silencing Inflammatory Activity by Injecting Nanocort in Patients at Risk for Atherosclerotic Disease (SILENCE)

Primary Purpose

Atherosclerosis, Inflammation

Status
Unknown status
Phase
Phase 1
Locations
Netherlands
Study Type
Interventional
Intervention
liposomal prednisolone
Placebo
Sponsored by
Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Atherosclerosis focused on measuring Atherosclerosis, inflammation

Eligibility Criteria

50 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Population with target to background ratio of 2.2 of the aorta or carotid artery on PET-CT

Exclusion Criteria:

  • Current medical history of auto-immune disease/vasculitis, active inflammatory diseases, Recent (<1 month prior to screening) or ongoing serious infection requiring IV antibiotic therapy.
  • Recent or current treatment with medications that may have a significant effect on plaque inflammation as measured by plaque TBR, including but not limited to:

    • Steroids for at least 6 weeks prior to baseline measurement and during study (with the exception of inhaled acute use steroids).
    • Biological based medicines (anti-TNF (ex. Infliximab), anti-IL-6 therapy (ex. Tocilizumab) or anti-IL-1 (ex. anakinra)) within 8 weeks before the baseline visit and during the study
    • No other disease modifying antirheumatic drugs (DMRADS) within 6 weeks of baseline and during study (such as cyclosporine, azatioprine, etc.)
  • Known systemic disorders such as hepatic, renal, hematologic, and malignant diseases or any clinically significant medical condition that could interfere with the conduct of the study.
  • Changes in dose or frequency of doses at least 6 weeks prior to baseline measurement (unstable dosing) in angiotensin-converting enzyme (ACE) inhibitors (ACE-I) or angiotensin-receptor blockers (ARBs), non-statin lipid-modifying therapy, thiazolidinediones, inhaled steroids, or leukotriene modifying agents, nonsteroidal anti-inflammatory drugs (NSAIDS), and cyclo-oxygenase-2 inhibitors (COXIBs)
  • Standard contra-indications to MRI, 18FDG PET, and CT based on physicians experience and current practices
  • Current medical history of poorly controlled diabetes defined as hemoglobin A1c (HbA1c) >7.5%.
  • Current medical history of drug or alcohol abuse within 12 months prior to screening.
  • History of anaphylaxis, anaphylactoid (resembling anaphylaxis) reactions, or severe allergic responses.
  • Inability or unwillingness to comply with the protocol requirements, or deemed by investigator to be unfit for the study.
  • Subject has planned cardiac surgery, PCI or carotid stenting, or major non-cardiac surgery during the course of the study period or for 14 days after the last treatment.
  • Use of any investigational drug in the 3 months prior to study drug administration.
  • Use of insulin or any oral anti-diabetic (except metformin) in the 30 days prior to baseline measurements. Those subjects who are taking metformin may be included in the study if they are on a stable dose for at least 4 weeks and have a HbA1c <7.5%.
  • Any contraindications for corticosteroid infusions (for example, but not limited current infections or vaccinations)

Sites / Locations

  • Academic Medical CenterRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Placebo Comparator

Arm Label

Liposomal prednisolone

Placebo control

Arm Description

Outcomes

Primary Outcome Measures

18Fludeoxyglucose Positron emission computed tomography scan (18FDG PET-CT scan)

Secondary Outcome Measures

Full Information

First Posted
October 13, 2011
Last Updated
May 18, 2012
Sponsor
Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)
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1. Study Identification

Unique Protocol Identification Number
NCT01601106
Brief Title
Silencing Inflammatory Activity by Injecting Nanocort in Patients at Risk for Atherosclerotic Disease
Acronym
SILENCE
Official Title
A Phase I/II, Single-Center, Randomized, Placebo-Controlled Study Evaluating the Therapeutic Efficacy of Intravenously Injected PEG-liposomal Prednisolone Sodium Phosphate (Nanocort®) in Subjects With Severe Inflamed Carotid or Aortic Atherosclerosis Plaques
Study Type
Interventional

2. Study Status

Record Verification Date
May 2012
Overall Recruitment Status
Unknown status
Study Start Date
September 2011 (undefined)
Primary Completion Date
May 2013 (Anticipated)
Study Completion Date
undefined (undefined)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)

4. Oversight

5. Study Description

Brief Summary
Cardiovascular disease(CVD) is the leading cause of morbidity and mortality in developed nations. CVD is primarily caused by atherosclerosis, a systemic disease characterized by lipid deposition in the subendothelial space with a concomitant, low-grade inflammatory reaction.(Fuster, Moreno et al. 2005) To date, most therapeutic interventions aimed at lowering CVD have thus far focused on modulating lipid levels, either lowering LDLc or increasing HDLc levels. Yet, since the introduction of statins 20 years ago, there have been few breakthroughs in the treatment of this disease. A promising strategy to reduce CVD is to directly target inflammation at the level of the vessel wall.(van Leuven, van Wijk et al.; Libby 2002) A potential drawback of anti-inflammatory strategies pertains to the thin line between inhibiting 'inappropriate' inflammation versus inducing immuno-suppression. Therefore, continuous low dosed anti-inflammatory drugs have great potential as novel treatment strategies. In the present project, the investigators propose to inject liposomal glucocorticoids intravenously in patients with an increased risk of atherosclerotic disease aiming to reduce vessel wall inflammation.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Atherosclerosis, Inflammation
Keywords
Atherosclerosis, inflammation

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
30 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Liposomal prednisolone
Arm Type
Active Comparator
Arm Title
Placebo control
Arm Type
Placebo Comparator
Intervention Type
Drug
Intervention Name(s)
liposomal prednisolone
Intervention Description
Two weekly dosages with 150 mg.
Intervention Type
Drug
Intervention Name(s)
Placebo
Primary Outcome Measure Information:
Title
18Fludeoxyglucose Positron emission computed tomography scan (18FDG PET-CT scan)
Time Frame
Day 8-13

10. Eligibility

Sex
All
Minimum Age & Unit of Time
50 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Population with target to background ratio of 2.2 of the aorta or carotid artery on PET-CT Exclusion Criteria: Current medical history of auto-immune disease/vasculitis, active inflammatory diseases, Recent (<1 month prior to screening) or ongoing serious infection requiring IV antibiotic therapy. Recent or current treatment with medications that may have a significant effect on plaque inflammation as measured by plaque TBR, including but not limited to: Steroids for at least 6 weeks prior to baseline measurement and during study (with the exception of inhaled acute use steroids). Biological based medicines (anti-TNF (ex. Infliximab), anti-IL-6 therapy (ex. Tocilizumab) or anti-IL-1 (ex. anakinra)) within 8 weeks before the baseline visit and during the study No other disease modifying antirheumatic drugs (DMRADS) within 6 weeks of baseline and during study (such as cyclosporine, azatioprine, etc.) Known systemic disorders such as hepatic, renal, hematologic, and malignant diseases or any clinically significant medical condition that could interfere with the conduct of the study. Changes in dose or frequency of doses at least 6 weeks prior to baseline measurement (unstable dosing) in angiotensin-converting enzyme (ACE) inhibitors (ACE-I) or angiotensin-receptor blockers (ARBs), non-statin lipid-modifying therapy, thiazolidinediones, inhaled steroids, or leukotriene modifying agents, nonsteroidal anti-inflammatory drugs (NSAIDS), and cyclo-oxygenase-2 inhibitors (COXIBs) Standard contra-indications to MRI, 18FDG PET, and CT based on physicians experience and current practices Current medical history of poorly controlled diabetes defined as hemoglobin A1c (HbA1c) >7.5%. Current medical history of drug or alcohol abuse within 12 months prior to screening. History of anaphylaxis, anaphylactoid (resembling anaphylaxis) reactions, or severe allergic responses. Inability or unwillingness to comply with the protocol requirements, or deemed by investigator to be unfit for the study. Subject has planned cardiac surgery, PCI or carotid stenting, or major non-cardiac surgery during the course of the study period or for 14 days after the last treatment. Use of any investigational drug in the 3 months prior to study drug administration. Use of insulin or any oral anti-diabetic (except metformin) in the 30 days prior to baseline measurements. Those subjects who are taking metformin may be included in the study if they are on a stable dose for at least 4 weeks and have a HbA1c <7.5%. Any contraindications for corticosteroid infusions (for example, but not limited current infections or vaccinations)
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Erik S. Stroes, MD PhD
Phone
+31205665978
Email
e.s.stroes@amc.uva.nl
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Erik S Stroes, MD PhD
Organizational Affiliation
AIDS Malignancy Consortium
Official's Role
Principal Investigator
Facility Information:
Facility Name
Academic Medical Center
City
Amsterdam
ZIP/Postal Code
1105AZ
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Erik S Stroes, MD PhD
Phone
+31205665978
Email
e.s.stroes@amc.uva.nl
First Name & Middle Initial & Last Name & Degree
Erik S Stroes, MD PhD

12. IPD Sharing Statement

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Silencing Inflammatory Activity by Injecting Nanocort in Patients at Risk for Atherosclerotic Disease

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