SirolimUs CoaTed Balloon for The TrEatment of Below The Knee Arterial Disease (FUTURE-BTK)
Primary Purpose
Peripheral Artery Disease, Atherosclerosis, Arterial Disease of Legs
Status
Recruiting
Phase
Not Applicable
Locations
International
Study Type
Interventional
Intervention
MagicTouch PTA Sirolimus drug coated balloon
POBA balloon
Sponsored by
About this trial
This is an interventional treatment trial for Peripheral Artery Disease focused on measuring PAD, DCB, PTA, Sirolimus
Eligibility Criteria
Inclusion Criteria:
- Age ≥ 21 years or minimum age
Rutherford class 4 to 6 in the target limb
Intraoperative Inclusion Criteria
- Single or sequential de novo or re-stenotic lesions (stenosis of > 50% or occlusions) from 2 to 20cm in the proximal 200mm of below the knee arteries. Lesion is considered as one lesion if there is maximum of 30mm gap between lesions at discretion of investigator. Below the knee arteries are tibioperoneal trunk, anterior tibial artery, posterior tibial artery and peroneal artery
- Inflow free from flow limiting lesions (<50% stenosis) confirmed by duplex or angiography. Subjects with flow limiting inflow lesions (>50% stenosis) can be included if lesion had been treated successfully (<30% residual stenosis) before or during the index procedure.
- Target vessel has angiographically documented run off to the foot after treatment (ie. without significant stenosis)
Exclusion Criteria:
- Comorbid conditions limiting life expectancy ≤ 1 year
- Subject is currently participating in another investigational drug or device study that has not reached first primary endpoint yet
- Subject is pregnant or planning to become pregnant during the course of the study
- Heel gangrene
- Prior bypass surgery of target vessel
- Planned amputation of the target limb
- Previously implanted stent in the target lesion
- Vulnerable or protected adults
- Bleeding diathesis or another disorder such as gastrointestinal ulceration which restrict the use of clopidogrel or aspirin
Known allergy to sirolimus
Intraoperative Exclusion Criteria
- Failure to successfully cross the target lesion with a guide wire (successful crossing means tip of the guide wire distal to the target lesion in the absence of flow limiting dissections or perforations).
- Target vessel has lesions extending beyond the ankle joint
- Failure to obtain <30% residual stenosis in a pre-existing lesion
- Lesions requiring retrograde access (SAFARI)
- Highly calcified lesions (Contiguous calcification on both sides of the lesion)
- Use of DCBs, drug eluting stent, specialty balloons or artherectomy devices during the index procedure. (Non-compliant balloons are not considered specialty balloons)
Sites / Locations
- Asan Medical Centre
- Khoo Teck Puat HospitalRecruiting
- National University HospitalRecruiting
- Ng Teng Fong General Hospital
- Sengkang General HospitalRecruiting
- Singapore General HospitalRecruiting
- Tan Tock Seng HospitalRecruiting
- Far Eastern Memorial Hospital
- Taipei Tzuchi Hospital
- National Taiwan University Hospital
- Shin Kong Wu Ho-Su Memorial Hospital
- Taipei Mackay Memorial Hospital
- Linkou Chang Gung Memorial Hospital
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Active Comparator
Arm Label
MagicTouch PTA sirolimus drug coated balloon (DCB)
Placebo balloon angioplasty
Arm Description
MagicTouch PTA sirolimus drug coated balloon (DCB) in addition to standard balloon angioplasty
Placebo balloon angioplasty in addition to standard balloon angioplasty (PTA)
Outcomes
Primary Outcome Measures
Primary patency at 6 months
Primary patency rate at 6 months defined as proportion of subjects with duplex ultrasonography-derived peak systolic velocity ratio of ≤ 2.4 (in absence of target lesion revascularisation)
Secondary Outcome Measures
Device and procedure related deaths
Proportion of device and procedure related deaths
All-cause death
Proportion of subjects died by any-cause
Major target limb amputation
Proportion of subjects with major target limb amputation
Target vessel thrombosis
Proportion of subjects with target vessel thrombosis
Proportion of subjects who experienced either death at 6 month or major target limb amputation at 6 month or target vessel thrombosis within 14 days.
Proportion of subjects who experienced either death at 6 month or major target limb amputation at 6 month or target vessel thrombosis within 14 days.
Occurrence of adverse events (AEs), serious AEs and AEs related to device and procedure
Occurrence of adverse events (AEs), serious AEs and AEs related to device and Occurrence of adverse events (AEs), serious AEs and AEs related to device and procedure
Procedural Success
Proportion of subjects with procedural success during hospital stay
Proportion of subjects who are free from clinically-driven Target Lesion Revascularization (TLR)
Proportion of subjects who are free from clinically-driven TLR
Proportion of subjects who are free from clinically-driven Target Vessel Revascularization (TVR)
Proportion of subjects who are free from clinically-driven Target Vessel Revascularization (TVR)
Primary patency
Primary patency rate at 12 and 24 months
Restenosis
Proportion of subjects with restenosis
Subjects who are free from MAE
Proportion of subjects who are free from MAE
Amputation-free survival
Amputation-free survival
Clinical Success
Proportion of subjects with clinical Success at 6, 12 and 24 months, Clinical success is defined as Improvement in Rutherford classification compared to the pre-procedure Rutherford classification
Device success
Proportion of subjects with device success at day 1
Technical success
Proportion of subjects with technical success at day 1
Wound assessment (if any)
Wound assessment (if any)
Toe Pressure or ABPI assessment
Toe Pressure or ABPI assessment
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT04511247
Brief Title
SirolimUs CoaTed Balloon for The TrEatment of Below The Knee Arterial Disease
Acronym
FUTURE-BTK
Official Title
FUTURE BTK: Randomized Controlled Trial of First SirolimUs CoaTed Balloon VersUs StandaRd Balloon Angioplasty in The TrEatment of Below The Knee Arterial Disease
Study Type
Interventional
2. Study Status
Record Verification Date
March 2023
Overall Recruitment Status
Recruiting
Study Start Date
August 15, 2020 (Actual)
Primary Completion Date
December 2024 (Anticipated)
Study Completion Date
December 2025 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Concept Medical Inc.
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
This study aims to conduct a randomized, double blind, randomised controlled multicentre trial of sirolimus drug coated balloon versus standard percutaneous transluminal angioplasty for the treatment of below the knee arterial disease.
Detailed Description
The burden of limb loss as a result of peripheral arterial disease (PAD) is high and this problem is set to worsen globally. Treatment of PAD primarily involves revascularisation of the limb. Angioplasty as a first line strategy of revascularization over surgical procedures has been adopted by most vascular centers. Local drug delivery using drug coated balloons (DCB) during angioplasty for PAD can successfully deliver effective local tissue concentrations of anti-proliferative drugs to the lesions in the artery involved in the PAD. This offers the potential for sustained anti-restenotic efficacy.
Randomized trials have shown superiority of Paclitaxel DCBs over just plain-balloon angioplasty for treatment of PAD, and DCB is now considered the standard of care. However, a recent meta-analyses which showed increased mortality at two years in patients treated with paclitaxel DCBs have called into question the safety of paclitaxel based DCBs.
Alternative drugs for DCBs are therefore urgently needed and sirolimus offers an attractive alternative. Compared to Paclitaxel, sirolimus is cytostatic in its mode of action with a high margin of safety. It has a high transfer rate to the vessel wall and has been shown to effectively inhibit neointimal hyperplasia in the porcine coronary model. In the coronary artery interventions, preliminary clinical studies using Sirolimus DCBs have also shown excellent procedural and 6 month patency.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Peripheral Artery Disease, Atherosclerosis, Arterial Disease of Legs
Keywords
PAD, DCB, PTA, Sirolimus
7. Study Design
Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Model Description
Eligible subjects will be randomised via a secure online system to a labelled device and to receive either Magic Touch sirolimus drug coated balloon in addition to standard balloon angioplasty or standard balloon angioplasty and placebo balloon.
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
219 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
MagicTouch PTA sirolimus drug coated balloon (DCB)
Arm Type
Experimental
Arm Description
MagicTouch PTA sirolimus drug coated balloon (DCB) in addition to standard balloon angioplasty
Arm Title
Placebo balloon angioplasty
Arm Type
Active Comparator
Arm Description
Placebo balloon angioplasty in addition to standard balloon angioplasty (PTA)
Intervention Type
Device
Intervention Name(s)
MagicTouch PTA Sirolimus drug coated balloon
Intervention Description
For participants randomised to MagicTouch PTA sirolimus DCB, following successful plain balloon angioplasty of the arterial lesion (defined as <30% residual stenosis after treatment at rated burst pressure of the angioplasty balloon), MagicTouch sirolimus coated balloon will be applied at the lesion after appropriate sizing using the diameter of the plain balloon angioplasty.
Intervention Type
Device
Intervention Name(s)
POBA balloon
Intervention Description
For participants randomised to the standard balloon angioplasty group, a placebo standard balloon which is identical to the SCB will also be applied at the lesion after appropriate sizing using the diameter of the plain balloon angioplasty
Primary Outcome Measure Information:
Title
Primary patency at 6 months
Description
Primary patency rate at 6 months defined as proportion of subjects with duplex ultrasonography-derived peak systolic velocity ratio of ≤ 2.4 (in absence of target lesion revascularisation)
Time Frame
6 months
Secondary Outcome Measure Information:
Title
Device and procedure related deaths
Description
Proportion of device and procedure related deaths
Time Frame
1,6,12 and 24 Months
Title
All-cause death
Description
Proportion of subjects died by any-cause
Time Frame
1,6,12 and 24 Months
Title
Major target limb amputation
Description
Proportion of subjects with major target limb amputation
Time Frame
6,12 and 24 Months
Title
Target vessel thrombosis
Description
Proportion of subjects with target vessel thrombosis
Time Frame
From day 0 to day 14
Title
Proportion of subjects who experienced either death at 6 month or major target limb amputation at 6 month or target vessel thrombosis within 14 days.
Description
Proportion of subjects who experienced either death at 6 month or major target limb amputation at 6 month or target vessel thrombosis within 14 days.
Time Frame
Day 0 to day 14, 6 Months
Title
Occurrence of adverse events (AEs), serious AEs and AEs related to device and procedure
Description
Occurrence of adverse events (AEs), serious AEs and AEs related to device and Occurrence of adverse events (AEs), serious AEs and AEs related to device and procedure
Time Frame
From Day 0 to 24 Months Follow-up
Title
Procedural Success
Description
Proportion of subjects with procedural success during hospital stay
Time Frame
From Day 1 to discharge up to maximum of 30 days
Title
Proportion of subjects who are free from clinically-driven Target Lesion Revascularization (TLR)
Description
Proportion of subjects who are free from clinically-driven TLR
Time Frame
6,12 and 24 Months
Title
Proportion of subjects who are free from clinically-driven Target Vessel Revascularization (TVR)
Description
Proportion of subjects who are free from clinically-driven Target Vessel Revascularization (TVR)
Time Frame
6,12 and 24 Months
Title
Primary patency
Description
Primary patency rate at 12 and 24 months
Time Frame
12 and 24 Months
Title
Restenosis
Description
Proportion of subjects with restenosis
Time Frame
6, 12 and 24 Months
Title
Subjects who are free from MAE
Description
Proportion of subjects who are free from MAE
Time Frame
6 Months
Title
Amputation-free survival
Description
Amputation-free survival
Time Frame
6, 12 and 24 Months
Title
Clinical Success
Description
Proportion of subjects with clinical Success at 6, 12 and 24 months, Clinical success is defined as Improvement in Rutherford classification compared to the pre-procedure Rutherford classification
Time Frame
6, 12 and 24 Months
Title
Device success
Description
Proportion of subjects with device success at day 1
Time Frame
Day 1
Title
Technical success
Description
Proportion of subjects with technical success at day 1
Time Frame
Day 1
Title
Wound assessment (if any)
Description
Wound assessment (if any)
Time Frame
1, 6, 12, 24 Months
Title
Toe Pressure or ABPI assessment
Description
Toe Pressure or ABPI assessment
Time Frame
6, 12, 24 Months
Other Pre-specified Outcome Measures:
Title
Health-related quality of life
Description
Mean change from baseline in EuroQol-5Dimensions (EQ-5D) health-related quality of life questionnaire score at 12 and 24 months. The score ranges from 0 to 1, and a higher score means a better outcome
Time Frame
12 and 24 months
Title
Walking impairment
Description
Mean change from baseline in walking impairment questionnaire score at 12 and 24 months. The score ranges from 0% to 100% and a higher score means a better outcome
Time Frame
12 and 24 months
10. Eligibility
Sex
All
Minimum Age & Unit of Time
21 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Age ≥ 21 years or minimum age
Rutherford class 4 to 6 in the target limb
Intraoperative Inclusion Criteria
Single or sequential de novo or re-stenotic lesions (stenosis of > 50% or occlusions) from 2 to 20cm in the proximal 200mm of below the knee arteries. Lesion is considered as one lesion if there is maximum of 30mm gap between lesions at discretion of investigator. Below the knee arteries are tibioperoneal trunk, anterior tibial artery, posterior tibial artery and peroneal artery
Inflow free from flow limiting lesions (<50% stenosis) confirmed by duplex or angiography. Subjects with flow limiting inflow lesions (>50% stenosis) can be included if lesion had been treated successfully (<30% residual stenosis) before or during the index procedure.
Target vessel has angiographically documented run off to the foot after treatment (ie. without significant stenosis)
Exclusion Criteria:
Comorbid conditions limiting life expectancy ≤ 1 year
Subject is currently participating in another investigational drug or device study that has not reached first primary endpoint yet
Subject is pregnant or planning to become pregnant during the course of the study
Heel gangrene
Prior bypass surgery of target vessel
Planned amputation of the target limb
Previously implanted stent in the target lesion
Vulnerable or protected adults
Bleeding diathesis or another disorder such as gastrointestinal ulceration which restrict the use of clopidogrel or aspirin
Known allergy to sirolimus
Intraoperative Exclusion Criteria
Failure to successfully cross the target lesion with a guide wire (successful crossing means tip of the guide wire distal to the target lesion in the absence of flow limiting dissections or perforations).
Target vessel has lesions extending beyond the ankle joint
Failure to obtain <30% residual stenosis in a pre-existing lesion
Lesions requiring retrograde access (SAFARI)
Highly calcified lesions (Contiguous calcification on both sides of the lesion)
Use of DCBs, drug eluting stent, specialty balloons or artherectomy devices during the index procedure. (Non-compliant balloons are not considered specialty balloons)
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Edward Choke
Phone
+65 69302164
Email
edward.choke.t.c@singhealth.com.sg
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Edward Choke
Organizational Affiliation
Sengkang General Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Asan Medical Centre
City
Seoul
Country
Korea, Republic of
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Lee Seung Hwan, Dr.
Facility Name
Khoo Teck Puat Hospital
City
Singapore
Country
Singapore
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Leong Chuo Ren
Facility Name
National University Hospital
City
Singapore
Country
Singapore
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Jackie Ho
Facility Name
Ng Teng Fong General Hospital
City
Singapore
Country
Singapore
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Vikram Vijayan
Facility Name
Sengkang General Hospital
City
Singapore
Country
Singapore
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Edward Choke
Facility Name
Singapore General Hospital
City
Singapore
Country
Singapore
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Tang Tjun Yip
Facility Name
Tan Tock Seng Hospital
City
Singapore
Country
Singapore
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Pua Uei, Dr.
First Name & Middle Initial & Last Name & Degree
Pua Uei, Dr.
Facility Name
Far Eastern Memorial Hospital
City
New Taipei City
Country
Taiwan
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Chen Jer-Shen, Dr.
Facility Name
Taipei Tzuchi Hospital
City
New Taipei City
Country
Taiwan
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Huang Hsuan-Li, Dr.
Facility Name
National Taiwan University Hospital
City
Taipei City
Country
Taiwan
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Lee Jen-Kuang, Dr.
Facility Name
Shin Kong Wu Ho-Su Memorial Hospital
City
Taipei City
Country
Taiwan
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Lin Chia-Hsun, Dr.
Facility Name
Taipei Mackay Memorial Hospital
City
Taipei City
Country
Taiwan
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Tsai Cheng-Ting, Dr.
Facility Name
Linkou Chang Gung Memorial Hospital
City
Taoyuan City
Country
Taiwan
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Chen Chun-Chi, Dr.
12. IPD Sharing Statement
Citations:
PubMed Identifier
27539695
Citation
Giacoppo D, Cassese S, Harada Y, Colleran R, Michel J, Fusaro M, Kastrati A, Byrne RA. Drug-Coated Balloon Versus Plain Balloon Angioplasty for the Treatment of Femoropopliteal Artery Disease: An Updated Systematic Review and Meta-Analysis of Randomized Clinical Trials. JACC Cardiovasc Interv. 2016 Aug 22;9(16):1731-42. doi: 10.1016/j.jcin.2016.06.008.
Results Reference
background
PubMed Identifier
27069105
Citation
Clever YP, Peters D, Calisse J, Bettink S, Berg MC, Sperling C, Stoever M, Cremers B, Kelsch B, Bohm M, Speck U, Scheller B. Novel Sirolimus-Coated Balloon Catheter: In Vivo Evaluation in a Porcine Coronary Model. Circ Cardiovasc Interv. 2016 Apr;9(4):e003543. doi: 10.1161/CIRCINTERVENTIONS.115.003543.
Results Reference
background
PubMed Identifier
28964764
Citation
Verheye S, Vrolix M, Kumsars I, Erglis A, Sondore D, Agostoni P, Cornelis K, Janssens L, Maeng M, Slagboom T, Amoroso G, Jensen LO, Granada JF, Stella P. The SABRE Trial (Sirolimus Angioplasty Balloon for Coronary In-Stent Restenosis): Angiographic Results and 1-Year Clinical Outcomes. JACC Cardiovasc Interv. 2017 Oct 23;10(20):2029-2037. doi: 10.1016/j.jcin.2017.06.021. Epub 2017 Sep 27.
Results Reference
background
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SirolimUs CoaTed Balloon for The TrEatment of Below The Knee Arterial Disease
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