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The Efficacy and Mechanism of Trientine in Patients With Hypertrophic Cardiomyopathy (TEMPEST)

Primary Purpose

Hypertrophic Cardiomyopathy

Status
Recruiting
Phase
Phase 2
Locations
United Kingdom
Study Type
Interventional
Intervention
Trientine
Placebo
Sponsored by
Manchester University NHS Foundation Trust
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Hypertrophic Cardiomyopathy

Eligibility Criteria

18 Years - 70 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Written informed consent.
  2. Age 18-70 inclusive.
  3. Hypertrophic cardiomyopathy (HCM), as defined by the European Society of Cardiology HCM guidelines as: "a wall thickness ≥15 mm in one or more LV myocardial segments that is not explained solely by loading conditions". The same definition is applied to first-degree relatives of patients with HCM i.e. all participants are required to have a LV wall thickness ≥15 mm. Wall thickness is as measured on the most recent cardiovascular magnetic resonance (CMR) scan performed prior to the baseline visit. If CMR has not been performed previously, wall thickness measurement should be taken from the most recent echocardiogram performed prior to the baseline visit. (It is recognised that in the European Society of Cardiology guidelines a clinical diagnosis of HCM in first-degree relatives requires a wall thickness that is less than this value, however ≥15 mm is applied here in order to ensure that all participants have an unequivocal phenotype).
  4. New York Heart Association class I, II or III at the most recent clinical assessment performed prior to the baseline visit.

Exclusion Criteria:

  1. Previous or planned septal reduction therapy.
  2. Previously documented myocardial infarction or severe coronary artery disease.
  3. Uncontrolled hypertension, defined as a systolic blood pressure of >180mmHg or a diastolic blood pressure of > 100mmHg at Visit 1.
  4. Known LV EF < 50%, as measured on the most recent CMR scan performed prior to the baseline visit. If CMR has not been performed previously, the most recent echocardiogram performed prior to the baseline visit should be used.
  5. Previously documented persistent atrial fibrillation.
  6. Anaemia, defined as haemoglobin being below the local site normal reference range, at Visit 1.
  7. Iron deficiency, defined as serum iron being below the local site normal reference range, at Visit 1.
  8. Copper deficiency, defined as serum copper being below the normal reference range, at Visit 1.
  9. Pacemaker or implantable cardioverter defibrillator.
  10. Known severe valvular heart disease, as demonstrated on the most recent heart imaging performed prior to the baseline visit.
  11. Previously documented other cardiomyopathic cause of myocardial hypertrophy (e.g. amyloidosis, Fabry disease, mitochondrial disease).
  12. History of hypersensitivity to any of the components of the investigational medicinal product (IMP).
  13. Known contraindication to MRI scanning.
  14. Pregnancy, lactation or planning pregnancy. Women of childbearing capacity are required to have a negative serum pregnancy test before treatment, must agree to pregnancy tests at study visits as defined in the Section 8 and must agree to maintain highly effective contraception as defined in Section 8 during the study.
  15. Any medical condition, which in the opinion of the Investigator, may place the patient at higher risk from his/her participation in the study, or is likely to prevent the patient from complying with the requirements of the study or completing the study.

Sites / Locations

  • Liverpool Heart and Chester Hospital NHS Foundation TrustRecruiting
  • Royal Brompton and Harefield NHS Foundation Trust
  • Manchester University NHS Foundation TrustRecruiting
  • Oxford University Hospitals NHS Foundation TrustRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Placebo Comparator

Arm Label

Trientine

Placebo

Arm Description

Trientine dihydrochloride 1200 mg per day. This shall be taken orally as two Cufence 200mg hard capsules two times per day. The IMP will be dispensed to participants every 13 weeks for the duration of the study period (52 weeks).

The placebo shall be taken orally as two capsules two times per day. This will be dispensed to participants every 13 weeks for the duration of the study period (52 weeks).

Outcomes

Primary Outcome Measures

Left ventricular mass indexed to body surface area (LVMi)
Change in LVMi (g/m2), measured using CMR, from baseline to week 52.

Secondary Outcome Measures

Urine copper excretion
Cumulative urine copper excretion, measured using urinary copper, assessed from baseline to weeks 13, 26, 39 and 52.
Exercise capacity
Change in exercise capacity, measured using cardiopulmonary exercise testing (CPET), assessed from baseline to week 52.
Number of non-sinus supraventricular heart beats, presence and amount of atrial fibrillation, number of ventricular-origin beats and presence and amount of non-sustained ventricular tachycardia
Change in number of non-sinus supraventricular heart beats, presence and amount of atrial fibrillation, number of ventricular-origin beats and presence and amount of non-sustained ventricular tachycardia, in 24 hours, measured using ambulatory heart monitoring, assessed from baseline to week 52.
Circulating high sensitivity troponin
Change in circulating high sensitivity troponin, assessed from baseline to week 52.
LV global longitudinal strain and strain rate, wall thickness, mass, volumes and ejection fraction (EF)
Change in LV global longitudinal strain and strain rate, wall thickness, mass, volumes and ejection fraction (EF) measured using CMR, assessed from baseline to week 52.
Peak left ventricular outflow
Change in peak left ventricular outflow tract gradient, measured using CMR, assessed from baseline to week 52.
Atrial volume and function
Change in atrial volume and function, measured using CMR, assessed from baseline to week 52.

Full Information

First Posted
January 11, 2021
Last Updated
January 27, 2023
Sponsor
Manchester University NHS Foundation Trust
Collaborators
National Institute for Health Research, United Kingdom, University of Manchester, University of Liverpool, Univar BV, University of Oxford
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1. Study Identification

Unique Protocol Identification Number
NCT04706429
Brief Title
The Efficacy and Mechanism of Trientine in Patients With Hypertrophic Cardiomyopathy
Acronym
TEMPEST
Official Title
A Randomised, Double-blind, Placebo-controlled, Phase 2 Evaluation of the Efficacy and Mechanism of Trientine in Patients With Hypertrophic Cardiomyopathy
Study Type
Interventional

2. Study Status

Record Verification Date
January 2023
Overall Recruitment Status
Recruiting
Study Start Date
December 1, 2020 (Actual)
Primary Completion Date
December 1, 2023 (Anticipated)
Study Completion Date
May 31, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Manchester University NHS Foundation Trust
Collaborators
National Institute for Health Research, United Kingdom, University of Manchester, University of Liverpool, Univar BV, University of Oxford

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This research study has been designed to test whether a drug called trientine dihydrochloride (also called Cufence) reduces heart muscle thickening, improves exercise capacity, improves heart function and reduces abnormal heart rhythms in patients with hypertrophic cardiomyopathy (HCM). The study is also assessing how trientine works in HCM. Participants will be prescribed either trientine or placebo, for a period of 12 months.
Detailed Description
HCM is the most common inherited cardiovascular disorder. It is characterised by left ventricular (LV) myocardial hypertrophy and fibrosis. Patients can experience symptoms of effort intolerance, progressive heart failure and abnormal heart rhythms. There are currently no treatments that alter the natural history of HCM. Patients and the cardiovascular field have identified a "critical need" for clinical studies of drug therapies that target HCM pathophysiological mechanisms. Trientine dihydrochloride is a copper-chelating agent licensed for Wilson disease, a genetic disorder of copper excretion, in which patients exhibit a cardiac phenotype that mimics HCM. Proof of concept has been established through an MRC-funded study to suggest that use of trientine may also be beneficial in HCM.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Hypertrophic Cardiomyopathy

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Trientine
Arm Type
Active Comparator
Arm Description
Trientine dihydrochloride 1200 mg per day. This shall be taken orally as two Cufence 200mg hard capsules two times per day. The IMP will be dispensed to participants every 13 weeks for the duration of the study period (52 weeks).
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
The placebo shall be taken orally as two capsules two times per day. This will be dispensed to participants every 13 weeks for the duration of the study period (52 weeks).
Intervention Type
Drug
Intervention Name(s)
Trientine
Other Intervention Name(s)
Cufence
Intervention Description
Trientine dihydrochloride is a white to pale yellow crystalline hygroscopic powder.
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Placebo capsule, manufactured with the exact components of the trientine capsules, without the active ingredient / investigational medicinal product.
Primary Outcome Measure Information:
Title
Left ventricular mass indexed to body surface area (LVMi)
Description
Change in LVMi (g/m2), measured using CMR, from baseline to week 52.
Time Frame
12 months
Secondary Outcome Measure Information:
Title
Urine copper excretion
Description
Cumulative urine copper excretion, measured using urinary copper, assessed from baseline to weeks 13, 26, 39 and 52.
Time Frame
12 months
Title
Exercise capacity
Description
Change in exercise capacity, measured using cardiopulmonary exercise testing (CPET), assessed from baseline to week 52.
Time Frame
12 months
Title
Number of non-sinus supraventricular heart beats, presence and amount of atrial fibrillation, number of ventricular-origin beats and presence and amount of non-sustained ventricular tachycardia
Description
Change in number of non-sinus supraventricular heart beats, presence and amount of atrial fibrillation, number of ventricular-origin beats and presence and amount of non-sustained ventricular tachycardia, in 24 hours, measured using ambulatory heart monitoring, assessed from baseline to week 52.
Time Frame
12 months
Title
Circulating high sensitivity troponin
Description
Change in circulating high sensitivity troponin, assessed from baseline to week 52.
Time Frame
12 months
Title
LV global longitudinal strain and strain rate, wall thickness, mass, volumes and ejection fraction (EF)
Description
Change in LV global longitudinal strain and strain rate, wall thickness, mass, volumes and ejection fraction (EF) measured using CMR, assessed from baseline to week 52.
Time Frame
12 months
Title
Peak left ventricular outflow
Description
Change in peak left ventricular outflow tract gradient, measured using CMR, assessed from baseline to week 52.
Time Frame
12 months
Title
Atrial volume and function
Description
Change in atrial volume and function, measured using CMR, assessed from baseline to week 52.
Time Frame
12 months
Other Pre-specified Outcome Measures:
Title
LV myocardial cellular mass
Description
Change in LV myocardial cellular mass, measured using CMR, from baseline to week 52.
Time Frame
12 months
Title
LV myocardial extracellular mass
Description
Change in LV myocardial extracellular mass, measured using CMR, from baseline to week 52.
Time Frame
12 months
Title
LV myocardial extracellular volume
Description
Change in LV myocardial extracellular volume, measured using CMR, from baseline to week 52.
Time Frame
12 months
Title
LV late gadolinium enhancement
Description
Change in LV late gadolinium enhancement, measured using CMR, from baseline to week 52.
Time Frame
12 months
Title
PCr/ATP ratio
Description
Change in PCr/ATP ratio, measured using 31P MRS (sub-group), from baseline to week 52.
Time Frame
12 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Written informed consent. Age 18-70 inclusive. Hypertrophic cardiomyopathy (HCM), as defined by the European Society of Cardiology HCM guidelines as: "a wall thickness ≥15 mm in one or more LV myocardial segments that is not explained solely by loading conditions". The same definition is applied to first-degree relatives of patients with HCM i.e. all participants are required to have a LV wall thickness ≥15 mm. Wall thickness is as measured on the most recent cardiovascular magnetic resonance (CMR) scan performed prior to the baseline visit. If CMR has not been performed previously, wall thickness measurement should be taken from the most recent echocardiogram performed prior to the baseline visit. (It is recognised that in the European Society of Cardiology guidelines a clinical diagnosis of HCM in first-degree relatives requires a wall thickness that is less than this value, however ≥15 mm is applied here in order to ensure that all participants have an unequivocal phenotype). New York Heart Association class I, II or III at the most recent clinical assessment performed prior to the baseline visit. Exclusion Criteria: Previous or planned septal reduction therapy. Previously documented myocardial infarction or severe coronary artery disease. Uncontrolled hypertension, defined as a systolic blood pressure of >180mmHg or a diastolic blood pressure of > 100mmHg at Visit 1. Known LV EF < 50%, as measured on the most recent CMR scan performed prior to the baseline visit. If CMR has not been performed previously, the most recent echocardiogram performed prior to the baseline visit should be used. Previously documented persistent atrial fibrillation. Anaemia, defined as haemoglobin being below the local site normal reference range, at Visit 1. Iron deficiency, defined as serum iron being below the local site normal reference range, at Visit 1. Copper deficiency, defined as serum copper being below the normal reference range, at Visit 1. Pacemaker or implantable cardioverter defibrillator. Known severe valvular heart disease, as demonstrated on the most recent heart imaging performed prior to the baseline visit. Previously documented other cardiomyopathic cause of myocardial hypertrophy (e.g. amyloidosis, Fabry disease, mitochondrial disease). History of hypersensitivity to any of the components of the investigational medicinal product (IMP). Known contraindication to MRI scanning. Pregnancy, lactation or planning pregnancy. Women of childbearing capacity are required to have a negative serum pregnancy test before treatment, must agree to pregnancy tests at study visits as defined in the Section 8 and must agree to maintain highly effective contraception as defined in Section 8 during the study. Any medical condition, which in the opinion of the Investigator, may place the patient at higher risk from his/her participation in the study, or is likely to prevent the patient from complying with the requirements of the study or completing the study.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Carly Lawrence
Phone
00 44 (0) 151 794 9763
Email
tempest@liverpool.ac.uk
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Chris Miller
Organizational Affiliation
Manchester University NHS Foundation Trust
Official's Role
Principal Investigator
Facility Information:
Facility Name
Liverpool Heart and Chester Hospital NHS Foundation Trust
City
Liverpool
ZIP/Postal Code
L14 3PE
Country
United Kingdom
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Robert Cooper
Email
Rob.Cooper@lhch.nhs.uk
First Name & Middle Initial & Last Name & Degree
Robert Cooper
Facility Name
Royal Brompton and Harefield NHS Foundation Trust
City
London
ZIP/Postal Code
SW3 6NP
Country
United Kingdom
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Sanjay Prasad
Email
S.Prasad@rbht.nhs.uk
First Name & Middle Initial & Last Name & Degree
Sanjay Prasad
Facility Name
Manchester University NHS Foundation Trust
City
Manchester
ZIP/Postal Code
M23 9LT
Country
United Kingdom
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Matthias Schmitt
Email
matthias.schmitt@mft.nhs.uk
First Name & Middle Initial & Last Name & Degree
Matthias Schmitt
Facility Name
Oxford University Hospitals NHS Foundation Trust
City
Oxford
ZIP/Postal Code
OX3 9DU
Country
United Kingdom
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Masliza Mahmod
Email
masliza.mahmod@cardiov.ox.ac.uk
First Name & Middle Initial & Last Name & Degree
Masliza Mahmod

12. IPD Sharing Statement

Plan to Share IPD
Undecided

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The Efficacy and Mechanism of Trientine in Patients With Hypertrophic Cardiomyopathy

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