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Colchicine Versus Placebo in Acute Myocarditis Patients (ARGO)

Primary Purpose

Acute Myocarditis

Status
Not yet recruiting
Phase
Phase 3
Locations
France
Study Type
Interventional
Intervention
Colchicine Pill
Placebo
Sponsored by
Assistance Publique - Hôpitaux de Paris
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Acute Myocarditis focused on measuring Myocarditis, Inflammation, Colchicine

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Symptom onset of 21 days or less, Chest pain and/or Heart failure symptoms and/or palpitations Troponins superior to 99 percentile of reference value, Myocarditis diagnostic confirmation (by Contrast-Enhanced Cardiac Magnetic Resonance (CMR), according to the Lake Louise criteria with the presence of myocardial damage), No evidence for ischemic heart disease on coronary angiography or coronary computed tomography angiography for patients with age superior to 40-year-old with one or more cardiovascular risk factor (hypertension, smoking, hypercholesterolemia, diabetes, personal or family history of coronary artery disease), Woman of child-bearing age with an effective contraception method according to the investigator for the duration of treatment and one month after, Man accepting effective contraception for the duration of treatment and one month after, Participant with affiliation to the French Health Care System "sécurité sociale", Written informed consent of the patient obtained. Exclusion Criteria: Cardiogenic shock requiring inotropes or vasopressors (patients with inotropes discontinued for more than 24 hours can be enrolled) Giant cell myocarditis or eosinophilic myocarditis Acute coronary syndrome or known coronary stenosis superior to 50% Toxic cardiomyopathy Active chronic inflammatory disease, chronic active infection, evolving cancer A recent severe sepsis (7 days) or all recent acute illness Hypersensitivity to Investgational Medical Product's active substances (colchicine) or to any of the excipients (including lactose, sucrose, microcrystalline cellulose, colloidal silica, magnesium stearate, colourants : E127, Dual Red 40 ) Any known contra-indication to CMR or associated contract products (claustrophobia, pace maker, defibrillator, history of hypersensitivity to gadoteric acid or to gadolinium contrast agents or to meglumine), Chronic treatment with corticosteroids or Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) or immunosuppressant. Sarcoidosis Severe liver (Child Pugh C) or known renal dysfunction (known Glomerular Filtration Rate (GFR) less or equal to 30 ml/min according Cockroft), Cytopenia : hemoglobin less than 100 grams/L, white blood cell count less than 3.0 G/L, platelet count less than 100 G/L Major digestive disorders (chronic diarrhea, inflammatory disease of the digestive tract as uncontrolled ulcerative colitis or active Crohn disease) Immunosuppression, spinal cord aplasia Hemopathy Hypereosinophilia more than 0.5 G/L Pregnant or nursing women, where pregnancy is defined as the state of a female after conception and until the termination of gestation, confirmed by a positive local laboratory test, Administration of any investigational drug or participation in another interventional trial, within 30 days before randomization, Participant under treatment having an interaction with colchicine [macrolides (telithromycin, azithromycin, clarithromycin, dirithromycin, erythromycin, josamycin, midecamycin, roxithromycin), pristinamycin,, cyclosporine, verapamil, all protease inhibitors, telaprevir, CYP3A4 powerful inhibitors, Participant under legal protection: under guardianship (trusteeship or curatorship)

Sites / Locations

  • Unité de Soins Intensifs Cardiologiques - Hôpital Cardiovasculaire Louis Pradel
  • Institut de Cardiologie - APHP Pitié Salpêtrière

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Colchicine

Placebo

Arm Description

Participant receive in addition to standard of care therapy, six months of Colchicine

Participant receive in addition to standard of care therapy, six months of placebo

Outcomes

Primary Outcome Measures

Extent of Late Gadolinium Enhancement (LGE) evaluated on Cardiac Magnetic Resonance (CMR)
Extent of LGE (pourcentage of left ventricle mass) is evaluated (centralized reading by the Corelab) on CMR performed at six months and compared to baseline CMR (performed at the hospital admision or inclusion). The inclusion visit takes place during the initial hospitalization.
Composite Clinical primary outcome
Composite Clinical primary outcome is assessed during the study period at six months on: the rate of rehospitalization for heart Failure or acute myocarditis recurrence; or the rate of clinically relevant recurrent chest pain (defined as leading to an unplanned/urgent consultation or hospitalization); or the rate of sustained ventricular arrhythmias; or the rate of left ventricular assistance; or the rate of heart transplantation; or the rate of cardiovascular death

Secondary Outcome Measures

Safety of colchicine
Safety of colchicine is defined as : Rate of Serious Adverse Events related to colchicine Rate of permanent treatment discontinuation Rate of diarrhea Rate of nausea and/or vomiting Rate of myelotoxicity (evaluated on Complete Blood Count) Renal function evaluated by creatinine level and creatinine clearance (MDRD)
Composite clinical secondary outcome
Composite Clinical secondary outcome is assessed during the study period at one year on: Rate of rehospitalization for heart failure or acute myocarditis recurrence Rate of clinically relevant recurrent chest pain (defined as leading to an unplanned/urgent consultation or hospitalization) Rate of sustained ventricular arrhythmias Rate of left ventricular assistance or heart transplantation Rate of cardiovascular death
Left ventricular volume on Cardiac Magnetic Resonance (CMR)
Left Ventricular Ejection Fraction (LVEF), left ventricular end-diastolic and left ventricular end-systolic volumes are evaluated (centralized reading by the Corelab) on CMR performed at six months and compared to baseline CMR (performed at the hospital admision or inclusion).
Left ventricular volume on transthoracic echocardiography (TTE)
Relative variation in Left ventricular ejection fraction (LVEF), end-diastolic volume and end-systolic volume between baseline and 6-months as determined by TTE.
Relative variation in Extent of late gadolinium enhancement (LGE) and edema
Relative variation in LGE and edema between baseline and six months determined centrally by the Corelab on the CMR
Tissue properties evaluated on Cardiac Magnetic Resonance (CMR)
Cardiac magnetic resonance criteria: value of native T1 and T2 mapping (ms), pourcentage of extracellular volume
Serum biomarkers
Serum biomarkers at hospital admission, 24h and 48h (after admission) and at six months: Troponin (I or T according to investigator), N-terminal pro-brain natriuretic peptide (NT-pro BNP), C-Reactiv Protein (CRP) and Creatin Kinase (CK)
Specific Inflammatory markers
A biocollection, only for participating centers, is performed for specific Inflammatory markers : interleukin 6 (IL-6), interleukin 1 beta (IL-1bβ) and ST2 (or soluble interleukin 1 receptor-like 1). Patients undergo two blood samples of 4 mL at inclusion ; 24 hours and 48 hours after the inclusion visit, if the patient is still in hospital.
Ventricular premature complex (VPC) evaluated on Holter ElectroCardiogramm (ECG)
VPC burden on Holter ECG performed during the hopsital consultation at three months

Full Information

First Posted
April 21, 2023
Last Updated
May 9, 2023
Sponsor
Assistance Publique - Hôpitaux de Paris
Collaborators
Hospices Civils de Lyon, Fonds de Dotation ACTION
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1. Study Identification

Unique Protocol Identification Number
NCT05855746
Brief Title
Colchicine Versus Placebo in Acute Myocarditis Patients
Acronym
ARGO
Official Title
Colchicine Versus Placebo in Acute Myocarditis Patients to Reduce Late Gadolinium Enhancement Mass on Cardiac Magnetic Resonance and the Risk of Clinical Outcomes: The ARGO Trial
Study Type
Interventional

2. Study Status

Record Verification Date
May 2023
Overall Recruitment Status
Not yet recruiting
Study Start Date
June 1, 2023 (Anticipated)
Primary Completion Date
December 1, 2023 (Anticipated)
Study Completion Date
June 1, 2027 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Assistance Publique - Hôpitaux de Paris
Collaborators
Hospices Civils de Lyon, Fonds de Dotation ACTION

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
Myocarditis is an inflammatory disease of the heart, mostly caused by viruses. Patients with acute myocarditis are exposed to several complications: recurrence, ventricular arrhythmias (from 5 to 30%), heart failure (5-10%), death or heart transplantation (< 4%). To date, there is no specific treatment for myocarditis. Patient management only focuses upon empirical optimal care of arrhythmia and heart failure. There is a strong rationale for using colchicine in acute myocarditis: the IL1 (Interleukin1) pathway plays a detrimental role in acute myocarditis. NLRP3 (NOD-like receptor family, pyrin domain containing 3) inflammasome assembly, and subsequent IL-1beta production, are profoundly inhibited by colchicine. colchicine has been shown to improve cardiac outcomes in inflammatory cardiac disorders, including pericarditis, coronary artery disease, and post pericardiotomy syndrome. In murine model of CVB3-induced myocarditis (coxsackievirus B3), colchicine improved myocarditis through reduction of NLRP3 activity. Small case series with improvement of left ejection fraction in myocarditis following low-dose colchicine in addition to conventional heart failure therapy have been reported. With its pleiotropic anti-inflammatory effect in the pro-inflammatory cascade, reducing the myocardial damage and cell death induced during myocarditis, colchicine has the potential to reduce the risk of heart failure and ventricular arrhythmias. Finally, colchicine is a drug widely available, at low cost, and has a long and well-known safety record.
Detailed Description
This study is a prospective, randomized, multicenter, double blind, controlled versus placebo, phase III study in which two groups of participants are compared: a group treated with the experimental treatment Colchicine (in addition to standard of care therapy) compared to a control group that receive the corresponding placebo (in addition to standard of care therapy). The inclusion visit takes place during the hospitalization stay. The study is presented to all patients presenting with acute myocarditis symptoms and inclusion criteria, hospitalized in participating centers. Once eligible participants have been informed and signed their informed consent, they are randomized (1:1) by a centralized web system (IWRS) in the experimental group (Colchicine) or the control group (Placebo). Participants receive then a numbered box with three months' treatment of Colchicine or placebo. The treatment must start at least within 72h after randomization. Another dispensing is performed during the three months' follow-up visit. All randomized participants are followed during six months after the end of the treatment.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Acute Myocarditis
Keywords
Myocarditis, Inflammation, Colchicine

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Model Description
This is a prospective, two arms, randomized (1:1), double blind, superiority study evaluating colchicine versus placebo administrated during six months among participants with acute myocarditis.
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
300 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Colchicine
Arm Type
Experimental
Arm Description
Participant receive in addition to standard of care therapy, six months of Colchicine
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Participant receive in addition to standard of care therapy, six months of placebo
Intervention Type
Drug
Intervention Name(s)
Colchicine Pill
Other Intervention Name(s)
Colchicine
Intervention Description
Participant receive, in addition to standard of care therapy, six months of colchicine (at a dose of 0.5 mg twice daily, morning and evening) beginning maximum 72 hours post-randomization. The standard of care is defined according to the European consensus paper as follow: All participants without contraindication receive a betablockers, and heart failure ESC (European Society of Cardiology) guidelines directed medical therapies if LVEF < 50% (Left Ventricular Ejection Fraction), including ACE (Angiotensin-Converting Enzyme) inhibitors, diuretics if indicated. The choice of the dosage and the drug is left at the investigator decision. During the six months of the treatment administration, in case of severe adverse reaction (such as nausea and/or diarrhea during five days), a dose reduction could be considered by the investigator: half of the study protocol dose could be accepted (0.5 mg per day in the morning). In case of remaining adverse reactions, the study drug should be stopped.
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Participant receive, in addition to standard of care therapy, six months of placebo (at a dose of 0.5 mg twice daily, morning and evening) beginning maximum 72 hours post-randomization. The standard of care is defined according to the European consensus paper as follow: All participants without contraindication receive a betablockers, and heart failure ESC (European Society of Cardiology) guidelines directed medical therapies if LVEF < 50% (Left Ventricular Ejection Fraction), including ACE (Angiotensin-Converting Enzyme) inhibitors, diuretics if indicated. The choice of the dosage and the drug is left at the investigator decision.
Primary Outcome Measure Information:
Title
Extent of Late Gadolinium Enhancement (LGE) evaluated on Cardiac Magnetic Resonance (CMR)
Description
Extent of LGE (pourcentage of left ventricle mass) is evaluated (centralized reading by the Corelab) on CMR performed at six months and compared to baseline CMR (performed at the hospital admision or inclusion). The inclusion visit takes place during the initial hospitalization.
Time Frame
Six months post-inclusion
Title
Composite Clinical primary outcome
Description
Composite Clinical primary outcome is assessed during the study period at six months on: the rate of rehospitalization for heart Failure or acute myocarditis recurrence; or the rate of clinically relevant recurrent chest pain (defined as leading to an unplanned/urgent consultation or hospitalization); or the rate of sustained ventricular arrhythmias; or the rate of left ventricular assistance; or the rate of heart transplantation; or the rate of cardiovascular death
Time Frame
Six months post-inclusion
Secondary Outcome Measure Information:
Title
Safety of colchicine
Description
Safety of colchicine is defined as : Rate of Serious Adverse Events related to colchicine Rate of permanent treatment discontinuation Rate of diarrhea Rate of nausea and/or vomiting Rate of myelotoxicity (evaluated on Complete Blood Count) Renal function evaluated by creatinine level and creatinine clearance (MDRD)
Time Frame
Six months post-inclusion
Title
Composite clinical secondary outcome
Description
Composite Clinical secondary outcome is assessed during the study period at one year on: Rate of rehospitalization for heart failure or acute myocarditis recurrence Rate of clinically relevant recurrent chest pain (defined as leading to an unplanned/urgent consultation or hospitalization) Rate of sustained ventricular arrhythmias Rate of left ventricular assistance or heart transplantation Rate of cardiovascular death
Time Frame
one year post-inclusion
Title
Left ventricular volume on Cardiac Magnetic Resonance (CMR)
Description
Left Ventricular Ejection Fraction (LVEF), left ventricular end-diastolic and left ventricular end-systolic volumes are evaluated (centralized reading by the Corelab) on CMR performed at six months and compared to baseline CMR (performed at the hospital admision or inclusion).
Time Frame
Six months post-inclusion
Title
Left ventricular volume on transthoracic echocardiography (TTE)
Description
Relative variation in Left ventricular ejection fraction (LVEF), end-diastolic volume and end-systolic volume between baseline and 6-months as determined by TTE.
Time Frame
6 months post-inclusion
Title
Relative variation in Extent of late gadolinium enhancement (LGE) and edema
Description
Relative variation in LGE and edema between baseline and six months determined centrally by the Corelab on the CMR
Time Frame
Six months post-inclusion
Title
Tissue properties evaluated on Cardiac Magnetic Resonance (CMR)
Description
Cardiac magnetic resonance criteria: value of native T1 and T2 mapping (ms), pourcentage of extracellular volume
Time Frame
Six months post-inclusion
Title
Serum biomarkers
Description
Serum biomarkers at hospital admission, 24h and 48h (after admission) and at six months: Troponin (I or T according to investigator), N-terminal pro-brain natriuretic peptide (NT-pro BNP), C-Reactiv Protein (CRP) and Creatin Kinase (CK)
Time Frame
Six months post-inclusion
Title
Specific Inflammatory markers
Description
A biocollection, only for participating centers, is performed for specific Inflammatory markers : interleukin 6 (IL-6), interleukin 1 beta (IL-1bβ) and ST2 (or soluble interleukin 1 receptor-like 1). Patients undergo two blood samples of 4 mL at inclusion ; 24 hours and 48 hours after the inclusion visit, if the patient is still in hospital.
Time Frame
Inclusion visit and 24 hours and 48 hours post-inclusion visit
Title
Ventricular premature complex (VPC) evaluated on Holter ElectroCardiogramm (ECG)
Description
VPC burden on Holter ECG performed during the hopsital consultation at three months
Time Frame
three months post-inclusion

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Symptom onset of 21 days or less, Chest pain and/or Heart failure symptoms and/or palpitations Troponins superior to 99 percentile of reference value, Myocarditis diagnostic confirmation (by Contrast-Enhanced Cardiac Magnetic Resonance (CMR), according to the Lake Louise criteria with the presence of myocardial damage), No evidence for ischemic heart disease on coronary angiography or coronary computed tomography angiography for patients with age superior to 40-year-old with one or more cardiovascular risk factor (hypertension, smoking, hypercholesterolemia, diabetes, personal or family history of coronary artery disease), Woman of child-bearing age with an effective contraception method according to the investigator for the duration of treatment and one month after, Man accepting effective contraception for the duration of treatment and one month after, Participant with affiliation to the French Health Care System "sécurité sociale", Written informed consent of the patient obtained. Exclusion Criteria: Cardiogenic shock requiring inotropes or vasopressors (patients with inotropes discontinued for more than 24 hours can be enrolled) Giant cell myocarditis or eosinophilic myocarditis Acute coronary syndrome or known coronary stenosis superior to 50% Toxic cardiomyopathy Active chronic inflammatory disease, chronic active infection, evolving cancer A recent severe sepsis (7 days) or all recent acute illness Hypersensitivity to Investgational Medical Product's active substances (colchicine) or to any of the excipients (including lactose, sucrose, microcrystalline cellulose, colloidal silica, magnesium stearate, colourants : E127, Dual Red 40 ) Any known contra-indication to CMR or associated contract products (claustrophobia, pace maker, defibrillator, history of hypersensitivity to gadoteric acid or to gadolinium contrast agents or to meglumine), Chronic treatment with corticosteroids or Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) or immunosuppressant. Sarcoidosis Severe liver (Child Pugh C) or known renal dysfunction (known Glomerular Filtration Rate (GFR) less or equal to 30 ml/min according Cockroft), Cytopenia : hemoglobin less than 100 grams/L, white blood cell count less than 3.0 G/L, platelet count less than 100 G/L Major digestive disorders (chronic diarrhea, inflammatory disease of the digestive tract as uncontrolled ulcerative colitis or active Crohn disease) Immunosuppression, spinal cord aplasia Hemopathy Hypereosinophilia more than 0.5 G/L Pregnant or nursing women, where pregnancy is defined as the state of a female after conception and until the termination of gestation, confirmed by a positive local laboratory test, Administration of any investigational drug or participation in another interventional trial, within 30 days before randomization, Participant under treatment having an interaction with colchicine [macrolides (telithromycin, azithromycin, clarithromycin, dirithromycin, erythromycin, josamycin, midecamycin, roxithromycin), pristinamycin,, cyclosporine, verapamil, all protease inhibitors, telaprevir, CYP3A4 powerful inhibitors, Participant under legal protection: under guardianship (trusteeship or curatorship)
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Thomas BOCHATON
Phone
+33472357549
Email
thomas.bochaton@chu-lyon.fr
First Name & Middle Initial & Last Name or Official Title & Degree
Julia CANTERINI
Phone
+33427856628
Email
julia.canterini@chu-lyon.fr
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Thomas BOCHATON
Organizational Affiliation
Cardiovascular hospital Louis Pradel
Official's Role
Study Chair
First Name & Middle Initial & Last Name & Degree
Mathieu KERNEIS
Organizational Affiliation
Department of Cardiology - Pitié Salpêtrière Hospital
Official's Role
Study Director
Facility Information:
Facility Name
Unité de Soins Intensifs Cardiologiques - Hôpital Cardiovasculaire Louis Pradel
City
Bron
ZIP/Postal Code
69029
Country
France
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Thomas BOCHATON
Phone
+33472357549
Email
thomas.bochaton@chu-lyon.fr
First Name & Middle Initial & Last Name & Degree
Julia CANTERINI
Phone
+33427856628
Email
julia.canterini@chu-lyon.fr
Facility Name
Institut de Cardiologie - APHP Pitié Salpêtrière
City
Paris
ZIP/Postal Code
75013
Country
France
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Mathieu KERNEIS
Phone
+33142163074
Email
mathieu.kerneis@aphp.fr
First Name & Middle Initial & Last Name & Degree
Karine BROCHARD
Phone
+3142162959
Email
karine.brochard-ext@aphp.fr

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
31120823
Citation
Tschope C, Cooper LT, Torre-Amione G, Van Linthout S. Management of Myocarditis-Related Cardiomyopathy in Adults. Circ Res. 2019 May 24;124(11):1568-1583. doi: 10.1161/CIRCRESAHA.118.313578.
Results Reference
background
PubMed Identifier
29764898
Citation
Ammirati E, Cipriani M, Moro C, Raineri C, Pini D, Sormani P, Mantovani R, Varrenti M, Pedrotti P, Conca C, Mafrici A, Grosu A, Briguglia D, Guglielmetto S, Perego GB, Colombo S, Caico SI, Giannattasio C, Maestroni A, Carubelli V, Metra M, Lombardi C, Campodonico J, Agostoni P, Peretto G, Scelsi L, Turco A, Di Tano G, Campana C, Belloni A, Morandi F, Mortara A, Ciro A, Senni M, Gavazzi A, Frigerio M, Oliva F, Camici PG; Registro Lombardo delle Miocarditi. Clinical Presentation and Outcome in a Contemporary Cohort of Patients With Acute Myocarditis: Multicenter Lombardy Registry. Circulation. 2018 Sep 11;138(11):1088-1099. doi: 10.1161/CIRCULATIONAHA.118.035319.
Results Reference
background
PubMed Identifier
25468248
Citation
Kyto V, Sipila J, Rautava P. Rate and patient features associated with recurrence of acute myocarditis. Eur J Intern Med. 2014 Dec;25(10):946-50. doi: 10.1016/j.ejim.2014.11.001. Epub 2014 Nov 7.
Results Reference
background
PubMed Identifier
32138965
Citation
Peretto G, Sala S, Rizzo S, Palmisano A, Esposito A, De Cobelli F, Campochiaro C, De Luca G, Foppoli L, Dagna L, Thiene G, Basso C, Della Bella P. Ventricular Arrhythmias in Myocarditis: Characterization and Relationships With Myocardial Inflammation. J Am Coll Cardiol. 2020 Mar 10;75(9):1046-1057. doi: 10.1016/j.jacc.2020.01.036.
Results Reference
background
PubMed Identifier
23992557
Citation
Imazio M, Brucato A, Cemin R, Ferrua S, Maggiolini S, Beqaraj F, Demarie D, Forno D, Ferro S, Maestroni S, Belli R, Trinchero R, Spodick DH, Adler Y; ICAP Investigators. A randomized trial of colchicine for acute pericarditis. N Engl J Med. 2013 Oct 17;369(16):1522-8. doi: 10.1056/NEJMoa1208536. Epub 2013 Aug 31.
Results Reference
background

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Colchicine Versus Placebo in Acute Myocarditis Patients

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