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Alirocumab in Patients With Acute Myocardial Infarction

Primary Purpose

Myocardial Infarction, Hypercholesterolemia

Status
Completed
Phase
Phase 4
Locations
United States
Study Type
Interventional
Intervention
alirocumab
placebo
Sponsored by
Virginia Commonwealth University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Myocardial Infarction focused on measuring Myocardial Infarction, Low Density Lipoprotein Cholesterol, proprotein convertase subtilisin kexin 9, human, alirocumab

Eligibility Criteria

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

Inclusion Criteria:

  1. Acute type I (spontaneous) NSTEMI defined as chest pain (or equivalent) with an onset of symptoms within 12 hours of presentation, a duration of >15 minutes, and elevated cardiac troponin I levels, with or without electrocardiographic changes [with the exclusion of ST elevation];
  2. On medical therapy with high intensity statin prior to admission (either atorvastatin 40-80 mg or rosuvastatin 20-40 mg) as documented by hospital or pharmacy records and with known LDL cholesterol ≥70 mg/dL within the prior 12 months.

Exclusion Criteria:

  1. Age <21 years of age
  2. Inability to give informed consent
  3. Previous, current or planned treatment with a PCSK9 inhibitor
  4. Known history of loss of function of PCSK9 (genetic mutation or sequence variation)
  5. Patient with homozygous familial hypercholesterolemia (clinically or by previous genotyping)
  6. Recent (<14 days) or active use of immunosuppressive drugs (including but not limited to high-dose corticosteroids [>1mg/kg of prednisone equivalent], Tumor Necrosis Factor-α blockers, cyclosporine) not including non-steroidal antinflammatory drugs or corticosteroids used for IV dye allergy or corticosteroids used as replacement therapy for pituitary/adrenal disease with a stable regimen for at least 6 weeks prior to randomization (note: topical, intra-articular, nasal, inhaled, and ophthalmic steroid therapies are not considered "systemic" and are allowed);
  7. Chronic auto-immune or auto-inflammatory disease (including but not limited to rheumatoid arthritis, systemic lupus erythematosus);
  8. History of cancer within the past 5 years, except for adequately treated basal cell skin cancer, squamous cell skin cancer, or in situ cervical cancer;
  9. Known chronic hepatitis B or C infection (excluding patients with a positive antibody who were successfully treated or who have demonstrated no viral load);
  10. Known human immunodeficiency virus infection.
  11. Use of fibrates other than fenofibrate within 6 weeks of the screening visit.
  12. Uncontrolled hypothyroidism. Note: patients on thyroid replacement therapy can be included if the dosage of thyroxin has been stable for at least 12 weeks prior to screening.
  13. Known history of a hemorrhagic stroke.
  14. Has been previously treated with at least 1 dose of alirocumab or any other anti-PCSK9 monoclonal antibody in other clinical studies.
  15. Conditions/situations such as:

    1. Any clinically significant abnormality identified at the time of screening that in the judgment of the investigator or any sub-investigator would preclude safe completion of the study or constrain assessment of endpoints, such as major systemic diseases or patients with short life expectancy.
    2. Patients considered by the investigator or any sub-investigator to be inappropriate for this study for any reason:

    i. Those patients deemed unable to meet specific protocol requirements, such as scheduled visits.

    ii. Those patients the investigator deems unable to administer or tolerate long-term injections.

    c. Investigator or any sub-investigator, pharmacist, study coordinator, other study staff, or relative thereof directly involved in the conduct of the protocol.

    d. Presence of any other conditions (geographic or social), actual or anticipated, that the investigator feels would restrict or limit the patient's participation for the duration of the study.

  16. Thyroid-stimulating hormone (TSH) < lower limit of normal (LLN) or > upper limit of normal (ULN); if TSH is abnormal due to controlled hypothyroidism (patient is on a stable dose of thyroid replacement therapy), the patient may be enrolled into the study;
  17. Exclusion Criteria Related to the Active Comparator and/or Mandatory Background Therapies: All contraindications to the background therapies or warnings/precautions of use (when appropriate) as displayed in the respective national product labeling.
  18. Exclusion Criteria Related to the Current Knowledge of Alirocumab

    1. Known hypersensitivity to monoclonal antibody therapeutics
    2. Pregnant or breastfeeding women
  19. Women of childbearing potential who are not protected by highly effective method(s) of birth control throughout the entire duration of study treatment and for 10 weeks after the last dose of study drug and/or who are unwilling or unable to be tested for pregnancy.
  20. Men capable of impregnating women who are not protected by highly effective method(s) of birth control and/or who are unwilling to use an effective contraceptive method throughout the entire duration of study treatment and for 10 weeks after the last dose of study drug.

Sites / Locations

  • Virginia Commonwealth University

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Placebo Comparator

Arm Label

Alirocumab

placebo

Arm Description

Alirocumab (150 mg) will be administered by subcutaneous injection once, within the first day of the patient's diagnosis of NSTEMI. Patients will also receive an 80 mg dose of atorvastatin.

Placebo (sterile saline) will be administered by subcutaneous injection once, within the first day of the patient's diagnosis of NSTEMI. Patients will also receive an 80 mg dose of atorvastatin.

Outcomes

Primary Outcome Measures

Changes in Low-density Lipoprotein (LDL) Cholesterol
Placebo-corrected percentage change in calculated LDL cholesterol from baseline to day 14

Secondary Outcome Measures

Change in Inflammatory Markers (hsCRP)
Placebo-corrected percentage change in inflammatory markers (hsCRP) from baseline to 3 days
Change in Inflammatory Markers (hsCRP)
Placebo-corrected Percentage Change in Inflammatory Markers (hsCRP) From Baseline to 14 Days

Full Information

First Posted
October 18, 2016
Last Updated
August 15, 2019
Sponsor
Virginia Commonwealth University
Collaborators
Regeneron Pharmaceuticals, Sanofi
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1. Study Identification

Unique Protocol Identification Number
NCT02938949
Brief Title
Alirocumab in Patients With Acute Myocardial Infarction
Official Title
Alirocumab in Patients With Acute Myocardial Infarction: A Randomized Controlled Double-Blinded Study
Study Type
Interventional

2. Study Status

Record Verification Date
August 2019
Overall Recruitment Status
Completed
Study Start Date
January 2017 (Actual)
Primary Completion Date
August 2018 (Actual)
Study Completion Date
August 16, 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Virginia Commonwealth University
Collaborators
Regeneron Pharmaceuticals, Sanofi

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
Phase IV investigator initiated clinical trial to study the effectiveness of alirocumab, an inhibitor of proprotein convertase subtilisin/kexin (PCSK9), versus placebo added to high-intensity statin (atorvastatin 80 mg) in lowering low density lipoprotein (LDL) cholesterol during non-ST segment elevation myocardial infarction (NSTEMI).
Detailed Description
This research will study the effects of early initiation of alirocumab in addition to high intensity statin therapy in patients who have previously been treated with high intensity statins with poor response, who present with a type I (spontaneous) acute NSTEMI. Patients will be dosed with drug or placebo once during the first day of their hospital admission. Blood samples will be collected at baseline, 3 days and 14 days after randomization for biomarker testing. Particular attention will be paid to additional LDL lowering effects, as well as the effects on PCSK9 levels and inflammatory biomarkers. Safety and tolerability will be monitored with complete blood count + differential and complete metabolic panels at each study visit.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Myocardial Infarction, Hypercholesterolemia
Keywords
Myocardial Infarction, Low Density Lipoprotein Cholesterol, proprotein convertase subtilisin kexin 9, human, alirocumab

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigator
Allocation
Randomized
Enrollment
20 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Alirocumab
Arm Type
Active Comparator
Arm Description
Alirocumab (150 mg) will be administered by subcutaneous injection once, within the first day of the patient's diagnosis of NSTEMI. Patients will also receive an 80 mg dose of atorvastatin.
Arm Title
placebo
Arm Type
Placebo Comparator
Arm Description
Placebo (sterile saline) will be administered by subcutaneous injection once, within the first day of the patient's diagnosis of NSTEMI. Patients will also receive an 80 mg dose of atorvastatin.
Intervention Type
Drug
Intervention Name(s)
alirocumab
Other Intervention Name(s)
Praluent
Intervention Type
Drug
Intervention Name(s)
placebo
Primary Outcome Measure Information:
Title
Changes in Low-density Lipoprotein (LDL) Cholesterol
Description
Placebo-corrected percentage change in calculated LDL cholesterol from baseline to day 14
Time Frame
baseline and 14 days
Secondary Outcome Measure Information:
Title
Change in Inflammatory Markers (hsCRP)
Description
Placebo-corrected percentage change in inflammatory markers (hsCRP) from baseline to 3 days
Time Frame
baseline to 3 days
Title
Change in Inflammatory Markers (hsCRP)
Description
Placebo-corrected Percentage Change in Inflammatory Markers (hsCRP) From Baseline to 14 Days
Time Frame
baseline to 14 days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
21 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Acute type I (spontaneous) NSTEMI defined as chest pain (or equivalent) with an onset of symptoms within 12 hours of presentation, a duration of >15 minutes, and elevated cardiac troponin I levels, with or without electrocardiographic changes [with the exclusion of ST elevation]; On medical therapy with high intensity statin prior to admission (either atorvastatin 40-80 mg or rosuvastatin 20-40 mg) as documented by hospital or pharmacy records and with known LDL cholesterol ≥70 mg/dL within the prior 12 months. Exclusion Criteria: Age <21 years of age Inability to give informed consent Previous, current or planned treatment with a PCSK9 inhibitor Known history of loss of function of PCSK9 (genetic mutation or sequence variation) Patient with homozygous familial hypercholesterolemia (clinically or by previous genotyping) Recent (<14 days) or active use of immunosuppressive drugs (including but not limited to high-dose corticosteroids [>1mg/kg of prednisone equivalent], Tumor Necrosis Factor-α blockers, cyclosporine) not including non-steroidal antinflammatory drugs or corticosteroids used for IV dye allergy or corticosteroids used as replacement therapy for pituitary/adrenal disease with a stable regimen for at least 6 weeks prior to randomization (note: topical, intra-articular, nasal, inhaled, and ophthalmic steroid therapies are not considered "systemic" and are allowed); Chronic auto-immune or auto-inflammatory disease (including but not limited to rheumatoid arthritis, systemic lupus erythematosus); History of cancer within the past 5 years, except for adequately treated basal cell skin cancer, squamous cell skin cancer, or in situ cervical cancer; Known chronic hepatitis B or C infection (excluding patients with a positive antibody who were successfully treated or who have demonstrated no viral load); Known human immunodeficiency virus infection. Use of fibrates other than fenofibrate within 6 weeks of the screening visit. Uncontrolled hypothyroidism. Note: patients on thyroid replacement therapy can be included if the dosage of thyroxin has been stable for at least 12 weeks prior to screening. Known history of a hemorrhagic stroke. Has been previously treated with at least 1 dose of alirocumab or any other anti-PCSK9 monoclonal antibody in other clinical studies. Conditions/situations such as: Any clinically significant abnormality identified at the time of screening that in the judgment of the investigator or any sub-investigator would preclude safe completion of the study or constrain assessment of endpoints, such as major systemic diseases or patients with short life expectancy. Patients considered by the investigator or any sub-investigator to be inappropriate for this study for any reason: i. Those patients deemed unable to meet specific protocol requirements, such as scheduled visits. ii. Those patients the investigator deems unable to administer or tolerate long-term injections. c. Investigator or any sub-investigator, pharmacist, study coordinator, other study staff, or relative thereof directly involved in the conduct of the protocol. d. Presence of any other conditions (geographic or social), actual or anticipated, that the investigator feels would restrict or limit the patient's participation for the duration of the study. Thyroid-stimulating hormone (TSH) < lower limit of normal (LLN) or > upper limit of normal (ULN); if TSH is abnormal due to controlled hypothyroidism (patient is on a stable dose of thyroid replacement therapy), the patient may be enrolled into the study; Exclusion Criteria Related to the Active Comparator and/or Mandatory Background Therapies: All contraindications to the background therapies or warnings/precautions of use (when appropriate) as displayed in the respective national product labeling. Exclusion Criteria Related to the Current Knowledge of Alirocumab Known hypersensitivity to monoclonal antibody therapeutics Pregnant or breastfeeding women Women of childbearing potential who are not protected by highly effective method(s) of birth control throughout the entire duration of study treatment and for 10 weeks after the last dose of study drug and/or who are unwilling or unable to be tested for pregnancy. Men capable of impregnating women who are not protected by highly effective method(s) of birth control and/or who are unwilling to use an effective contraceptive method throughout the entire duration of study treatment and for 10 weeks after the last dose of study drug.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Antonio Abbate, MD, PhD
Organizational Affiliation
Virginia Commonwealth University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Virginia Commonwealth University
City
Richmond
State/Province
Virginia
ZIP/Postal Code
23298
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
The investigators plan to present the data promptly upon analysis as an abstract to a national meeting and/or a manuscript.

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Alirocumab in Patients With Acute Myocardial Infarction

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