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Colchicine Cardiovascular Outcomes Trial (COLCOT) (COLCOT)

Primary Purpose

Coronary Artery Disease, Myocardial Infarction

Status
Completed
Phase
Phase 3
Locations
Canada
Study Type
Interventional
Intervention
colchicine
colchicine placebo
Sponsored by
Montreal Heart Institute
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Coronary Artery Disease

Eligibility Criteria

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

Inclusion Criteria:

  • Males and females of at least 18 years of age capable and willing to provide informed consent
  • Patient must have suffered a documented acute myocardial infarction within the last 30 days
  • Patient must be treated according to national guidelines (including anti-platelet therapy, statin, renin-angiotensin-aldosterone system inhibitor (preferably angiotensin-converting enzyme) and beta-blocker when indicated)
  • Patient must have completed any planned percutaneous revascularization procedures associated with his or her qualifying myocardial infarction
  • Female patient is either not of childbearing potential, defined as postmenopausal for at least one year or surgically sterile, or is of childbearing potential and practicing at least one method of contraception and preferably two complementary forms of contraception
  • Patient is judged to be in good general health as determined by the principal investigator
  • Patient must be able and willing to comply with the requirements of this study protocol

Exclusion Criteria:

  • Patient with a poorly controlled medical condition, such as New York Heart Association Class III-IV heart failure, a left ventricular ejection fraction of less than 35%, recent stroke (within the past 3 months), or any other condition which in the opinion of the investigator, would put the patient at risk if participating in this study
  • Patient with a Type 2 index MI (secondary to ischemic imbalance)
  • Patient with a prior coronary artery bypass graft within the past 3 years, or planned
  • Patient currently in cardiogenic shock or with hemodynamic instability
  • Patient with a history of cancer or lymphoproliferative disease within the last 3 years other than a successfully treated non-metastatic cutaneous squamous cell or basal cell carcinoma and or localized carcinoma in situ of the cervix
  • Patient with inflammatory bowel disease (Crohn's disease or ulcerative colitis) or patient with chronic diarrhea
  • Patient with pre-existent progressive neuromuscular disease or patient with creatine phosphokinase level greater than 3 times the upper limit of normal (unless due to myocardial infarction which is allowed) as measured within the past 30 days and determined to be non-transient through repeat testing
  • Patient with any of the following as measured within the past 30 days, and determined to be non-transient through repeat testing: hemoglobin less than 115 grams/L, white blood cell count less than 3.0 X 10(9)/L,platelet count less than 110 X 10(9)/L, alanine aminotransferase greater than 3 times the upper limit of normal, total bilirubin greater than 2 times the upper limit of normal (unless due to Gilbert syndrome, which is allowed), creatinine greater than 2 times the upper limit of normal
  • Patient with a history of cirrhosis, chronic active hepatitis or sever hepatic disease
  • Female patient who is pregnant, or breast-feeding or is considering becoming pregnant during the study or for 6 months after the last dose of study medication
  • Patient with a history of clinically significant drug or alcohol abuse in the last year
  • Patient is currently using or plan to begin chronic systemic steroid therapy (oral or intravenous) during the study (topical or inhaled steroids are allowed)
  • Patient currently taking colchicine for other indications (mainly chronic indications represented by Familial Mediterranean Fever or gout); there is no wash-out period required for patients who have been treated with colchicine and stopped treatment prior to enrollment
  • Patient with history of an allergic reaction or significant sensitivity to colchicine
  • Patient who has used an investigational chemical agent less than 30 days or 5 half-lives prior to the screening visit (whichever is longer)
  • Patient is considered by he investigator, for any reason, to be an unsuitable candidate for the study

Sites / Locations

  • Montreal Heart Institute

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Placebo Comparator

Arm Label

colchicine

colchicine placebo

Arm Description

0.5 mg tablet of colchicine taken once a day

0.5 mg tablet of placebo taken once a day

Outcomes

Primary Outcome Measures

First Event of Cardiovascular Death, Resuscitated Cardiac Arrest, Acute Myocardial Infarction, Stroke, or Urgent Hospitalization for Angina Requiring Coronary Revascularization
The descriptive statistics are the number of participants having at least one of the composites of the primary endpoint.

Secondary Outcome Measures

Death (Total Mortality)
The descriptive statistics are the number of participants having deceased.
Cardiovascular Death
The descriptive statistics are presented as the number of participants having had a cardiovascular death.
Resuscitated Cardiac Arrest
The descriptive statistics are presented as the number of participants having had resuscitated cardiac arrest
Myocardial Infarction
The descriptive statistics are presented as the number of participants having had myocardial infarction.
Stroke
The descriptive statistics are presented as the number of participants having had a stroke.
Urgent Hospitalization for Angina Requiring Coronary Revascularization
The descriptive statistics are presented as the number of participants having had urgent hospitalization for angina requiring coronary revascularization.
First Event of Cardiovascular Death, Resuscitated Cardiac Arrest, Acute MI or Stroke.
The descriptive statistics are presented as the number of participants having had a first event of cardiovascular death, resuscitated cardiac arrest, acute MI or stroke.

Full Information

First Posted
August 26, 2015
Last Updated
September 23, 2020
Sponsor
Montreal Heart Institute
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1. Study Identification

Unique Protocol Identification Number
NCT02551094
Brief Title
Colchicine Cardiovascular Outcomes Trial (COLCOT)
Acronym
COLCOT
Official Title
Colchicine Cardiovascular Outcomes Trial (COLCOT)
Study Type
Interventional

2. Study Status

Record Verification Date
September 2020
Overall Recruitment Status
Completed
Study Start Date
December 4, 2015 (Actual)
Primary Completion Date
July 17, 2019 (Actual)
Study Completion Date
July 17, 2019 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Montreal Heart Institute

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The study evaluates whether long-term treatment with colchicine reduces rates of cardiovascular events in patients after myocardial infarction. Patients who have suffered a documented acute myocardial infarction within the last 30 days, are treated according to the national guidelines and after having completed any planned percutaneous revascularization procedures associated with their initial infarction will receive either colchicine (0.5 mg per day) or matching placebo (1:1 allocation ratio) for an estimated 2 years period or until the target of 301 primary endpoints has been reached.
Detailed Description
Atherosclerosis is the most common cause of myocardial infarction, stroke and peripheral arterial disease. Research has clearly demonstrated that inflammation plays a key role in the initiation, progression and manifestations of atherosclerosis. Atherosclerotic lesions begin as an accumulation of lipid-laden cells (primarily macrophages) beneath the endothelium, and progress with the further accumulation of cells, connective-tissue elements, lipids and debris through immunological and inflammatory activation. Neutrophils and other inflammatory cells have been shown to invade culprit atherosclerotic lesions in acute coronary syndromes. It is likely that the inflammatory process is responsible for the high rate of cardiovascular events despite significant advances in the treatment of risk factors such as hypercholesterolemia and hypertension. It is vital to improve our understanding of the inflammatory nature of atherosclerotic disease and modify the inflammatory process with targeted therapies. Prospective cohort studies have consistently shown that high sensitivity C-reactive protein (hs-CRP) and several other biomarkers of inflammation are independently associated with increasing risk of future cardiovascular events in different populations. This together with animal models showing that reduced inflammation has anti-atherosclerotic effects, create the impetus to test the hypothesis that treatment of the underlying inflammatory process will contribute to improved cardiovascular clinical outcomes. Colchicine is an inexpensive, yet potent, anti-inflammatory drug approved for acute use in patients with gout and chronic use in patients with Familial Mediterranean Fever. The mechanism of action is through the inhibition of tubulin polymerization and potentially also through effects on cellular adhesion molecules and inflammatory chemokines. Colchicine may also have direct anti-inflammatory effects by inhibiting key inflammatory signaling networks known as the inflammasome and pro-inflammatory cytokines. Through the disruption of the cytoskeleton, colchicine is believed to suppress secretion of cytokines and chemokines as well as in vitro platelet aggregation. Considerable work has highlighted the potential of colchicine in the treatment of cardiovascular diseases mediated by pro-inflammatory processes. More recently colchicine has been evaluated for its effect on cardiovascular events in patients with coronary artery disease (CAD).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Coronary Artery Disease, Myocardial Infarction

7. Study Design

Primary Purpose
Prevention
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
4745 (Actual)

8. Arms, Groups, and Interventions

Arm Title
colchicine
Arm Type
Active Comparator
Arm Description
0.5 mg tablet of colchicine taken once a day
Arm Title
colchicine placebo
Arm Type
Placebo Comparator
Arm Description
0.5 mg tablet of placebo taken once a day
Intervention Type
Drug
Intervention Name(s)
colchicine
Other Intervention Name(s)
no other name
Intervention Description
0.5 mg tablet taken once a day
Intervention Type
Drug
Intervention Name(s)
colchicine placebo
Other Intervention Name(s)
no other name
Intervention Description
sugar pill manufactured to mimic colchicine 0.5 mg tablet
Primary Outcome Measure Information:
Title
First Event of Cardiovascular Death, Resuscitated Cardiac Arrest, Acute Myocardial Infarction, Stroke, or Urgent Hospitalization for Angina Requiring Coronary Revascularization
Description
The descriptive statistics are the number of participants having at least one of the composites of the primary endpoint.
Time Frame
From randomization to occurence of first event, assessed up to 3.5 years
Secondary Outcome Measure Information:
Title
Death (Total Mortality)
Description
The descriptive statistics are the number of participants having deceased.
Time Frame
From randomization to death, assessed up to 3.5 years
Title
Cardiovascular Death
Description
The descriptive statistics are presented as the number of participants having had a cardiovascular death.
Time Frame
From randomization to death, assessed up to 3.5 years
Title
Resuscitated Cardiac Arrest
Description
The descriptive statistics are presented as the number of participants having had resuscitated cardiac arrest
Time Frame
From randomization to event, assessed up to 3.5 years
Title
Myocardial Infarction
Description
The descriptive statistics are presented as the number of participants having had myocardial infarction.
Time Frame
From randomization to event, assessed up to 3.5 years
Title
Stroke
Description
The descriptive statistics are presented as the number of participants having had a stroke.
Time Frame
From randomization to event, assessed up to 3.5 years
Title
Urgent Hospitalization for Angina Requiring Coronary Revascularization
Description
The descriptive statistics are presented as the number of participants having had urgent hospitalization for angina requiring coronary revascularization.
Time Frame
From randomization to event, assessed up to 3.5 years
Title
First Event of Cardiovascular Death, Resuscitated Cardiac Arrest, Acute MI or Stroke.
Description
The descriptive statistics are presented as the number of participants having had a first event of cardiovascular death, resuscitated cardiac arrest, acute MI or stroke.
Time Frame
From randomization to occurence of first event, assessed up to 3.5 years
Other Pre-specified Outcome Measures:
Title
First Event of Deep Venous Thrombosis or Pulmonary Embolus
Description
The descriptive statistics are presented as the number of participants having had a first event of deep venous thrombosis or pulmonary embolus.
Time Frame
From randomization to occurence of first event, assessed up to 3.5 years
Title
Atrial Fibrillation
Description
The descriptive statistics are presented as the number of participants having had atrial fibrillation.
Time Frame
From randomization to event, assessed up to 3.5 years
Title
Heart Failure Hospitalization
Description
The descriptive statistics are presented as the number of participants having had heart failure hospitalization.
Time Frame
From randomization to event, assessed up to 3.5 years
Title
Coronary Revascularization
Description
The descriptive statistics are presented as the number of participants having had coronary revascularization.
Time Frame
From randomization to event, assessed up to 3.5 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Males and females of at least 18 years of age capable and willing to provide informed consent Patient must have suffered a documented acute myocardial infarction within the last 30 days Patient must be treated according to national guidelines (including anti-platelet therapy, statin, renin-angiotensin-aldosterone system inhibitor (preferably angiotensin-converting enzyme) and beta-blocker when indicated) Patient must have completed any planned percutaneous revascularization procedures associated with his or her qualifying myocardial infarction Female patient is either not of childbearing potential, defined as postmenopausal for at least one year or surgically sterile, or is of childbearing potential and practicing at least one method of contraception and preferably two complementary forms of contraception Patient is judged to be in good general health as determined by the principal investigator Patient must be able and willing to comply with the requirements of this study protocol Exclusion Criteria: Patient with a poorly controlled medical condition, such as New York Heart Association Class III-IV heart failure, a left ventricular ejection fraction of less than 35%, recent stroke (within the past 3 months), or any other condition which in the opinion of the investigator, would put the patient at risk if participating in this study Patient with a Type 2 index MI (secondary to ischemic imbalance) Patient with a prior coronary artery bypass graft within the past 3 years, or planned Patient currently in cardiogenic shock or with hemodynamic instability Patient with a history of cancer or lymphoproliferative disease within the last 3 years other than a successfully treated non-metastatic cutaneous squamous cell or basal cell carcinoma and or localized carcinoma in situ of the cervix Patient with inflammatory bowel disease (Crohn's disease or ulcerative colitis) or patient with chronic diarrhea Patient with pre-existent progressive neuromuscular disease or patient with creatine phosphokinase level greater than 3 times the upper limit of normal (unless due to myocardial infarction which is allowed) as measured within the past 30 days and determined to be non-transient through repeat testing Patient with any of the following as measured within the past 30 days, and determined to be non-transient through repeat testing: hemoglobin less than 115 grams/L, white blood cell count less than 3.0 X 10(9)/L,platelet count less than 110 X 10(9)/L, alanine aminotransferase greater than 3 times the upper limit of normal, total bilirubin greater than 2 times the upper limit of normal (unless due to Gilbert syndrome, which is allowed), creatinine greater than 2 times the upper limit of normal Patient with a history of cirrhosis, chronic active hepatitis or sever hepatic disease Female patient who is pregnant, or breast-feeding or is considering becoming pregnant during the study or for 6 months after the last dose of study medication Patient with a history of clinically significant drug or alcohol abuse in the last year Patient is currently using or plan to begin chronic systemic steroid therapy (oral or intravenous) during the study (topical or inhaled steroids are allowed) Patient currently taking colchicine for other indications (mainly chronic indications represented by Familial Mediterranean Fever or gout); there is no wash-out period required for patients who have been treated with colchicine and stopped treatment prior to enrollment Patient with history of an allergic reaction or significant sensitivity to colchicine Patient who has used an investigational chemical agent less than 30 days or 5 half-lives prior to the screening visit (whichever is longer) Patient is considered by he investigator, for any reason, to be an unsuitable candidate for the study
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jean-Claude Tardif, MD
Organizational Affiliation
Montreal Heart Institute
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Andreas Orfanos, MD
Organizational Affiliation
Montreal Health Innovations Coordinating Centre
Official's Role
Study Director
Facility Information:
Facility Name
Montreal Heart Institute
City
Montreal
State/Province
Quebec
ZIP/Postal Code
H1T1C8
Country
Canada

12. IPD Sharing Statement

Citations:
PubMed Identifier
32860034
Citation
Bouabdallaoui N, Tardif JC, Waters DD, Pinto FJ, Maggioni AP, Diaz R, Berry C, Koenig W, Lopez-Sendon J, Gamra H, Kiwan GS, Blondeau L, Orfanos A, Ibrahim R, Gregoire JC, Dube MP, Samuel M, Morel O, Lim P, Bertrand OF, Kouz S, Guertin MC, L'Allier PL, Roubille F. Time-to-treatment initiation of colchicine and cardiovascular outcomes after myocardial infarction in the Colchicine Cardiovascular Outcomes Trial (COLCOT). Eur Heart J. 2020 Nov 7;41(42):4092-4099. doi: 10.1093/eurheartj/ehaa659.
Results Reference
derived
PubMed Identifier
31733140
Citation
Tardif JC, Kouz S, Waters DD, Bertrand OF, Diaz R, Maggioni AP, Pinto FJ, Ibrahim R, Gamra H, Kiwan GS, Berry C, Lopez-Sendon J, Ostadal P, Koenig W, Angoulvant D, Gregoire JC, Lavoie MA, Dube MP, Rhainds D, Provencher M, Blondeau L, Orfanos A, L'Allier PL, Guertin MC, Roubille F. Efficacy and Safety of Low-Dose Colchicine after Myocardial Infarction. N Engl J Med. 2019 Dec 26;381(26):2497-2505. doi: 10.1056/NEJMoa1912388. Epub 2019 Nov 16.
Results Reference
derived

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Colchicine Cardiovascular Outcomes Trial (COLCOT)

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