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Efficacy and Safety of Ad5FGF-4 for Myocardial Ischemia in Patients With Stable Angina Due to Coronary Artery Disease (ASPIRE)

Primary Purpose

Angina, Stable

Status
Terminated
Phase
Phase 3
Locations
Russian Federation
Study Type
Interventional
Intervention
Alferminogene tadenovec
Sponsored by
Cardium Therapeutics
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Angina, Stable focused on measuring Angina Pectoris, Myocardial Ischemia, Chest Pain, Coronary Artery Disease, Heart Diseases, Cardiovascular Diseases, Myocardial Perfusion, Reversible Perfusion Defect Size, SPECT-MIBI, Anti-Anginal Medication, Quality of Life

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Patients 18-75 years of age, inclusive
  • Postmenopausal female patients, women of childbearing potential and men willing to use an effective contraception method while on the study treatment and/or who agree not to become pregnant or make their partner pregnant throughout the study and during one year after administration of the study drug
  • Female subjects of childbearing potential who have a negative urine pregnancy test, and are willing to use an acceptable form of birth control during the study
  • Diagnostic coronary angiogram in the past confirming the presence of coronary artery disease. Patients with extensive disease, or high risk for intervention, or who don't want the higher risk angioplasty or surgery, or have had angioplasty with recurrent angina and vessels are not ideal for angioplasty are ideal candidates
  • Stable angina pectoris being treated with chronic anti-anginal medication(s) at a stable dose for 2 weeks prior to randomization
  • Left ventricular ejection fraction (LVEF) of ≥30%. If the LVEF is <30% the patient can be enrolled if there is no recent or current congestive heart failure present
  • Evidence of stress induced myocardial ischemia by ATP technetium-99m sestamibi SPECT, defined as a reversible perfusion defect size of ≥9%
  • Willing and able to comply with the study requirements
  • Provided written informed consent

Exclusion Criteria:

  • Female patients who are pregnant, lactating (breast milk feeding), or planning a pregnancy during the course of the study and one year after administration of the study drug. Women of child bearing potential who are not using an acceptable method of birth control. Women of child bearing potential with a positive urine pregnancy test within 24 hours prior to the start of investigational product
  • Patients with unstable angina for whom an immediate revascularization procedure is indicated
  • Patients for whom a cardiac revascularization procedure is planned in the next 3 months
  • Myocardial infarction within the 3 months prior to the Screening visit
  • Congestive heart failure NYHA Class IV
  • Myocarditis or restrictive pericarditis
  • Left main coronary stenosis ≥70% (unless the patient has a patent graft or collateral vessels supplying the left coronary circulation) or proximal stenoses ≥70% in all major coronary conduit vessels (coronary arteries and bypass grafts)
  • A single patent coronary conduit (for example, totally occluded RCA and LCx with no bypass grafts. Patient will not tolerate balloon occlusion of the LAD for infusion)
  • Clinically significant aortic or mitral valvular heart disease.
  • Life threatening coronary ostial stenosis that precludes adequate catheter engagement in any target vessel, unless the vessel can be accessed via a patent bypass graft
  • Coronary artery to venous communications, which bypass the coronary capillary bed
  • Untreated life-threatening ventricular arrhythmias
  • Uncontrolled arterial hypertension with systolic blood pressure >180 mm Hg and diastolic pressure >100 mm Hg
  • CABG surgery within the past 6 months, unless those grafts are now occluded
  • Percutaneous transluminal coronary angioplasty (PTCA) within the past 3 months, unless the stented/dilated vessel(s) are now occluded
  • Enhanced external counterpulsation (EECP) within 3 months prior to the start of screening evaluations
  • Transmyocardial or percutaneous myocardial laser revascularization within the previous year
  • Prior treatment with any cardiovascular gene therapy
  • Patients who received an investigational drug or biologic within 30 days of screening or are currently participating in an investigational drug, biologic or device trial

Sites / Locations

  • Municipal Hospital #15

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

No Intervention

Arm Label

Arm A: Ad5FGF-4

Arm B

Arm Description

Adenovirus serotype-5 mediated human fibroblast growth factor-4 gene transfer and standard of care angina medication

Standard of care angina medication

Outcomes

Primary Outcome Measures

Change in reversible perfusion defect size (RPDS) as measured by adenosine triphosphate (ATP) single-photon emission computed tomography with technetium-99m sestamibi (SPECT)

Secondary Outcome Measures

Change in angina frequency and nitroglycerin use
Change in quality of life using the Seattle Angina Questionnaire
Change in patient functional class using CCS anginal classification
Safety of Ad5FGF-4 as assessed by adverse events and clinical laboratory testing
Long-term safety of Ad5FGF-4 as assessed by serious adverse events

Full Information

First Posted
February 29, 2012
Last Updated
September 27, 2016
Sponsor
Cardium Therapeutics
Collaborators
Advanced Biosciences Research
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1. Study Identification

Unique Protocol Identification Number
NCT01550614
Brief Title
Efficacy and Safety of Ad5FGF-4 for Myocardial Ischemia in Patients With Stable Angina Due to Coronary Artery Disease
Acronym
ASPIRE
Official Title
A Randomized, Controlled, Parallel Group, Multicenter Phase 3 Study to Evaluate the Efficacy and Safety of Ad5FGF-4 Using SPECT Myocardial Perfusion Imaging in Patients With Stable Angina Pectoris
Study Type
Interventional

2. Study Status

Record Verification Date
September 2016
Overall Recruitment Status
Terminated
Study Start Date
March 2012 (undefined)
Primary Completion Date
May 2016 (Actual)
Study Completion Date
undefined (undefined)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Cardium Therapeutics
Collaborators
Advanced Biosciences Research

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to determine whether a single intracoronary infusion of Ad5FGF-4, delivered during induced transient ischemia, is effective in improving myocardial perfusion, angina functional class, patient symptoms, and quality of life. Short-term (8 weeks) and long-term (12 month) safety of Ad5FGF-4 will also be evaluated. The primary endpoint is change in adenosine triphosphate (ATP) stress SPECT reperfusion defect size.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Angina, Stable
Keywords
Angina Pectoris, Myocardial Ischemia, Chest Pain, Coronary Artery Disease, Heart Diseases, Cardiovascular Diseases, Myocardial Perfusion, Reversible Perfusion Defect Size, SPECT-MIBI, Anti-Anginal Medication, Quality of Life

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
11 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Arm A: Ad5FGF-4
Arm Type
Experimental
Arm Description
Adenovirus serotype-5 mediated human fibroblast growth factor-4 gene transfer and standard of care angina medication
Arm Title
Arm B
Arm Type
No Intervention
Arm Description
Standard of care angina medication
Intervention Type
Genetic
Intervention Name(s)
Alferminogene tadenovec
Other Intervention Name(s)
Generx, Cardionovo (Russian Trade Name)
Intervention Description
One-time intracoronary infusion of Ad5FGF-4 (6x10e9 viral particles in buffer)
Primary Outcome Measure Information:
Title
Change in reversible perfusion defect size (RPDS) as measured by adenosine triphosphate (ATP) single-photon emission computed tomography with technetium-99m sestamibi (SPECT)
Time Frame
Baseline and Week 8
Secondary Outcome Measure Information:
Title
Change in angina frequency and nitroglycerin use
Time Frame
Baseline and Week 8
Title
Change in quality of life using the Seattle Angina Questionnaire
Time Frame
Baseline and Week 8
Title
Change in patient functional class using CCS anginal classification
Time Frame
Baseline and Week 8
Title
Safety of Ad5FGF-4 as assessed by adverse events and clinical laboratory testing
Time Frame
Through Week 8
Title
Long-term safety of Ad5FGF-4 as assessed by serious adverse events
Time Frame
Through Month 12

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients 18-75 years of age, inclusive Postmenopausal female patients, women of childbearing potential and men willing to use an effective contraception method while on the study treatment and/or who agree not to become pregnant or make their partner pregnant throughout the study and during one year after administration of the study drug Female subjects of childbearing potential who have a negative urine pregnancy test, and are willing to use an acceptable form of birth control during the study Diagnostic coronary angiogram in the past confirming the presence of coronary artery disease. Patients with extensive disease, or high risk for intervention, or who don't want the higher risk angioplasty or surgery, or have had angioplasty with recurrent angina and vessels are not ideal for angioplasty are ideal candidates Stable angina pectoris being treated with chronic anti-anginal medication(s) at a stable dose for 2 weeks prior to randomization Left ventricular ejection fraction (LVEF) of ≥30%. If the LVEF is <30% the patient can be enrolled if there is no recent or current congestive heart failure present Evidence of stress induced myocardial ischemia by ATP technetium-99m sestamibi SPECT, defined as a reversible perfusion defect size of ≥9% Willing and able to comply with the study requirements Provided written informed consent Exclusion Criteria: Female patients who are pregnant, lactating (breast milk feeding), or planning a pregnancy during the course of the study and one year after administration of the study drug. Women of child bearing potential who are not using an acceptable method of birth control. Women of child bearing potential with a positive urine pregnancy test within 24 hours prior to the start of investigational product Patients with unstable angina for whom an immediate revascularization procedure is indicated Patients for whom a cardiac revascularization procedure is planned in the next 3 months Myocardial infarction within the 3 months prior to the Screening visit Congestive heart failure NYHA Class IV Myocarditis or restrictive pericarditis Left main coronary stenosis ≥70% (unless the patient has a patent graft or collateral vessels supplying the left coronary circulation) or proximal stenoses ≥70% in all major coronary conduit vessels (coronary arteries and bypass grafts) A single patent coronary conduit (for example, totally occluded RCA and LCx with no bypass grafts. Patient will not tolerate balloon occlusion of the LAD for infusion) Clinically significant aortic or mitral valvular heart disease. Life threatening coronary ostial stenosis that precludes adequate catheter engagement in any target vessel, unless the vessel can be accessed via a patent bypass graft Coronary artery to venous communications, which bypass the coronary capillary bed Untreated life-threatening ventricular arrhythmias Uncontrolled arterial hypertension with systolic blood pressure >180 mm Hg and diastolic pressure >100 mm Hg CABG surgery within the past 6 months, unless those grafts are now occluded Percutaneous transluminal coronary angioplasty (PTCA) within the past 3 months, unless the stented/dilated vessel(s) are now occluded Enhanced external counterpulsation (EECP) within 3 months prior to the start of screening evaluations Transmyocardial or percutaneous myocardial laser revascularization within the previous year Prior treatment with any cardiovascular gene therapy Patients who received an investigational drug or biologic within 30 days of screening or are currently participating in an investigational drug, biologic or device trial
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Gabor Rubanyi
Organizational Affiliation
Cardium Therapeutics
Official's Role
Study Director
Facility Information:
Facility Name
Municipal Hospital #15
City
Moscow
Country
Russian Federation

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
17825712
Citation
Henry TD, Grines CL, Watkins MW, Dib N, Barbeau G, Moreadith R, Andrasfay T, Engler RL. Effects of Ad5FGF-4 in patients with angina: an analysis of pooled data from the AGENT-3 and AGENT-4 trials. J Am Coll Cardiol. 2007 Sep 11;50(11):1038-46. doi: 10.1016/j.jacc.2007.06.010. Epub 2007 Aug 24.
Results Reference
background
PubMed Identifier
14563572
Citation
Grines CL, Watkins MW, Mahmarian JJ, Iskandrian AE, Rade JJ, Marrott P, Pratt C, Kleiman N; Angiogene GENe Therapy (AGENT-2) Study Group. A randomized, double-blind, placebo-controlled trial of Ad5FGF-4 gene therapy and its effect on myocardial perfusion in patients with stable angina. J Am Coll Cardiol. 2003 Oct 15;42(8):1339-47. doi: 10.1016/s0735-1097(03)00988-4.
Results Reference
background
PubMed Identifier
11901038
Citation
Grines CL, Watkins MW, Helmer G, Penny W, Brinker J, Marmur JD, West A, Rade JJ, Marrott P, Hammond HK, Engler RL. Angiogenic Gene Therapy (AGENT) trial in patients with stable angina pectoris. Circulation. 2002 Mar 19;105(11):1291-7. doi: 10.1161/hc1102.105595.
Results Reference
background
PubMed Identifier
23957658
Citation
Kaski JC, Consuegra-Sanchez L. Evaluation of ASPIRE trial: a Phase III pivotal registration trial, using intracoronary administration of Generx (Ad5FGF4) to treat patients with recurrent angina pectoris. Expert Opin Biol Ther. 2013 Dec;13(12):1749-53. doi: 10.1517/14712598.2013.827656. Epub 2013 Aug 19.
Results Reference
derived

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Efficacy and Safety of Ad5FGF-4 for Myocardial Ischemia in Patients With Stable Angina Due to Coronary Artery Disease

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