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ReVeRA-201: Etripamil in Atrial Fibrillation, Phase 2

Primary Purpose

Atrial Fibrillation

Status
Completed
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
Etripamil
Placebo
Sponsored by
Milestone Pharmaceuticals Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Atrial Fibrillation focused on measuring atrial fibrillation, ventricular rate control, rapid ventricular rate, etripamil

Eligibility Criteria

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

Inclusion Criteria:

A patient will be eligible for study participation if they meet all of the following criteria:

  1. Aged 18 years and over.
  2. Has provided written informed consent.
  3. Patients with episodes of paroxysmal, persistent or permanent AF (Atrial Fibrillation), presenting with AF and a ventricular rate ≥110 bpm, measured over 1 minute
  4. Patients should receive appropriate antithrombotic therapy as per the applicable guidelines for atrial fibrillation management (e.g., Canadian Cardiovascular Society (CCS) guidelines / European Society of Cardiology (ESC) guidelines).

    1. Etripamil (a calcium channel blocker) is intended for acute rate control only. If rhythm control is desired (outside of the present protocol), anticoagulation as per guidelines may start after the administration of study drug.

Exclusion Criteria:

A patient will be excluded from the study if they meet any of the following criteria:

  1. Has evidence of atrial flutter (ECG) at presentation.
  2. Has a history of stroke,Transient Ischemic Attack (TIA) or peripheral embolism within the last 3 months.
  3. Has received by IV route any of the following within one hour before study drug administration: flecainide, procainamide, digoxin, beta-blocker, or calcium channel blocker.
  4. Has signs and symptoms of severe congestive heart failure at presentation (e.g. tachypnea, oxygen desaturation <90% unless due to known pulmonary disease, pulmonary rales, sign of peripheral hypoperfusion).
  5. Hemodynamic instability, with systolic blood pressure <90 mmHg or diastolic blood pressure <60 mmHg.
  6. Known uncorrected severe aortic or mitral stenosis.
  7. Hypertrophic cardiomyopathy with outflow tract obstruction.
  8. Has a history of second- or third-degree atrioventricular block.
  9. Regular rhythm suggesting a complete Atrioventricular (AV) block.
  10. Has a history or evidence of torsades de pointes, sick sinus syndrome, or Brugada syndrome.
  11. Evidence of Acute Coronary Syndrome within the last 12 months except if patient was successfully revascularized.
  12. Positive pregnancy test result at screening, and females of childbearing potential who do not agree to use adequate method of contraception for the duration of the study.
  13. Has evidence of any clinically significant acute or chronic condition of the nasal cavity (e.g., rhinitis or deviated septum) which could interfere with administration of the study drug in either or both nasal cavities.
  14. Has a history of sensitivity to verapamil.
  15. Has previously participated in a clinical study for etripamil.
  16. Has a history of sensitivity to any components of the investigational product.
  17. Signs of alcohol or drug intoxication at the time of presentation which, in the opinion of the Investigator, would impact the validity of study results.
  18. Is currently participating in another drug or device study, or has received an investigational drug or device within 30 days of Screening.
  19. Has evidence of clinically significant cardiovascular, endocrine, gastrointestinal, hematologic, hepatic, immunologic, neurologic, oncologic, pulmonary, psychiatric, or renal disease or any other condition which, in the opinion of the Investigator, would jeopardize the safety of the patient or impact the validity of study results.

Sites / Locations

  • QEII HSC - Nova Scotia Health Authority
  • Hamilton Health Science
  • PACE (Partners in Advanced Cardiac Evaluation)
  • Ottawa Hospital General & Civic Campus Research Institute
  • Institut de Cardiologie de Montreal
  • CHU Montréal
  • CIUSSS du Nord-de-l'Île-de-Montréal - Hôpital du Sacré-Cœur
  • CISSS Bas-Saint-Laurent / Hôpital de Rimouski
  • CISSS des Laurentides / Unité de recherche clinique
  • CIUSSS de l'Estrie - CHU
  • CISSS de Lanaudière - Hôpital Pierre-Le Gardeur
  • Jeroen Bosch Ziekenhuis Rijnstate Ziekenhuis
  • Jeroen Bosch Ziekenhuis
  • Slingeland Ziekenhuis
  • Treant Zorggroep
  • Elkerliek Ziekenhuis
  • Franciscus Gasthuis
  • Gelre Ziekenhuizen

Arms of the Study

Arm 1

Arm 2

Arm Type

Placebo Comparator

Experimental

Arm Label

Placebo

Etripamil

Arm Description

Patients will receive a total of 200 μL of placebo ((i.e. 100 μL in each nostril) via the Aptar Pharma Nasal Spray Bidose System. The devices will be prefilled and packaged. Instructions on device usage will be provided.

Patients will receive a total of 200 μL of etripamil Nasal spray 70 mg via the Aptar Pharma Nasal Spray Bidose System. The devices will be prefilled and packaged. Instructions on device usage will be provided.

Outcomes

Primary Outcome Measures

The maximum reduction in ventricular rate, measured on Holter monitoring, within 60 minutes from drug administration.

Secondary Outcome Measures

The elapsed time from drug administration to nadir (lowest average heart rate) in the 60 minutes post drug administration.
The percentage of patients achieving ventricular rate of <100 bpm in the 60 minutes post drug administration.
The percentage of patients with 10% reduction from baseline ventricular rate in the 60 minutes post drug administration.
The percentage of patients with 20% reduction from baseline ventricular rate in the 60 minutes post drug administration.
The percentage of patients cardioverting into sinus rhythm in the 60 minutes post drug administration.
Rating of Treatment Satisfaction Questionnaire for Medication (TSQM).

Full Information

First Posted
July 8, 2020
Last Updated
October 19, 2023
Sponsor
Milestone Pharmaceuticals Inc.
Collaborators
The Montreal Health Innovations Coordinating Center (MHICC), JSS Medical Research Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT04467905
Brief Title
ReVeRA-201: Etripamil in Atrial Fibrillation, Phase 2
Official Title
Multi-Centre, Placebo-Controlled, Phase 2 Study of Etripamil Nasal Spray (NS) for the Reduction of Ventricular Rate in Patients With Atrial Fibrillation.
Study Type
Interventional

2. Study Status

Record Verification Date
October 2023
Overall Recruitment Status
Completed
Study Start Date
November 19, 2020 (Actual)
Primary Completion Date
August 3, 2023 (Actual)
Study Completion Date
August 10, 2023 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Milestone Pharmaceuticals Inc.
Collaborators
The Montreal Health Innovations Coordinating Center (MHICC), JSS Medical Research Inc.

4. Oversight

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

5. Study Description

Brief Summary
Many patients with atrial fibrillation experience persistent tachycardia with episodes of rapid ventricular rate despite chronic treatment to reduce ventricular rate. The objectives of this study are to demonstrate the superiority of a nasal spray of etripamil over placebo, in reducing ventricular rate in patients with atrial fibrillation; and to evaluate the safety and efficacy of etripamil Nasal Spray in patients with atrial fibrillation (AF).
Detailed Description
This is a multi-center, randomized, double-blind, placebo-controlled study to evaluate the effects of etripamil Nasal Spray in patients with atrial fibrillation (AF). This study includes Screening, the Treatment Period and Follow-up procedures. Each patient will receive placebo or 70 mg of etripamil intranasally; treatment will be randomized in a 1:1 ratio, to yield 50 evaluable patients with atrial fibrillation in 2 groups of 25. Patients with atrial fibrillation (AF) will be selected by the Investigator. The screening procedures will include obtaining informed consent, a review of inclusion/exclusion criteria, a complete physical examination, and recording of any concomitant medications. After screening procedures are complete, eligible patients will be randomized to receive etripamil or placebo. Heart rate will be measured via Holter ECG (Electrocardiogram)10 minutes prior to and immediately before drug administration; patients must exhibit a rapid ventricular rate (≥110 bpm measured during 1 minute) on the Holter report prior to drug administration in order to receive the study drug. Blinded study drug will be administered during Holter ECG (Electrocardiogram) monitoring, which will be conducted for at least 10 minutes prior to and for 6 hours after administration. Patients will undergo a safety follow-up assessment and return the Holter device approximately 24 hours post-dose. Patients will also be contacted by phone 7 days post-dosing for safety follow-up.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Atrial Fibrillation
Keywords
atrial fibrillation, ventricular rate control, rapid ventricular rate, etripamil

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Patients will receive a total of 200 μL of placebo ((i.e. 100 μL in each nostril) via the Aptar Pharma Nasal Spray Bidose System. The devices will be prefilled and packaged. Instructions on device usage will be provided.
Arm Title
Etripamil
Arm Type
Experimental
Arm Description
Patients will receive a total of 200 μL of etripamil Nasal spray 70 mg via the Aptar Pharma Nasal Spray Bidose System. The devices will be prefilled and packaged. Instructions on device usage will be provided.
Intervention Type
Drug
Intervention Name(s)
Etripamil
Intervention Description
The formulation of etripamil Nasal Spray will consist of MSP-2017 (etripamil), water, acetic acid, disodium ethylene-diamine-tetra-acetic acid (EDTA), and sulfuric acid. The dose of etripamil to be evaluated in this study is 70 mg.
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
The formulation of placebo will consist of water, sodium acetate, disodium, disodium ethylene-diamine-tetra-acetic acid (EDTA), and sulfuric acid to reproduce the same pH as the etripamil formulation.
Primary Outcome Measure Information:
Title
The maximum reduction in ventricular rate, measured on Holter monitoring, within 60 minutes from drug administration.
Time Frame
60 minutes post drug administration
Secondary Outcome Measure Information:
Title
The elapsed time from drug administration to nadir (lowest average heart rate) in the 60 minutes post drug administration.
Time Frame
60 minutes post drug administration
Title
The percentage of patients achieving ventricular rate of <100 bpm in the 60 minutes post drug administration.
Time Frame
60 minutes post drug administration
Title
The percentage of patients with 10% reduction from baseline ventricular rate in the 60 minutes post drug administration.
Time Frame
60 minutes post drug administration
Title
The percentage of patients with 20% reduction from baseline ventricular rate in the 60 minutes post drug administration.
Time Frame
60 minutes post drug administration
Title
The percentage of patients cardioverting into sinus rhythm in the 60 minutes post drug administration.
Time Frame
60 minutes post drug administration
Title
Rating of Treatment Satisfaction Questionnaire for Medication (TSQM).
Time Frame
60 minutes post drug administration

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: A patient will be eligible for study participation if they meet all of the following criteria: Aged 18 years and over. Has provided written informed consent. Patients with episodes of paroxysmal, persistent or permanent AF (Atrial Fibrillation), presenting with AF and a ventricular rate ≥110 bpm, measured over 1 minute Patients should receive appropriate antithrombotic therapy as per the applicable guidelines for atrial fibrillation management (e.g., Canadian Cardiovascular Society (CCS) guidelines / European Society of Cardiology (ESC) guidelines). Etripamil (a calcium channel blocker) is intended for acute rate control only. If rhythm control is desired (outside of the present protocol), anticoagulation as per guidelines may start after the administration of study drug. Exclusion Criteria: A patient will be excluded from the study if they meet any of the following criteria: Has evidence of atrial flutter (ECG) at presentation. Has a history of stroke,Transient Ischemic Attack (TIA) or peripheral embolism within the last 3 months. Has received by IV route any of the following within one hour before study drug administration: flecainide, procainamide, digoxin, beta-blocker, or calcium channel blocker. Has signs and symptoms of severe congestive heart failure at presentation (e.g. tachypnea, oxygen desaturation <90% unless due to known pulmonary disease, pulmonary rales, sign of peripheral hypoperfusion). Hemodynamic instability, with systolic blood pressure <90 mmHg or diastolic blood pressure <60 mmHg. Known uncorrected severe aortic or mitral stenosis. Hypertrophic cardiomyopathy with outflow tract obstruction. Has a history of second- or third-degree atrioventricular block. Regular rhythm suggesting a complete Atrioventricular (AV) block. Has a history or evidence of torsades de pointes, sick sinus syndrome, or Brugada syndrome. Evidence of Acute Coronary Syndrome within the last 12 months except if patient was successfully revascularized. Positive pregnancy test result at screening, and females of childbearing potential who do not agree to use adequate method of contraception for the duration of the study. Has evidence of any clinically significant acute or chronic condition of the nasal cavity (e.g., rhinitis or deviated septum) which could interfere with administration of the study drug in either or both nasal cavities. Has a history of sensitivity to verapamil. Has previously participated in a clinical study for etripamil. Has a history of sensitivity to any components of the investigational product. Signs of alcohol or drug intoxication at the time of presentation which, in the opinion of the Investigator, would impact the validity of study results. Is currently participating in another drug or device study, or has received an investigational drug or device within 30 days of Screening. Has evidence of clinically significant cardiovascular, endocrine, gastrointestinal, hematologic, hepatic, immunologic, neurologic, oncologic, pulmonary, psychiatric, or renal disease or any other condition which, in the opinion of the Investigator, would jeopardize the safety of the patient or impact the validity of study results.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Denis Roy, M.D
Organizational Affiliation
Montreal Heart Institute (MHI)
Official's Role
Principal Investigator
Facility Information:
Facility Name
QEII HSC - Nova Scotia Health Authority
City
Halifax
State/Province
Nova Scotia
ZIP/Postal Code
B3H 3A7
Country
Canada
Facility Name
Hamilton Health Science
City
Hamilton
State/Province
Ontario
ZIP/Postal Code
L2L 2X2
Country
Canada
Facility Name
PACE (Partners in Advanced Cardiac Evaluation)
City
Newmarket
State/Province
Ontario
ZIP/Postal Code
L3Y 2P6
Country
Canada
Facility Name
Ottawa Hospital General & Civic Campus Research Institute
City
Ottawa
State/Province
Ontario
ZIP/Postal Code
K1Y4E9
Country
Canada
Facility Name
Institut de Cardiologie de Montreal
City
Montréal
State/Province
Quebec
ZIP/Postal Code
H1T 1C8
Country
Canada
Facility Name
CHU Montréal
City
Montréal
State/Province
Quebec
ZIP/Postal Code
H2X 0A9
Country
Canada
Facility Name
CIUSSS du Nord-de-l'Île-de-Montréal - Hôpital du Sacré-Cœur
City
Montréal
State/Province
Quebec
ZIP/Postal Code
H4J 1C5
Country
Canada
Facility Name
CISSS Bas-Saint-Laurent / Hôpital de Rimouski
City
Rimouski
State/Province
Quebec
ZIP/Postal Code
G5L 5T1
Country
Canada
Facility Name
CISSS des Laurentides / Unité de recherche clinique
City
Saint-Jérôme
State/Province
Quebec
ZIP/Postal Code
J7Z 5T3
Country
Canada
Facility Name
CIUSSS de l'Estrie - CHU
City
Sherbrooke
State/Province
Quebec
ZIP/Postal Code
J1H 5N4
Country
Canada
Facility Name
CISSS de Lanaudière - Hôpital Pierre-Le Gardeur
City
Terrebonne
State/Province
Quebec
ZIP/Postal Code
J6V 2H2
Country
Canada
Facility Name
Jeroen Bosch Ziekenhuis Rijnstate Ziekenhuis
City
Arnhem
ZIP/Postal Code
6815 AD
Country
Netherlands
Facility Name
Jeroen Bosch Ziekenhuis
City
Den Bosch
ZIP/Postal Code
5223 GZ
Country
Netherlands
Facility Name
Slingeland Ziekenhuis
City
Doetinchem
ZIP/Postal Code
7009 BL
Country
Netherlands
Facility Name
Treant Zorggroep
City
Emmen
ZIP/Postal Code
7824 AA
Country
Netherlands
Facility Name
Elkerliek Ziekenhuis
City
Helmond
ZIP/Postal Code
5707 HA
Country
Netherlands
Facility Name
Franciscus Gasthuis
City
Rotterdam
ZIP/Postal Code
3045 PM
Country
Netherlands
Facility Name
Gelre Ziekenhuizen
City
Zutphen
ZIP/Postal Code
7207 AE
Country
Netherlands

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

ReVeRA-201: Etripamil in Atrial Fibrillation, Phase 2

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