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Study to Evaluate the Effect on Parameters of Systemic Inflammation and Disease Outcomes and Safety of RPH-104 in Subjects With Acute ST-elevation Myocardial Infarction

Primary Purpose

Acute ST Segment Elevation Myocardial Infarction

Status
Completed
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
RPH-104 80 mg
Placebo
Sponsored by
R-Pharm Overseas, Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Acute ST Segment Elevation Myocardial Infarction focused on measuring STEMI, Myocardial infarction, Cardiovascular diseases, CVD, Coronary heart disease, CHD

Eligibility Criteria

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

Inclusion Criteria:

  • Subjects who gave voluntary written Informed consent to participate in the study and to follow all Protocol procedures.
  • STEMI diagnosis defined as chest pain or its equivalent with ECG findings evidencing ST elevation (>1 mm) in two or more consecutive leads or acute left bunch branch block according the investigator's judgement.
  • Percutaneous coronary intervention (PCI) with stenting was performed within no more than 12 hours after onset of chest pain or its equivalent and randomization was performed in no more than 12 hours after PCI (overall within 24 hours of onset of chest pain or equivalent).
  • Consent of female subjects with childbearing potential defined as all female subjects with physiological potential to conceive, to use highly effective contraceptive methods throughout the study starting from screening (signing Informed Consent Form) and negative pregnancy test.

Highly effective contraceptive methods include combination of two of the following methods (a+b or a+c or b+c):

  1. oral, injection or implanted hormonal contraceptives; in case of oral contraceptives, the female subjects should administer the same product for at least 3 months prior to the study therapy;
  2. intrauterine device or contraceptive system;
  3. barrier methods: condom or occlusive cap (diaphragm or cervical cap / vaginal fornix cap) with spermicidal foam/gel/film/cream/vaginal suppository

    • Ability and willingness of the subject, according to the reasonable investigator's judgment, to attend the study site at all scheduled visits, undergo the study procedures and follow the Protocol requirements including subcutaneous injections by qualified site personnel.

Exclusion Criteria:

  • Hypersensitivity to test product (RPH-104) and/or its ingredients/excipients.
  • Pregnancy and breastfeeding.
  • Verified chronic heart failure (The American Heart Association / The American College of Cardiology (AHA/ACC) C-D class, New York Heart Association (NYHA) Functional class (FC) III-IV)
  • Pre-existing severe valvular heart disease according to the investigator's assessment.
  • Pre-existing left ventricular (LV) dysfunction (ejection fraction (EF)<40%)
  • History of STEMI
  • Complications of acute myocardial infarction (MI) in the form of acute left ventricular failure and cardiogenic shock defined as stable blood pressure decrease (SBP<90 mm Hg) associated with signs of hypoperfusion as well as cases when inotropic and/or mechanical support is required to maintain SBP; and / or unstable hemodynamics.
  • Active infections (acute or chronic); active tuberculosis.
  • Recent (less than 5 half-life periods) or current administration of colchicine, as well as agents with an immunosuppressant mechanism of action, including, but not limited to:

glucocorticoids at doses of > 1 mg/kg of methylprednisolone equivalent, tumor necrosis factor-alfa (TNFα) blockers, Interleukin-1 (IL-1) and other biological drugs, cyclosporine and other immunosuppressants. Non-steroidal anti-inflammatory drugs (NSAIDs) are allowed.

  • Immunization with live vaccines within 90 days prior to the study product administration.
  • Chronic systemic autoimmune or autoinflammatory diseases
  • Suspected necessity in cardiosurgery.
  • Oncology (or diagnosis of oncology within the last 5 years).
  • History of organ transplantation or necessity in transplantation at the screening initiation or scheduled transplantation during the study.
  • Neutropenia (absolute neutrophil count <1800/mm^3).
  • Participation in another clinical study within the previous 3 months prior to Screening visit.
  • Other medical (including mental) conditions or abnormal laboratory findings which may increase the risk for the subject associated with the study participation or administration of the study products or which may affect interpretation of the study results and, according to the investigator, render the subject ineligible for the study.*

    *If, in the Investigator's opinion, administration of a non-live COVID-19 (SARS-CoV-2) vaccine increases the risk for the patient related to his/her participation in the study, the Investigator can make a decision not to include this patient into the study.

  • The subjects working at the study site or subjects working for Sponsor directly involved in this clinical study.

Sites / Locations

  • Sinai Center of Thrombosis Research and Drug Development
  • Cleveland Clinic
  • University of Virginia Health System
  • Virginia Commonwealth University
  • State Budgetary Institution of Healthcare of Moscow "City Clinical Hospital №64" of the Moscow Department of Health
  • State Institution of Healthcare in Moscow "City Clinical Hospital № 51 Moscow Health Department"
  • Federal State Institution "Russian Cardiology Research and Production Complex" of the Ministry of Healthcare of the Russian Federation
  • Moscow State Clinical Hospital named after V.V. Veresaev
  • State Autonomous institution of healthcare of the Perm region "City clinical hospital № 4"
  • Ryazan State Medical University n.a. academician I.P. Pavlov on the basis of Regional Clinical cardiology Dispensary
  • St. Petersburg State Budgetary Healthcare Institution "Saint Martyr Elizabeth City Hospital"
  • The State Budgetary Health Care Institution of the Yaroslavl Region "Regional Clinical Hospital"

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Placebo Comparator

Arm Label

RPH-104 80 mg

RPH-104 160 mg

Placebo

Arm Description

subjects will receive subcutaneous single injection of 2 mL (80 mg) of RPH-104 and 2 mL of placebo on different administration sites

subjects will receive subcutaneous single injection of 2 mL (80 mg) of RPH-104 and 2 mL of (80 mg) of RPH-104 on different administration sites

subjects will receive subcutaneous single injection of 2 mL of placebo and 2 mL of placebo on different administration sites

Outcomes

Primary Outcome Measures

High-sensitive С-reactive protein (hsCRP) area under curve (AUC) from baseline until Day 14
hsCRP area under curve (AUC) from baseline (Day 1) until Day 14

Secondary Outcome Measures

hsCRP AUC from baseline until Day 28
hsCRP AUC from baseline (Day 1) until Day 28
Incidence of fatal outcomes (cardiac and non-cardiac) during 12-month follow-up period
Incidence of hospitalizations due to heart failure (HF) or other cardiac reasons not associated with HF, or due to non-cardiac reasons during 12-month follow-up period
Incidence of new cases of HF during 12-month follow-up period
New cases of HF are defined as hospitalization due to HF or new onset of HF.
Changes in levels of brain natriuretic peptide (BNP, NT-proBNP) during 12-month follow-up period compared to baseline
Changes in End-diastolic (EDV) volume after 12 months compared to baseline
Measured by echocardiography (Echo-CG) (in mL).
Changes in End-systolic (ESV) volume after 12 months compared to baseline
Measured by Echo-CG (in mL).
Changes in EF (Simpson BP) after 12 months compared to baseline
Measured by Echo-CG (in percentage).
Changes in regional LV function after 12 months compared to baseline
Assessment of regional LV function using the wall motion score index (WMSI), measured by Echo-CG.
Changes in fractional area change (FAC) parameter after 12 months compared to baseline
Measured by Echo-CG (in percentage).
Changes in Tricuspid Annular Plane Systolic Excursion (TAPSE) parameter after 12 months compared to baseline
Measured by Echo-CG (in mm).
Changes in Transmitral flow rate
Changes in Transmitral flow rate after 12 months compared to baseline, measured by Echo-CG.
Changes in mitral valve (MV) septal e' velocity (e'sept) after 12 months compared to baseline
Measured by Echo-CG (in cm/s).
Changes in MV lateral e' velocity (e'lat) after 12 months compared to baseline
Measured by Echo-CG (in cm/s).
BNP AUC from Day 1 (baseline) until Day 28
NT-pro-BNP AUC from Day 1 (baseline) until Day 28
Incidence of "fatal outcome (due to any reason) or hospitalization due to HF or new onset of HF" during 12-month follow-up period
Incidence of "fatal outcome (due to any reason) or hospitalization due to HF" during 12-month follow-up period

Full Information

First Posted
July 3, 2020
Last Updated
January 18, 2023
Sponsor
R-Pharm Overseas, Inc.
Collaborators
Cromos Pharma LLC, Data Management 365, Keystat, LLC, R-Pharm, K-Research
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1. Study Identification

Unique Protocol Identification Number
NCT04463251
Brief Title
Study to Evaluate the Effect on Parameters of Systemic Inflammation and Disease Outcomes and Safety of RPH-104 in Subjects With Acute ST-elevation Myocardial Infarction
Official Title
International, Double Blind, Randomized, Placebo-controlled Study to Evaluate the Effect on Parameters of Systemic Inflammation and Disease Outcomes and Safety of RPH-104 in Subjects With Acute ST-elevation Myocardial Infarction
Study Type
Interventional

2. Study Status

Record Verification Date
January 2023
Overall Recruitment Status
Completed
Study Start Date
December 7, 2020 (Actual)
Primary Completion Date
November 3, 2021 (Actual)
Study Completion Date
October 10, 2022 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
R-Pharm Overseas, Inc.
Collaborators
Cromos Pharma LLC, Data Management 365, Keystat, LLC, R-Pharm, K-Research

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
The goal of the study is to evaluate the effect of single administration of RPH-104 at 80 mg and 160 mg on parameters of systemic inflammation and outcomes of the disease in subjects with ST-segment elevation myocardial infarction (STEMI)
Detailed Description
After signing informed consent, the investigator will assess the subject's eligibility for the study. After signing the informed consent form, the investigator will assess the subject's eligibility for the study. The following procedures will be performed during the screening: collection of medical history, recording previous and concomitant therapy, demographic data, recording 12-lead ECG findings on which STEMI diagnosis was based, recording date and time of STEMI symptom development, recording date, time and results of coronary angiography (CAG) at admission to the study site, measurement of blood neutrophil count, vital signs, physical examination including measurement of body weight (if hospital bed is available), blood sampling for hematology, biochemistry, determination of concentration of hsCRP and brain natriuretic peptide (BNP; N-terminal (NT)-pro hormone brain natriuretic peptide (NT-pro-BNP)), for females with retained reproductive potential - pregnancy test (test strips). The subjects meeting selection criteria will be randomized to one of the three groups (in 1:1:1 ratio) for single subcutaneous administration of RPH-104 80 mg, RPH-104 160 mg or placebo. Screening, randomization and administration of the study products will be made on the same (first) study day. Further 4-week (28-day) clinical follow-up and additional 6- and 12-month clinical follow-up period will be performed. The end of clinical part of the study will be the date of the last visit of the last subject within additional 12-month clinical follow-up. The maximum number of screened patients will be 146 subjects, 102 subjects will be randomized, 34 subjects per group.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Acute ST Segment Elevation Myocardial Infarction
Keywords
STEMI, Myocardial infarction, Cardiovascular diseases, CVD, Coronary heart disease, CHD

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
102 (Actual)

8. Arms, Groups, and Interventions

Arm Title
RPH-104 80 mg
Arm Type
Experimental
Arm Description
subjects will receive subcutaneous single injection of 2 mL (80 mg) of RPH-104 and 2 mL of placebo on different administration sites
Arm Title
RPH-104 160 mg
Arm Type
Experimental
Arm Description
subjects will receive subcutaneous single injection of 2 mL (80 mg) of RPH-104 and 2 mL of (80 mg) of RPH-104 on different administration sites
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
subjects will receive subcutaneous single injection of 2 mL of placebo and 2 mL of placebo on different administration sites
Intervention Type
Biological
Intervention Name(s)
RPH-104 80 mg
Intervention Description
solution for subcutaneous administration 40 mg/mL, 2 mL in the 4-mL transparent glass vial
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Normal Saline (0.9% Sodium Chloride solution for Injection), 2 mL in the 4-mL transparent glass vial
Primary Outcome Measure Information:
Title
High-sensitive С-reactive protein (hsCRP) area under curve (AUC) from baseline until Day 14
Description
hsCRP area under curve (AUC) from baseline (Day 1) until Day 14
Time Frame
Day 1 until Day 14
Secondary Outcome Measure Information:
Title
hsCRP AUC from baseline until Day 28
Description
hsCRP AUC from baseline (Day 1) until Day 28
Time Frame
up to Day 28
Title
Incidence of fatal outcomes (cardiac and non-cardiac) during 12-month follow-up period
Time Frame
up to Day 365
Title
Incidence of hospitalizations due to heart failure (HF) or other cardiac reasons not associated with HF, or due to non-cardiac reasons during 12-month follow-up period
Time Frame
up to Day 365
Title
Incidence of new cases of HF during 12-month follow-up period
Description
New cases of HF are defined as hospitalization due to HF or new onset of HF.
Time Frame
up to Day 365
Title
Changes in levels of brain natriuretic peptide (BNP, NT-proBNP) during 12-month follow-up period compared to baseline
Time Frame
From Day 1 until Day 365
Title
Changes in End-diastolic (EDV) volume after 12 months compared to baseline
Description
Measured by echocardiography (Echo-CG) (in mL).
Time Frame
From Day 1 Until Day 365
Title
Changes in End-systolic (ESV) volume after 12 months compared to baseline
Description
Measured by Echo-CG (in mL).
Time Frame
From Day 1 Until Day 365
Title
Changes in EF (Simpson BP) after 12 months compared to baseline
Description
Measured by Echo-CG (in percentage).
Time Frame
From Day 1 Until Day 365
Title
Changes in regional LV function after 12 months compared to baseline
Description
Assessment of regional LV function using the wall motion score index (WMSI), measured by Echo-CG.
Time Frame
From Day 1 Until Day 365
Title
Changes in fractional area change (FAC) parameter after 12 months compared to baseline
Description
Measured by Echo-CG (in percentage).
Time Frame
From Day 1 Until Day 365
Title
Changes in Tricuspid Annular Plane Systolic Excursion (TAPSE) parameter after 12 months compared to baseline
Description
Measured by Echo-CG (in mm).
Time Frame
From Day 1 Until Day 365
Title
Changes in Transmitral flow rate
Description
Changes in Transmitral flow rate after 12 months compared to baseline, measured by Echo-CG.
Time Frame
From Day 1 Until Day 365
Title
Changes in mitral valve (MV) septal e' velocity (e'sept) after 12 months compared to baseline
Description
Measured by Echo-CG (in cm/s).
Time Frame
From Day 1 Until Day 365
Title
Changes in MV lateral e' velocity (e'lat) after 12 months compared to baseline
Description
Measured by Echo-CG (in cm/s).
Time Frame
From Day 1 Until Day 365
Title
BNP AUC from Day 1 (baseline) until Day 28
Time Frame
up to Day 28
Title
NT-pro-BNP AUC from Day 1 (baseline) until Day 28
Time Frame
up to Day 28
Title
Incidence of "fatal outcome (due to any reason) or hospitalization due to HF or new onset of HF" during 12-month follow-up period
Time Frame
up to Day 365
Title
Incidence of "fatal outcome (due to any reason) or hospitalization due to HF" during 12-month follow-up period
Time Frame
up to Day 365

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Subjects who gave voluntary written Informed consent to participate in the study and to follow all Protocol procedures. STEMI diagnosis defined as chest pain or its equivalent with ECG findings evidencing ST elevation (>1 mm) in two or more consecutive leads or acute left bunch branch block according the investigator's judgement. Percutaneous coronary intervention (PCI) with stenting was performed within no more than 12 hours after onset of chest pain or its equivalent and randomization was performed in no more than 12 hours after PCI (overall within 24 hours of onset of chest pain or equivalent). Consent of female subjects with childbearing potential defined as all female subjects with physiological potential to conceive, to use highly effective contraceptive methods throughout the study starting from screening (signing Informed Consent Form) and negative pregnancy test. Highly effective contraceptive methods include combination of two of the following methods (a+b or a+c or b+c): oral, injection or implanted hormonal contraceptives; in case of oral contraceptives, the female subjects should administer the same product for at least 3 months prior to the study therapy; intrauterine device or contraceptive system; barrier methods: condom or occlusive cap (diaphragm or cervical cap / vaginal fornix cap) with spermicidal foam/gel/film/cream/vaginal suppository Ability and willingness of the subject, according to the reasonable investigator's judgment, to attend the study site at all scheduled visits, undergo the study procedures and follow the Protocol requirements including subcutaneous injections by qualified site personnel. Exclusion Criteria: Hypersensitivity to test product (RPH-104) and/or its ingredients/excipients. Pregnancy and breastfeeding. Verified chronic heart failure (The American Heart Association / The American College of Cardiology (AHA/ACC) C-D class, New York Heart Association (NYHA) Functional class (FC) III-IV) Pre-existing severe valvular heart disease according to the investigator's assessment. Pre-existing left ventricular (LV) dysfunction (ejection fraction (EF)<40%) History of STEMI Complications of acute myocardial infarction (MI) in the form of acute left ventricular failure and cardiogenic shock defined as stable blood pressure decrease (SBP<90 mm Hg) associated with signs of hypoperfusion as well as cases when inotropic and/or mechanical support is required to maintain SBP; and / or unstable hemodynamics. Active infections (acute or chronic); active tuberculosis. Recent (less than 5 half-life periods) or current administration of colchicine, as well as agents with an immunosuppressant mechanism of action, including, but not limited to: glucocorticoids at doses of > 1 mg/kg of methylprednisolone equivalent, tumor necrosis factor-alfa (TNFα) blockers, Interleukin-1 (IL-1) and other biological drugs, cyclosporine and other immunosuppressants. Non-steroidal anti-inflammatory drugs (NSAIDs) are allowed. Immunization with live vaccines within 90 days prior to the study product administration. Chronic systemic autoimmune or autoinflammatory diseases Suspected necessity in cardiosurgery. Oncology (or diagnosis of oncology within the last 5 years). History of organ transplantation or necessity in transplantation at the screening initiation or scheduled transplantation during the study. Neutropenia (absolute neutrophil count <1800/mm^3). Participation in another clinical study within the previous 3 months prior to Screening visit. Other medical (including mental) conditions or abnormal laboratory findings which may increase the risk for the subject associated with the study participation or administration of the study products or which may affect interpretation of the study results and, according to the investigator, render the subject ineligible for the study.* *If, in the Investigator's opinion, administration of a non-live COVID-19 (SARS-CoV-2) vaccine increases the risk for the patient related to his/her participation in the study, the Investigator can make a decision not to include this patient into the study. The subjects working at the study site or subjects working for Sponsor directly involved in this clinical study.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Yan Lavrovsky
Organizational Affiliation
R-Pharm Overseas, Inc.
Official's Role
Study Director
Facility Information:
Facility Name
Sinai Center of Thrombosis Research and Drug Development
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21215
Country
United States
Facility Name
Cleveland Clinic
City
Cleveland
State/Province
Ohio
ZIP/Postal Code
44195
Country
United States
Facility Name
University of Virginia Health System
City
Charlottesville
State/Province
Virginia
ZIP/Postal Code
22908
Country
United States
Facility Name
Virginia Commonwealth University
City
Richmond
State/Province
Virginia
ZIP/Postal Code
23298-5051
Country
United States
Facility Name
State Budgetary Institution of Healthcare of Moscow "City Clinical Hospital №64" of the Moscow Department of Health
City
Moscow
ZIP/Postal Code
117292
Country
Russian Federation
Facility Name
State Institution of Healthcare in Moscow "City Clinical Hospital № 51 Moscow Health Department"
City
Moscow
ZIP/Postal Code
121309
Country
Russian Federation
Facility Name
Federal State Institution "Russian Cardiology Research and Production Complex" of the Ministry of Healthcare of the Russian Federation
City
Moscow
ZIP/Postal Code
121552
Country
Russian Federation
Facility Name
Moscow State Clinical Hospital named after V.V. Veresaev
City
Moscow
ZIP/Postal Code
127644
Country
Russian Federation
Facility Name
State Autonomous institution of healthcare of the Perm region "City clinical hospital № 4"
City
Perm
ZIP/Postal Code
2614107
Country
Russian Federation
Facility Name
Ryazan State Medical University n.a. academician I.P. Pavlov on the basis of Regional Clinical cardiology Dispensary
City
Ryazan
ZIP/Postal Code
390026
Country
Russian Federation
Facility Name
St. Petersburg State Budgetary Healthcare Institution "Saint Martyr Elizabeth City Hospital"
City
St Petersburg
ZIP/Postal Code
195257
Country
Russian Federation
Facility Name
The State Budgetary Health Care Institution of the Yaroslavl Region "Regional Clinical Hospital"
City
Yaroslavl
ZIP/Postal Code
150062
Country
Russian Federation

12. IPD Sharing Statement

Citations:
PubMed Identifier
33902621
Citation
Samsonov M, Bogin V, Van Tassell BW, Abbate A. Interleukin-1 blockade with RPH-104 in patients with acute ST-elevation myocardial infarction: study design and rationale. J Transl Med. 2021 Apr 26;19(1):169. doi: 10.1186/s12967-021-02828-z.
Results Reference
derived

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Study to Evaluate the Effect on Parameters of Systemic Inflammation and Disease Outcomes and Safety of RPH-104 in Subjects With Acute ST-elevation Myocardial Infarction

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