Angina Pectoris, Heart Failure, Myocardial Ischemia
Conditions
Brief summary
This study investigates whether symptom-limited exercise capacity in ischemic cardiomyopathy patients with angina is deleteriously affected by treatment with CK-1827452.
Detailed description
The primary objective of this study is to assess the effect of intravenous (i.v.) CK-1827452 on symptom-limited exercise tolerance in patients with ischemic cardiomyopathy and angina. The secondary objectives are to assess the tolerability of CK-1827452 administered three times daily (tid) to steady state in an immediate-release (IR), blend-in-capsule oral formulation to outpatients with ischemic cardiomyopathy and angina and to assess CK-1827452 plasma concentrations at trough and 1 hour after dosing with CK-1827452 administered tid to steady state in an IR, blend-in-capsule oral formulation to outpatients with ischemic cardiomyopathy and angina.
Interventions
DRUGCK-1827452 24mg and 6 mg iv infusion
I.V. infusion for 2 hours at 24mg/hr followed by 18 hours at 6mg/hr
DRUGCK-1827452 12.5mg capsule
12.5mg oral immediate release capsule
DRUGCK-1827452 48 mg and 11 mg iv infusion
I.V. infusion for 2 hours at 48mg/hr followed by 18 hours at 11mg/hr
DRUGCK-1827452 25mg capsule
25mg oral immediate release capsule
Matching placebo iv infusion
DRUGPlacebo capsule
Matching placebo oral immediate release capsule
Sponsors
Cytokinetics
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. The patient has signed an Informed Consent Form/Patient Information Sheet for this study approved by the governing Institutional Review Board (IRB) or Independent Ethics Committee (IEC). 2. The patient is at least 18 years old. 3. The patient has ischemic heart disease documented by any one or more of the following: * A history of myocardial infarction documented by elevated CPK-MB, troponin I or T, or the presence of electrocardiographic Q waves consistent with myocardial infarction. * Coronary angiography demonstrating at least 1 major epicardial coronary artery (i.e., left main, left anterior descending, left circumflex, or right coronary artery) with a stenosis of at least 60% diameter or greater but excluding stenosis of the left main coronary artery unless revascularized by coronary artery bypass grafting. 4. The patient has a history of ≥ 1 episode of exercise induced angina within 2 months prior to the initial screening visit. 5. The patient has been taking a beta blocker and an ACE inhibitor (and/or an ARB) for at least 4 weeks. If prescribed, diuretics must have been administered for at least 4 weeks prior to the initial screening visit. 6. The patient is NYHA Class II-III at the time of enrollment and has been so for ≥ 3 months prior to the initial screening visit. 7. The patient has a history of a left ventricular ejection fraction (LVEF) ≤ 35%. 8. The patient has a history of EITHER a left ventricular end-diastolic diameter ≥ 55 mm, OR a left ventricular end-diastolic diameter index ≥ 32 mm/m2. 9. The patient can be expected to complete at least 4 minutes of a Modified Naughton ETT (see Appendix B). 10. For female patients only: The patient is post-menopausal (≥ 1 year) or sterilized, or if she is of childbearing potential, she is not breastfeeding, her pregnancy test is negative, she has no intention to become pregnant during the course of the study, and she is using contraceptive drugs or devices.
Exclusion criteria
1. The patient has acute myocarditis; clinically significant restrictive, constrictive, or hypertrophic obstructive cardiomyopathy; or clinically significant congenital heart disease. 2. The patient has a SBP \> 160 mmHg, documented on at least 3 separate occasions, at least 10 minutes apart. 3. The patient has a DBP \> 90 mmHg, documented on at least 3 separate occasions, at least 10 minutes apart. 4. The patient has levels of troponin I or T, or CPK-MB \> the upper limit of normal at any time from 6 weeks prior to the Initial Screening Visit (Visit 1) and up to randomization. 5. The patient has severe aortic or mitral stenosis. 6. The patient has had an acute coronary syndrome, transient ischemic attack, or revascularization procedure within 6 weeks of the Initial Screening Visit (Visit 1). 7. The patient has significant co-morbid conditions (i.e., lung disease, arthritis, peripheral vascular disease) that may limit his or her treadmill exercise capacity. 8. The patient has renal impairment defined by a calculated creatinine clearance \< 30 cc/min or a need for renal replacement therapy. 9. The patient has known hepatic impairment defined by a total bilirubin \> 3 mg/dL, or an ALT or AST \> 2 times the upper limit of normal. 10. The patient has received an investigational drug or device within 30 days or 5 half-lives, whichever is greater, of randomization. 11. The patient weighs \> 120 kg. 12. The patient has a body temperature \> 38 ° C, confirmed by at least 2 successive measurements, at least 10 minutes apart. 13. The patient has any laboratory abnormality which, in the opinion of the investigator, should preclude his or her participation in the study. 14. The patient has had any prior treatment with CK-1827452.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Participants Stopping Exercise Treadmill Test 3 (ETT-3) for Angina at Stage Earlier Than Baseline Exercise Treadmill Test (ETT-B) | 1 day | The Modified Naughton Exercise Treadmill Test was employed in this study. Exercise Treadmill Test 3 (ETT-3) was performed during the last 2 hours of the 20-hour infusion of study drug or placebo. Baseline Exercise Treadmill Test (ETT-B) was performed prior to dosing. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Participants Stopping ETT-3 for Any Reason at Stage Earlier Than ETT-B | 1 day | The Modified Naughton Exercise Treadmill Test was employed in this study. Exercise Treadmill Test 3 (ETT-3) was performed during the last 2 hours of the 20-hour infusion of study drug or placebo. Baseline Exercise Treadmill Test (ETT-B) was performed prior to dosing. |
| Increase in Exercise Duration During ETT-3 vs. ETT-B | 1 day | — |
| Participants Stopping ETT-3 for Angina at Any Stage | 1 day | This Outcome Measure includes all participants who stopped ETT-3 for angina at any stage, not only those who stopped at a stage earlier than ETT-B. Note: All 9 subjects who stopped ETT-3 for angina also stopped ETT-B for angina. |
| Participants With 1 mm ST Segment Depression During ETT-3 | 1 day | ST Segment Depression measured by Electrocardiography while performing ETT-3. |
Countries
Georgia, Russia
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Mid Dose Active Drug CK-1827452 20 hour infusion followed by 6 days three times a day oral dose and a final single oral dose | 31 |
| High Dose Active Drug CK-1827452 20 hour infusion followed by 6 days three times a day oral dose and a final single oral dose | 34 |
| All Placebo 20 hour infusion followed by 6 days three times a day oral dose and a final single oral dose | 29 |
| Total | 94 |
Baseline characteristics
| Characteristic | Mid Dose Active Drug | High Dose Active Drug | All Placebo | Total |
|---|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 20 Participants | 18 Participants | 12 Participants | 50 Participants |
| Age, Categorical Between 18 and 65 years | 11 Participants | 16 Participants | 17 Participants | 44 Participants |
| Age, Continuous | 65.2 years STANDARD_DEVIATION 10 | 62.6 years STANDARD_DEVIATION 8.1 | 62.3 years STANDARD_DEVIATION 9.8 | 63.4 years STANDARD_DEVIATION 9.3 |
| Region of Enrollment Georgia | 31 participants | 20 participants | 22 participants | 73 participants |
| Region of Enrollment Russian Federation | 0 participants | 14 participants | 7 participants | 21 participants |
| Sex: Female, Male Female | 8 Participants | 5 Participants | 6 Participants | 19 Participants |
| Sex: Female, Male Male | 23 Participants | 29 Participants | 23 Participants | 75 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — | — / — |
| other Total, other adverse events | 2 / 31 | 7 / 34 | 3 / 29 | 12 / 94 |
| serious Total, serious adverse events | 0 / 31 | 1 / 34 | 0 / 29 | 1 / 94 |
Outcome results
Primary
Participants Stopping Exercise Treadmill Test 3 (ETT-3) for Angina at Stage Earlier Than Baseline Exercise Treadmill Test (ETT-B)
The Modified Naughton Exercise Treadmill Test was employed in this study. Exercise Treadmill Test 3 (ETT-3) was performed during the last 2 hours of the 20-hour infusion of study drug or placebo. Baseline Exercise Treadmill Test (ETT-B) was performed prior to dosing.
Time frame: 1 day
Population: The Safety ETT Population consists of all patients in the Randomized Population who received any study drug and who performed ETT-3.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Mid Dose Active Drug | Participants Stopping Exercise Treadmill Test 3 (ETT-3) for Angina at Stage Earlier Than Baseline Exercise Treadmill Test (ETT-B) | 0 Participants |
| High Dose Active Drug | Participants Stopping Exercise Treadmill Test 3 (ETT-3) for Angina at Stage Earlier Than Baseline Exercise Treadmill Test (ETT-B) | 0 Participants |
| All Placebo | Participants Stopping Exercise Treadmill Test 3 (ETT-3) for Angina at Stage Earlier Than Baseline Exercise Treadmill Test (ETT-B) | 1 Participants |
Secondary
Increase in Exercise Duration During ETT-3 vs. ETT-B
Time frame: 1 day
Population: The Safety ETT Population consists of all patients in the Randomized Population who received any study drug and who performed ETT-3.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Mid Dose Active Drug | Increase in Exercise Duration During ETT-3 vs. ETT-B | 41.5 seconds | Standard Deviation 113.1 |
| High Dose Active Drug | Increase in Exercise Duration During ETT-3 vs. ETT-B | 40.5 seconds | Standard Deviation 70.6 |
| All Placebo | Increase in Exercise Duration During ETT-3 vs. ETT-B | 60.1 seconds | Standard Deviation 71.2 |
Secondary
Participants Stopping ETT-3 for Angina at Any Stage
This Outcome Measure includes all participants who stopped ETT-3 for angina at any stage, not only those who stopped at a stage earlier than ETT-B. Note: All 9 subjects who stopped ETT-3 for angina also stopped ETT-B for angina.
Time frame: 1 day
Population: The Safety ETT Population consists of all patients in the Randomized Population who received any study drug and who performed ETT-3.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Mid Dose Active Drug | Participants Stopping ETT-3 for Angina at Any Stage | 0 Participants |
| High Dose Active Drug | Participants Stopping ETT-3 for Angina at Any Stage | 7 Participants |
| All Placebo | Participants Stopping ETT-3 for Angina at Any Stage | 2 Participants |
Secondary
Participants Stopping ETT-3 for Any Reason at Stage Earlier Than ETT-B
The Modified Naughton Exercise Treadmill Test was employed in this study. Exercise Treadmill Test 3 (ETT-3) was performed during the last 2 hours of the 20-hour infusion of study drug or placebo. Baseline Exercise Treadmill Test (ETT-B) was performed prior to dosing.
Time frame: 1 day
Population: The Safety ETT Population consists of all patients in the Randomized Population who received any study drug and who performed ETT-3.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Mid Dose Active Drug | Participants Stopping ETT-3 for Any Reason at Stage Earlier Than ETT-B | 4 Participants |
| High Dose Active Drug | Participants Stopping ETT-3 for Any Reason at Stage Earlier Than ETT-B | 2 Participants |
| All Placebo | Participants Stopping ETT-3 for Any Reason at Stage Earlier Than ETT-B | 1 Participants |
Secondary
Participants With 1 mm ST Segment Depression During ETT-3
ST Segment Depression measured by Electrocardiography while performing ETT-3.
Time frame: 1 day
Population: The Safety ETT Population consists of all patients in the Randomized Population who received any study drug and who performed ETT-3. However, majority of patients did not have ECGs assessable (per protocol) for 1 mm ST depression.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Mid Dose Active Drug | Participants With 1 mm ST Segment Depression During ETT-3 | 0 Participants |
| High Dose Active Drug | Participants With 1 mm ST Segment Depression During ETT-3 | 1 Participants |
| All Placebo | Participants With 1 mm ST Segment Depression During ETT-3 | 2 Participants |