The Alirocumab for Stopping Atherosclerosis Progression in Saphenous Vein Grafts (ASAP-SVG) Pilot Trial

Phase 4

Terminated

• Conditions: Saphenous Vein Graft Atherosclerosis
• Interventions: Drug: Matching Placebo subcutaneous injection; Drug: Alirocumab 150 MG/ML subcutaneous injection

• Registration Number: NCT03542110
• Lead Sponsor: Minneapolis Heart Institute Foundation

Brief Summary

This is a phase IV, multi-center, double-blind, randomized, placebo- controlled study evaluating the effect of alirocumab on SVG atherosclerotic disease burden, as assessed by IVUS at baseline and following 78 weeks of treatment in subjects with at least one intermediate SVG lesion receiving optimal statin therapy. Subjects will be randomized 1:1 into 2 treatment groups: alirocumab 150 mg subcutaneously every 2 weeks or placebo subcutaneously every 2 weeks.

Detailed Description

Not available

Study Timeline

• Study First Submitted: 2018-05-18
• Study First Submitted QC: 2018-05-18
• Study First Posted: 2018-05-31
• Study Start: 2018-08-04
• Primary Completion: 2020-06-30
• Study Completion: 2020-07-31
• Status Verified: 2021-09
• Last Update Submitted: 2021-09-15
• Last Update Posted: 2021-09-16

Recruitment & Eligibility

• Status: TERMINATED
• Sex: All
• Target Recruitment: 46

Inclusion Criteria

1. Age 18 years or greater.
2. Willing and able to give informed consent. The patients must be able to comply with study procedures and follow-up.
3. Undergoing clinically-indicated coronary and SVG angiography.
4. Have at least one target saphenous vein graft with an intermediate SVG lesion (defined as a lesion with 30-60% angiographic diameter stenosis) amenable to examination with IVUS. The SVG should have no thrombus or ulceration and should not be considered responsible for the patient's clinical presentation and referral for angiography.
5. Receiving optimal statin therapy defined as use of a high intensity statin (atorvastatin 40-80 mg daily or rosuvastatin 20-40 mg daily), any statin therapy with achieved LDL-C level <70mg/dL, or maximally-tolerated statin dose for patients who are statin intolerant statin.

Exclusion Criteria

1. Positive pregnancy test or breast-feeding.
2. Coexisting conditions that limit life expectancy to less than 18 months or that could affect a patient's compliance with the protocol.
3. Estimated glomerular filtration rate (eGFR) <30 ml/min/1.73m2.
4. Severe peripheral arterial disease limiting vascular access.
5. History of allergic reaction to iodine-based contrast agents that cannot be premedicated.
6. Known hypersensitivity to alirocumab.
7. Any prior use of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor therapy.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Matching Placebo subcutaneous injection	Matching Placebo subcutaneous injection	Matching placebo subcutaneously every 2 weeks
Alirocumab 150 MG/ML subcutaneous injection	Alirocumab 150 MG/ML subcutaneous injection	Alirocumab 150 mg subcutaneously every 2 weeks

Primary Outcome Measures

Name	Time	Method
Nominal change in intermediate SVG lesion percent atheroma volume (PAV) from baseline to 78 weeks post randomization, as assessed by intravascular ultrasonography (IVUS).	78 weeks	To evaluate the effect of alirocumab on the change in burden of saphenous vein graft (SVG) atherosclerosis as measured by percent atheroma volume (PAV) in patients with intermediate SVG lesions who are undergoing clinically-indicated coronary angiography and are receiving optimal statin therapy.

Secondary Outcome Measures

Name	Time	Method
Angiographic failure of target SVG lesion from baseline to 78 weeks.	78 weeks	To evaluate the effect of alirocumab on the incidence of angiographic failure of an intermediate target SVG lesion.
Nominal change in TAV and normalized TAV of an intermediate SVG lesion from baseline to 78 weeks	78 weeks	evaluate the effect of alirocumab on the change in total and normalized total atheroma volume (TAV) of an intermediate SVG lesion
Incidence of target SVG failure and major adverse cardiac events.	Randomization to 80 weeks	To evaluate the effect of alirocumab on the incidence of target SVG failure (defined as the composite of death, myocardial infarction, and target lesion revascularization) and the incidence of major adverse cardiac events (MACE, defined as the composite of death, acute coronary syndrome, or coronary revascularization) during follow-up.

Trial Locations

Locations (4)

San Francisco VA Medical Center; 🇺🇸 San Francisco, California, United States

Atlanta VA Medical Center; 🇺🇸 Atlanta, Georgia, United States

Minneapolis Heart Institute/ Abbott North Western Hospital-Allina Health; 🇺🇸 Minneapolis, Minnesota, United States

Dallas VA Medical Center; 🇺🇸 Dallas, Texas, United States