Anakinra Versus Placebo for the Treatment of Acute MyocarditIS

Phase 2

Completed

• Conditions: Acute Myocarditis
• Interventions: Drug: ANAKINRA 100 mg/daily subcutaneously; Drug: Placebo

• Registration Number: NCT03018834
• Lead Sponsor: Assistance Publique - Hôpitaux de Paris

Brief Summary

There is no specific treatment of acute myocarditis, especially during the inflammatory period. Interleukin (IL) is specifically involved during this period and play a role in myocardial oedema. ANAKINRA, an IL-1β Blocker, is a new treatment that has never been evaluated in myocarditis. The benefit for the patient could be important with a reduction of heart failure and ventricular arrhythmias.

Hypothesis : ANAKINRA in addition to standard therapy for treatment of Acute Myocarditis is superior to standard therapy based on an association of beta-blockers and Angiotensin-Converting-Enzyme inhibitor (ACE).

Detailed Description

It is a Double Blind Randomized clinical trial Phase IIb of superiority, enrolling two groups: one group treated with the standard of care, defined as the maximum tolerated dosage of any beta blockers and ACE, and placebo versus ANAKINRA in addition to the standard of care in patients treated for an acute Myocarditis.

Patients will be randomized to receive ANAKINRA 100 mg/daily or placebo subcutaneously once a day until hospital discharge, for a maximum of 14 days, in addition to standard care: ACE and Beta-blocker for 6 months. Randomization 1:1 will be conducted centrally using the electronic Case Report Form (eCRF).

As an exploratory analysis, a second randomization for ACE discontinuation in patients without left ventricular dysfunction (LVEF \> 50%) at one month post discharge will be performed.

One group will stopped the treatment at one month and the second group will continued the ACE for 6 months. This second randomization is in open label.

Study Timeline

• Study First Submitted: 2016-12-12
• Study First Submitted QC: 2017-01-10
• Study First Posted: 2017-01-12
• Study Start: 2017-05-30
• Primary Completion: 2021-06-28
• Study Completion: 2022-05-30
• Status Verified: 2024-03
• Last Update Submitted: 2024-03-05
• Last Update Posted: 2024-03-06

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 120

Inclusion Criteria

• Patients hospitalized for Acute myocarditis defined as:
• Chest Pain (or modification of the ECG) AND Troponin Rise (*1.5 Normal range) AND Myocarditis proven by MRI in the first 72h after admission
• Age > 18 and <65 years old
• Accepting effective contraception during treatment duration (men and women childbearing potential)
• Signed informed consent Normal Coronary angiography or coronary CT Scan (made during the previous year is acceptable) (normal is defined as stenosis < 50%) (In the case of patients under 40 with typical MRI of myocarditis, coronary angiography is not mandatory and left to the doctor's discretion)

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Exclusion Criteria

• Active coronary disease
• Clinical Suspicion or proven underlying disease: systemic lupus, antiphospholipid antibodies, Lyme disease, trypanosomiase disease, myositis, signs of sarcoidosis, giant cell myocarditis, treated chronic inflammatory disease, tuberculosis, HIV, hepatitis B virus (HBV) or hepatitis C virus (HCV), Hepatitis B virus (HBV) infection,
• Latex allergy
• Pregnancy, breastfeeding
• Contra-indication to ANAKINRA (known hypersensitivity to the active substance or to any of the excipients, neutropenia < 1,5.10^9/L)
• Renal failure, Creatine Clearance (CrCl) < 30 ml/min (MDRD)
• Malignancy or any comorbidity limiting survival or conditions predicting inability to complete the study
• History of malignancy
• Non Steroidian Anti Inflammatory drug within the past 14 days
• Anti Tumor Necrosis Factor (TNF) within the past 14 days
• No affiliation to the French Health Care System "sécurité sociale"
• Hepatic impairment = Child-Pugh Class C
• Mechanical ventilation
• Circulatory assistance

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
A: ANAKINRA	ANAKINRA 100 mg/daily subcutaneously	ANAKINRA 100 mg/daily subcutaneously once a day until hospital discharge, for a maximum of 14 days, in addition to standard care: ACE and Beta-blocker for 6 months.
B: Placebo	Placebo	PLACEBO 100 mg/daily subcutaneously once a day until hospital discharge, for a maximum of 14 days, in addition to standard care: ACE and Beta-blocker for 6 months.

Primary Outcome Measures

Name	Time	Method
Number of days alive free of any myocarditis complications	within 28 days post hospitalization	Number of days alive free of any myocarditis complications defined as ventricular arrhythmias, heart failure, chest pain, ventricular dysfunction defined as LVEF\<50%, within 28 days post hospitalization

Secondary Outcome Measures

Name	Time	Method
Heart Failure	at 12 months	Heart Failure
Total cost	on average 14 days	Total cost
Total Quality Adjusted Life Year (QALYs),	on average 14 days	measure of the perceived utility by patients of a medication (Anakinra) that corresponds to a year of life gained
Ventricular tachycardia	during the 12 months follow-up	Ventricular tachycardia
NT-proBNP above 450 pg/mL (in patients aged below 50); above 900 pg/mL (age 50-75 years) or BNP ≤ 400pg/mL 50% decrease of the troponin level at discharge compared to admission	an average of 14 days	NT-proBNP above 450 pg/mL (in patients aged below 50); above 900 pg/mL (age 50-75 years) or BNP ≤ 400pg/mL
Left Ventricul Ejection Fraction (LVEF) assessed by Trans Thoracic Echocardiograhy (TTE)	at 6 month	Left Ventricul Ejection Fraction (LVEF) assessed by Trans Thoracic Echocardiograhy (TTE)
LVEF assessed by cardiac MRI	at 1 year	LVEF assessed by cardiac MRI
Incremental cost effectiveness	on average 14 days	cost-effectiveness of ANAKINRA in the setting of acute myocarditis
Left Ventricul Ejection Fraction (LVEF) assessed by cardiac Magnetic Resonance Imaging (MRI)	at 6 month	Left Ventricul Ejection Fraction (LVEF) assessed by cardiac Magnetic Resonance Imaging (MRI)
All cause of death rate	during the 12 months follow-up	All cause of death rate
Cardiovascular death	at 12 months	Cardiovascular death
Cost utility ratios	on average 14 days	Cost utility ratios
LVEF assessed by cardiac TTE	at 1 year	LVEF assessed by cardiac TTE

Trial Locations

Locations (2)

ACTION Study Group - Department of Cardiology - Pitié Salpétrière Hospital, 47 Bd de l'Hopital; 🇫🇷 Paris, France

Department of internal medicine - Pitié Salpétrière Hospital, 47 Bd de l'Hopital; 🇫🇷 Paris, France