A Randomised, Double-blind, Placebo-controlled, Phase 2 Study of the Efficacy and Safety of Pirfenidone in Patients With Heart Failure and Preserved Left Ventricular Ejection Fraction (PIROUETTE)
试验速览
- 阶段
- 2 期
- 状态
- 已完成
- 入组人数
- 129
- 试验地点
- 1
- 主要终点
- Extracellular volume fraction (ECV)
研究概览
简要总结
This randomised, double-blind, placebo-controlled, phase 2 study aims to evaluate the efficacy and safety of the anti-fibrotic drug pirfenidone in the treatment of patients with heart failure and preserved left ventricular ejection fraction (HFpEF). Participants will be randomised to receive either pirfenidone or placebo, for a period of 12 months.
详细描述
Myocardial fibrosis is a key pathological mechanism in HFpEF. Pirfenidone is an anti-fibrotic medication licensed for the treatment of idiopathic lung fibrosis, for which it reduces lung function decline, improves progression free survival and reduces all cause mortality. In pre-clinical models, pirfenidone attenuates profibrotic pathways and is associated with regression of myocardial fibrosis. Previous studies in HFpEF populations using anti-fibrotic medications, such as angiotensin-converting enzyme (ACE) inhibitors, angiotensin-II receptor blockers and aldosterone antagonists have shown some benefit in reaching secondary end-points but do not reduce mortality. HFpEF is the final result of a number of specific underlying pathological mechanisms, and targeted treatment of these mechanisms has been cited as the future approach to further clinical trials. The investigators aim to select a population of HFpEF patients with high levels of interstitial myocardial fibrosis as measured on cardiac MRI (CMR), and randomise participants to receive pirfenidone or placebo. The primary outcome is to detect a significant reduction in myocardial fibrosis as measured on CMR after 12 months of intervention.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
入排标准
- 年龄范围
- 40 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Written informed consent.
- •Male or female; aged 40 years or older.
- •HF, defined as one symptom present at the time of screening, and one sign present at the time of screening or in the previous 12 months. Symptoms and signs are defined as:
- •Symptoms: dyspnoea on exertion, orthopnoea or paroxysmal nocturnal dyspnoea Signs: peripheral oedema, crackles on chest auscultation post-cough, raised jugular venous pressure or chest x-ray demonstrating pleural effusion, pulmonary congestion, or cardiomegaly
- •Left Ventricular Ejection Fraction (LVEF) > 45% at Visit 0, (any local LVEF measurement made using echocardiography or CMR).
- •BNP ≥ 100 pg/ml or NTproBNP ≥ 300 pg/ml recorded at Visit
- •For patients in atrial fibrillation on Visit 0 ECG, BNP > 300pg/ml or NTproBNP > 900 pg/ml at Visit
- •Myocardial fibrosis, defined as Extracellular Matrix (ECM) volume > 27% by CMR at Visit 0.
排除标准
- •Myocardial infarction, coronary artery bypass graft surgery or percutaneous coronary intervention within the previous 6 months.
- •Probable alternative cause of patient's HF symptoms that in the opinion of the investigator primarily accounts for patient's dyspnoea such as significant pulmonary disease, anaemia or obesity. Specifically, patients with the below are excluded:
- •Severe chronic obstructive pulmonary disease (COPD) (i.e., requiring home oxygen, chronic nebuliser therapy, or chronic oral steroid therapy), or
- •Haemoglobin < 9 g/dl, or
- •Body mass index (BMI) > 55 kg/m
- •Known pericardial constriction, genetic hypertrophic cardiomyopathy, or infiltrative cardiomyopathy.
- •Clinically significant congenital heart disease.
- •Presence of severe valvular heart disease.
- •Atrial fibrillation or flutter with a resting ventricular rate > 100 bpm.
- •Any medical condition, which in the opinion of the Investigator, may place the patient at higher risk from his/her participation in the study, or is likely to prevent the patient from complying with the requirements of the study or completing the study.
- •Severe renal dysfunction at Visit 0, defined as estimated Glomerular Filtration Rate (eGFR) <30 mL/min (using Chronic Kidney Disease Epidemiology Collaboration Equation (CKD-EPI) calculation), or end-stage renal disease requiring dialysis.
- •History of severe hepatic impairment or liver dysfunction at Visit 0, defined as total bilirubin above the upper limit of normal (ULN) (excluding patients with Gilbert's syndrome), aspartate aminotransferase (AST) or alanine transaminase (ALT) >3 times the ULN or alkaline phosphatase >2.5 times the ULN.
- •Prolonged corrected QT interval, defined as a corrected QT interval >500 msec on ECG using Bazett formula.
- •Known hypersensitivity to any of the components of the investigational medicinal product (IMP).
- •Use of other investigational drugs at the time of enrolment, or within 30 days or 5 half-lives of enrolment, whichever is longer.
- •Fluvoxamine use within 28 days of Visit
- •Contraindication to MRI scanning or gadolinium-based contrast agent
- •Pregnancy, lactation or planning pregnancy. Women of childbearing capacity are required to have a negative serum pregnancy test before treatment, must agree to pregnancy tests at study visits as defined in the Section 7.2.5 and must agree to maintain highly effective contraception during the study and for 3 months thereafter. Similarly male participants with female partners of childbearing potential must agree to maintain highly effective contraception during the study and for 3 months thereafter.
研究组 & 干预措施
Pirfenidone
Pirfenidone 801mg capsule by mouth, three times a day (target dose) for 12 months
干预措施: Pirfenidone (Drug)
Placebo
Placebo capsule by mouth, three times a day (target dose) for 12 months
干预措施: Placebo (Drug)
结局指标
主要结局
Extracellular volume fraction (ECV)
时间窗: 12 months
Absolute change in myocardial ECV, measured using CMR, from baseline to week 52
次要结局
- Left ventricular strain - Echo(12 months)
- Left atrial volume(12 months)
- Myocardial energetic status(12 months)
- Left ventricular volume(12 months)
- Left ventricular strain - CMR(12 months)
- Diastolic function(12 months)
- Myocardial cell structure(12 months)
- Patient morbidity(12 months)
- Cardiovascular mortality(12 months)
- Left ventricular (LV) mass(12 months)
- Left ventricular ejection fraction(12 months)
- Left ventricular torsion(12 months)
- Cardiac biomarkers - high-sensitivity Troponin T (hsTnT)(12 months)
- All cause mortality(12 months)
- Hospitalisation for heart failure(12 months)
- Cardiac biomarkers - N-Terminal-Pro-Brain Natriuretic Peptide (NT-Pro BNP)(12 months)
- Patient exercise capacity(12 months)