Comparison of ATI-5923, a Novel Vitamin K Antagonist, With Warfarin in Patients Requiring Chronic Anticoagulation

Phase 2

• Conditions: Atrial Fibrillation; Atrial Flutter; Venous Thromboembolic Disease; Myocardial Infarction; Cardiomyopathy
• Interventions: Drug: ATI-5923; Drug: Coumadin (warfarin)

• Registration Number: NCT00691470
• Lead Sponsor: ARYx Therapeutics

Brief Summary

The purpose of this research study is to test an experimental drug ATI-5923 vs Coumadin. The study is intended to demonstrate ATI-5923 is superior to Coumadin for keeping INR values in the desired therapeutic range. Patients who require chronic anticoagulation with one or more of the following conditions are eligible for the study: atrial fibrillation or atrial flutter, prosthetic heart valve, venous thromboembolic disease, or history of myocardial infarction or cardiomyopathy will be enrolled.

Detailed Description

The primary study objective is to evaluate whether ATI-5923 is superior to adjusted dose warfarin in the quality of anticoagulation as measured by interpolated INR time in therapeutic range. This is a Phase II/III multi-center, randomized, stratified, double blind, parallel group, active control study comparing ATI-5923 with Coumadin in patients who require chronic, oral anticoagulation. Up to 600 patients who successfully complete all screening assessments and meet all eligibility criteria will be enrolled in the study and receive study drug treatment for 6-12 months depending on time of study entry.

Study Timeline

• Study Start: 2008-05
• Study First Submitted: 2008-06-03
• Study First Submitted QC: 2008-06-04
• Study First Posted: 2008-06-05
• Status Verified: 2008-10
• Primary Completion: 2009-06
• Study Completion: 2009-06
• Last Update Submitted: 2010-02-01
• Last Update Posted: 2010-02-02

Recruitment & Eligibility

• Status: UNKNOWN
• Sex: All
• Target Recruitment: 600

Inclusion Criteria

1. Patients with one or more of the following indications for chronic warfarin anticoagulation (the patient may either be a new candidate for anticoagulation or may already be receiving warfarin):

   1. Atrial fibrillation (paroxysmal, persistent or permanent, not due to a reversible cause, documented by ECG) or atrial flutter.
   2. A prosthetic heart valve in the aortic or mitral position that requires chronic anticoagulation.
   3. A history of venous thromboembolic disease (DVT and/or PE) requiring long term anticoagulation (> 6 months).
   4. A history of myocardial infarction or cardiomyopathy requiring anticoagulation.
   5. Currently receiving chronic warfarin therapy for another indication not listed, with Sponsor approval.

2. Male or female greater than 18 years of age.

3. Able and willing to sign IRB approved written informed consent to participate in the study.

4. Able and willing to follow instructions, to comply with protocol requirements, and to attend required study visits.

Exclusion Criteria

1. Contraindications to anticoagulation as listed in the warfarin package insert (Appendix D), such as active bleeding or lesions at risk of bleeding such as gastric ulceration, colonic or cerebral AV malformations, cerebral or aortic aneurysms, pericarditis or endocarditis. Patients who have had recent (< 14 days from screening) surgery or invasive procedures or are about to undergo surgery or other invasive procedures, such as lumbar puncture. Patients with blood dyscrasias or inherited disorders of hemostasis. Patients with a history of hemorrhagic tendencies or prior serious hemorrhagic events such as hemorrhage within the cranium, eye, spinal cord, retroperitoneum, or gastrointestinal tract.
2. Laboratory evidence at screening of clinically significant active bleeding, such as unexplained positive occult blood in stool, or unexplained positive urinary blood that is more than trace positive for hemoglobin.
3. Concomitant use of other anticoagulant or antiplatelet agents that may add to the hemostatic burden such as clopidogrel, ticlopidine, heparin or low molecular weight heparin (LMWH), or regular use of non selective long acting NSAIDs that cannot be discontinued prior to initiating ATI 5923/warfarin dosing (daily use of 81-100 mg aspirin is allowed).
4. A life expectancy of < 1 year, end stage renal failure requiring dialysis, end stage pulmonary disease requiring home oxygen, severe heart failure (NYHA class IV).
5. Dementia, severe psychiatric disorder, or ongoing alcohol or substance abuse.
6. Laboratory screening values indicating severe anemia (Hb < 10 gm/L), thrombocytopenia (platelet count < 90,000/mcL), or active liver disease.
7. Patients with conditions that will interfere with determination of the INR using the INRatio device, i.e., hematocrit <30% or >55%. Patients with the antiphospholipid syndrome may have abnormal INR results and should not be enrolled.
8. History of non disabling ischemic stroke within the last 3 months, prior major disabling ischemic stroke, or any history of intracranial bleeding.
9. Pregnant or nursing women or women of childbearing potential who will not use adequate contraception, such as oral or implantable contraceptives, IUD, or barrier methods (IUD or condom) with spermicide.
10. Currently participating in another clinical trial at screening, treatment with an investigational drug within 30 days of the first dose of study medication, or patients who previously participated in an ATI-5923 trial.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
1. ATI-5923	ATI-5923	Dose adjusted ATI-5923
2. Coumadin	Coumadin (warfarin)	Dose adjusted Coumadin (warfarin)

Primary Outcome Measures

Name	Time	Method
Percent of time INR is in therapeutic range after the exclusion of the first 4 weeks of treatment, using the linear interpolation method of Rosendaal(Rosendaal, 1993).	After the first month through end of study.

Secondary Outcome Measures

Name	Time	Method
The proportion of all study recorded INR values that are within the target range, after the exclusion of the INR values from the first 4 weeks of treatment	After the first month through end of study
Proportion of time patients have significant deviations from therapeutic INR range.	After the first month through end of study
A composite of the following clinically important outcome events	After the first month through end of study

Trial Locations

Locations (40)

Cardiovascular Research Institute, LLC; 🇺🇸 Canton, Ohio, United States

Heart and Vascular Clinic; 🇺🇸 Lacombe, Louisiana, United States

Androscoggin Cardiology Associates; 🇺🇸 Auburn, Maine, United States

Cardiology Associates of Fairfield County, PC; 🇺🇸 Trumbull, Connecticut, United States

Internal Medicine of Greer; 🇺🇸 Greer, South Carolina, United States

Stamford Therapeutics Consortium; 🇺🇸 Stamford, Connecticut, United States

Steljes Cardiology, PC; 🇺🇸 Henderson, Nevada, United States

The Heart Center, PC; 🇺🇸 Huntsville, Alabama, United States

Nature Coast Clinical Research; 🇺🇸 Inverness, Florida, United States

Northeast Georgia Heart Center, PC; 🇺🇸 Gainesville, Georgia, United States

Birmingham Heart Clinic, PC; 🇺🇸 Birmingham, Alabama, United States

Cardiology PC; 🇺🇸 Birmingham, Alabama, United States

Mobile Heart Specialists, PC; 🇺🇸 Mobile, Alabama, United States

Escondido Cardiology Associates; 🇺🇸 Escondido, California, United States

University of California San Diego Medical Center; 🇺🇸 San Diego, California, United States

Progressive Clinical Research; 🇺🇸 Vista, California, United States

New West Physicians Clinical Research; 🇺🇸 Golden, Colorado, United States

Jacksonville Heart Center; 🇺🇸 Jacksonville Beach, Florida, United States

Florida Research Network, LLC; 🇺🇸 Gainesville, Florida, United States

Jacksonville Heart Center - Pavillon; 🇺🇸 Jacksonville, Florida, United States

The Heart and Vascular Institute of Florida; 🇺🇸 Safety Harbor, Florida, United States

Orlando Heart Center; 🇺🇸 Orlando, Florida, United States

Jacksonville Center for Clinical Research; 🇺🇸 Jacksonville, Florida, United States

Jacksonville Heart Center - South; 🇺🇸 Jacksonville, Florida, United States

Georgia Heart Specialists; 🇺🇸 Covington, Georgia, United States

Fox Valley Clinical Research Center, LLC; 🇺🇸 Aurora, Illinois, United States

Illinois Heart and Lung Research Center; 🇺🇸 Normal, Illinois, United States

DuPage Medical Group; 🇺🇸 Winfield, Illinois, United States

Community Clinical Research Center; 🇺🇸 Anderson, Indiana, United States

McFarland Clinic PC; 🇺🇸 Ames, Iowa, United States

Endeavor Medical Research, PLC; 🇺🇸 Alpena, Michigan, United States

Bend Memorial Clinic; 🇺🇸 Bend, Oregon, United States

Lankenau Institute for Medical Research; 🇺🇸 Wynnewood, Pennsylvania, United States

Plaza Medical Group, PC; 🇺🇸 Oklahoma City, Oklahoma, United States

York Clinical Research; 🇺🇸 Norfolk, Virginia, United States

Cardiovascular Research Institute of Dallas; 🇺🇸 Dallas, Texas, United States

Daniel Gottlieb, MD; 🇺🇸 Burien, Washington, United States

Southwest Heart; 🇺🇸 Tucson, Arizona, United States

St. Luke's Cardiology Associates; 🇺🇸 Jacksonville, Florida, United States

Medical Associates Clinic, LLP; 🇺🇸 Pierre, South Dakota, United States