NIH Clinical Research Studies

Protocol Number: 07-H-0055

Active Accrual, Protocols Recruiting New Patients

Title:
Effects of Interleukin-1 Inhibition on C-Reactive Protein Levels, Endothelial Progenitor Cell Mobilization and Endothelial Function in Patients with Coronary Artery Disease
Number:
07-H-0055
Summary:
This study will determine whether an experimental drug called Rilonacept can improve artery function in patients with atherosclerosis, a disease in which fatty deposits in arteries cause the vessels to stiffen, impeding blood flow. Atherosclerosis is believed to be caused in part by inflammation. Rilonacept blocks production of a protein called CRP, which, in high levels in the blood is associated with increased inflammation. Patients with coronary artery disease who have elevated blood levels of CRP are at increased risk of heart attack, heart failure and sudden death compared with people who have lower levels of the protein.

Patients 18 years of age and older with atherosclerotic coronary artery disease with a CRP level between 2 and 10 mg/L may be eligible for this study.

Patients are randomly assigned to receive four doses of either Rilonacept or placebo, given at 2-week intervals as injections under the skin. In addition to treatment, patients undergo the following procedures during eight visits to the NIH Clinical Center:

-Visit 1 (screening visit): Medical history, measurement of vital signs (temperature, blood pressure, heart rate and breathing rate), electrocardiogram (EKG) and blood tests.

-Visit 2: Blood tests, chest X-ray, treadmill exercise testing, tuberculin skin test, brachial artery flow-mediated dilation. Brachial artery flow-mediated dilation is used to measure how well the brachial artery (artery inside the elbow) dilates. An ultrasound device placed just above the elbow measures the size of the brachial artery and the flow of blood through it before and after a pressure cuff is inflated around the forearm.

-Visit 3: Injection of study drug.

-Visits 4, 5, and 6: Review of any changes in health or medical treatment, measurement of vital signs, blood tests, EKG, injection of study drug.

-Visit 7: Review of any changes in health or medical treatment, measurement of vital signs, blood tests, EKG, treadmill exercise testing, brachial artery flow-mediated dilation.

-Visit 8: Review of any changes in health or medical treatment, measurement of vital signs, blood tests, EKG, treadmill exercise testing, brachial artery flow-mediated dilation.

Sponsoring Institute:
National Heart, Lung and Blood Institute (NHLBI)
Recruitment Detail
Type: Participants currently recruited/enrolled
Gender: Male & Female
Referral Letter Required: No
Population Exclusion(s): Children

Eligibility Criteria:
INCLUSION CRITERIA:

-Male and non-pregnant, non-lactating female subjects, over 18 years of age at Screening Visit 1.

-Diagnosis of atherosclerotic CAD by coronary angiography

-High sensitivity C-reactive protein (hsCRP) between 2.0 and 10.0 g/L, inclusive, at Screening Visits 1 and 2, with percent change in CRP from Visit 1 to Visit 2 of less than 50% to +100%.

-Taking a HMG-CoA reductase inhibitor (and, if applicable, other agents to treat dyslipidemia) at a stable dose(s) for at least 60 days prior to Screening Visit 1 and agreeing to continue on that dose(s) at least until Week 12 (Visit 8) of the study.

-If taking aspirin (and/or other anti-platelet anti-thrombotic medication, if applicable), use at a stable dose for at least 30 days prior to Screening Visit 1 and agreeing to continue on that dose at least until Week 12 of the study.

-For men and women of childbearing potential, willingness to utilize adequate contraception and not become pregnant (or have their partner[s] become pregnant) during the full course of the study. [A woman will not be considered of childbearing potential, if she is post-menopausal for greater than 2 years or surgically sterile (bilateral tubal ligation, bilateral oophorectomy or hysterectomy). The following methods of birth control are adequate contraception and must be used throughout the study and for 2 months after the last dose of study medication: condom or diaphragm plus either contraceptive sponge, foam or jelly; IUD; contraceptives (oral, transdermal patch or parenteral) for 2 or more cycles prior to screening; vasectomy].

-Willing, at time of study enrollment, to return for all clinic visits specified in the protocol and complete all study-related procedures.

EXCLUSION CRITERIA:

-BMI (body mass index) greater than 49.9 kg/m2 at Screening Visit 1 (BMI is to be calculated to the nearest tenth BMI unit).

-Vascular intervention within 60 days prior to Screening Visit 1.

-Infection (or history of recurrent infections), use of systemic antibiotics, or clinically significant trauma (including surgery) within 30 days prior to Screening Visit 1.

-History or evidence of acute coronary syndrome (including new q-wave or new bundle branch block) or other significant acute vascular event within 60 days prior to Screening Visit 1.

-Acute or chronic inflammatory condition other than atherosclerosis (including, but not limited to, rheumatoid arthritis, systemic lupus erythematosis, polymyalgia rheumatica, autoimmune vasculitis, or myositis).

-Recently diagnosed diabetes mellitus (within 30 days prior to Screening Visit 1); or fasting glucose greater than 125 mg/dL and HbA1c greater than 6.5% at Screening Visit 1 in a subject without prior history of diabetes mellitus; or HbA1c greater than 7.0% at Screening Visit 1 in a subject without prior history of diabetes mellitus; or HbA1c greater than 8.5% at Screening Visit 1 in a subject with a prior history of diabetes mellitus.

-History of dyslipidemia with LDL-cholesterol greater than 250 mg/dL, or fasting triglycerides greater than 400 mg/dL during screening.

-Clinical evidence of congestive heart failure NYHA Class III-IV within 30 days prior to Screening Visit 1.

-History of hypersensitivity other than localized injection site reaction to any biologic agent.

-Use of a thiazolidinedione within 60 days prior to Screening Visit 1.

-Use of immunosuppressive or immunomodulatory medication (including, but not limited to glucocorticoids, methotrexate, leflunomide, mycophenolate, sulfasalazine, hydroxychloroquine, copaxone, cyclosporine, tacrolimus, sirolimus, azathioprine, cyclophosphamide, thalidomide) within 60 days prior to Screening Visit 1 (use of an inhaled glucocorticoid is permitted).

-Prior use of an immunomodulatory biologic drug within the last 6 months (including, but not limited to interferons, interleukins or interleukin antagonist, tumor necrosis factor antagonist, colony-stimulating factors, antibody-based drugs and immune globulins) except immunizations and biologics used as standard care in cardiac care settings.

-Received a live/live attenuated vaccine (smallpox vaccinia, measles, mumps, rubella, measles mumps-rubella [MMR] combination, oral polio [Sabin], intranasal influenza, yellow fever, chickenpox [varicella], oral typhoid) within 90 days prior to Screening Visit 1 or other immunization within 30 days prior to Screening Visit 1.

-Prior or planned organ transplant recipient.

-Severe respiratory disease, including, but not limited to, severe bronchiectasis, chronic obstructive pulmonary disease, bullous lung disease, uncontrolled asthma, or pulmonary fibrosis.

-A history of tuberculosis infection, history of a positive skin test for tuberculosis, or a chest radiograph at Screening Visit 1 consistent with prior tuberculosis infection, including, but not limited to apical scarring, apical fibrosis, or multiple calcified apical granulomata.

-Positive result (5 mm or more in duration at 48 to 72 hours post-placement) of the PPD 5 TU placed at Screening Visit 2 (all subjects, including those having received a BCG vaccination, will have a PPD 5 TU placed at Screening Visit 2).

-History or presence of malignancy (except for successfully treated basal cell carcinoma of the skin or in situ carcinoma of the cervix) within the past 5 years.

-HIV positive.

-Hepatitis B surface antigen or Hepatitis C antibody positive at Screening Visit 1.

-ALT, AST or alkaline phosphatase greater than twice the upper limit of the normal range, serum creatinine or total bilirubin greater than 1.5 times the upper limit of normal at Screening Visit 1.

-Hemoglobin less than 11.0 gm/dL, white blood cell (WBC) count less than 3,000/mm3, neutrophil count less than 2000/mm3 or platelet count less than 100,000/mm3 at Screening Visit 1.

-Participation in any clinical research study evaluating another investigational drug or therapy within 30 days prior to Screening Visit 1.

-History of substance abuse (drug or alcohol) or any other factor (e.g. serious psychiatric condition) that limits the subject's ability to comply with the study procedure.

-Elective surgery or vascular intervention planned to occur during the study.

-Any medical condition which, in the opinion of the Investigator, would interfere with participation in the study, interfere with interpretation of study outcome measures, or place the subject at risk.

Special Instructions:
Currently Not Provided
Keywords:
Endothelium
Inflammation
Nitric Oxide
Rilonacept
Cytokines
Recruitment Keyword(s):
Coronary Artery Disease
CAD
Atherosclerosis
Condition(s):
Coronary Artery Disease
Atherosclerosis
Inflammation
Endothelial Dysfunction
Investigational Drug(s):
Rilonacept
Investigational Device(s):
None
Intervention(s):
Drug: Rilonacept
Procedure/Surgery: Treadmill Exercise Test
Supporting Site:
National Heart, Lung and Blood Institute

Contact(s):
Patient Recruitment and Public Liaison Office
Building 61
10 Cloister Court
Bethesda, Maryland 20892-4754
Toll Free: 1-800-411-1222
TTY: 301-594-9774 (local),1-866-411-1010 (toll free)
Fax: 301-480-9793

Electronic Mail:prpl@mail.cc.nih.gov

Citation(s):
Dinarello CA. Biologic basis for interleukin-1 in disease. Blood. 1996 Mar 15;87(6):2095-147. Review.

Colotta F, Re F, Muzio M, Bertini R, Polentarutti N, Sironi M, Giri JG, Dower SK, Sims JE, Mantovani A. Interleukin-1 type II receptor: a decoy target for IL-1 that is regulated by IL-4. Science. 1993 Jul 23;261(5120):472-5.

Dinarello CA. Interleukin 1 and interleukin 18 as mediators of inflammation and the aging process. Am J Clin Nutr. 2006 Feb;83(2):447S-455S. Review.

Active Accrual, Protocols Recruiting New Patients

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