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Interleukin-1 Blockade In Recently Decompensated Heart Failure - 2 (REDHART2)

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ClinicalTrials.gov Identifier: NCT03797001
Recruitment Status : Recruiting
First Posted : January 8, 2019
Last Update Posted : January 5, 2024
Sponsor:
Information provided by (Responsible Party):
Virginia Commonwealth University

Brief Summary:
REDHART2 is a randomized, double-blinded, placebo-controlled trial to determine the effects of Anakinra on peak aerobic exercise capacity measured with a cardiopulmonary test after 24 weeks in patients with recently decompensated systolic heart failure and increased systemic inflammation.

Condition or disease Intervention/treatment Phase
Heart Failure, Systolic Inflammation Drug: Anakinra Drug: Placebo Phase 2

Detailed Description:
The REDHART2 (REcently Decompensated Heart failure Anakinra Response 2 Trial) study is a phase II clinical trial of anakinra or placebo to determine improvement in aerobic exercise capacity (by measuring maximal oxygen uptake (VO2)) in patients with recently decompensated systolic heart failure (HF). The recently completed pilot REDHART study showed anakinra treatment for 12 weeks led to a significant improvement in peak aerobic exercise capacity, whereas anakinra treatment for 2 weeks did not, and no significant changes were seen in placebo. The REDHART2 study is designed to expand and confirm the beneficial effect of sustained anakinra treatment (24 weeks) on peak VO2, and to explore the potential effect size on hospital readmissions for HF. The rationale of Interleukin-1 (IL-1) blockade with anakinra in heart failure stems from the evidence of a) reduced adverse cardiac remodeling and heart failure in animal models of acute myocardial infarction (AMI); b) reduced incidence of heart failure in patients with ST-segment elevation AMI; c) enhanced IL-1 activity in patients with heart failure, d) quenching of the acute inflammatory response in patients with acute decompensated heart failure, e) direct cardiodepressant effects of IL-1 in animal models, f) improved exercise capacity in pilot studies including patients with stable systolic heart failure, stable diastolic heart failure, and, recently decompensated systolic heart failure in the pilot REDHART study. Patients will be randomized 2:1 to active treatment, such that patients will be twice as likely to receive anakinra versus placebo.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 102 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: The Effects of Interleukin-1 Blockade On Exercise Capacity In Patients With Recently Decompensated Systolic Heart Failure
Actual Study Start Date : January 4, 2019
Estimated Primary Completion Date : June 30, 2024
Estimated Study Completion Date : June 30, 2024

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Heart Failure
Drug Information available for: Anakinra

Arm Intervention/treatment
Experimental: anakinra
Anakinra subcutaneous injection, 100 mg daily for 24 weeks
Drug: Anakinra
100 mg subcutaneous injection, daily for 24 weeks

Placebo Comparator: placebo
Placebo subcutaneous injection, daily for 24 weeks
Drug: Placebo
subcutaneous injection, daily for 24 weeks




Primary Outcome Measures :
  1. changes in peak oxygen consumption (VO2) [ Time Frame: baseline - 24 weeks ]
    changes in peak oxygen consumption (VO2) after 24 weeks of treatment


Secondary Outcome Measures :
  1. changes in peak VO2 at earlier endpoints [ Time Frame: baseline - 6 weeks and baseline - 12 weeks ]
    changes in peak VO2 at earlier endpoints (6 and 12 weeks)

  2. echocardiography assessments [ Time Frame: baseline - 24 weeks ]
    evaluation of heart function by standard echocardiography assessments at 24 weeks

  3. hemodynamic assessments [ Time Frame: baseline - 24 weeks ]
    estimates of arterial elastance at 6, 12 and 24 weeks

  4. Quality of Life Assessments [ Time Frame: baseline - 24 weeks ]
    Duke Activity Status Index will be administered at 6, 12 and 24 weeks to provide patient perception of changes. Responses are yes or no, with yes responses corresponding to better clinical condition.

  5. Biomarker - high sensitivity C-reactive protein (CRP) [ Time Frame: baseline - 24 weeks ]
    The change in blood levels of CRP will be measured from baseline to 24 weeks.

  6. Biomarker - N-terminal pro b-type Natriuretic Peptide (NT-proBNP) [ Time Frame: baseline - 24 weeks ]
    The change in blood levels of NT-proBNP will be measured from baseline to 24 weeks.

  7. Clinical Outcome - cardiac death [ Time Frame: baseline - 24 weeks ]
    Instances of cardiac death during the study will be recorded

  8. Clinical Outcome - hospitalization for heart failure [ Time Frame: baseline - 24 weeks ]
    Instances of hospitalization for heart failure during the study will be recorded



Information from the National Library of Medicine

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Ages Eligible for Study:   21 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

All 6 criteria need to be met for enrollment of the patient in the study

  1. Primary diagnosis for hospitalization is decompensated heart failure established as the finding at admission of both conditions listed below:

    • dyspnea or respiratory distress or tachypnea at rest or with minimal exertion;
    • evidence of elevated cardiac filling pressure or pulmonary congestion (at least one of the conditions must be met):
    • pulmonary congestion/edema at physical exam OR chest XRay;
    • plasma BNP levels ≥200 pg/mL;
    • invasive measurement of left ventricular end-diastolic pressure >18 mmHg or of pulmonary artery occluding pressure (wedge) >16 mmHg.
  2. The patient has a prior documentation of impaired left ventricular systolic function (ejection fraction ≤40%) at most recent assessment by any imaging modality (within 12 months).
  3. The patient is now clinically stable, euvolemic, and meets standard criteria for hospital discharge as documented by all the 3 conditions listed below:

    • absence of dyspnea or pulmonary congestion/distress at rest;
    • absence of pitting edema in the lower extremities, or in any other region;
    • stable hemodynamic parameters (blood pressure, heart rate).
  4. The patient is of age ≥21 years old, and is willing and able to provide written informed consent.
  5. The patient is willing and able to comply with the protocol (i.e., self-administration, or exercise test).
  6. The patient has screening high sensitivity plasma C-reactive protein levels (hsCRP) >2 mg/L.

Exclusion Criteria:

Subjects will not be eligible if they meet any of the following 15 exclusion criteria.

  1. The primary diagnosis for admission is NOT decompensated heart failure, including diagnosis of acute coronary syndromes, hypertensive urgency/emergency, tachy- or brady-arrhythmias.
  2. Concomitant clinically significant comorbidities that would interfere with the execution or interpretation of the study including but not limited to acute coronary syndromes, uncontrolled hypertension or orthostatic hypotension, tachy- or brady-arrhythmias, acute or chronic pulmonary disease or neuromuscular disorders affecting respiration.
  3. Recent (previous 3 months) or planned resynchronization therapy (CRT), or valve surgeries.
  4. Previous or planned implantation of left ventricular assist devices or heart transplant.
  5. Chronic use of intravenous inotropes.
  6. Recent (<14 days) use of immunosuppressive or anti-inflammatory drugs (including oral corticosteroids at a dose of prednisone equivalent of 0.5 mg/kg/day but not including inhaled or low dose oral corticosteroids or non-steroidal anti-inflammatory drugs).
  7. Chronic inflammatory disorder (including but not limited to rheumatoid arthritis, systemic lupus erythematosus).
  8. Active infection (of any type), including chronic/recurrent infectious disease (i.e. HBV, HCV, and HIV/AIDS) - but excluding HCV+ with undetectable plasma RNA.
  9. Active malignancy - excluding carcinoma in situ [any location] or localized non-melanoma skin cancer.
  10. Any comorbidity limiting survival or ability to complete the study.
  11. Stage V kidney disease or on renal-replacement therapy.
  12. Neutropenia (<1,500/mm3 or <1,000/mm3 in African-American patients).
  13. Pregnancy.
  14. Angina, hypertension, arrhythmias, electrocardiograph (ECG) changes, or other non-cardiac limitations (i.e., peak respiratory exchange ratio VCO2/VO2 [RER]<1.0, reflecting sub-maximal test) that limit maximum exertion during CPX obtained during the baseline testing.
  15. Hypersensitivity to Kineret or to E. coli derived products. 16) Evidence of COVID19 within the last 60 days or recent (21 days) exposure to close personal contact.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03797001


Contacts
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Contact: Benjamin Van Tassell, PharmD 804-828-4583 bvantassell@vcu.edu

Locations
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United States, Virginia
Virginia Commonwealth University Recruiting
Richmond, Virginia, United States, 23298
Contact: Benjamin Van Tassell, PharmD    804-828-4583    bvantassell@vcu.edu   
Sponsors and Collaborators
Virginia Commonwealth University
Investigators
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Principal Investigator: Benjamin Van Tassell, PharmD Virginia Commonwealth University
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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Responsible Party: Virginia Commonwealth University
ClinicalTrials.gov Identifier: NCT03797001    
Other Study ID Numbers: REDHART2 HM20014686
First Posted: January 8, 2019    Key Record Dates
Last Update Posted: January 5, 2024
Last Verified: January 2024

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: Yes
Keywords provided by Virginia Commonwealth University:
heart failure
inflammation
anakinra
exercise capacity
Additional relevant MeSH terms:
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Heart Failure
Heart Failure, Systolic
Inflammation
Systolic Murmurs
Heart Diseases
Cardiovascular Diseases
Pathologic Processes
Heart Murmurs
Interleukin 1 Receptor Antagonist Protein
Antirheumatic Agents