V-PLAQUE: Coronary Computed Tomography Study to Assess the Effect of Inclisiran in Addition to Maximally Tolerated Statin Therapy on Atherosclerotic Plaque Progression in Participants With a Diagnosis of Non-obstructive Coronary Artery Disease Without Previous Cardiovascular Events

Sponsor

Novartis Pharmaceuticals (Industry)

Overall Status

Recruiting

CT.gov ID

NCT05360446

Collaborator

(none)

600

Enrollment

Locations

Arms

36.3

Anticipated Duration (Months)

Patients Per Site

1.7

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

CKJX839D12303 is a research study to determine if the study treatment, called inclisiran, in comparison to placebo taken in addition to statin medication can effectively reduce the total amount of plaque formed in the heart's vessels as measured by coronary computed tomography angiography (CCTA) from baseline to month 24. This study is being conducted in eligible participants with a diagnosis of non-obstructive coronary artery disease (NOCAD), where the coronary arteries are blocked less than 50%, and with no previous cardiovascular events.

Condition or Disease	Intervention/Treatment	Phase
Coronary Artery Disease	Drug: Inclisiran sodium 300 mg Drug: Placebo	Phase 3

Detailed Description

The purpose of this study is to evaluate the efficacy of inclisiran compared to placebo on top of maximally tolerated statin therapy in reducing total coronary atheroma volume assessed by coronary computed tomography angiography from baseline to month 24 in participants with a diagnosis of NOCAD without previous cardiovascular events, a CT-adapted Leaman score >5 and a FFRct >0.8. Participants will either receive inclisiran 300 mg subcutaneously administered on Day 1, Month 3 (Day 90), and every 6 months up until Month 21. The study duration is 24 months. Participants will have a CCTA performed at baseline and at the month 24/end of study visit.

Study Design

Study Type:

Interventional

Anticipated Enrollment :

600 participants

Allocation:

Randomized

Intervention Model:

Parallel Assignment

Intervention Model Description:

Multi-center, randomized, double-blind, placebo-controlled, parallel-groupMulti-center, randomized, double-blind, placebo-controlled, parallel-group

Masking:

Triple (Participant, Care Provider, Investigator)

Masking Description:

Sponsor personnel participating in the study conducted will be blinded also.

Primary Purpose:

Treatment

Official Title:

A Multi-center, Randomized, Double-blind, Placebo-controlled, Parallel-group Phase IIIb Study Evaluating the Effect of Inclisiran on Atherosclerotic Plaque Progression Assessed by Coronary Computed Tomography Angiography (CCTA) in Participants With a Diagnosis of Non-obstructive Coronary Artery Disease Without Previous Cardiovascular Events (VICTORION-PLAQUE)

Actual Study Start Date :

Jul 8, 2022

Anticipated Primary Completion Date :

Jul 18, 2025

Anticipated Study Completion Date :

Jul 18, 2025

Arms and Interventions

Arm	Intervention/Treatment
Placebo Comparator: Placebo Subcutaneous injection	Drug: Placebo Subcutaneously administered on Day 1, Month 3 (Day 90), and every 6 months thereafter.
Experimental: Inclisiran sodium Subcutaneous injection	Drug: Inclisiran sodium 300 mg Subcutaneously administered on Days 1, Month 3 (Day 90), and every 6 months thereafter.

Arm

Intervention/Treatment

Placebo Comparator: Placebo

Subcutaneous injection

Drug: Placebo

Subcutaneously administered on Day 1, Month 3 (Day 90), and every 6 months thereafter.

Experimental: Inclisiran sodium

Subcutaneous injection

Drug: Inclisiran sodium 300 mg

Subcutaneously administered on Days 1, Month 3 (Day 90), and every 6 months thereafter.

Outcome Measures

Primary Outcome Measures

Percentage change in total coronary atheroma volume [From baseline to month 24]
Evaluating inclisiran compared to placebo both on top of maximally tolerated statin therapy in reducing total coronary atheroma volume assessed by coronary computed tomography angiography (CCTA) in participants with a diagnosis of non-obstructive coronary artery disease (NOCAD) without previous cardiovascular events.

Secondary Outcome Measures

Percentage change in LDL-C [From baseline to month 24]
Full fasting lipid panel will be collected throughout the study beginning at baseline.
Percentage change in low attenuation plaque volume evaluated by CCTA [From baseline to month 24]
Evaluating inclisiran compared to placebo in percentage change in low attenuation plaque volume evaluated by CCTA.
Percentage of participants with progression, regression, or no change of total plaque atheroma volume [From baseline to month 24]
Evaluating inclisiran compared to placebo in percentage of participants experiencing progression, regression, or no change of total atheroma volume.

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years to 80 Years

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

Male or female ≥18 years or ≤80 years of age at signing of informed consent.
Fasting LDL-C local lab value at the Screening Visit of either i) ≥100 mg/dL if on statin therapy but not on a maximally tolerated statin therapy; ii) ≥150 mg/dL if statin naive and without documented statin intolerance; or iii) ≥70 mg/dL if on a stable (≥4 weeks) dose of maximally tolerated statin therapy or if statin intolerant.
Participants may be pre-identified based on a CCTA or an invasive angiography that is performed as part of standard of care within 12 months prior to the participant's

Screening Visit demonstrating:

Presence of coronary artery plaque with visual diameter stenosis <50% or
Coronary artery plaque with visual artery stenosis >50% but Fractional Flow Reserve (FFR) >0.8 by special wire measurement (CCTA or coronary angiography)
Fasting LDL-C local lab value ≥70 mg/dL at the assessment performed during the Statin Optimization Period 3 Visit for participants going through the Statin Optimization Period.
Participants having Non-Obstructive Coronary Artery (NOCA)* confirmed by CCTA with FFRct >0.8 and CT-adapted Leaman score >5** or coronary artery plaque with visual diameter stenosis >50% but with FFRct >0.8 and CT-adapted Leaman score >5 without previous cardiovascular events.

*=NOCA is defined as the presence of coronary artery plaque with visual diameter stenosis <50%.

**=CT-adapted Leaman score, which includes information on lesion localization, plaque composition, degree of stenosis by CCTA is demonstrated to be an independent long-term predictor of hard cardiac events.

A standard of care CCTA may serve as the study baseline CCTA scan if it is performed within 3 months prior to the participant's Screening Visit and meets the inclusion criteria of FFRct >0.8 and CT-adapted Leaman score >5, which will be assessed by the Imaging Core Lab.
At the Baseline Visit, participants must be on a stable (≥4 weeks) dose of maximally tolerated statin therapy. Participants not on maximally tolerated statin therapy and who do not have documented statin intolerance can be screened but must enter the study via a Statin Optimization Period.

Exclusion Criteria:

Previous cardiovascular events history including myocardial infarction (MI), or prior coronary revascularization [percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG)].
Planned revascularization (PCI) or (CABG).
Previous cerebrovascular events including:
Prior ischemic stroke thought not to be caused by atrial fibrillation, valvular heart disease or mural thrombus.
History of prior percutaneous or surgical carotid artery revascularization.
History of Peripheral Artery Disease (PAD):
Prior documentation of a resting ankle-brachial index <0.85.
History of prior percutaneous or surgical revascularization of an iliac, femoral, or popliteal artery.
Prior non-traumatic amputation of a lower extremity due to peripheral artery disease.
Cardiac disorders, including any of the following:
Clinically significant cardiac arrhythmias (e.g., ventricular tachycardia, atrial fibrillation) within 3 months prior to randomization that is not controlled by medication or via ablation at the time of the Screening Visit.
Complete left bundle branch block, high-grade atrioventricular (AV) block (e.g., bifascicular block, Mobitz type II and third-degree AV block) prior to randomization.
NOCA participant who was prescreened by the Investigator with visual diameter stenosis

50% but FFR <0.8.

Contraindication for CCTA (e.g., allergic reactions to the contrast dye) or CCTA not meeting entry standards after two attempts during the Baseline CCTA Visit as assessed by the Imaging Core Lab.
Pacemaker or implantable cardioverter-defibrillator (ICD) in situ.
Systolic Left Ventricle Ejection Fraction <30% at the Screening Visit.
Uncontrolled severe hypertension: systolic blood pressure >180 mmHg or diastolic blood pressure >110 mmHg prior to randomization (assessed at the Screening Visit) despite antihypertensive therapy.
Heart failure New York Heart Association (NYHA) class III or class IV at the Screening Visit.
Renal insufficiency (eGFR <30 mL/min/1.73m2) as measured by the Modification of Diet in Renal Disease (MDRD) formula at the Screening Visit and at the Statin Optimization 3 Visit.
Active liver disease defined as any known current infectious, neoplastic, or metabolic pathology of the liver at the Screening Visit. Participants who enter the Statin Optimization Period must have AST and ALT ≤3x ULN (as defined by local laboratory reference ranges collected at the Screening Visit) and reported by the Statin Optimization Telephone Visit 1 to be allowed to continue in the Statin Optimization Period.

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Novartis Investigative Site	Beverly Hills	California	United States	90210
2	Novartis Investigative Site	Canton	Ohio	United States	44710
3	Novartis Investigative Site	Auchenflower	Queensland	Australia	4066
4	Novartis Investigative Site	Leabrook	South Australia	Australia	5068
5	Novartis Investigative Site	Murdoch	Western Australia	Australia	6150
6	Novartis Investigative Site	Genk		Belgium	3600
7	Novartis Investigative Site	Hasselt		Belgium	3500
8	Novartis Investigative Site	Turnhout		Belgium	2300
9	Novartis Investigative Site	Rozzano	MI	Italy	20089
10	Novartis Investigative Site	Madrid		Spain	28040