COLpEF: Colchicine in HFpEF
Study Details
Study Description
Brief Summary
Heart failure is a growing epidemic that affects up to 500,000 individuals in Canada, with 50,000 new cases being diagnosed each year. Half of these will have HF with preserved ejection fraction (HFpEF).
HFpEF has been associated with high rates of morbidity, mortality, and health care expenditures. Its pathophysiology remains poorly understood, and positive medication trial results to date have been rare.
Inflammation is strongly associated with a profibrotic activation in HFpEF, which is in turn associated with the severity and prognosis of the disease.
Colchicine is a potent anti-inflammatory drug which properties relate to the suppression of tubulin polymerization and inflammasome inhibition, thus reducing the production of IL-1β and IL-18.
The investigators thus propose a pilot study of 6 months follow-up duration that will test the efficacy and safety of 2 dosing regimens of colchicine (vs. placebo) in patients with HFpEF.
Condition or Disease | Intervention/Treatment | Phase |
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Phase 2 |
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
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Active Comparator: Colchicine 0.5 mg die Colchicine 0.5 mg die |
Drug: Colchicine
Patients meeting all inclusion criteria and no exclusion criteria will be randomly assigned to receive either colchicine (0.5mg once daily), colchicine (0.5mg twice daily) or matched placebo (1:1:1 allocation ratio), in addition to standard of care.
|
Active Comparator: Colchicine 0.5 mg bid Colchicine 0.5 mg bid |
Drug: Colchicine
Patients meeting all inclusion criteria and no exclusion criteria will be randomly assigned to receive either colchicine (0.5mg once daily), colchicine (0.5mg twice daily) or matched placebo (1:1:1 allocation ratio), in addition to standard of care.
|
Placebo Comparator: Placebo Placebo |
Drug: Placebo
Patients meeting all inclusion criteria and no exclusion criteria will be randomly assigned to receive either colchicine (0.5mg once daily), colchicine (0.5mg twice daily) or matched placebo (1:1:1 allocation ratio), in addition to standard of care.
|
Outcome Measures
Primary Outcome Measures
- Change in hs-CRP (C reactive protein) [Change from baseline to 6 months in hs-CRP]
The primary endpoint will be the change from baseline to 6 months in hs-CRP (mg/L), a circulating biomarker of inflammation.
Secondary Outcome Measures
- Change in circulating biomarkers of hemodynamic stress [Change from baseline to 6 months in other biomarkers]
Change in circulating biomarkers of hemodynamic stress (N-terminal pro-brain natriuretic peptide (NT-proBNP, in pg/mL))
- Change in circulating biomarkers of myocardial injury [Change from baseline to 6 months in other biomarkers]
Change in circulating biomarkers of myocardial injury (hs-TnT, Troponin, in ng/L)
- Change in left ventricular (LV) diastolic function [Change from baseline to 6 months in LV diastolic function]
Change in a combination of echocardiography-based measures assessing left ventricular (LV) diastolic function
- Change in functional status and symptoms [Change from baseline to 6 months in functional status and symptoms]
Change in functional status and New York Heart Association (NYHA) class
Other Outcome Measures
- Safety endpoints [Monitoring of adverse events will throughout the study, from baseline to 6 months in exploratory endpoints]
Monitoring of adverse events will include gastrointestinal manifestations, hepatotoxicity, myelotoxicity, myotoxicity, and risk of infections.
Eligibility Criteria
Criteria
Inclusion Criteria:
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Patients ≥ 40 and < 80 years of age;
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Chronic symptomatic HFpEF defined as follows: left ventricular ejection fraction (LVEF) > or = 45% by echocardiography within 6 months prior to screening visit;
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Stable clinically and therapeutically for at least 1 month before enrolment; *NYHA functional class II to IV;
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Evidence of structural heart disease defined by at least 1 of the following echocardiography findings: LV hypertrophy (i.e. septal or posterior wall thickness ≥1.1 cm) or left atrial enlargement (i.e., width ≥3.8 cm, length ≥5.0 cm, area ≥20 cm2, volume ≥55 ml, or volume index ≥29 ml/m2);
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an NT-proBNP of ≥600 pg/ml if in sinus rhythm, and ≥1800 pg/ml if in atrial fibrillation;
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and at least one of the following criteria defining chronic enhanced inflammatory milieu:
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Obesity, defined as body mass index (BMI) > 30kg/m2,
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Diabetes mellitus,
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Evidence of pathological systemic inflammation including: high hs-CRP levels (hs-CRP>5mg/L), or the combination of high neutrophil count and low lymphocyte count (Neutrophil to Lymphocyte Ratio >3).
Exclusion Criteria:
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Patients > 80 years of age;
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Any prior echocardiographic measurement of LVEF <45%;
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Presence of clinical, biological or echocardiography signs of cardiac amyloidosis;
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Presence of hemodynamically significant valvular heart disease in the opinion of the investigator;
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Presence of active infection within the 3 months prior to enrolment;
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Acute decompensated HF, acute coronary syndrome (including myocardial infarction), cardiac surgery, other major cardiovascular surgery, or urgent percutaneous coronary intervention (PCI) within the 3 months prior to baseline visit or an elective PCI within 30 days prior to baseline visit;
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Current acute decompensated HF requiring augmented therapy with diuretic agents, vasodilator agents, and/or inotropic drugs;
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Changes in diuretics and / or renin-angiotensin-aldosterone system (RAAS) inhibitors regimen within 30 days prior to visit;
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History of hypersensitivity to colchicine;
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Life-threatening or uncontrolled dysrhythmia, including symptomatic or sustained ventricular tachycardia and atrial fibrillation or atrial flutter with a resting ventricular rate >120 beats per minute;
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Any surgical or medical condition that 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;
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Evidence of hepatic disease as determined by any 1 of the following: serum glutamate oxaloacetate transaminase (SGOT) or serum glutamate pyruvate transaminase (SGPT) values exceeding 3× the upper limit of normal, bilirubin>1.5 mg/dL (>25.65 μmol/L) at baseline visit; or patient with a history of cirrhosis, chronic active hepatitis or severe hepatic disease;
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Patients with estimated glomerular filtration rate (eGFR) <30 ml/min/1.73 m2 as calculated by the Modification in Diet in Renal Disease (MDRD) formula at baseline visit;
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History or presence of any other disease with a life expectancy of <1 year;
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Women of child-bearing potential;
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Patient with inflammatory bowel disease (Crohn's disease or ulcerative colitis) or patient with chronic diarrhea;
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Patient with pre-existent progressive neuromuscular disease;
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Patient currently taking colchicine for other indications (mainly chronic indications represented by Familial Mediterranean Fever or gout);
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Patients currently under long-term anti-inflammatory medication for a chronic condition (steroids, NSAIDS);
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Patient considered by the investigator, for any reason, to be an unsuitable candidate for the study.
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
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1 | Montreal Heart Institute | Montréal | Quebec | Canada | H1T 1C8 |
Sponsors and Collaborators
- Montreal Heart Institute
Investigators
- Principal Investigator: Nadia Bouabdallaoui, MD, Montreal Heart Institute
Study Documents (Full-Text)
None provided.More Information
Publications
- Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, Chiuve SE, Cushman M, Delling FN, Deo R, de Ferranti SD, Ferguson JF, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Lutsey PL, Mackey JS, Matchar DB, Matsushita K, Mussolino ME, Nasir K, O'Flaherty M, Palaniappan LP, Pandey A, Pandey DK, Reeves MJ, Ritchey MD, Rodriguez CJ, Roth GA, Rosamond WD, Sampson UKA, Satou GM, Shah SH, Spartano NL, Tirschwell DL, Tsao CW, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association. Circulation. 2018 Mar 20;137(12):e67-e492. doi: 10.1161/CIR.0000000000000558. Epub 2018 Jan 31. Review. Erratum in: Circulation. 2018 Mar 20;137(12 ):e493.
- Bhatia RS, Tu JV, Lee DS, Austin PC, Fang J, Haouzi A, Gong Y, Liu PP. Outcome of heart failure with preserved ejection fraction in a population-based study. N Engl J Med. 2006 Jul 20;355(3):260-9.
- Leung YY, Yao Hui LL, Kraus VB. Colchicine--Update on mechanisms of action and therapeutic uses. Semin Arthritis Rheum. 2015 Dec;45(3):341-50. doi: 10.1016/j.semarthrit.2015.06.013. Epub 2015 Jun 26. Review.
- Murphy SP, Kakkar R, McCarthy CP, Januzzi JL Jr. Inflammation in Heart Failure: JACC State-of-the-Art Review. J Am Coll Cardiol. 2020 Mar 24;75(11):1324-1340. doi: 10.1016/j.jacc.2020.01.014. Review.
- Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, Redfield MM. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med. 2006 Jul 20;355(3):251-9.
- Paulus WJ, Tschöpe C. A novel paradigm for heart failure with preserved ejection fraction: comorbidities drive myocardial dysfunction and remodeling through coronary microvascular endothelial inflammation. J Am Coll Cardiol. 2013 Jul 23;62(4):263-71. doi: 10.1016/j.jacc.2013.02.092. Epub 2013 May 15. Review.
- Tromp J, Westenbrink BD, Ouwerkerk W, van Veldhuisen DJ, Samani NJ, Ponikowski P, Metra M, Anker SD, Cleland JG, Dickstein K, Filippatos G, van der Harst P, Lang CC, Ng LL, Zannad F, Zwinderman AH, Hillege HL, van der Meer P, Voors AA. Identifying Pathophysiological Mechanisms in Heart Failure With Reduced Versus Preserved Ejection Fraction. J Am Coll Cardiol. 2018 Sep 4;72(10):1081-1090. doi: 10.1016/j.jacc.2018.06.050.
- Zile MR, Jhund PS, Baicu CF, Claggett BL, Pieske B, Voors AA, Prescott MF, Shi V, Lefkowitz M, McMurray JJ, Solomon SD; Prospective Comparison of ARNI With ARB on Management of Heart Failure With Preserved Ejection Fraction (PARAMOUNT) Investigators. Plasma Biomarkers Reflecting Profibrotic Processes in Heart Failure With a Preserved Ejection Fraction: Data From the Prospective Comparison of ARNI With ARB on Management of Heart Failure With Preserved Ejection Fraction Study. Circ Heart Fail. 2016 Jan;9(1). pii: e002551. doi: 10.1161/CIRCHEARTFAILURE.115.002551.
- MP-33-2021-2929