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Myocardial InjuryPhase 4EARLY-MYO-CTDNCT04197050

Effect of Sacubitril/Valsartan on Reduced Right Ventricular Ejection Fraction in Patients With CTD

A Phase 4 study testing Sacubitril / Valsartan Oral Tablet in people with Myocardial Injury and Connective Tissue Diseases, run by RenJi Hospital at 1 site in China.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

Heart failure, one of the leading causes of connective tissue disease (CTD) mortality, has attracted increasing attention. Currently, no known study had focused on the effect of sacubitril/valsartan on right ventricular dysfunction and in the systemic disease induced heart disease. Read more about this study

Who is it for?
Ages 18 to 75 years
Conditions the study is for
Myocardial Injury, Connective Tissue Diseases
What is being tested?
Sacubitril / Valsartan Oral Tablet
Type of treatment
Pill or oral medicine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
60 participants
Where
1 siteChina
Study dates
20 Feb 2020to Nov 2022
Phase
Phase 4
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 75 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age between 18-75 years old.
  • confirmed CTD(including systemic lupus erythematosus, myositis, polymyositis, systemic sclerosis, sarcoid, Sjögren's syndrome or mixed connective tissue disease)
  • SLEDAI ≤ 6 in patients with SLE or ESR ≤ 30 in patients with SSc
  • already have OPT for CTD at least 3 month
  • RVEF ≤ 45%
  • Providing written informed consent

Who cannot join

  • Documented coronary artery disease or prior angiography for coronary artery disease (>50% stenosis).
  • Patients with known congenital heart disease or other systemic diseases that might induce RVrEF.
  • Patients with standard metallic contraindications to CMR or an estimated glomerular filtration rate < 30 ml/min/1.73 m2.

Trial locations and contacts

1 site in 1 country.

China1 site
  • Renji Hospital

    Shanghai, Shanghai Municipality, 200127

Other trials in China

About this study

Official title: Effect of Sacubitril/Valsartan on Right Ventricular Dysfunctioning Patients With Connective Tissue Disease

Heart failure, one of the leading causes of connective tissue disease (CTD) mortality, has attracted increasing attention. Currently, no known study had focused on the effect of sacubitril/valsartan on right ventricular dysfunction and in the systemic disease induced heart disease. We aimed to observe the effect of sacubitril/valsartan on primary endpoints (6 minutes walking test and myocardial fibrosis) in CTD patients with right ventricular ejection fraction reduction (RV-HFrEF).

Read the detailed description

Patients with CTD frequently exhibit multi-organ pathophysiological and functional damage. Heart failure, one of the leading causes of CTD mortality, has attracted increasing attention. Mostly, patients with CTD present with nonspecific cardiac symptoms, normal ECG, and preserved left ventricular ejection fraction (LVEF) and therefore do not receive an early cardiac diagnosis and treatment. Pulmonary arterial hypertension (PAH), right ventricular (RV) dilatation and hypertrophy might become the first and the most frequent cardiac findings. Sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitors, is a "superstar" which inhibits both neprilysin and renin-angiotensin aldosterone system that closely related to the heart failure mechanism. It has been strongly recommended as class I drug in treating the patient with chronic HFrEF from 2017 ACC/AHA/HFSA heart failure guideline for the ability of dramatically reduce the cardiovascular mortality rate.

Cardiovascular magnetic resonance (CMR) is able to depict myocardial characteristics from structure to tissue properties using cine and late gadolinium enhancement (LGE) sequences. Newly developed imaging studies to date include T1 mapping and T1-derived extracellular volume estimation. All the previous studies in CTD have been restricted to patients with advanced cardiac involvement.

Together with clinical assessment and multi-imaging tests, the aim of the present study is going to observe the effect of sacubitril/valsartan on primary endpoints (6 minutes walking test and myocardial fibrosis) in CTD patients with RV-HFrEF.

Being tested
Sacubitril / Valsartan Oral Tablet
Keywords
Connective Tissue Diseases, sacubitril/valsartan, Cardiovascular Magnetic Resonance, Extracellular Volume, exercise tolerance
Medical subject headings
Connective Tissue Diseases

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Sacubitril / Valsartan Oral TabletDrug

    Also called CMR examination

    After recruiting participants and collecting the baseline information, sacubitril/valsartan group will receive sacubitril/valsartan and optimal pharmaceutical treatment (OPT). The control group will receive valsartan and OPT. A CMR scan and a post-processed imaging procedure will later be carried on in order to detect the cardiac impairment.

Study groups in NCT04197050
Study groupRoleWhat they receive
sacubitril/valsartan groupExperimentalThe diagnosis of CTD was made based on the clinical classification criteria. The patient was diagnosed by an echocardiography demonstration, when RVEF is suggested lower or equal to 45%, the patient will be considered a candidate after consent is signed. sacubitril/valsartan will be given.
Receives: Drug: Sacubitril / Valsartan Oral Tablet
control groupNo interventionThe diagnosis of CTD was made based on the clinical classification criteria. The patient was diagnosed by an echocardiography demonstration, when RVEF is suggested lower or equal to 45%, the patient will be considered a candidate after consent is signed. Valsartan will be given.

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Exercise tolerance

    6 minutes walking test

    Measured: change between 1 and 6 months after treatment

  2. Fibrosis Assessment

    LGE assessment

    Measured: change between 1 and 6 months after treatment

  3. Fibrosis Assessment

    ECV quantification

    Measured: change between 1 and 6 months after treatment

Secondary outcomes (2)
  1. CTD activity

    antinuclear antibody

    Measured: change between 1 and 6 months after treatment

  2. Cardiovascular Mortality Rate

    all cause of death

    Measured: change between 1 and 6 months after treatment

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted12 Dec 2019
  2. Study start20 Feb 2020 (estimated)
  3. Primary completionNov 2022 (estimated)
  4. Study completionNov 2022 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Double blind
Who is masked
Participant, Investigator
Enrolment
60 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04197050
Sponsor's protocol ID
2019-11-01R
Acronym
EARLY-MYO-CTD
Status last verified
Nov 2019
First submitted
27 Nov 2019
Last updated
7 Jan 2020
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Braun J, Kruger K, Manger B, Schneider M, Specker C, Trappe HJ. Cardiovascular Comorbidity in Inflammatory Rheumatological Conditions. Dtsch Arztebl Int. 2017 Mar 24;114(12):197-203. doi: 10.3238/arztebl.2017.0197.

    PubMed 28407841
  • Leal GN, Silva KF, Franca CM, Lianza AC, Andrade JL, Campos LM, Bonfa E, Silva CA. Subclinical right ventricle systolic dysfunction in childhood-onset systemic lupus erythematosus: insights from two-dimensional speckle-tracking echocardiography. Lupus. 2015 May;24(6):613-20. doi: 10.1177/0961203314563135. Epub 2014 Dec 8.

    PubMed 25492941
  • Hassoun PM. The right ventricle in scleroderma (2013 Grover Conference Series). Pulm Circ. 2015 Mar;5(1):3-14. doi: 10.1086/679607.

    PubMed 25992267
  • Wigley FM, Lima JA, Mayes M, McLain D, Chapin JL, Ward-Able C. The prevalence of undiagnosed pulmonary arterial hypertension in subjects with connective tissue disease at the secondary health care level of community-based rheumatologists (the UNCOVER study). Arthritis Rheum. 2005 Jul;52(7):2125-32. doi: 10.1002/art.21131.

    PubMed 15986394
  • Argula RG, Karwa A, Lauer A, Gregg D, Silver RM, Feghali-Bostwick C, Schanpp LM, Egbert K, Usher BW, Ramakrishnan V, Hassoun PM, Strange C. Differences in Right Ventricular Functional Changes during Treatment between Systemic Sclerosis-associated Pulmonary Arterial Hypertension and Idiopathic Pulmonary Arterial Hypertension. Ann Am Thorac Soc. 2017 May;14(5):682-689. doi: 10.1513/AnnalsATS.201608-655OC.

    PubMed 28282243
  • Rich S, Pogoriler J, Husain AN, Toth PT, Gomberg-Maitland M, Archer SL. Long-term effects of epoprostenol on the pulmonary vasculature in idiopathic pulmonary arterial hypertension. Chest. 2010 Nov;138(5):1234-9. doi: 10.1378/chest.09-2815.

    PubMed 21051399
  • van de Veerdonk MC, Kind T, Marcus JT, Mauritz GJ, Heymans MW, Bogaard HJ, Boonstra A, Marques KM, Westerhof N, Vonk-Noordegraaf A. Progressive right ventricular dysfunction in patients with pulmonary arterial hypertension responding to therapy. J Am Coll Cardiol. 2011 Dec 6;58(24):2511-9. doi: 10.1016/j.jacc.2011.06.068.

    PubMed 22133851
  • Guo Q, Wu LM, Wang Z, Shen JY, Su X, Wang CQ, Gong XR, Yan QR, He Q, Zhang W, Xu JR, Jiang M, Pu J. Early Detection of Silent Myocardial Impairment in Drug-Naive Patients With New-Onset Systemic Lupus Erythematosus: A Three-Center Prospective Study. Arthritis Rheumatol. 2018 Dec;70(12):2014-2024. doi: 10.1002/art.40671.

    PubMed 30070061
  • Owens AT, Brozena S, Jessup M. Neprilysin Inhibitors: Emerging Therapy for Heart Failure. Annu Rev Med. 2017 Jan 14;68:41-49. doi: 10.1146/annurev-med-052915-015509. Epub 2016 Sep 21.

    PubMed 27686019
  • McMurray JJ, Packer M, Desai AS, Gong J, Lefkowitz MP, Rizkala AR, Rouleau JL, Shi VC, Solomon SD, Swedberg K, Zile MR; PARADIGM-HF Investigators and Committees. Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med. 2014 Sep 11;371(11):993-1004. doi: 10.1056/NEJMoa1409077. Epub 2014 Aug 30.

    PubMed 25176015
  • Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Colvin MM, Drazner MH, Filippatos GS, Fonarow GC, Givertz MM, Hollenberg SM, Lindenfeld J, Masoudi FA, McBride PE, Peterson PN, Stevenson LW, Westlake C. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation. 2017 Aug 8;136(6):e137-e161. doi: 10.1161/CIR.0000000000000509. Epub 2017 Apr 28. No abstract available.

    PubMed 28455343
  • Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, Gonzalez-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P; ESC Scientific Document Group. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016 Jul 14;37(27):2129-2200. doi: 10.1093/eurheartj/ehw128. Epub 2016 May 20. No abstract available.

    PubMed 27206819
  • Velazquez EJ, Morrow DA, DeVore AD, Duffy CI, Ambrosy AP, McCague K, Rocha R, Braunwald E; PIONEER-HF Investigators. Angiotensin-Neprilysin Inhibition in Acute Decompensated Heart Failure. N Engl J Med. 2019 Feb 7;380(6):539-548. doi: 10.1056/NEJMoa1812851. Epub 2018 Nov 11.

    PubMed 30415601
  • Pascual-Figal D, Wachter R, Senni M, Belohlavek J, Noe A, Carr D, Butylin D. Rationale and design of TRANSITION: a randomized trial of pre-discharge vs. post-discharge initiation of sacubitril/valsartan. ESC Heart Fail. 2018 Apr;5(2):327-336. doi: 10.1002/ehf2.12246. Epub 2017 Dec 14.

    PubMed 29239515
  • Jiang M, Wang Z, Su X, Gong X, Pu J, Wu L, Liu C, Yao Q, Kong L, Xu J, He B. The Significance of Interstitial Fibrosis on Left Ventricular Function in Hypertensive versus Hypertrophic Cardiomyopathy. Sci Rep. 2018 Jul 3;8(1):9995. doi: 10.1038/s41598-018-27049-1.

    PubMed 29968754

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Sacubitril / Valsartan Oral Tablet in people with Myocardial Injury and Connective Tissue Diseases, run by RenJi Hospital at 1 site in China.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 7 Jan 2020. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in China. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

Contact Meng Jiang, MD (+86 13788912766, jiangmeng0919@163.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Exercise tolerance (time frame: change between 1 and 6 months after treatment). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04197050, which also lists 19 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 7 Jan 2020.

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