E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Patients hospitalized with Acute Heart Failure (AHF), normal to elevated blood pressure, and mild to moderate renal impairment. |
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MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 9.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10000803 |
E.1.2 | Term | Acute heart failure |
|
E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
The Pre-RELAX-AHF Phase II pilot portion of the study has been completed. This
amendment focuses on the RELAX-AHF main Phase III portion of the study.
RELAX-AHF Main Phase:
The objectives of this phase of the study are to confirm the efficacy of IV relaxin, in addition to
standard therapy, in improving symptoms of heart failure, dyspnea, and in preventing
intermediate term re-admission for HF or renal failure and cardiovascular death in subjects
hospitalized for AHF with normal to elevated blood pressure and mild to moderate renal
impairment.
The study’s safety objective is to assess the overall safety of IV relaxin in this patient population.
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E.2.2 | Secondary objectives of the trial | |
E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Able to provide written informed consent
2. Male or female ≥ 18 years of age, with body weight <160 kg
3. Systolic blood pressure > 125 mmHg at the start of screening and at the end of screening
4. Hospitalized for AHF. AHF is defined as including all of the following measured at any
time between presentation (including the emergency department [ED]) and the end of
screening:
a. Dyspnea at rest or with minimal exertion
b. Pulmonary congestion on chest radiograph
c. BNP ≥ 350pg/mL or NT-pro-BNP ≥1400 pg/mL
5. Able to be randomized within 16 hours from presentation to the hospital, including the ED
6. Received IV furosemide of at least 40 mg (or equivalent) at any time between admission
to emergency services (either ambulance or hospital, including the ED) and the start of
screening for the study
7. Impaired renal function defined as an estimated glomerular filtration rate (eGFR) on
admission between 30-75 mL/min/1.73 m2, calculated using the simplified Modification
of Diet in Renal Disease (sMDRD) equation |
|
E.4 | Principal exclusion criteria |
1. Pregnant or breast-feeding women (women of child bearing potential must have the
results of a negative pregnancy test recorded prior to study drug administration)
2. Administration of intravenous radiographic contrast agent within 72 hours prior to
screening or acute contrast-induced nephropathy at the time of screening
3. Temperature >38°C (oral or equivalent) or sepsis or active infection requiring IV anti-
microbial treatment
4. Current (within 2 hours prior to screening) or planned (through the completion of study
drug infusion) treatment with any IV therapies, including vasodilators (including
nesiritide), positive inotropic agents and vasopressors, or mechanical support (intra-aortic
balloon pump, endotracheal intubation, mechanical ventilation, or any ventricular assist
device), with the exception of IV nitrates at a dose of < 0.1 mg/kg/hr if the patient has a
systolic BP > 150 mmHg at screening
5. Current or planned ultrafiltration, hemofiltration, or dialysis
6. Known significant pulmonary disease
7. Known significant valvular disease (including any of the following: severe aortic stenosis
[AVA < 1.0 or peak gradient > 50 on prior or current echocardiogram], severe aortic
regurgitation, or severe mitral stenosis)
8. Any organ transplant recipient, or patient currently listed for transplant or admitted for
any transplantation
9. Major surgery within 30 days
10. Hematocrit < 25% or blood transfusion in the prior 14 days or active, life-threatening GI
bleeding
11. Major neurologic event, including cerebrovascular events, in the prior 60 days
12. Clinical diagnosis of acute coronary syndrome within 45 days prior to screening
(including the present admission) as determined by both clinical and enzymatic criteria
13. Troponin > 3 times the upper limit of normal (including "borderline/intermediate")
between presentation and screening.
14. AHF due to significant arrhythmias (including any of the following: ventricular
tachycardia, bradyarrhythmias with ventricular rate <45 beats per minute or any second
or third degree AV block or atrial fibrillation/flutter with ventricular response of >120
beats per minute)
15. Acute myocarditis or hypertrophic obstructive, restrictive, or constrictive
cardiomyopathy (does not include restrictive mitral filling patterns seen on Doppler
echocardiographic assessments of diastolic function)
16. Known hepatic impairment
17. Non-cardiac pulmonary edema, including suspected sepsis
18. Administration of an investigational drug or implantation of investigational device, or
participation in another trial, within 30 days before screening or previous treatment with
relaxin
19. Inability to follow instructions or comply with follow-up procedures |
|
E.5 End points |
E.5.1 | Primary end point(s) |
The two primary efficacy endpoints for the Phase III RELAX-AHF are:
1)Area Under the Curve (AUC) representing the change in patient-reported dyspnea from
baseline measured by a 100-mm Visual Analog Scale (VAS) from baseline through Day 5
2) Moderately or markedly better patient-reported dyspnea relative to the start of study drug
on the 7-point Likert scale at 6, 12 and 24 hours (at all 3 timepoints) |
|
E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | Yes |
E.8.2.3 | Other | No |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 5 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | Information not present in EudraCT |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
|
E.8.7 | Trial has a data monitoring committee | Yes |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
|
Patients will be followed a minimum of 60 days and up to a maximum of 180 days from start of first study drug dose. |
|
E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 2 |
E.8.9.1 | In the Member State concerned months | |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial years | 2 |