E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Excercise angina in patients with Coronary Artery Disease |
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E.1.1.1 | Medical condition in easily understood language |
Chest pain during exercise in patients suffering from Coronary Artery Disease which is a condition due to a constriction of the vessels which conduct the blood to the cardiac muscle |
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E.1.1.2 | Therapeutic area | Diseases [C] - Cardiovascular Diseases [C14] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 14.0 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10014292 |
E.1.2 | Term | Effort angina |
E.1.2 | System Organ Class | 10007541 - Cardiac disorders |
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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 primary study objective will be to investigate whether ranolazine 750 mg b.i.d. is effective in increasing exercise capacity (exercise treadmill time at peak). |
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E.2.2 | Secondary objectives of the trial |
The secondary study objectives will be to verify whether ranolazine is effective in reducing angina frequency and nitroglycerin consumption/week.
The assessment of safety by evaluation of adverse events, laboratory findings and physical examination will also be considered a secondary study objective.
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
• Male and female patients (females of childbearing potential must be using adequate contraceptive precautions such as implants, injectables, combined oral contraceptives, intrauterine devices, sexual abstinence or vasectomised partner).
• Patients aged ≥ 18 years. (n.b. no upper limit specified)
• Patients with coronary artery disease confirmed by angiography, prior MI, prior revascularization (PCI, CABG) and with exercise angina not controlled by the standard therapy.
• ST-segment depression ≥ 1mm during exercise ECG.
• Capacity to perform the exercise test.
• Able and willing to sign informed consent and to comply with study procedures.
• Written informed consent prior to enrolment into the study.
• Females of childbearing potential or within two years from the menopause must have a negative urine pregnancy test
Inclusion criterion at visit 1
• Reproducible ST-segment depression ≥ 1mm during two exercise tests performed 1 week apart (difference in exercise no more than 20%).
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E.4 | Principal exclusion criteria |
• Angina at rest.
• ECG abnormalities at rest (left bundle-branch block, resting ST-segment depression ≥ 1mm, tachyarrhythmia).
• Presence of factors that preclude satisfactory interpretation of the ECG (e.g. resting ST-segment depression ≥ 1mm in any lead, left bundle-branch block, digoxin therapy) or repolarisation and conduction abnormalities.
• Heart failure (class III or IV NYHA).
• Moderate-severe hypertension (SBP>160 mmHg and/or DBP>100 mmHg).
• Hypotension.
• Acute coronary syndrome or coronary revascularization procedure within the prior 3 months before enrolment.
• Females who are pregnant or nursing.
• Any clinically relevant haematological or biochemical abnormality on routine screening, according to Investigator’s judgment.
• Severe concurrent pathology, including terminal illness (cancer, AIDS, etc.).
• Renal impairment defined as creatinine clearance< 30 mL/min.
• Mild, moderate or severe hepatic impairment or hepatic insufficiency defined as: SGOT or SGPT > 3 times greater than normal upper limit or total serum bilirubin > 1.5 times greater than normal upper limit
• Pre-existing QT prolongation (including congenital long QT syndrome, uncorrected hypokalemia).
• Patients on QT-prolonging drugs such as Class Ia (e.g., quinidine) and Class III (e.g., dofetilide, sotalol, dronedarone) antiarrhythmics, and antipsychotics (e.g., thioridazine, ziprasidone).
• Existing contraindications for exercise testing (e.g. acute myocarditis or pericarditis, DVT, severe aortic stenosis)
• Dementia, psychosis, alcoholism (>350 g ethanol/week) or chronic abuse of medicines, drugs or psychoactive substances.
• Conditions which in the Investigator’s opinion may interfere with the study’s execution or due to which the patient should not participate for safety reasons.
• Risk of low patient cooperation.
• Inability or unwillingness to issue the informed consent.
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E.5 End points |
E.5.1 | Primary end point(s) |
Primary variable of efficacy is the change from baseline to the end of treatment (24 weeks of full-dose treatment) in treadmill Total Exercise Duration (TED) at peak ranolazine plasma levels. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
After 24 weeks of full-dose treatment. |
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E.5.2 | Secondary end point(s) |
- Change in treadmill total exercise duration with ranolazine or placebo at peak ranolazine plasma levels (4 hrs after dosing) after 4 (Visit 6) and 12 (Visit 7) weeks of full-dose treatment.
- Change in time to 1 mm ST-segment depression at peak ranolazine plasma levels.
- Change in time to angina at peak ranolazine plasma levels.
- Number of angina attacks/week.
- Number of sublingual nitroglycerin consumption/week.
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
If not specified has to be intended at each visit when the parameter is assessed |
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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) | No |
E.7.4 | Therapeutic use (Phase IV) | Yes |
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.8.2.4 | Number of treatment arms in the trial | 2 |
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.8.4.1 | Number of sites anticipated in Member State concerned | 8 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 97 |
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 | No |
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 |
Austria |
Greece |
Ireland |
Italy |
Spain |
Switzerland |
United Kingdom |
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E.8.7 | Trial has a data monitoring committee | No |
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
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 1 |
E.8.9.1 | In the Member State concerned months | 8 |
E.8.9.1 | In the Member State concerned days | 15 |
E.8.9.2 | In all countries concerned by the trial years | 1 |
E.8.9.2 | In all countries concerned by the trial months | 8 |
E.8.9.2 | In all countries concerned by the trial days | 15 |