| E.1 Medical condition or disease under investigation |
| E.1.1 | Medical condition(s) being investigated |
| symptomatic hypertrophic cardiomyopathy (SHCM) |
|
| E.1.1.1 | Medical condition in easily understood language |
|
| 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 | 17.0 |
| E.1.2 | Level | PT |
| E.1.2 | Classification code | 10020871 |
| E.1.2 | Term | Hypertrophic cardiomyopathy |
| E.1.2 | System Organ Class | 10010331 - Congenital, familial and genetic disorders |
|
| 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 demonstrate the efficacy of ranolazine in improving the Exercise capacity in patients affected by SHCM using the V02 peak technique |
|
| E.2.2 | Secondary objectives of the trial |
| Secondary objectives will be to demonstrate the efficacy of ranolazine on diastolic function, symptomatic status and natriuretic peptide biomarker proBNP in patients affected by SHCM. The assessment of safety by evaluation of adverse events, laboratory findings, the rest standard 12-lead ECG, detection of 24-hour arrhythmic burden by Holter ECG monitoring and physical examination will also be considered a secondary study objectives. |
|
| E.2.3 | Trial contains a sub-study | No |
| E.3 | Principal inclusion criteria |
• Male and female gender;
• Females of childbearing potential or within two years from the menopause must have a negative urine pregnancy test (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 which fulfil conventional echocardiographic criteria for the diagnosis of SHCM: Maximum LV wall thickness >= 1.5 cm;
• Patients aged > 18 years;
• Patients with exertion symptoms and functional limitation (angina and or HF NYHA II-III);
• Presence of sinus rhythm;
• Peak V02 < 75% of predicted for age and gender;
• Absence of resting LV outflow tract obstruction (peak gradient < 30 mmHg);
• Written informed consent prior to enrolment into the study
• Persons capable to understand the nature, significance and implications of the clinical trial. |
|
| E.4 | Principal exclusion criteria |
• Females of childbearing potential not using adequate contraceptive precautions;
• Females who are pregnant or lactating;
• Presence of known coronary artery disease (CAD);
• Presence of Chronic Obstructive Airways Disease;
• Concomitant administration of potent CYP3A4 inhibitors
• Concomitant administration of dronedarone Class Ia (e.g. quinidine) or Class III (e.g. dofetilide, sotalol) antiarrhythmics other than amiodarone, or other QT-prolonging drugs;
• Concomitant use of CYP3A4 inducers (e.g. rifampicin, phenytoin, phenobarbital, carbamazepine, St. John’s Wort)
•Concomitant use of > 1000 mg daily dose of metformin during the study
•Concomitant use of >20 mg daily dose of Simvastatin during the study (in case of patients taking simvastatin >20 mg daily, the switch to other statins not metabolized by the CYP3A4 could be considered).
• Patients with QTc at baseline >= 500 ms;
• Any clinically relevant haematological or biochemical abnormality on routine screening, according to Investigator’s judgment;
• Severe concurrent pathology, including terminal illness (cancer, AIDS, etc.);
• Severe renal impairment defined as GFR < 29 mL/minor creatinine level > 2.5 mg/dL; GFR must always be calculated;
• Moderate or severe hepatic impairment or hepatic insufficiency defined as SGOT or SGPT > 2 times greater than normal upper limit or total serum bilirubin > 1.5 times greater than normal upper
limit;
• Dementia, psychosis, alcoholism (>280 g ethanol/week for male or >140 g ethanol/week for female patients) 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;
• Inability to perform a cardiopulmonary test;
• Lactose intolerance;
• Hypersensitivity to ranolazine or one of the excipients. |
|
| E.5 End points |
| E.5.1 | Primary end point(s) |
| Evaluation of Exercise Capacity with the V02 peak in patients with SHCM after 5 months of treatment with ranolazine or placebo |
|
| E.5.1.1 | Timepoint(s) of evaluation of this end point |
|
| E.5.2 | Secondary end point(s) |
| E/E’ ratio evaluation; Natriuretic peptides biomarkers evaluation (proBNP biomarkers); Symptomatic Status evaluation (Minnesota Living With Heart Failure Questionnaire) |
|
| E.5.2.1 | Timepoint(s) of evaluation of this end point |
|
| 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) | Yes |
| E.7.3 | Therapeutic confirmatory (Phase III) | No |
| 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.8.2.4 | 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 | 3 |
| E.8.5 | The trial involves multiple Member States | Yes |
| E.8.5.1 | Number of sites anticipated in the EEA | 13 |
| E.8.6 Trial involving sites outside the EEA |
| E.8.6.1 | Trial being conducted both within and outside the EEA | No |
| E.8.6.2 | Trial being conducted completely outside of the EEA | No |
| 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
|
|
| E.8.9 Initial estimate of the duration of the trial |
| E.8.9.1 | In the Member State concerned years | 0 |
| E.8.9.1 | In the Member State concerned months | 29 |
| E.8.9.1 | In the Member State concerned days | 14 |
| E.8.9.2 | In all countries concerned by the trial years | 0 |
| E.8.9.2 | In all countries concerned by the trial months | 29 |
| E.8.9.2 | In all countries concerned by the trial days | 14 |