E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Stable angina with normal ejection fraction |
Angina stabile con frazione di eiezione nella norma |
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E.1.1.1 | Medical condition in easily understood language |
Stable angina |
Angina stabile |
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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 | 20.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10002383 |
E.1.2 | Term | Angina pectoris |
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 |
Demonstrate the efficacy of ranolazine in reducing segmentary post systolic thickening due to myocardial ischemia - allowing the synchronisation of the impaired myocardial segments - using strain imaging (SI) derived from 2-dimensional speckle-tracking echocardiography in patients with stable effort angina. |
Dimostrare l¿efficacia della ranolazina nel ridurre l¿inspessimento segmentario post sistolico secondario a ischemia miocardica, permettendo cos¿ la sincronizzazione dei segmenti miocardici compromessi ¿ mediante la strain imaging (SI) derivata dalla ecocardiografia speckle tracking a 2 dimensioni in pazienti affetti da angina stabile |
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E.2.2 | Secondary objectives of the trial |
Demonstrate the efficacy of ranolazine on exercise capacity in patients affected by stable effort angina using the supine bicycle exercise test and the symptomatic status. The assessment of safety by evaluation of adverse events, laboratory findings, the rest standard 12-lead ECG, and physical examination will also be considered as secondary study objectives. |
Dimostrare l¿efficacia di ranolazina sulla capacit¿ di esercizio in pazienti affetti da angina stabile mediante l¿utilizzo del test di esercizio con la bicicletta in posizione supina e la rilevazione dello stato sintomatico. Verr¿ inoltre studiata nella stessa popolazione la safety di ranolazina. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
• Male and female gender (females of childbearing potential must be using adequate contraceptive precautions such as implants, injectables, combined oral contraceptives, intrauterine devices, sexual abstinence or vasectomised partner); • Females of childbearing potential or within two years from the menopause must have a negative urine pregnancy test; • Patients which diagnosis of stable effort chronic angina based on clinical symptoms (angina; ischemic equivalents) or ischemia tests (stress ECG/stress-exercise echocardiography/Miocardial perfusion scintigraphy) independently from baseline antianginal therapy. • Patients aged = 18 years; • Patients with normal LV ejection fraction (EF) without LV wall motion abnormalities detected by standard echocardiography or if abnormalities are present, the post systolic thickening must be present in a different, non-contiguous segment; • Patients with post systolic thickening independently from baseline antianginal therapy, defined as the presence of SI = 50%, 5 min. during and/or after the supine bicycle speckle tracking echo stress (speckle tracking) test performed by using the standard Bruce protocol; • Presence of sinus rhythm; • Written informed consent prior to enrolment into the study. |
• Uomini e Donne (le donne in età fertile dovranno precauzionalmente fare uso di adeguate metodiche contraccettive); • Le donne in età fertile o entro due anni dalla presumibile data della menopausa dovranno avere un test urinario di gravidanza negativo; • Pazienti con diagnosi clinica di angina stabile (angina; equivalenti ischemici) o mediante test ischemici (ECG da stress/Ecocardiografia da stress/scintigrafia perfusionale miocardica) indipendente dalla terapia antianginosa di base; • Pazienti di età = 18 anni; • Pazienti con Frazione di Eiezione ventricolare sinistra normale (EF) senza anomalie della motilità della ventricolare sinistra diagnosticata mediante ecocardiografia standard o, in caso di presenza di dette anomalie, presenza di inspessimento post sistolico in un segmento differente non contiguo; • Pazienti con inspessimento post sistolico indipendente dalla terapia antiangionosa di base, definite come presenza di un SI = 50%, 5 min. durante e/o dopo il test di ecco stress mediante bicicletta supina speckle tracking eseguito secondo il protocollo standard di Bruce; • Presenza di ritmo sinusale; • Consenso informato scritto prima dell’ingresso nello studio. |
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E.4 | Principal exclusion criteria |
• Females of childbearing potential not using adequate contraceptive precautions; • Presence of unstable angina, left main trunk disease, previous myocardial infarction, previous cardiac surgery, artificial pacemaker, non-sinus rhythm, significant valvular heart disease; • Presence of congestive heart failure; • Presence of Chronic Obstructive Airways Disease; • Concomitant administration of potent CYP3A4 inhibitors (e.g. itraconazole, ketoconazole, voriconazol, posaconazol, HIV protease inhibitors, clarithromycin, telithromycin, nefazodone). Grapefruit juice is also a potent CYP3A4 inhibitor. • Concomitant administration of Class Ia (e.g. quinidine) or Class III (e.g. dofetilide, sotalol) antiarrhythmics other than amiodarone. • 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/min; creatinine level > 2.5 mg/dL; BUN >60 mg/dL; • 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 (>350 g ethanol/week) or chronic abuse of medicines, drugs or psychoactive substances; • Females who are pregnant or lactating; • 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 an exercise stress test. |
• Donne in età fertile che non fanno uso di adeguate precauzioni contraccettive; • Presenza di angina instabile, left main trunk disease, pregresso infarto del miocardio, pregresso intervento chirurgico cardiaco, presenza di pacemaker artificiale, ritmo non sinusale, malattia valvolare cardiaca significativa; • Presenza di scompenso cardiaco congestizio; • Presenza di Broncopneumopatia Cronica Ostruttiva; • Somministrazione concomitante di potenti inibitori del citocromo CYP3A4 (es. itraconazole, ketoconazole, voriconazol, posaconazol, HIV protease inhibitors, clarithromycin, telithromycin, nefazodone). Anche il succo di pompelmo è un potente inibitore del citocromo CYP3A4; • Somministrazione concomitante di antiaritmici di Classe Ia )es. chinidina) o di Classe III (es. dofetilide, sotalolo) diversi dall’amiodarone; • Qualunque anormalità ematologica o biochimica clinicamente rilevante, presente nei test di screening, secondo il giudizio dello sperimentatore; • Patologia concomitante di grado severo, incluse le malattie in stadio terminale (Cnacro, AIDS….); • Insufficienza renale di grado severo definita come GFR < 29 mL/min; creatininemia > 2.5 mg/dL; BUN >60 mg/dL; • Alterazione della funzionalità epatica di grado moderato o severo, o insufficienza epatica definite come presenza di valori di GOT o GPT > 2 volte la norma o bilirubina totale > 1.5 oltre la norma; • Demenza, psicosi, alcolismo (>350 g etanolo/settimana) o abuso cronico di medicine, sostanze stupefacenti o psicostimolanti; • Donne in gravidanza o allattamento; • Condizioni che a giudizio dello Sperimentatore possono interferire con l’esecuzione dello studio o per le quali, per motivi di safety i pazienti non possono parteciparvi; • Pazienti a rischio di scarsa collaborazione; • Incapacità o riluttanza a firmare il consenso informato; • Incapacità ad eseguire un test da stress. |
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E.5 End points |
E.5.1 | Primary end point(s) |
Evaluation of SI in patients with stable effort angina after 2 months and 3 weeks of treatment with ranolazine + standard therapy (ST) or standard therapy (ST) alone using the 2-dimensional speckle-tracking echocardiography. |
Valutazione della SI in pazienti con angina stabile dopo 2 mesi di trattamento e tre settimane con ranolazina + ST o ST mediante l’utilizzo ecocardiografia speckle tracking a 2 dimensioni. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
2 MONTHS AND 3 WEEKS |
2 MESI E 3 SETTIMANE |
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E.5.2 | Secondary end point(s) |
The change in Exercise capacity after 2 months and 3 weeks of treatment with ranolazine 375/500/750 mg /bid + ST or ST alone in the two study groups; The change in Symptomatic Status Evaluation using the Seattle Angina Questionnaire, after 2 months and 3 weeks of treatment with ranolazine 375/500/750 mg /bid + ST or ST alone in the two study groups; The change in Symptomatic Status Evaluation using the Seattle Angina Questionnaire, after 1 month of treatment with ranolazine 375/500/750 mg /bid + ST or ranolazine 500 mg/bid + ST in the two study groups from visit 7 to visit 8 (end study visit).; The change in SI, after 1 month of treatment with ranolazine 375/500/750 mg /bid + ST or ranolazine 500 mg/bid + ST in the two study groups from visit 7 to visit 8 (end study visit).; The change in Exercise capacity, after 1 month of treatment with ranolazine 375/500/750 mg /bid + ST or ranolazine 500 mg/bid + ST in the two study groups from visit 7 to visit 8 (end study visit). |
Il cambiamento nella capacit¿ di esercizio dopo 2 mesi e 3 settimane di trattamento con ranolazina 375/500/750 mg / bid + ST o solo ST nei due gruppi di studio; La variazione del Symptomatic Status Evaluation utilizzando il Seattle Angina Questionnaire, dopo 2 mesi e 3 settimane di trattamento con ranolazina 375/500/750 mg / bid + ST o solo ST nei due gruppi di studio; La variazione di Symptomatic Status Evaluation utilizzando il Seattle Angina Questionnaire, dopo 1 mese di trattamento con ranolazina 375/500/750 mg / bid + ST o ranolazina 500 mg / bid + ST nei due gruppi di studio dalla visita 7 alla visita 8 (fine visita di studio).; Il cambiamento di SI, dopo 1 mese di trattamento con ranolazina 375/500/750 mg / bid + ST o ranolazina 500 mg / bid + ST nei due gruppi di studio dalla visita 7 alla visita 8 (visita di studio fine).; Il cambiamento nella capacit¿ di esercizio, dopo 1 mese di trattamento con ranolazina 375/500/750 mg / bid + ST o ranolazina 500 mg / bid + ST nei due gruppi di studio da visita 7 alla visita 8 (visita di studio finale). |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
2 MONTHS and 3 WEEKS; 2 MONTHS AND 3 WEEKS; 1 MONTH; 1 MONTH; 1 MONTH |
2 MESI e 3 SETTIMANE; 2 MESI E 3 SETTIMANE; 1 MESE; 1 MESE; 1 MESE |
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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) | 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 | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
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 | No |
E.8.2.3 | Other | Yes |
E.8.2.3.1 | Comparator description |
Terapia standard |
Standard therapy |
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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
| Yes |
E.8.4 | The trial involves multiple sites in the Member State concerned | No |
E.8.4.1 | Number of sites anticipated in Member State concerned | 1 |
E.8.5 | The trial involves multiple Member States | No |
E.8.5.1 | Number of sites anticipated in the EEA | 1 |
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 | Information not present in EudraCT |
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 | 1 |
E.8.9.1 | In the Member State concerned days | 21 |
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 | 1 |
E.8.9.2 | In all countries concerned by the trial days | 21 |