E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Post-operative atrial fibrillation (POAF) |
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E.1.1.1 | Medical condition in easily understood language |
Prevention of post-operative atrial fibrillation |
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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 | 10003658 |
E.1.2 | Term | Atrial fibrillation |
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 |
- To compare the efficacy of AGN-151607 with placebo to prevent postoperative atrial fibrillation (POAF) in participants who are undergoing open chest cardiac surgery - To compare the efficacy of AGN-151607 with placebo to reduce AF burden in participants who are undergoing open-chest cardiac surgery |
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E.2.2 | Secondary objectives of the trial |
- To compare the efficacy of AGN-151607 with placebo to prevent POAF using alternative definitions for AF in participants who are undergoing open-chest cardiac surgery - To compare the safety of AGN-151607 with placebo in participants undergoing open-chest cardiac surgery
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
- 55 to 90 years of age, inclusive, at the time of signing the informed consent - Scheduled to undergo open-chest cardiac surgery. Includes: coronary artery bypass graft (CABG) and/or valve repair/replacement (inclusionary valve repair/replacement procedures for the primary reason for surgery include: aortic or mitral valve repair/replacement; combination of aortic and tricuspid valve repair/replacement; combination of mitral and tricuspid valve repair/replacement; CABG/valve combination procedures [when valvular procedure is one of the 4 sub-bulleted procedures immediately above]; left atrial appendage [LAA] procedures are allowed if CABG and/or valve repair/replacement is the qualifying surgical procedure, but is not a qualifying surgical procedure on its own) - In sinus rhythm for the last 48 hours prior to randomization based on standard-of-care assessments and study ECGs (note: continuous ECG monitoring for 48 hours is not required; prior history of paroxysmal AF is acceptable) - Willing to wear an electrocardiogram (ECG) patch for a full 30 days post-surgery and for 7 days after each study visit |
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E.4 | Principal exclusion criteria |
• Any medical condition that may put the participant at increased risk with exposure to botulinum toxin type A, including diagnosed muscular dystrophy (eg, Duchenne's muscular dystrophy), myasthenia gravis, Eaton-Lambert syndrome, amyotrophic lateral sclerosis, mitochondrial disease, or any other significant disease which might interfere with neuromuscular function • Participants with presence or history of any of the following within 3 months prior to the Day 1 visit that may indicate a vulnerable respiratory state per the investigator's clinical judgment: aspiration pneumonia, lower respiratory tract infections, uncontrolled asthma, severe chronic obstructive pulmonary disease or otherwise compromised respiratory function • Permanent/persistent AF • Has a known allergy or sensitivity to any botulinum toxin type A preparation; has a known allergy or sensitivity to medical adhesive (eg, ECG patch adhesive; hydrogel based adhesive) • Severe (> 55mm left atrial diameter) left atrial enlargement • Left ventricular ejection fraction (LVEF) < 25%; presence or history of symptomatic atrioventricular block > 1st degree within the last 30 days (note: presence of a pacemaker is not exclusionary per se) • Exclusionary valve repair/replacement procedures include combination of aortic and mitral valve repair/replacement; isolated tricuspid valve repair/replacement. • Prior or concomitant therapy with Class I or III antiarrhythmic drugs unless proper washout was documented • Botulinum toxin type A (of any serotype) use within 6 months of randomization • Has been immunized for any botulinum toxin type A serotype as determined by participant medical history • Preoperative need for inotropes/vasopressors or intra-aortic balloon pump • Prior open-chest, sternotomy cardiac surgery • History of ablation for AF • Planned ablation procedure for AF at the time of surgery • Emergency surgery • Impaired prognosis defined as EuroSCORE II > 7% perioperative mortality at screening is exclusionary |
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E.5 End points |
E.5.1 | Primary end point(s) |
• Percentage of participants with at least 1 continuous atrial fibrillation (AF) episode ≥ 30 seconds during the first 30 days post surgery • Percentage of time spent in AF (AF burden) during the first 30 days post surgery • Percentage of participants with at least 1 event of symptomatic AF during the first 30 days post surgery • Time to first occurrence of AF during the first 30 days post surgery within the first 30 days post surgery |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
within the first 30 days post surgery |
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E.5.2 | Secondary end point(s) |
• Percentage of participants with at least 1 continuous AF episode ≥ 2 minutes during the first 30 days post-surgery • Percentage of participants with at least 1 continuous AF episode ≥ 5 minutes during the first 30 days post-surgery • Percentage of participants with at least 1 continuous AF episode ≥ 30 minutes during the first 30 days post-surgery • Percentage of participants with at least 1 continuous AF episode ≥ 1 hour during the first 30 days post surgery • Percentage of participants with at least 1 continuous AF episode ≥ 4 hours during the first 30 days post surgery • Percentage of participants with at least 1 continuous AF episode ≥ 6 hours during the first 30 days post surgery • Percentage of participants with at least 1 continuous AF episode ≥ 12 hours during the first 30 days post surgery • Percentage of participants with at least 1 continuous AF episode ≥ 24 hours during the first 30 days post surgery • Adverse events (AEs), physical examination, clinical laboratory tests, vital signs, electrocardiogram (ECGs), pulmonary function • Potential immunogenicity response
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
within the first 30 days post surgery |
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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 | No |
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 | Yes |
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 | 3 |
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.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 11 |
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 |
Canada |
Germany |
Italy |
Netherlands |
Spain |
Sweden |
United Kingdom |
United States |
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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
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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 | 3 |
E.8.9.1 | In the Member State concerned months | 11 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 3 |
E.8.9.2 | In all countries concerned by the trial months | 11 |
E.8.9.2 | In all countries concerned by the trial days | 0 |