E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Acute myocardial infarction, acute myocardial ischemia, STEMI ST elevation myocardial infarction |
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E.1.1.1 | Medical condition in easily understood language |
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E.1.1.2 | Therapeutic area | Diseases [C] - Cardiovascular Diseases [C14] |
MedDRA Classification |
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 evaluate the safety and tolerability of dutogliptin in combination with filgrastim in subjects with STEMI compared with placebo |
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E.2.2 | Secondary objectives of the trial |
• To assess preliminary efficacy of dutogliptin in combination with filgrastim in subjects with STEMI compared with placebo as determined by cardiac magnetic resonance imaging (cMRI) • To determine the pharmacokinetics (PK) of dutogliptin in a subset of the study population • To establish the pharmacodynamics (PD) of dutogliptin (plasma DPP4 activity) in a subset of the study population
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Male or female born between 1933 and 2000. 2. Body weight <96 kg (~212 lb). 3. Able to provide written informed consent, including signing and dating the informed consent form (ICF). 4. Diagnosis of STEMI (defined as new ST-segment elevation at the J point of at least 2 continuous leads of >2 mm [0.2 mV] in men or >1.5 mm [0.1 mV] in women in leads V2 and V3 OR >1 mm in any other contiguous precordial leads or the limb leads [for both men and women]) with PCI (bare metal or drug-eluting stent) and Thrombolysis in Myocardial Infarction flow grade 2 or 3 occurring >2 hours and <24 hours after symptom onset. 5. LVEF ≤45% obtained by cECHO performed within 36 hours post-stent placement. 6. Receiving standard medical therapy for post-myocardial infarction (MI) treatment, according to local procedures and PI discretion. 7. Female subjects of childbearing potential must have a negative serum pregnancy test at Screening and an additional negative urine pregnancy test prior to the first dose of IMP unless regulated differently by national legislation. 8. Sexually active female subjects of childbearing potential (i.e., women who are not postmenopausal or who have not had a bilateral oophorectomy, hysterectomy, or tubal ligation) and all male subjects (who have not been surgically sterilized by vasectomy) must agree to use effective contraception during the study.
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E.4 | Principal exclusion criteria |
1. Previous MI prior to Screening. 2. Complex peri/post-MI clinical course, including arrhythmias, cardiogenic shock, pulmonary edema requiring mechanical ventilation, or requirement for vasopressor medications. 3. Significant pre-existing cardiomyopathy with known LVEF ≤45% or moderate to severe mitral or aortic valvular disease. 4. Amyloidosis, hypertrophic obstructive cardiomyopathy, restrictive cardiomyopathy, or constrictive pericarditis. 5. Existing heart transplant. 6. Ventricular tachycardia or fibrillation not associated with an acute ischemic episode. 7. Uncontrolled hypertension (systolic >180 mmHg or diastolic >120 mmHg). 8. Treatment with any DPP4 inhibitors (e.g., alogliptin, linagliptin, vildagliptin, saxagliptin, sitagliptin) or granulocyte-colony stimulating factor medication (e.g., filgrastim, lenograstim, pegfilgrastim, lipegfilgrastim) within 4 months prior to Randomization. 9. Contraindication to treatment with filgrastim, including known allergy to filgrastim or other G-CSF medication. 10. Anemia defined as hemoglobin <9 g/dL prior to Randomization. 11. Thrombocytosis (platelets >500 k/uL). 12. Known positive serology for hepatitis B, hepatitis C, or human immunodeficiency virus (HIV). 13. Alanine aminotransferase (ALT) concentrations >3 times the upper limit of normal (ULN) or bilirubin >2 x ULN prior to Randomization, according to local laboratory assessments. 14. History of cirrhosis and Child-Pugh score B or C. 15. Current fever greater than 101.4 °F (38.6 °C) or recent systemic infection within 2 weeks prior to Randomization. 16. Contraindication to cMRI procedure, including prior implantable cardioverter defibrillator placement, known reaction to gadolinium, claustrophobia, non-MRI-compatible, cochlear implant, obesity, or presence of ferromagnetic material including shunts, shrapnel, penile prostheses, or blood vessel coil. 17. Pregnant, planning to become pregnant, or nursing female subjects. 18. Autoimmune disease requiring immunosuppressive therapy or chronic steroid treatment >5 mg/day prednisolone or equivalent. 19. Significant renal impairment defined as estimated glomerular filtration rate <45 mL/min/1.73 m2, using the Chronic Kidney Disease Epidemiology Collaboration equation. 20. Active neoplasm requiring surgery, chemotherapy, or radiation within the prior 12 months (subjects with a history of malignancy who have undergone curative resection or otherwise not requiring treatment for at least 12 months prior to Screening with no detectable recurrence are allowed). 21. Malignant hematological disease, i.e., chronic myeloid leukemia or myelodysplastic syndrome. 22. History of cerebrovascular accident or transient ischemic attack in the past 6 months. 23. History of pneumonia in the last 4 weeks. 24. History of any significant medical or psychiatric disorder that in the opinion of the investigator would make the subject unsuitable for participation in the study. 25. Treatment with an investigational drug within 30 days or 5 half-lives (whichever is longer) or treatment with an investigational biologic drug within 6 weeks prior to randomization. 26. Participation in another concurrent clinical trial involving a therapeutic intervention (participation in observational studies and/or registry studies is permitted). 27. Unable or unwilling to comply with the requirements of the study. 28. Subject and/or an immediate family member is an employee of the investigational site directly affiliated with this study, the sponsor or the contract research organization. 29. Considered by the investigator to be unsuitable to participate in the study for any other reason. 30. Persons who are in an institution as a result of an administrative or judicial order, or soldiers. 31. History of alcohol or drug abuse.
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E.5 End points |
E.5.1 | Primary end point(s) |
Safety assessments will include reporting of AEs and serious AEs (SAEs), clinical laboratory tests, ECGs, vital signs, and physical examinations. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
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E.5.2 | Secondary end point(s) |
Efficacy 1 Change from baseline to Day 90 (Month 3) in the following cardiac functional parameters as assessed by central, blinded review of cMRI: • LVEF • Left ventricular end systolic volume (absolute and indexed) • Left ventricular end diastolic volume (absolute and indexed) • Infarct size • Left ventricular mass (absolute and indexed) • Regional wall motion
3.Efficacy 2 Individual clinical endpoints, including recurrent non-fatal MI, non-fatal stroke, death due to any cause, cardiovascular (CV) death (death due to acute MI, chronic heart failure [CHF], stroke, or sudden cardiac death, CEC), stent thrombosis or CHF hospitalization evaluated at 90 (Month 3).
4.Efficacy 3 Combined clinical endpoints, including major adverse cardiac events, defined as non-fatal MI, non-fatal stroke, CV death, stent thrombosis, and CHF hospitalization
5.Efficacy 4 Time to cardiovascular event, as defined by the time from Randomization to the first occurrence of recurrent non-fatal MI, non-fatal stroke, death due to any cause, stent thrombosis, and CHF hospitalization
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
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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 | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | No |
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 | 1 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 29 |
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 |
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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 | 0 |
E.8.9.1 | In the Member State concerned days | 0 |
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 | 0 |
E.8.9.2 | In all countries concerned by the trial days | 0 |