E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Recent-onset symptomatic atrial fibrillation |
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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.1.2 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 flecainide acetate inhalation solution and placebo for the conversion of atrial fibrillation (AF) to sinus rhythm (SR) in patients with recent-onset, symptomatic newly diagnosed or paroxysmal AF |
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E.2.2 | Secondary objectives of the trial |
To compare the effects of flecainide acetate inhalation solution and placebo on the time to conversion of AF to SR, AF-related symptoms, hospitalizations, AF-related interventions, and the time to discharge in patients with recent-onset, symptomatic newly diagnosed or paroxysmal AF |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. ≥18 and ≤85 years of age 2. Recent onset of symptomatic newly diagnosed or paroxysmal AF a) Recent onset is defined as a symptom duration ≥1 and ≤48 hours at time of dosing b) Newly diagnosed AF is AF that has not been diagnosed previously, independent of its duration c) Paroxysmal AF is defined as recurrent AF in a patient whose previous AF episode(s) self-terminated (ie, without treatment) or terminated with intervention ≤7 days of onset. d) A symptomatic recent-onset AF episode post cardiac ablation for paroxysmal AF would be considered eligible
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E.4 | Principal exclusion criteria |
1. History of non self-terminating AF/atrial flutter: a) One or more failed attempts to restore SR with pharmacological therapy b) ECV procedure for an AF episode ≤1 year prior to screening. Exception: One (1) prior ECV is allowed if no option for pharmacological conversion was previously available c) More than 3 ECV procedures in ≤5 years prior to screening 2. Current diagnosis of persistent AF 3. One or more episodes of AFL ≤6 months prior to randomization 4. Hemodynamic or cardiac instability during AF, defined as at least 3 consecutive measurements of any of the following during screening: a) Systolic blood pressure (SBP) <100 or ≥160 mmHg b) Diastolic blood pressure (DBP) ≥95 mmHg c) Ventricular HR <80 or >160 bpm 5. Respiratory rate >22 breaths per minute 6. History of decompensated heart failure 7. Evidence of significant HF defined as any of the following: a) Hospitalization in the last 12 months for HF or suspected HF event b) Most recent assessment of left ventricular ejection fraction <45% c) New York Heart Association Class II-IV symptoms d) Medication history suggestive of HF per the Investigator's discretion 8. Signs or symptoms of ongoing myocardial ischemia, including any of the following: a) Significant ST segment elevation or depression (ie, ≥2 mm) on a standard 12-lead ECG b) Echocardiogram findings (eg, wall motion abnormalities) suggestive of acute myocardial infarction c) Angina pectoris, atypical angina pectoris, or receiving antianginal medication for ischemia 9. History of MI ≤3 months of screening 10. History of uncorrected moderate or severe aortic or mitral valvular stenosis, in the opinion of the Investigator; a) If an echocardiogram is performed at screening, moderate or severe valvular stenosis observed during the examination is considered exclusionary. 11. History of LV hypertrophy with LV thickness >12 mm as observed in the most recent assessment, ie, an echocardiogram 12. Stroke (including transient ischemic attack) ≤3 months prior to randomization 13. History of any of the following cardiac abnormalities: a) Long QT syndrome b) Conduction system disease c) Brugada syndrome d) Torsade de pointes e) Diagnosed with sinus node dysfunction or any of the following: i. History of unexplained or cardiovascular syncope ii. Bradycardia suggestive of sinus node dysfunction iii. Prior electrical or pharmacological cardioversion associated with sinus or ventricular pause >3 seconds or ventricular heart rate <45 bpm at time of conversion 14. Any of the following ECG-related features at screening: a) QT interval corrected for heart rate using the Fridericia formula (QTcF) >480 msec b) Wide QRS complex (ie, duration ≥120 msec) or history of documented wide QRS complex tachycardia (ie, wide QRS complex with ventricular heart rate >100 bpm) c) Presence of VT. Site telemetry should be equipped with an alarm system for VT and premature ventricular complexes (PVCs) or be continuously visually observed prior to dosing. 15. Presence of a pacemaker 16. Cardiac surgery for any of the exclusionary conditions (eg, valvular disease, hypertrophy, coronary artery disease) ≤6 months prior to randomization 17. Known severe renal impairment or patient receiving dialysis 18. Known abnormal liver function, including hepatic disease or biochemical evidence of significant liver derangement 19. Uncorrected hypokalemia 20. Uncorrected hypomagnesemia 21. Chronic obstructive pulmonary disease or other established pulmonary disease in need of inhalation medication 22. History of bronchospasm (eg, hyperreactive airways to inhalants) or difficulty inhaling medications 23. Previous or current hospitalization for COVID-19, or any secondary cardiomyopathy from COVID-19 24. Treatment with Class I or III AADs ≤7 days prior to randomization 25. Treatment with amiodarone ≤12 weeks prior to randomization 26. Known hypersensitivity to flecainide acetate, any active metabolites of flecainide acetate, or any excipients in FlecIH-103 27. Any condition or circumstance which in the opinion of the Investigator may make the patient unsuitable for the study 28. Known drug or alcohol dependence ≤12 months prior to screening as judged by the Investigator 29. A body mass index >35 kg/m2 30. Legally incompetent to provide informed consent 31. Previous treatment with any other investigational drug ≤30 days from screening or 5 half-lives of the drug, whichever is longer 32. Female of childbearing potential 33) Males whose sexual partners are women of childbearing potential (WOCBP), unless they use at least one highly effective method of contraception during the study or are permanently sterile by bilateral orchiectomy
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E.5 End points |
E.5.1 | Primary end point(s) |
The proportion of patients whose AF converts to SR ≤90 minutes after initiation of dosing |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
≤90 minutes after initiation of dosing |
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E.5.2 | Secondary end point(s) |
1) The time to conversion of AF to SR ≤90 minutes after initiation of dosing 2) The proportion of patients with AF-related symptoms at the 90 minute time point 3) The proportion of patients requiring hospitalization prior to discharge 4) The prevalence (ie, events per patient) of additional AF-related interventions required prior to discharge 5) The time to discharge-eligible status
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
1) ≤90 minutes after initiation of dosing 2) 90 minutes after initiation of dosing 3) prior to discharge 4) discharge-eligible status |
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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 | Yes |
E.6.7 | Pharmacodynamic | Yes |
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) | Yes |
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 | 10 |
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 |
Canada |
United States |
Czechia |
Hungary |
Netherlands |
Poland |
Spain |
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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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A patient will have fulfilled the requirements for study completion if/when the patient has completed the 96-hour follow-up contact. |
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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 | 0 |
E.8.9.1 | In the Member State concerned months | 10 |
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 | 1 |
E.8.9.2 | In all countries concerned by the trial days | 0 |