Safety and Efficacy of Aliskiren in Post Myocardial Infarction Patients (ASPIRE)

This study has been completed.
Sponsor:
Information provided by (Responsible Party):
Novartis
ClinicalTrials.gov Identifier:
NCT00414609
First received: December 19, 2006
Last updated: July 5, 2012
Last verified: July 2012
  Purpose

The core and extension studies assessed the safety and efficacy of aliskiren when added to optimized standard therapy in patients that have had a high risk acute myocardial infarction (heart attack).


Condition Intervention Phase
Myocardial Infarction
Drug: Aliskiren
Drug: placebo
Phase 3

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Investigator)
Primary Purpose: Treatment
Official Title: A 36-week, Multicenter, Randomized, Double-blind, Placebo-controlled, Parallel-group Study Including a 2 Year Extension Study to Evaluate Efficacy and Safety of Aliskiren on the Prevention of Left Ventricular Remodeling in High Risk Post-acute Myocardial Infarction Patients When Added to Optimized Standard Therapy

Resource links provided by NLM:


Further study details as provided by Novartis:

Primary Outcome Measures:
  • Core Study: Change From Baseline in Left Ventricular End Systolic Volume (LVESV) as Measured by Echocardiography at End of Study. [ Time Frame: Baseline and final visit (after 26 to 36 weeks of treatment) ] [ Designated as safety issue: No ]
    Change from baseline to end of study in left ventricular end systolic volume (LVESV) as measured by echocardiography. LVESV is a measurement of the volume of blood in the heart's left ventricular chamber at the end of the heart's contraction. This measurement was made by the echocardiography lab. LVESV values between 22 to 58 mL for men and 19-49 mL for women are considered normal. Baseline LVESV was a covariate.

  • Extension Study: Percentage of Participants With Deaths, Serious Adverse Events (SAEs), Discontinuation for Adverse Events (AEs) and Discontinuations for Abnormal Lab Values [ Time Frame: Extension study (24 weeks) ] [ Designated as safety issue: No ]
    AEs are defined as any unfavorable and unintended diagnosis, symptom, sign (including an abnormal laboratory finding), syndrome or disease which either occurs during study, having been absent at baseline, or, if present at baseline, appears to worsen. Serious adverse events are any untoward medical occurrences that result in death, are life threatening, require (or prolong) hospitalization, cause persistent or significant disability/incapacity, result in congenital anomalies or birth defects, or are other conditions which in judgment of investigators represent significant hazards.


Secondary Outcome Measures:
  • Core Study: Time to First Occurrence for the Composite Endpoints of Echocardiogram and Adjudicated Outcomes [ Time Frame: LVEF was measured at baseline and at final visit (after 26 to 36 weeks of treatment). Other endpoint components were assessed from randomization until the end of the study (week 36). ] [ Designated as safety issue: No ]
    Composite outcome 1 included: Cardiovascular (CV) Death, hospitalization for heart failure (HF), or absolute reduction in Left Ventricular Ejection Fraction (LVEF) greater than 6%. Composite outcome 2 included: CV Death, hospitalization for HF, recurrent Myocardial Infarction, Stroke, or Resuscitated Sudden Death. LVEF was measured at baseline and final visit. All other events were adjudicated by a blinded external committee. Each composite endpoint analysis was based on (a) the percent of patients with that endpoint and (b) days in study to 1st event (or last exposure if no event occurred).

  • Core Study: Change From Baseline in Left Ventricular End Diastolic Volume (LVEDV) [ Time Frame: Baseline and final visit (after 26 to 36 weeks of treatment) ] [ Designated as safety issue: No ]
    Change from baseline to end of study in left ventricular end diastolic volume (LVEDV) as measured by echocardiography. (LVEDV) is a measurement of the volume of blood in the heart's left ventricular chamber at the beginning of the chamber's filling with blood. This measurement was made by the echocardiography lab. LVEDV values between 67 to 155 mL for men and 56 to 104 mL for women are considered normal. Baseline LVEDV was a covariate.

  • Core Study: Change From Baseline in Left Ventricular Ejection Fraction (LVEF) [ Time Frame: Baseline and final visit (after 26 to 36 weeks of treatment ) ] [ Designated as safety issue: No ]
    Change from baseline to end of study in left ventricular ejection fraction (LVEF) (%) as measured by echocardiography. LVEF is the fraction of blood (in percent) pumped out of the heart's left ventricular chamber with each heart beat, and is a measure of cardiac output for the heart. This measurement was made by the echocardiography lab. Ejection fraction percentages > 55% are considered normal. Baseline LVEF was a covariate.

  • Core Study: Change From Baseline to End of Study in Infarction Segment Length (ISL) as Measured by Echocardiography [ Time Frame: Baseline and final visit (after 26 to 36 weeks of treatment) ] [ Designated as safety issue: No ]
    Change from baseline to end of study in infarction segment length (ISL) (%) as measured by echocardiography. This is the length of the myocardial infarction segment as a percentage of the total cavity perimeter length as calculated by the echocardiography lab. Baseline ISL was a covariate.

  • Core Study: Change From Baseline to End of Study in Wall Motion Score (WMS) as Measured by Echocardiography [ Time Frame: Baseline and final visit (after 26 to 36 weeks of treatment) ] [ Designated as safety issue: No ]
    Change from baseline to end of study in Wall Motion Score (WMS) as measured by echocardiography. WMS was obtained by examining multiple segments of the left ventricle and assigning each segment a score based on myocardial thickening: 1 for normal, 2 for hypokinetic; 3 for akinetic; and 4 for dyskinetic. The WMS was obtained as the average score for the segments visualized and was calculated by the echocardiography lab. Possible values range from 1 to 5. Higher scores are considered worse. Baseline WMS was a covariate.

  • Extension Study: Change From Baseline in Left Ventricular End Systolic Volume (LVESV) at Month 12 [ Time Frame: Baseline(extension study), Month 12 (extension study) ] [ Designated as safety issue: No ]
    Change from baseline to Month 12 in left ventricular end systolic volume (LVESV) as measured by echocardiography. LVESV is a measurement of the volume of blood in the heart's left ventricular chamber at the end of the heart's contraction. This measurement was made by the echocardiography lab. LVESV values between 22 to 58 mL for men and 19-49 mL for women are considered normal.

  • Extension Study: Change From Baseline in Left Ventricular End Diastolic Volume (LVEDV) at Month 12 [ Time Frame: Baseline (extension study), Month 12 (extension study) ] [ Designated as safety issue: No ]
    Change from baseline to Month 12 in left ventricular end diastolic volume (LVEDV) as measured by echocardiography. LVEDV is a measurement of the volume of blood in the heart's left ventricular chamber at the beginning of the chamber's filling with blood. This measurement was made by the echocardiography lab. LVEDV values between 67 to 155 mL for men and 56 to 104 mL for women are considered normal.

  • Extension Study: Change From Baseline in Left Ventricular Ejection Fraction (LVEF) at Month 12 [ Time Frame: Baseline(extension study), Month 12 (extension study) ] [ Designated as safety issue: No ]
    Change from baseline to Month 12 in left ventricular ejection fraction (LVEF) (%) as measured by echocardiography. LVEF is the fraction of blood (in percent) pumped out of the heart's left ventricular chamber with each heart beat, and is a measure of cardiac output for the heart. This measurement was made by the echocardiography lab. Ejection fraction percentages > 55% are considered normal.

  • Extension Study: Percentage of Participants With Orthostatic Blood Pressure Change [ Time Frame: Baseline (Day 0 Extension study), Week 2, Months 1, 3, 6, 9,16, 20, 24 ] [ Designated as safety issue: No ]
    Orthostatic blood pressure change is defined as a decrease of at least 20 mmHg in systolic blood pressure or a decrease of at least 10 mmHg in diastolic blood pressure when a patient moves from a sitting position to a standing position. A patient could show orthostatic blood pressure change at more than one visit. End of study is Month 24 or early discontinuation.

  • Extension Study: Percentage of Participants With Specified Criteria in Selected Labs by Laboratory Parameter [ Time Frame: 24 Months ] [ Designated as safety issue: No ]

    Fasting blood samples were collected throughout the study and were analyzed at a central laboratory. Percentage of participants with the following clinically significant laboratory values are reported:

    Potassium <3.5 mmol/L; Low value (Normal reference range: 3.5- 5.3)

    Potassium >5.5 mmol/L and Potassium >6.0 mmol/L; High values (Normal reference range: 3.5-5.3)

    Creatinine >176.8 μmol/L; High value (Normal reference range= Male: 62- 106 and Female 44- 80)

    Blood Urea Nitrogen (BUN) >14.28; High value (Normal reference range: 2.1- 8.9)



Enrollment: 820
Study Start Date: December 2006
Study Completion Date: July 2011
Primary Completion Date: September 2009 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Aliskiren

Core Study: Aliskiren ascending doses: 75 mg tablet for 1st week, 150 mg for 2nd week, 300 mg for next 34 weeks orally once daily in the morning.

Extension Study: Patients from both the core arms who completed core study and signed informed consent form were included in this arm of extension study.

Patients received 150 mg aliskiren tablet orally once a day for two weeks. Patients were then up-titrated to 300 mg aliskiren orally once a day at the discretion of the principal investigator based on their clinical condition for the duration of the study.

Drug: Aliskiren
Aliskiren was available in 75 mg tablet, 150 mg tablet
Other Name: Tekturna®
Placebo Comparator: placebo
Core study: placebo for 36 weeks once daily in the morning
Drug: placebo
Placebo tablets matching aliskiren for 36 weeks once daily in the morning for core period only.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Core Study Inclusion Criteria:

  • Male or female patients 18 years and older.
  • Patients within 7-42 days of an acute myocardial infarction associated with left ventricular systolic dysfunction.
  • Documented left ventricular systolic dysfunction associated with the qualifying acute myocardial.
  • Patients must be on stable doses of the following concomitant medications for at least 2 weeks prior to Visit 1 unless contraindicated due to intolerance:

    • A Beta-blocker
    • An Anti-platelet agent
    • A Statin
    • An evidence-based dose of an Angiotensin Converting Enzyme Inhibitor (ACEI) or Angiotensin Receptor Blocker (ARB) but not both.
  • Qualifying Echocardiogram at Visit 1:

Core Study Exclusion Criteria:

  • Patients requiring both Angiotensin Converting Enzyme Inhibitor (ACEI) and Angiotensin Receptor Blocker (ARB) combination therapy at V1 or any time during the study.
  • Severe refractory hypertension defined as mean sitting systolic blood pressure (MSSBP) ≥ 180 mmHg and/or mean sitting diastolic blood pressure (MSDBP) ≥ 110 mmHg) at Visit 2.
  • Cardiogenic shock or systolic BP < 100 mmHg or diastolic < 60 mmHg within the 24 hours prior to Visits 1 or 2
  • Estimated Glomerular Filtration Rate (eGFR) < 30 ml/min/1.73m2 using the MDRD formula at Visit 1.
  • Stroke or transient ischemic event (TIA) within 6 months of Study Visit 1

Extension Study Inclusion Criteria:

  • Male or female patients who completed the core study through Visit 10 while on double-blind study drug
  • Patients who were able to participate in the study, and who consented to do so after the purpose and nature of the study had been clearly explained to them (written informed consent)

Extension Study Exclusion Criteria:

  • New York Heart Association (NYHA) class IV Congestive Heart Failure at Visit 1 (Core study Visit 10)
  • Symptomatic hypotension or reported systolic blood pressure (BP) < 90 mmHg within 24 hours prior to Visit 1 (Core study Visit 10)
  • Known Estimated Glomerular Filtration Rate (eGFR) < 30 mL/min/1.73m^2 using the Modification of Diet in Renal Disease (MDRD) formula at Visit 1 (Core study Visit 10)
  • Pregnant or nursing (lactating) women, where pregnancy was defined as the state of a female after conception and until the termination of gestation, confirmed by a positive hCG laboratory test (> 5 mIU/mL)
  • Women of child-bearing potential, defined as all women physiologically capable of becoming pregnant Unless post-menopausal or using an acceptable method of contraception
  • Any surgical or medical condition that in the opinion of the investigator may place the patient at higher risk from his/her participation in the study or was likely to prevent the patient from complying with the requirements or completing the study

Other protocol-defined inclusion/exclusion criteria applied

  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00414609

  Show 23 Study Locations
Sponsors and Collaborators
Novartis
Investigators
Study Chair: Novartis US Novartis
  More Information

No publications provided by Novartis

Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: Novartis
ClinicalTrials.gov Identifier: NCT00414609     History of Changes
Obsolete Identifiers: NCT00699075
Other Study ID Numbers: CSPP100A2340
Study First Received: December 19, 2006
Results First Received: December 20, 2010
Last Updated: July 5, 2012
Health Authority: United States: Food and Drug Administration
Argentina: Administracion Nacional de Medicamentos, Alimentos y Tecnologia Medica
Belgium: Ministry of Social Affairs, Public Health and the Environment
Brazil: National Health Surveillance Agency
Canada: Canadian Institutes of Health Research
Colombia: INVIMA Instituto Nacional de Vigilancia de Medicamentos y Alimentos
Czech Republic: State Institute for Drug Control
Denmark: Danish Medicines Agency
Germany: Federal Institute for Drugs and Medical Devices
Hungary: National Institute of Pharmacy
India: Ministry of Health
Israel: Israeli Health Ministry Pharmaceutical Administration
Italy: The Italian Medicines Agency
South Korea: Korea Food and Drug Administration (KFDA)
Netherlands: Medicines Evaluation Board (MEB)
Norway: Norwegian Medicines Agency
Peru: General Directorate of Pharmaceuticals, Devices, and Drugs
Poland: Office for Registration of Medicinal Products, Medical Devices and Biocidal Products
Russia: Pharmacological Committee, Ministry of Health
Slovakia: State Institute for Drug Control
Spain: Spanish Agency of Medicines
Sweden: Medical Products Agency
Turkey: Ministry of Health
United Kingdom: Medicines and Healthcare Products Regulatory Agency
Venezuela: Ministry of Health and Social Development

Keywords provided by Novartis:
myocardial infarction, aliskiren, heart failure
Post acute myocardial infarction with systolic dysfunction

Additional relevant MeSH terms:
Infarction
Myocardial Infarction
Ventricular Remodeling
Ischemia
Pathologic Processes
Necrosis
Myocardial Ischemia
Heart Diseases
Cardiovascular Diseases
Vascular Diseases
Pathological Conditions, Anatomical

ClinicalTrials.gov processed this record on July 26, 2014