A Comparison Of Outcomes In Patients In New York Heart Association (NYHA) Class II Heart Failure When Treated With Eplerenone Or Placebo In Addition To Standard Heart Failure Medicines - Full Text View

Sponsor:	Pfizer
Information provided by (Responsible Party):	Pfizer
ClinicalTrials.gov Identifier:	NCT00232180

Purpose

In an earlier study, eplerenone was shown to improve survival in patients who had heart failure immediately following a heart attack. However, it is not known how patients with established mild-to-moderate heart failure (NYHA Class II), who have the additional risk of sudden death, will respond if treated with eplerenone. In this trial, eplerenone plus standard heart failure medicines is being compared to placebo plus standard heart failure medicines in terms of an additional ability to prolong life and prevent re-hospitalizations for worsening heart failure in these patients.

The Data Safety Monitoring Committee (DSMC) observed during its conduct of the protocol-specified second interim analysis on the 6th of May, 2010 that the efficacy of eplerenone had met the pre-specified stopping rules in the protocol. As a result of the discussion between the DSMC and the Executive Steering Committee (ESC), the ESC recommended that EMPHASIS-HF should be terminated, Based on the convincing efficacy and the consideration that it would be unethical not to offer this treatment to patients, the ESC recommended that all the patients in the trial should be transferred to open-label eplerenone. The Open Label Extension eplerenone arm will last for 12 months. Eplerenone is not currently approved for the indication studied in this patient population.

On May 26, 2010, further enrollment into EMPHASIS-HF was stopped. The amendment is considered to be the most appropriate way to ensure that all the subjects who participated in the double-blind phase of the EMPHASIS-HF trial can be offered treatment with eplerenone

Condition	Intervention	Phase
Heart Failure	Drug: Eplerenone	Phase III

Study Type:	Interventional
Study Design:	Allocation: Non-Randomized Endpoint Classification: Safety Study Intervention Model: Single Group Assignment Masking: Open Label Primary Purpose: Treatment
Official Title:	The Effect Of Eplerenone Versus Placebo On Cardiovascular Mortality And Heart Failure Hospitalization In Subjects With NYHA Class II Chronic Systolic Heart Failure

Resource links provided by NLM:

MedlinePlus related topics: Heart Failure

U.S. FDA Resources

Further study details as provided by Pfizer:

Primary Outcome Measures:

Number of Participants With First Occurrence of Cardiovascular (CV) Mortality or Hospitalization Due to Heart Failure (HF) (Adjudicated) [ Time Frame: Baseline (30 March 2006) up to 50 months (25 May 2010) ] [ Designated as safety issue: Yes ]
CV mortality is defined as death due to heart failure, myocardial infarction, cardiac arrhythmia, stroke / cerebral vascular accident (CVA), other CV cause (such as aneurysm or pulmonary embolism). Hospitalization due to HF is defined as an overnight stay, or longer, in a hospital environment (emergency room, observation unit or in-patient care, or similar facility including admission to a day care facility) due to HF as the primary reason for hospitalization as determined by the Endpoint Committee Adjudicator.

Secondary Outcome Measures:

Number of Participants With First Occurrence of All-cause Mortality or HF Hospitalization (Adjudicated) [ Time Frame: Baseline (30 March 2006) up to 50 months (25 May 2010) ] [ Designated as safety issue: Yes ]
Death due to any cause or first of occurence HF hospitalization. HF hospitalization is defined as an overnight stay, or longer, in a hospital environment (emergency room, observation unit or in patient care, or similar facility including admission to a day care facility) due to HF as the primary reason for hospitalization as determined by the Endpoint Committee Adjudicator.
Number of Participants With First Occurrence of All-cause Mortality (Adjudicated) [ Time Frame: Baseline (30 March 2006) up to 50 months (25 May 2010) ] [ Designated as safety issue: Yes ]
Death due to any cause.
Number of Participants With First Occurrence of CV Mortality (Adjudicated) [ Time Frame: Baseline (30 March 2006) up to 50 months (25 May 2010) ] [ Designated as safety issue: Yes ]
CV mortality is defined as death due to heart failure, myocardial infarction, cardiac arrhythmia, stroke / cerebral vascular accident (CVA), other CV cause (such as aneurysm or pulmonary embolism).
Number of Participants With First Occurrence of All-cause Hospitalization (Adjudicated) [ Time Frame: Baseline (30 March 2006) up to 50 months (25 May 2010) ] [ Designated as safety issue: Yes ]
Hospitalization due to any cause is defined as an overnight stay, or longer, in a hospital environment (emergency room, observation unit or in-patient care, or similar facility including admission to a day care facility).
Number of Participants With First Occurrence of HF Hospitalization (Adjudicated) [ Time Frame: Baseline (30 March 2006) up to 50 months (25 May 2010) ] [ Designated as safety issue: Yes ]
First occurrence of HF hospitalization. Hospitalization due to HF is defined as an overnight stay, or longer, in a hospital environment (emergency room, observation unit or in patient care, or similar facility including admission to a day care facility) due to HF as the primary reason for hospitalization as determined by the Endpoint Committee Adjudicator.
Number of Participants With First Occurrence of All-cause Mortality or All-cause Hospitalization (Adjudicated) [ Time Frame: Baseline (30 March 2006) up to 50 months (25 May 2010) ] [ Designated as safety issue: Yes ]
Death due to any cause or hospitalization due to any cause. Hospitalization due to any cause is defined as an overnight stay, or longer, in a hospital environment (emergency room, observation unit or in-patient care, or similar facility including admission to a day care facility).
Number of Participants With First Occurrence of HF Mortality or HF Hospitalization (Adjudicated) [ Time Frame: Baseline (30 March 2006) up to 50 months (25 May 2010) ] [ Designated as safety issue: Yes ]
Death due to HF or first occurence of HF hospitalization. Hospitalization due to HF is defined as an overnight stay, or longer, in a hospital environment (emergency room, observation unit or in patient care, or similar facility including admission to a day care facility) due to HF as the primary reason for hospitalization as determined by the Endpoint Committee Adjudicator.
Number of Participants With First Occurrence of CV Hospitalization (Adjudicated) [ Time Frame: Baseline (30 March 2006) up to 50 months (25 May 2010) ] [ Designated as safety issue: Yes ]
First occurrence of CV hospitalization. CV hospitalization is defined as hospitalization due to HF (first or subsequent), acute myocardial infarction, angina pectoris (unstable), cardiac arrhythmia (atrial fibrillation [AF], atrial flutter, supraventricular arrhythmias, or ventricular arrhythmias), stroke / CVA, other CV reasons (such as hypotension or peripheral vascular disease), implantation of a cardioverter defibrillator (ICD), or cardiac resynchronization therapy (CRT) with CV event as the primary reason for hospitalization as determined by Endpoint Committee Adjudicator.
Number of Participants With First Occurrence of Fatal or Nonfatal Myocardial Infarction (Adjudicated) [ Time Frame: Baseline (30 March 2006) up to 50 months (25 May 2010) ] [ Designated as safety issue: Yes ]
Number of Participants With First Occurrence of Fatal or Nonfatal Stroke (Adjudicated) [ Time Frame: Baseline (30 March 2006) up to 50 months (25 May 2010) ] [ Designated as safety issue: Yes ]
Number of Participants With First Occurrence of Implantation of Cardiac Defibrillator (ICD) (Adjudicated) [ Time Frame: Baseline (30 March 2006) up to 50 months (25 May 2010) ] [ Designated as safety issue: Yes ]
Number of Participants With First Occurrence of Implantation of Resynchronization Device (Cardiac Resynchronization Therapy [CRT]) (Adjudicated) [ Time Frame: Baseline (30 March 2006) up to 50 months (25 May 2010) ] [ Designated as safety issue: Yes ]
First occurrence of implantation of resynchronization device. CRT is use of a specialized pacemaker to re-coordinate the action of the right and left ventricles in heart failure.
Number of Participants With First Occurrence of Hospitalization Due to Worsening Renal Function (Adjudicated) [ Time Frame: Baseline (30 March 2006) up to 50 months (25 May 2010) ] [ Designated as safety issue: Yes ]
First occurrence of hospitalization due to worsening renal function. Hospitalization due to worsening renal function is defined as an overnight stay, or longer, in a hospital environment (emergency room, observation unit or in-patient care, or similar facility including admission to a day care facility) due to worsening renal function as the primary reason for hospitalization as determined by Endpoint Committee Adjudicator. Worsening renal function is defined as doubling of serum creatinine level from baseline level.
Number of Participants With First Occurrence of Hospitalization Due to Hyperkalemia (Adjudicated) [ Time Frame: Baseline (30 March 2006) up to 50 months (25 May 2010) ] [ Designated as safety issue: Yes ]
First occurrence of hospitalization due to hyperkalemia. Hospitalization due to hyperkalemia is defined as an overnight stay, or longer, in a hospital environment (emergency room, observation unit or in-patient care, or similar facility including admission to a day care facility) due to hyperkalemia as the primary reason for hospitalization as determined by Endpoint Committee Adjudicator. Hyperkalemia is defined as serum potassium level > 5.5 milliequivalents per liter (mEq/L).
Number of Participants With New Onset Atrial Fibrillation or Flutter [ Time Frame: Baseline (30 March 2006) up to 50 months (25 May 2010) ] [ Designated as safety issue: Yes ]
New onset of atrial fibrillation or flutter is defined as the diagnosis of atrial fibrillation or flutter in a subject after randomization, where atrial fibrillation was not present before randomization.
Number of Participants With New Onset Diabetes Mellitus (DM) [ Time Frame: Baseline (30 March 2006) up to 50 months (25 May 2010) ] [ Designated as safety issue: Yes ]
The definition of new onset diabetes mellitus is the diagnosis of diabetes mellitus in a participating subject after randomization, when DM was not present before randomization.

Enrollment:	2752
Study Start Date:	March 2006
Estimated Study Completion Date:	November 2011
Primary Completion Date:	May 2010 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Active Comparator: Eplerenone arm Eplerenone administered on top of background standard heart failure therapy	Drug: Eplerenone Eplerenone administered on top of background standard heart failure therapy

Eligibility

Ages Eligible for Study:	55 Years and older
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

History (Hx) of chronic systolic heart failure of ischemic or non-ischemic etiology of at least 4 weeks duration; Currently, New York Heart Association (NYHA) functional Class II and on optimal dose, or maximally tolerated dose of standard heart failure medicines (advisable to include ACE-I/ARBs; beta-blockers) and diuretics if indicated for fluid overload. Should have participated in the double-blind phase of the EMPHASIS-HF trial

Exclusion Criteria:

Severe chronic systolic heart failure symptomatic at rest despite optimal medical therapy; estimated glomerular filtration rate (eGFR) <30 ml/min/1.73m2.

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT00232180

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Sponsors and Collaborators

Pfizer

Investigators

Study Director:

Pfizer CT.gov Call Center

Pfizer

More Information

Additional Information:

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No publications provided by Pfizer

Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Zannad F, McMurray JJ, Krum H, van Veldhuisen DJ, Swedberg K, Shi H, Vincent J, Pocock SJ, Pitt B; EMPHASIS-HF Study Group. Eplerenone in patients with systolic heart failure and mild symptoms. N Engl J Med. 2011 Jan 6;364(1):11-21. Epub 2010 Nov 14.

Zannad F, McMurray JJ, Drexler H, Krum H, van Veldhuisen DJ, Swedberg K, Shi H, Vincent J, Pitt B. Rationale and design of the Eplerenone in Mild Patients Hospitalization And SurvIval Study in Heart Failure (EMPHASIS-HF). Eur J Heart Fail. 2010 Jun;12(6):617-22. Epub 2010 Apr 13.

Responsible Party:	Pfizer
ClinicalTrials.gov Identifier:	NCT00232180 History of Changes
Other Study ID Numbers:	A6141079
Study First Received:	September 30, 2005
Results First Received:	May 20, 2011
Last Updated:	October 12, 2011
Health Authority:	United States: Food and Drug Administration

Keywords provided by Pfizer:

Open-label
single arm mortality/morbidity trial eplerenone chronic systolic heart failure

Additional relevant MeSH terms:

Heart Failure
Heart Failure, Systolic
Heart Diseases
Cardiovascular Diseases
Eplerenone
Spironolactone
Aldosterone Antagonists
Hormone Antagonists

Hormones, Hormone Substitutes, and Hormone Antagonists
Physiological Effects of Drugs
Pharmacologic Actions
Diuretics
Natriuretic Agents
Cardiovascular Agents
Therapeutic Uses

ClinicalTrials.gov processed this record on February 09, 2012