Effect of Short-term Prednisone Therapy on C-reactive Protein in Patients With Acute Heart Failure

Acute Heart Failure Clinical Trial

— CORTAHF  

Official title:

Effect of Short-Term Prednisone Therapy on C-reactive Protein Change in Emergency Department Patients With Acute Heart Failure and Elevated Inflammatory Markers

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT05916586
• Other study ID #: CHF202301
• Status: Recruiting
• Phase: N/A
• Start date: August 11, 2023
• Est. completion date: October 2024

Study information

• Verified date: January 2024
• Source: Heart Initiative
• Contact: Maria Novosadova, MD
• Phone: +41614851250
• Email: MariaNovosadova[@]momentum-research.com
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This is a multicenter, parallel-group, randomized, open-label, controlled trial. Patients with a diagnosis of acute heart failure (AHF) in the emergency department (ED) or after emergency presentation to hospital will be screened and informed of the study. After signed consent, patients will be randomized into the control group (usual AHF treatment) or intervention group (usual AHF treatment + prednisone). Prednisone will be given for 7 days. Patients will be assessed at days 2, 4 or at discharge if earlier, and at day 7 at hospital visit. If the patient has been discharged before day 7, a follow-up visit will be scheduled at day 7 for endpoints assessment followed by a scheduled hospital visit at day 31 and a telephone follow-up at day 91. Study drug will be dispensed for the patient to take home until day 7.

Description:

CORTAHF is a parallel-group, comparative, open-label, randomised (1:1), controlled trial. Patients with a diagnosis of AHF in the ED or after emergency presentation to hospital will be screened and informed of the study. After signed consent, patients will be randomized into the control group (usual AHF treatment) or intervention group (usual AHF treatment + prednisone).

Prednisone will be given for 7 days. Patients will be assessed at days 2, 4 or at discharge if earlier, and at day 7 at hospital visit. If the patient has been discharged before day 7, a follow-up visit will be scheduled at day 7 for endpoints assessment followed by a scheduled hospital visit at day 31 and a telephone follow-up at day 91. Study drug will be dispensed for the patient to take home until day 7.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 120
• Est. completion date: October 2024
• Est. primary completion date: October 2024
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 85 Years

Eligibility

Inclusion Criteria:

1. Age 18 to 85 years of age

2. Unplanned ED visit or hospital presentation within the 12 hours prior to Screening with acute or worsening dyspnea and/or orthopnea, and pulmonary congestion on chest X-ray or lung ultrasound.

3. All measures from presentation to randomization of systolic blood pressure = 100 mmHg, and of heart rate = 60 bpm.

4. Written informed consent to participate in the study.

5. Biomarker levels indicative of congestion and inflammation: At Screening, NT-proBNP > 1,500 pg/mL and CRP > 20 mg/L

6. Patient agrees for follow-up visits at the hospital at day 7 in case of earlier discharge and Day 31.

Exclusion Criteria:

1. Anticipated life expectancy less than 6 months

2. Mechanical ventilation (not including CPAP/BIPAP) prior to Screening.

3. Significant pulmonary disease contributing substantially to the patients' dyspnea such as FEV1< 1 liter or need for chronic systemic or non-systemic steroid therapy, or any kind of primary right heart failure such as primary pulmonary hypertension or recurrent pulmonary embolism.

4. Myocardial infarction, unstable angina or cardiac surgery within 3 months, or cardiac resynchronization therapy (CRT) device implantation within 3 months, or percutaneous transluminal coronary intervention (PTCI), within 1 month prior to inclusion.

5. Index Event (admission for AHF) triggered primarily by a correctable etiology such as significant arrhythmia (e.g., sustained ventricular tachycardia, or atrial fibrillation/flutter with sustained ventricular response >130 beats per minute, or bradycardia with sustained ventricular arrhythmia <45 beats per minute), infection, severe anemia, acute coronary syndrome, pulmonary embolism, exacerbation of COPD, planned admission for device implantation or severe non-adherence leading to very significant fluid accumulation prior to admission and brisk diuresis after admission. Troponin elevations without other evidence of an acute coronary syndrome are not an exclusion.

6. Uncorrected thyroid disease, active myocarditis, or known amyloid or hypertrophic obstructive cardiomyopathy.

7. History of heart transplant or on a transplant list, or using or planned to be implanted with a ventricular assist device.

8. Sustained ventricular arrhythmia with syncopal episodes within the 3 months prior to screening that is untreated.

9. Presence at screening of any hemodynamically significant valvular stenosis or regurgitation, except mitral or tricuspid regurgitation secondary to left ventricular dilatation, or the presence of any hemodynamically significant obstructive lesion of the left ventricular outflow tract.

10. Primary liver disease considered to be life threatening

11. Renal disease or eGFR < 30 or > 80 mL/min/1.73m2 (as estimated by the simplified MDRD formula) at inclusion or history of dialysis.

12. Systemic steroid therapy, within 30 days from inclusion.

13. Inability to consent, or patient under guardianship measure

14. Participation in another intervention trial in the past 30 days

15. Anticipated non-adherence to study protocol or follow-up.

16. Pregnant or nursing (lactating) women.

17. Known hypersensitivity to steroids or constituents of prednisone tablets (excipients)

18. Psychotic states not yet controlled by treatment

19. Concomitant administration of live vaccines and up to 3 months after end of corticotherapy administration.

20. Patient under legal protection measure (tutorship or curatorship) and patient deprived of freedom

21. Persons subject to psychiatric care without their consent

Related Conditions & MeSH terms

• Acute Heart Failure
• Heart Failure

Intervention

Drug:
• Prednisone
Prednisone 40 mg orally once a day for 7 days

Locations

Country	Name	City	State
Armenia	"Armenia" Republican Medical Center	Yerevan
Armenia	"Mikaelyan" Surgery Institute	Yerevan
Armenia	Erebouni Medical Center	Yerevan

Sponsors (1)

Lead Sponsor	Collaborator
Heart Initiative

Country where clinical trial is conducted

Armenia, 

References & Publications (22)

Arrigo M, Jessup M, Mullens W, Reza N, Shah AM, Sliwa K, Mebazaa A. Acute heart failure. Nat Rev Dis Primers. 2020 Mar 5;6(1):16. doi: 10.1038/s41572-020-0151-7. — View Citation

Burstin H. "Crossing the Quality Chasm" in emergency medicine. Acad Emerg Med. 2002 Nov;9(11):1074-7. doi: 10.1111/j.1553-2712.2002.tb01560.x. No abstract available. — View Citation

Cannon JA, McKean AR, Jhund PS, McMurray JJ. What can we learn from RELAX-AHF compared to previous AHF trials and what does the future hold? Open Heart. 2015 Dec 23;2(1):e000283. doi: 10.1136/openhrt-2015-000283. eCollection 2015. — View Citation

Cotter G, Dittrich HC, Weatherley BD, Bloomfield DM, O'Connor CM, Metra M, Massie BM; Protect Steering Committee, Investigators, and Coordinators. The PROTECT pilot study: a randomized, placebo-controlled, dose-finding study of the adenosine A1 receptor antagonist rolofylline in patients with acute heart failure and renal impairment. J Card Fail. 2008 Oct;14(8):631-40. doi: 10.1016/j.cardfail.2008.08.010. Epub 2008 Sep 14. — View Citation

Davison BA, Senger S, Sama IE, Koch GG, Mebazaa A, Dickstein K, Samani NJ, Metra M, Anker SD, Cleland JG, Ng LL, Mordi IR, Zannad F, Filippatos GS, Hillege HL, Ponikowski P, van Veldhuisen DJ, Lang CC, van der Meer P, Nunez J, Bayes-Genis A, Edwards C, Voors AA, Cotter G. Is acute heart failure a distinctive disorder? An analysis from BIOSTAT-CHF. Eur J Heart Fail. 2021 Jan;23(1):43-57. doi: 10.1002/ejhf.2077. Epub 2021 Jan 22. — View Citation

Du Clos TW. Function of C-reactive protein. Ann Med. 2000 May;32(4):274-8. doi: 10.3109/07853890009011772. — View Citation

EuroQol Group. EuroQol--a new facility for the measurement of health-related quality of life. Health Policy. 1990 Dec;16(3):199-208. doi: 10.1016/0168-8510(90)90421-9. — View Citation

Freund Y, Cachanado M, Delannoy Q, Laribi S, Yordanov Y, Gorlicki J, Chouihed T, Feral-Pierssens AL, Truchot J, Desmettre T, Occelli C, Bobbia X, Khellaf M, Ganansia O, Bokobza J, Balen F, Beaune S, Bloom B, Simon T, Mebazaa A. Effect of an Emergency Department Care Bundle on 30-Day Hospital Discharge and Survival Among Elderly Patients With Acute Heart Failure: The ELISABETH Randomized Clinical Trial. JAMA. 2020 Nov 17;324(19):1948-1956. doi: 10.1001/jama.2020.19378. — View Citation

Goonewardena SN, Stein AB, Tsuchida RE, Rattan R, Shah D, Hummel SL. Monocyte Subsets and Inflammatory Cytokines in Acute Decompensated Heart Failure. J Card Fail. 2016 May;22(5):358-65. doi: 10.1016/j.cardfail.2015.12.014. Epub 2015 Dec 17. — View Citation

Kalogeropoulos AP, Tang WH, Hsu A, Felker GM, Hernandez AF, Troughton RW, Voors AA, Anker SD, Metra M, McMurray JJ, Massie BM, Ezekowitz JA, Califf RM, O'Connor CM, Starling RC, Butler J. High-sensitivity C-reactive protein in acute heart failure: insights from the ASCEND-HF trial. J Card Fail. 2014 May;20(5):319-26. doi: 10.1016/j.cardfail.2014.02.002. Epub 2014 Feb 12. — View Citation

Le Conte P, Terzi N, Mortamet G, Abroug F, Carteaux G, Charasse C, Chauvin A, Combes X, Dauger S, Demoule A, Desmettre T, Ehrmann S, Gaillard-Le Roux B, Hamel V, Jung B, Kepka S, L'Her E, Martinez M, Milesi C, Morawiec E, Oberlin M, Plaisance P, Pouyau R, Raherison C, Ray P, Schmidt M, Thille AW, Truchot J, Valdenaire G, Vaux J, Viglino D, Voiriot G, Vrignaud B, Jean S, Mariotte E, Claret PG. Management of severe asthma exacerbation: guidelines from the Societe Francaise de Medecine d'Urgence, the Societe de Reanimation de Langue Francaise and the French Group for Pediatric Intensive Care and Emergencies. Ann Intensive Care. 2019 Oct 10;9(1):115. doi: 10.1186/s13613-019-0584-x. — View Citation

Liu C, Ge N, Zhai JL, Zhang JX. Dexamethasone-induced diuresis is associated with inhibition of the renin-angiotensin-aldosterone system in rats. Kaohsiung J Med Sci. 2016 Dec;32(12):614-619. doi: 10.1016/j.kjms.2016.09.007. Epub 2016 Oct 27. — View Citation

Liu C, Liu G, Zhou C, Ji Z, Zhen Y, Liu K. Potent diuretic effects of prednisone in heart failure patients with refractory diuretic resistance. Can J Cardiol. 2007 Sep;23(11):865-8. doi: 10.1016/s0828-282x(07)70840-1. — View Citation

Liu C, Zhao Q, Zhen Y, Zhai J, Liu G, Zheng M, Ma G, Wang L, Tian L, Ji L, Li L, Duan L, Liu K. Effect of Corticosteroid on Renal Water and Sodium Excretion in Symptomatic Heart Failure: Prednisone for Renal Function Improvement Evaluation Study. J Cardiovasc Pharmacol. 2015 Sep;66(3):316-22. doi: 10.1097/FJC.0000000000000282. — View Citation

Mebazaa A, Yilmaz MB, Levy P, Ponikowski P, Peacock WF, Laribi S, Ristic AD, Lambrinou E, Masip J, Riley JP, McDonagh T, Mueller C, deFilippi C, Harjola VP, Thiele H, Piepoli MF, Metra M, Maggioni A, McMurray J, Dickstein K, Damman K, Seferovic PM, Ruschitzka F, Leite-Moreira AF, Bellou A, Anker SD, Filippatos G. Recommendations on pre-hospital & early hospital management of acute heart failure: a consensus paper from the Heart Failure Association of the European Society of Cardiology, the European Society of Emergency Medicine and the Society of Academic Emergency Medicine. Eur J Heart Fail. 2015 Jun;17(6):544-58. doi: 10.1002/ejhf.289. Epub 2015 May 21. — View Citation

Metra M, Teerlink JR, Cotter G, Davison BA, Felker GM, Filippatos G, Greenberg BH, Pang PS, Ponikowski P, Voors AA, Adams KF, Anker SD, Arias-Mendoza A, Avendano P, Bacal F, Bohm M, Bortman G, Cleland JGF, Cohen-Solal A, Crespo-Leiro MG, Dorobantu M, Echeverria LE, Ferrari R, Goland S, Goncalvesova E, Goudev A, Kober L, Lema-Osores J, Levy PD, McDonald K, Manga P, Merkely B, Mueller C, Pieske B, Silva-Cardoso J, Spinar J, Squire I, Stepinska J, Van Mieghem W, von Lewinski D, Wikstrom G, Yilmaz MB, Hagner N, Holbro T, Hua TA, Sabarwal SV, Severin T, Szecsody P, Gimpelewicz C; RELAX-AHF-2 Committees Investigators. Effects of Serelaxin in Patients with Acute Heart Failure. N Engl J Med. 2019 Aug 22;381(8):716-726. doi: 10.1056/NEJMoa1801291. — View Citation

Nieminen MS, Dickstein K, Fonseca C, Serrano JM, Parissis J, Fedele F, Wikstrom G, Agostoni P, Atar S, Baholli L, Brito D, Colet JC, Edes I, Gomez Mesa JE, Gorjup V, Garza EH, Gonzalez Juanatey JR, Karanovic N, Karavidas A, Katsytadze I, Kivikko M, Matskeplishvili S, Merkely B, Morandi F, Novoa A, Oliva F, Ostadal P, Pereira-Barretto A, Pollesello P, Rudiger A, Schwinger RH, Wieser M, Yavelov I, Zymlinski R. The patient perspective: Quality of life in advanced heart failure with frequent hospitalisations. Int J Cardiol. 2015 Jul 15;191:256-64. doi: 10.1016/j.ijcard.2015.04.235. Epub 2015 May 1. — View Citation

Oppe, M., R. Rabin, et al. (2008). EQ-5D User Guide. Version 1.0. Rotterdam, The Netherlands, The EuroQol Group.

Raess N, Schuetz P, Cesana-Nigro N, Winzeler B, Urwyler SA, Schaedelin S, Rodondi N, Blum MR, Briel M, Mueller B, Christ-Crain M, Blum CA. Influence of Prednisone on Inflammatory Biomarkers in Community-Acquired Pneumonia: Secondary Analysis of a Randomized Trial. J Clin Pharmacol. 2021 Nov;61(11):1406-1414. doi: 10.1002/jcph.1914. Epub 2021 Jul 27. — View Citation

RECOVERY Collaborative Group; Horby P, Lim WS, Emberson JR, Mafham M, Bell JL, Linsell L, Staplin N, Brightling C, Ustianowski A, Elmahi E, Prudon B, Green C, Felton T, Chadwick D, Rege K, Fegan C, Chappell LC, Faust SN, Jaki T, Jeffery K, Montgomery A, Rowan K, Juszczak E, Baillie JK, Haynes R, Landray MJ. Dexamethasone in Hospitalized Patients with Covid-19. N Engl J Med. 2021 Feb 25;384(8):693-704. doi: 10.1056/NEJMoa2021436. Epub 2020 Jul 17. — View Citation

Wedzicha JA Ers Co-Chair, Miravitlles M, Hurst JR, Calverley PM, Albert RK, Anzueto A, Criner GJ, Papi A, Rabe KF, Rigau D, Sliwinski P, Tonia T, Vestbo J, Wilson KC, Krishnan JA Ats Co-Chair. Management of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline. Eur Respir J. 2017 Mar 15;49(3):1600791. doi: 10.1183/13993003.00791-2016. Print 2017 Mar. — View Citation

Yao TC, Huang YW, Chang SM, Tsai SY, Wu AC, Tsai HJ. Association Between Oral Corticosteroid Bursts and Severe Adverse Events : A Nationwide Population-Based Cohort Study. Ann Intern Med. 2020 Sep 1;173(5):325-330. doi: 10.7326/M20-0432. Epub 2020 Jul 7. — View Citation

* Note: There are 22 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Change of CRP level	Change of CRP level, defined by CRP level at day 7 minus CRP level at inclusion.	7 days
Secondary	WHF adverse event, death, or hospital readmission	Time to first event of WHF adverse event, death, or hospital readmission for decompensated HF to day 91.	91 days
Secondary	Change in quality of life	Changes in quality of life measured by the EQ-5D-5L from randomization to day 7.	7 days