Rosiglitazone and Metformin: Outcomes Trial in Nondiabetic Patients With Stable Coronary Syndromes (Romance) Pilot Study

Coronary Artery Disease Clinical Trial

Official title:

A Single-Center, Randomized, Double-Blind, Placebo-Controlled Clinical Trial of Combined Rosiglitazone/Metformin (Avandamet®) vs. Placebo on Serological Outcomes in Non-Diabetic Patients With Stable Coronary Syndromes

Clinical Trial Details — Status: Terminated

Administrative data

• NCT number: NCT00343395
• Other study ID #: 128-013
• Status: Terminated
• Phase: Phase 4
• First received: June 21, 2006
• Last updated: March 15, 2011
• Start date: June 2006
• Est. completion date: January 2008

Study information

• Verified date: March 2011
• Source: Intermountain Health Care, Inc.
• Contact: n/a
• Is FDA regulated: No
• Health authority: United States: Food and Drug Administration
• Study type: Interventional

Clinical Trial Summary

Nearly half of all Americans will die from cardiovascular disease caused by the build up of atherosclerotic plaque within coronary arteries. Most deaths in these patients arise from the development of acute coronary syndromes (ACS) such as myocardial infarction, unstable angina, or sudden death. ACS is characterized by coronary plaque erosion or rupture, which is triggered by endothelial changes, including inflammation, and thrombosis. Diabetes, with insulin resistance as a major component, has been shown to engender adverse metabolic events within the endothelial cell [1], including impaired endothelial function, augmented vasoconstriction, increased inflammation and thrombosis. Activation of the transcription factors nuclear factor KB (NF-KB) and activator protein 1 (AP-1) induces inflammatory gene expression, with liberation of leukocyte-attracting chemokines, increased production of inflammatory cytokines, and augmented expression of cellular adhesion molecules. These metabolic processes may therefore play a significant role in the development of ACS.The hypothesis is that rosiglitazone and metformin, or the combination of both may provide positive anti-atherogenic effect, even among patients without diabetes. This pilot study proposes to evaluate the effect of placebo vs. combined rosiglitazone/metformin (Avandamet®) on surrogate blood markers of atherosclerosis activity among non-diabetic and pre-diabetic patients with known stable coronary syndromes. This will provide further evidence justifying a large definitive outcomes-based clinical trial.

Description:

This is a single-center, randomized, double-blind trial comparing combined rosiglitazone/metformin (Avandametä) to placebo in subjects with normal or intermediate fasting glucose (IFG) and stable coronary artery disease.Subjects meeting entry criteria will be randomized in a 1:1 ratio to receive either placebo or combined rosiglitazone/metformin (Avandametä) 4/1000 mg. Laboratory specimens including high sensitivity C-reactive protein (hs-CRP), glucose, HgbA1C, complete lipid profile, will be obtained after a 10 hour fast as specified by study visits. Subjects will return for repeat study visits at 2, 4, 6 and 8 months for repeat laboratory evaluations, including safety labs consisting of serum creatinine, liver enzymes, and a CBC. Additionally, subjects will have IL-6 and TNF-a measured for research purposes at baseline and subsequent follow-up visits. All subjects will be followed for a minimum of 8 months. This pilot study proposes to evaluate the effect of placebo, or combined rosiglitazone/metformin onsurrogate blood markers of atherosclerosis activity among non-diabetic and pre-diabetic patients with known stable coronary syndromes.

Recruitment information / eligibility

• Status: Terminated
• Enrollment: 200
• Est. completion date: January 2008
• Est. primary completion date: November 2007
• Accepts healthy volunteers: No
• Gender: Both
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• The patient (male or non-pregnant female) must be > 18 years of age.

• The patient or legally authorized representative must sign a written informed consent, prior to the procedure, using a form that is approved by the local Institutional Review Board.

• Angiographically documented coronary artery disease defined as the presence of at least one 50% or greater stenosis of a major coronary artery.

• Stabilized post any prior ACS event (i.e., without ongoing ischemic rest pain, congestive heart failure, or malignant arrhythmias) for at least 3 months

• Fasting blood glucose 87-125 mg/dL

Exclusion Criteria:

• Age <18 years

• Known hypersensitivity to metformin or rosiglitazone

• Renal insufficiency defined as calculated creatinine clearance (CrCl) <40 mL/min using the following formula:

Men: CrCL (mL/min) = Weight (kg) x (140-age) 72 x serum creatinine (mg/dL) Women: 0.85 x the value calculated for men

• Pregnant and/or lactating women, and women of child bearing potential are excluded from this trial

• Co-morbidity such that the patient is not expected to survive >2 years

• Current therapy with rosiglitazone or metformin

• PCI within the previous six months (other than for the qualifying event)

• Prior CABG within the previous two months, scheduled CABG, or a decision to perform CABG made prior to enrollment

• Overt diabetes mellitus (FBG>126 or antidiabetic therapy)

• Any diagnosis of congestive heart failure

• Obstructive hepatobiliary disease or other significant hepatic disease (defined as the presence of at least one of the following: AST, ALT, GGT, total bilirubin, or alkaline phosphatase >3x upper limit normal, not related to MI

• Participation in any other clinical trials involving investigational or marketed products within 30 days prior to entry in the study.

Study Design

Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor), Primary Purpose: Treatment

Related Conditions & MeSH terms

• Coronary Artery Disease
• Coronary Disease
• Myocardial Ischemia

Intervention

Drug:
• AVANDAMET
2/500 mg

Locations

Country	Name	City	State
United States	Intermountain Medical Center	Murray	Utah

Sponsors (2)

Lead Sponsor	Collaborator
Intermountain Health Care, Inc.	GlaxoSmithKline

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	To demonstrate the effect (change from baseline) of each study intervention on hs-C-reactive protein.		Study completion	No
Primary	To demonstrate the safety of the interventions on clinical outcomes (death, MI, cardiovascular hospitalizations) and serious drug-related adverse events.		Study completion	Yes
Secondary	To demonstrate the effect (change from baseline) of each study intervention on lipid levels		Study completion	No
Secondary	To demonstrate the effect (change from baseline) of each study intervention on inflammatory marker levels other than hs-CRP		Study completion	No
Secondary	To demonstrate the effect (change from baseline) of each study intervention on HgbA1C		Study completion	No
Secondary	To demonstrate the effect (change from baseline) of each study intervention on fasting blood glucose		Study completion	No
Secondary	Safety: Differences in adverse events between the two arms		Interim; completion of study	Yes