effect of rvx000222 on time to major adverse cardiovascular events in high-risk t2dm subjects with cad

Conditions: Diabetes Mellitus, Type 2; Coronary Artery Disease

Summary: the purpose of this study is to determine whether bromodomain extraterminal domain (bet) inhibition treatment with rvx000222 in high-risk type 2 diabetes mellitus patients with coronary artery disease increases the time to major adverse cardiovascular events.

the majority (75%) of deaths in subjects with diabetes mellitus (dm) are due to atherosclerotic cardiovascular disease (cvd). recent studies suggest a major adverse cardiovascular event (mace) rate of \>11% over 18 months in type 2 diabetes mellitus (t2dm) despite a baseline ldl-c of \<2.1 mmol/l. bromodomains (brds) are a family of evolutionary conserved protein-interaction modules that play key functions in chromatin organization and regulation of gene transcription. one recognized family of bromodomain-containing proteins is the bromodomain and extra-terminal (bet) family. bet inhibition represents a novel, epigenetic approach to treat cad. rvx000222 affects biological processes important in atherosclerosis and acute coronary events via selective inhibition of bet proteins. rvx000222 is available as a capsule formulation with standard excipients and established stability. the betonmace study will focus on prevention of subsequent mace in subjects with cad and dm with high intensity statin therapy as co-medication.

Eligibility criteria:
inclusion criteria: • acs event of either unstable angina or myocardial infarction 7-90 days prior visit 1: unstable angina: for a qualifying unstable angina event, each of components (a), (b), and (c) must be satisfied: a.) characteristic ischemic pain or discomfort in chest/associated referral areas, occurring at rest/with minimal exertion b.) ecg changes consistent with acute myocardial ischemia based on new/presumed st elevation/depression or t-wave inversion c.) objective evidence of obstructive cad based on 1+ of the following: i. new/presumed new evidence of myocardial ischemia/infarction by perfusion imaging ii. new/presumed new regional wall motion abnormality iii. current evidence of at least 1 epicardial coronary artery stenosis ≥70% by coronary angiography iv. need for coronary revascularization for the index acs event, including a percutaneous coronary intervention (pci) with or without coronary stenting. prior mi 7-90 days prior screening treated with or without a percutaneous coronary intervention (pci). for a qualifying event of mi 2 of the following 3 criteria must be satisfied: a.) characteristic ischemic chest pain/pain in associated referral areas b.) dynamic elevation of troponin t/i or ckmb if troponint/i is unavailable at local lab (at least \>uln for lab) c.) development of new q-waves in ≥2 adjacent ecg leads or development of new dominant r wave in v1 * documented diagnosis of t2dm (1+ of the following criteria): documented history of t2dm, history of taking diabetes medication, and/or hba1c ≥6.5% at visit 1 * for males hdl-c\<40 mg/dl(1.04 mmol/l), for females hdl-c\<45 mg/dl(1.17 mmol/l) at visit 1 * subjects currently not on high intensity statin therapy could start rosuvastatin at visit 1 and those currently on therapy besides atorvastatin/rosuvastatin can be switched to rosuvastatin at visit 1 * female subjects of non-childbearing potential (post-surgical sterilization/post-menopausal) or if childbearing potential have neg urine pregnancy test and be willing and able to use non-hormonal birth control (non-hormonal iud, condom or diaphragm) or remain abstinent from screening to follow-up visit * give signed informed consent exclusion criteria: * heart disease which will w/in 90 days of visit 1 likely need coronary bypass, pci, cardiac transplantation, surgical repair and/or replacement * previous/current diagnosis of severe heart failure or documented lvef\<25% determined by contrast left ventriculography, radionuclide ventriculography or echocardiography. absence of lvef measurement in subject w/out a previous/current diagnosis of heart failure does not exclude entry into study * evidence of cardiac ep instability incl. history of uncontrolled ventricular arrhythmias, atrial fibrillation/flutter or supraventricular tachycardias w/ a ventricular response hr\>100bpm at rest w/in 4 wks prior visit 1 * cabg w/in 90 days prior visit 1 * evidence of severe renal impairment as determined by either egfr\<30 ml/min/1.7m2 at visit 1 or current need for dialysis * uncontrolled hypertension defined as 2 consecutive measurements of sitting bp of systolic\>180 mmhg or diastolic\>100 mmhg at visit 1 * treatment w/ immunosuppressants w/in 12 mos prior visit 1 * use of fibrates at any dose or niacin/nicotinic acid 250+ mg w/in 30 days prior visit 1 * known allergy/sensitivity to any ingredient in imp * history of intolerance to atorvastatin/rosuvastatin * triglycerides\>400 mg/dl (4.52 mmol/l) at visit 1 * any medical/surgical condition which might significantly alter absorption, distribution, metabolism or excretion of medication * evidence of cirrhosis from liver imaging/biopsy, history of hepatic encephalopathy, esophageal/gastric varices, active hepatitis or prior porta-caval shunt procedure or a child-pugh score of ≥5 points * alt/ast\>1.5xuln by central lab at visit 1 * tot. bilirubin\>uln by central lab at visit 1 * history of malignancy of any organ syst treated/untreated w/in the past 2 yrs whether or not there is evidence of local recurrence/metastases except localized basal skin cell carcinoma * history/evidence of drug/alcohol abuse w/in 12 mos of visit 1 * pregnancy * any condition which may place subject at higher risk from his/her participation in the study or is likely to prevent subject from completing/complying w/ requirements of study * use of other investigational drugs and devices w/in 30 days or 5 half-lives of visit 1, whichever is longer * history of noncompliance to medical regimens or unwillingness to comply w/ study protocol * any condition that would confound the evaluation/interpretation of efficacy and/or safety data * persons directly involved in execution of this protocol