A Research Study to Look at How Ziltivekimab Works Compared to Placebo in People With Heart Failure and Inflammation

Study Overview
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Brief Summary
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This study will be done to see if ziltivekimab can be used to treat people living with heart failure and inflammation. Participants will either get ziltivekimab or placebo. The study is expected to last for up to 4 years. Participants will have up to 20 clinic visits. Participants will have to use a study app on their phone to record and share information about all their injections of study medicine and to fill in questionnaires.

Official Title
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HERMES: Effects of Ziltivekimab Versus Placebo on Morbidity and Mortality in Patients With Heart Failure With Mildly Reduced or Preserved Ejection Fraction and Systemic Inflammation

Conditions
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Heart Failure

Intervention / Treatment
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* Drug: Ziltivekimab
* Drug: Placebo


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Serum high-sensitivity C-reactive protein (hs-CRP) greater than equal to 2 milligrams per liter (mg/L) at screening (visit 1) Disease specific - cardiovascular At least one of the following: N-terminal-pro-brain natriuretic peptide (NT-proBNP) greater than equal to 300 picograms per milliliter (pg/mL) at screening (Visit 1) for patients without ongoing atrial fibrillation/flutter. If ongoing atrial fibrillation/flutter at screening (visit 1), NTproBNP must be greater than equal to 600 pg/mL. Hospitalisation or urgent/unplanned visit with a primary diagnosis of decompensated heart failure which required intravenous loop diuretic treatment, within the last 9 months prior to screening (visit 1) in combination with NT-proBNP greater than equal to 200 pg/mL at screening (Visit 1) for patients without ongoing atrial fibrillation/flutter. If ongoing atrial fibrillation/flutter at screening (visit 1), NT-proBNP must be greater than equal to 600 pg/mL. Diagnosis of heart failure (New York Heart Association [classification] [NYHA] Class II-IV). Left ventricular ejection fraction (LVEF) greater than 40 percentage (%) documented by echocardiography within 12 months prior to or at screening (visit 1). The LVEF must be documented in medical records and the most recent measurement must be used to determine eligibility with no interim event signalling potential deterioration in ejection fraction (e.g., myocardial infarction [MI] or heart failure [HF] hospitalisation). Structural heart disease and/or functional heart disease documented by echocardiography within 12 months prior to or at screening (visit 1) showing at least one of the following: Left atrial (LA) volume index greater than 34 milliliter per meter square (mL/m^2). LA diameter greater than equal to 3.8 centimeter (cm). LA length greater than equal to 5.0 cm. LA area greater than equal to 20 cm square. LA volume greater than equal to 55 milliters (mL). Intraventricular septal thickness greater than equal to 1.1 cm. Posterior wall thickness greater than equal to 1.1 cm. Left ventricular (LV) mass index greater than equal to 115 grams per meter square (g⁄m^2 ) in men or greater than equal to 95 g⁄m^2 in women. E/e' (mean septal and lateral) greater than equal to 10. e' (mean septal and lateral) less than 9 centimeter per second (cm/s). No heart failure hospitalisations or urgent heart failure visits between screening (visit 1) and randomisation (visit 2). Exclusion Criteria: Medical conditions - cardiovascular Myocardial infarction, stroke, unstable angina pectoris, transient ischaemic attack, or heart failure hospitalisation, within 30 days prior to screening (visit 1). Systolic blood pressure greater than equal to 180 millimeters of mercury (mmHg) at screening (visit 1). If the systolic blood pressure is 160-179 mmHg, the patient should be receiving greater than equal to 3 antihypertensive drugs. (Note: Potential participants may be retested for this criterion within the visit window and without rescreening, at the discretion of the investigator). Heart rate above 110 or below 40 beats per minute as evaluated on the electrocardiogram (ECG) performed at screening (visit 1) (Note: Potential participants may be retested for this criterion within the visit window and without rescreening, at the discretion of the investigator). Planned coronary, carotid or peripheral artery revascularisation known during the screening period (visit 1). (Note: Planned coronary angiogram is not exclusionary). Planned cardiac device or atrial flutter/atrial fibrillation ablation procedure known during the screening period (visit 1). Major cardiac surgical, non-cardiac surgical, or major endoscopic procedure (thoracoscopic or laparoscopic) within the past 60 days prior to randomisation (visit 2) or any major surgical procedure planned at the time of randomisation (visit 2). Heart failure due to infiltrative cardiomyopathy (e.g., sarcoid, amyloid), arrhythmogenic right ventricular cardiomyopathy, Takutsubo cardiomyopathy, genetic hypertrophic cardiomyopathy or obstructive cardiomyopathy, active myocarditis, constrictive pericarditis, cardiac tamponade, uncorrected more than moderate primary valve disease. Primary pulmonary hypertension, chronic pulmonary embolism, severe pulmonary disease including COPD. Any other condition judged by the investigator that could account for heart failure symptoms and signs (e.g., anaemia, hypothyroidism). Medical conditions - infections/immunosuppression - Clinical evidence of, or suspicion of, active infection at the discretion of the investigator.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Ziltivekimab 15 mg<br>Participants will receive ziltivekimab 15 milligrams (mg) subcutaneous (s.c.) injection once-monthly and added to standard of care for up to 4 years. | Drug: Ziltivekimab<br>* Participants will receive ziltivekimab 15 milligrams (mg) subcutaneous (s.c.) injection once-monthly and added to standard of care for up to 4 years.<br>|
| Placebo Comparator: Placebo<br>Participants will receive ziltivekimab placebo subcutaneous (s.c.) injection once-monthly and added to standard of care for up to 4 years. | Drug: Placebo<br>* Participants will receive ziltivekimab placebo subcutaneous (s.c.) injection once-monthly and added to standard of care for up to 4 years.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time to First Occurrence of a Composite Heart Failure Endpoint Consisting of: Cardiovascular (CV) Death, Heart Failure (HF) Hospitalisation or Urgent HF Visit | Measured in months. | From randomisation (month 0) to end of study (up to 48 months) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time to First Occurrence of 4-point Expanded Composite HF Endpoint, a Composite Endpoint Consisting of: CV Death, HF Hospitalisation or Urgent HF Visit, Non-fatal Myocardial Infarction (MI), Non-fatal Stroke | Measured in months. | From randomisation (month 0) to end of study (up to 48 months) | 
| Number of CV Deaths, HF Hospitalisations or Urgent HF Visits (First and Recurrent) | Measured as count of event. | From randomisation (month 0) to end of study (up to 48 months) | 
| Time to Occurrence of CV Death | Measured in months. | From randomisation (month 0) to end of study (up to 48 months) | 
| Time to Occurrence of all-cause Death | Measured in months. | From randomisation (month 0) to end of study (up to 48 months) | 
| Time to First Occurrence of 4-point Expanded Composite HF Endpoint, a Composite Endpoint Consisting of: All-cause Death, HF Hospitalisation or Urgent HF Visit, Non-fatal MI, Non-fatal stroke | Measured in months. | From randomisation (month 0) to end of study (up to 48 months) | 
| Hierarchical Composite of: Time to All-cause Death, Number of HF Hospitalisations or Urgent HF Visits, Time to First HF Hospitalisation or Urgent HF Visit, difference of at least 5 in KCCQ clinical summary score change from baseline to 12 months | Kansas City Cardiomyopathy Questionnaire (KCCQ) measures Health-Related Quality of Life (HRQOL) and is a disease-specific health status instrument for HF. Score ranges from 0 to 100, with 0 as the lowest score and 100 as the highest score. Higher scores indicate better health status, fewer symptoms, and greater disease-specific health related quality of life, respectively. Measured as total wins for each treatment group. | From randomisation (month 0) to end of study (up to 48 months) | 
| Time to First Occurrence of HF Hospitalisation or Urgent HF Visit | Measured in months. | From randomisation (month 0) to end of study (up to 48 months) | 
| Number of Events of Atrial Fibrillation | Measured as count of event. | From randomisation (month 0) to end of study (up to 48 months) | 
| Change in KCCQ Clinical Summary Score | KCCQ measures Health-Related Quality of Life (HRQOL) and is a disease-specific health status instrument for HF. Score ranges from 0 to 100, with 0 as the lowest score and 100 as the highest score. Higher scores indicate better health status, fewer symptoms, and greater disease-specific health related quality of life, respectively. Measured as score. | From randomisation (month 0) to 12 months | 
| Improvement of 5 Points or More in KCCQ Clinical Summary Score (Yes/No) | Kansas City Cardiomyopathy Questionnaire (KCCQ) measures Health-Related Quality of Life (HRQOL) and is a disease-specific health status instrument for HF. Score ranges from 0 to 100, with 0 as the lowest score and 100 as the highest score. Higher scores indicate better health status, fewer symptoms, and greater disease-specific health related quality of life, respectively. Measured as count of participant. | From randomisation (month 0) to 12 months | 
| Improvement of 10 Points or More in KCCQ Clinical Summary Score (Yes/No) | Kansas City Cardiomyopathy Questionnaire (KCCQ) measures Health-Related Quality of Life (HRQOL) and is a disease-specific health status instrument for HF. Score ranges from 0 to 100, with 0 as the lowest score and 100 as the highest score. Higher scores indicate better health status, fewer symptoms, and greater disease-specific health related quality of life, respectively. Measured as count of participant. | From randomisation (month 0) to 12 months | 
| Improvement in New York Heart Association (Classification) [NYHA Class] (Yes/No) | NEW YORK HEART ASSOCIATION CLASSIFICATION (NYHA) Class I: Participant with cardiac disease but without resulting limitations of physical activity. Class II: Participants with cardiac disease resulting in slight limitation of physical activity. Class III: Participants with cardiac disease resulting in marked limitation of physical activity. Class IV: Participants with cardiac disease resulting in inability to carry on any physical activity without discomfort. Measured as count of participant. | From randomisation (month 0) to 12 months | 
| Time to First Occurrence of a Composite Chronic Kidney Disease (CKD) Endpoint Consisting of: CV death, Onset of Persistent Greater Than Equal To 40 Percentage Reduction in eGFR (CKD- EPI) compared with baseline; Kidney failure | eGFR = estimated glomerular filtration rate; CKD-EPI = chronic kidney disease - epidemiology collaboration. Kidney failure defined as: death from kidney failure, onset of persistent eGFR less than 15 milliliters per minute (mL/min)/1.73 meter square (m^2) (CKD-EPI), initiation of chronic kidney replacement therapy (maintenance dialysis or kidney transplantation). Measured in months. | From randomisation (month 0) to end of study (up to 48 months) | 
| Change in Estimated Glomerular Filtration Rate (eGFR) (Chronic Kidney Disease - Epidemiology Collaboration [CKD-EPI]) | Measured as mL/min/1.73 m^2. | From randomisation (month 0) to 12 months | 
| Annual Rate of Change in eGFR (CKD-EPI) (Total eGFR Slope) | Measured as mL/min/1.73 m^2/year. | From randomisation (month 0) to end of study (up to 48 months) | 
| Number of Hospitalisations With Infection as Primary Cause or Death Due to Infection | Measured as count of event. | From randomisation (month 0) to end of study (up to 48 months) | 
| Change in High-sensitivity C-reactive Protein (hs-CRP) | Measured as ratio to baseline. | From randomisation (month 0) to 12 months | 
| Change in N-terminal-pro-brain Natriuretic Peptide (NT-proBNP) | Measured as ratio to baseline. | From randomisation (month 0) to 12 months |