Clinical trial NCT01670981: An Efficacy, Safety and Tolerability Study of Ixmyelocel-T Administered Via Transendocardial Catheter-based Injections to Subjects With Heart Failure Due to Ischemic Dilated Cardiomyopathy (IDCM)
Official title: Multicenter, Randomized, Double-Blind, Placebo-Controlled, Parallel Group Study to Evaluate the Efficacy, Safety and Tolerability of Transendocardial Injection of Ixmyelocel-T in Subjects With Heart Failure Due to Ischemic Dilated Cardiomyopathy (IDCM).
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE2
Conditions: Ischemic Dilated Cardiomyopathy (IDCM)
Keywords: Ischemic dilated cardiomyopathy
Heart failure
ixCELL
ixCELL DCM
IDCM
DCM
stem cells
MSC
cell therapy
Lead sponsor: Vericel Corporation
Sponsor class: INDUSTRY
First posted: 2012-08-23
Enrollment: 114
Sex: ALL
Minimum age (years): 30
Maximum age (years): 86
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: This study is designed to assess the efficacy, safety and tolerability of ixmyelocel-T compared to placebo (vehicle control) when administered via transendocardial catheter-based injections to patients with end stage heart failure due to IDCM, who have no reasonable revascularization options (either surgical or percutaneous interventional) likely to provide clinical benefit.

Detailed description: The primary objective of this study is to evaluate the efficacy of ixmyelocel-T compared to placebo (vehicle control) on the average per patient number of all-cause deaths, cardiovascular hospital admissions, and unplanned outpatient or emergency department visits to treat acute decompensated heart failure, over the 12 months following administration of investigational product (IP).

Eligibility criteria: Inclusion Criteria:

1. Males and non-pregnant, non-lactating females;
2. Age 30 to 86 years of age;
3. Diagnosis of ischemic dilated cardiomyopathy;
4. LVEF ≤ 35% by echocardiogram;
5. Symptomatic heart failure in NYHA functional class III or IV;
6. Subject is not a candidate for reasonable revascularization procedures that will produce clinical improvement;
7. Subject is receiving appropriate clinical standard of care heart failure therapy, as tolerated and as dictated by a subject's current medical condition, for at least 30 days prior to screening;
8. Must have an automatic implantable cardioverter defibrillator (AICD);
9. Worsening heart failure hospitalization or equivalent within 6 months prior to screening, hospitalization equivalent defined as an unplanned outpatient/emergency department visit for treatment of acute decompensated heart failure; or have an N-terminal prohormone B-type natriuretic peptide (NT-proBNP) ≥2000 pg/mL or BNP ≥400 pg/mL within 30 days of screening (including screening); or have a 6-minute walk test (6MWT) distance of ≤400 meters at screening;
10. Life expectancy of at least 12 months in the opinion of the Investigator;
11. LV wall thickness ≥ 7mm (by echocardiogram) at anticipated target injection area;
12. Hemodynamic stability without IV vasopressors or support devices;
13. Given medical history and concurrent medication, subject is an acceptable candidate for bone marrow aspiration and cardiac catheterization and transendocardial injection procedures in the opinion of the Investigator;
14. Willing and able to comply scheduled visits and tolerate study procedures.
15. Voluntarily provide a personally-signed and dated informed consent.

Exclusion Criteria:

Disease-specific:

1. Severe primary valvular heart disease including, but not limited to, aortic valve stenosis and insufficiency;
2. VAD implantation, heart transplantation, cardiomyoplasty, left ventricular reduction surgery, or cardiac shunt implantation;
3. Planned heart failure-related device interventions (e.g., VAD implantation, initial cardiac resynchronization therapy) or planned cardiac procedures (e.g., heart transplant, cardiomyoplasty, valvular repair);
4. Current arrhythmias that would prohibit accurate NOGA® electromechanical mapping and NOGA®-guided injections;
5. LV thrombus (as documented on echocardiography or LV angiography);
6. Myocardial infarction, stroke or transient ischemic attack within 3 months prior to screening;
7. Percutaneous coronary intervention, valvuloplasty, cardiac surgery, and other major cardiac procedure within 30 days prior to screening;
8. In the opinion of the Investigator, the subject's left ventricular wall is unsuitable for transendocardial injections (due to thickness or other reasons).

   Medical History:
9. Stroke or transient ischemic attack (TIA) within 3 months of screening;
10. Hemoglobin A1c (HbA1c) ≥ 9% at screening;
11. Diabetic subjects with uncontrolled or untreated proliferative retinopathy as determined by dilated eye exam administered by a qualified eye care professional as per American Diabetes Association guidelines;
12. Blood clotting disorder not caused by medication (e.g., thrombophilia);
13. Active malignancy (non-basal cell) requiring surgery, chemotherapy, and/or radiation in the past 12 months;
14. Drug or alcohol abuse that would interfere with the subject's compliance with study procedures;
15. Allergies to any equine, porcine, or bovine products;
16. Body mass index (BMI) ≥ 40 kg/m2 at screening;
17. Established chronic kidney disease (CKD) requiring dialysis (Stage 5); estimated creatinine clearance \< 15 mL/min at screening;
18. Subject has allergy or is unable to tolerate cardiac imaging contrast agents; also the inability to get a good quality echocardiogram image at screening (as determined by the imaging core lab).

    Laboratory Parameters:
19. Abnormal laboratory values (performed at central lab) at screening:

    * Platelets \< 50,000 μL;
    * Hemoglobin \< 9.0 g/dL;
    * Aspartate aminotransferase/alanine aminotransferase (AST/ALT) \> 3 times the upper limit of normal (ULN);
    * Human immunodeficiency virus 1 (HIV 1), HIV 2, or syphilis positive (rapid plasma reagin \[RPR\]);
    * Active hepatitis B surface antigen (HBsAg) or hepatitis C virus (HCV) antibodies;
    * NOTE: Additional lab tests may be performed per local requirements including but not limited to: hepatitis B core antibody, human T lymphotropic virus I/II.

    Exclusionary Procedures, Devices, or Medication:
20. Subjects receiving anti-angiogenic drugs (e.g., anti-vascular endothelial growth factor \[VEGF\]);
21. Chronic exposure to cytotoxic therapy for oncologic or chronic non-oncologic reasons in the prior 3 months or expected requirement over the course of the study;
22. Concurrent participation in another interventional clinical trial or receiving experimental intervention within 30 days of screening or having previously been exposed to Aastrom's ixmyelocel T product or previously received allogeneic cell therapy, autologous cell therapy cultured with animal proteins.
23. In the opinion of the Investigator, the subject is unsuitable for cellular therapy or has a food/drug allergy, surgical or medical condition, clinically significant psychiatric disorders, poor nutritional status, or lab abnormality requiring further medical evaluation that may interfere with the investigational product, interfere with the study results' interpretation, interfere with the subject's ability to complete the study or compromise the subject's safety.

Primary outcomes:
measure: Average number of clinical events over 12 months post-treatment.
timeFrame: 12 Months
Secondary outcomes:
measure: The win ratio of the hierarchical occurrence of all-cause deaths/left ventricular assist device (LVAD) implant/heart transplant, cardiovascular hospitalizations, and unplanned outpatient and ED interventions to treat ADHF
timeFrame: 12 Months
measure: Change from baseline to 12 months post-treatment in 6-minute walk test.
timeFrame: 12 Months
measure: Change from baseline to 12 months post-treatment in left ventricular function as evaluated by echocardiography.
timeFrame: 12 Months
measure: Change from baseline to 12 months post-treatment in quality of life.
timeFrame: 12 Months
measure: Change from baseline to 12 months post-treatment in NYHA Classification.
timeFrame: 12 Months
measure: Percent of patients with adverse events.
timeFrame: 12 Months
measure: Percent of patients with major adverse cardiac events (MACE).
timeFrame: 12 Months
Other outcomes:
Locations:
city: Birmingham
country: United States
facility: Cardiology, P.C. & Center for Therapeutic Angiogenesis
state: Alabama
city: Birmingham
country: United States
facility: University of Alabama at Birmingham
state: Alabama
city: Gilbert
country: United States
facility: Mercy Gilbert Medical Center
state: Arizona
city: Phoenix
country: United States
facility: Mayo Clinic Arizona
state: Arizona
city: La Jolla
country: United States
facility: Scripps Clinic
state: California
city: La Jolla
country: United States
facility: UCSD Medical Center
state: California
city: Los Angeles
country: United States
facility: Cedars-Sinai Heart and Lung Institute
state: California
city: Los Angeles
country: United States
facility: University of California Los Angeles (UCLA)
state: California
city: Oxnard
country: United States
facility: St. John's Regional Medical Center
state: California
city: Stanford
country: United States
facility: Stanford University
state: California
city: Daytona Beach
country: United States
facility: Cardiology Research Associates
state: Florida
city: Gainesville
country: United States
facility: University of Florida - Division of Cardiology
state: Florida
city: Jacksonville
country: United States
facility: Mayo Clinic Florida (Jacksonville)
state: Florida
city: Miami
country: United States
facility: University of Miami - Miller School of Medicine
state: Florida
city: Atlanta
country: United States
facility: Emory University Hospital
state: Georgia
city: Augusta
country: United States
facility: Georgia Regents University
state: Georgia
city: Chicago
country: United States
facility: Rush University Medical Center
state: Illinois
city: New Orleans
country: United States
facility: Ochsner Clinic Foundation
state: Louisiana
city: Boston
country: United States
facility: Massachusetts General Hospital, Division of Cardiology
state: Massachusetts
city: Saginaw
country: United States
facility: Michigan CardioVascular Institute
state: Michigan
city: Rochester
country: United States
facility: Mayo Clinic
state: Minnesota
city: Newark
country: United States
facility: Newark Beth Israel Hospital
state: New Jersey
city: New York
country: United States
facility: Columbia University Medical Center
state: New York
city: Cincinnati
country: United States
facility: The Carl and Edyth Linder Center for Research & Education at The Christ Hospital
state: Ohio
city: Cleveland
country: United States
facility: University Hospitals - Case Medical Center
state: Ohio
city: Philadelphia
country: United States
facility: Temple University
state: Pennsylvania
city: Pittsburgh
country: United States
facility: UPMC Cardiovascular Institute
state: Pennsylvania
city: Pittsburgh
country: United States
facility: Veterans Administration Healthcare System
state: Pennsylvania
city: Germantown
country: United States
facility: Stern Cardiovascular Foundation, Inc.
state: Tennessee
city: Dallas
country: United States
facility: Soltero Cardiovascular Research Center
state: Texas
city: Houston
country: United States
facility: Methodist DeBakey Heart and Vascular Center
state: Texas
city: Salt Lake City
country: United States
facility: University of Utah Health Services Center
state: Utah
city: Seattle
country: United States
facility: Swedish Medical Center - Cherry Hill Professional Building
state: Washington
city: Madison
country: United States
facility: University of Wisconsin-Madison Cardiovascular Medicine
state: Wisconsin
city: Edmonton
country: Canada
facility: University of Alberta Hospital
state: Alberta
city: Montreal
country: Canada
facility: Montreal Heart Institute
state: Quebec
Study officials:
References:
citation: Patel AN, Henry TD, Quyyumi AA, Schaer GL, Anderson RD, Toma C, East C, Remmers AE, Goodrich J, Desai AS, Recker D, DeMaria A; ixCELL-DCM Investigators. Ixmyelocel-T for patients with ischaemic heart failure: a prospective randomised double-blind trial. Lancet. 2016 Jun 11;387(10036):2412-21. doi: 10.1016/S0140-6736(16)30137-4. Epub 2016 Apr 5.