The main objective of this study is to assess the safety, efficacy and dose response of LABR-312 administered intravenously at the time of percutaneous coronary intervention (PCI) with a drug eluting stent in reducing restenosis as measured by Optical Coherence Tomography (OCT) at 9 months post procedure in patients with diabetes mellitus (DM). Administration of LABR-312 at the time of PCI will reduce restenosis compared with placebo as assessed by the OCT endpoint of % neointimal hyperplasia (%NIH) volume at 9 months in patients with DM.
This is a phase IIb, prospective, multi-center, multi-national, randomized, double-blind, two-arm, 1:1 (escalating dose LABR-312 vs. placebo) clinical trial. In both study arms, all target lesions will be treated with the Resolute Integrity Drug Eluting Stent during the index PCI. Lesions that are planned to be treated must be declared and recorded at the time of randomization. Randomization will be stratified by the presence or absence of insulin treatment, HbA1c level (\<7.5% vs. ≥7.5%), and by pre-procedure monocyte count (≥500/uL or below). Subjects (n=\~270) will be randomized to receive either the study drug LABR-312 or the placebo. Conditionally to ongoing safety monitoring, dose escalation of LABR-312 in the study arm will be performed: 0.01 mg (first 45 patients vs. 45 patients receiving placebo), up to 0.03 mg (next consecutive 45 patients vs. 45 patients receiving placebo) and up to 0.08 mg (final 45 consecutive patients vs. 45 patients receiving placebo). If a decision is made not to dose escalate, recruitment will continue with the highest dose level deemed safe by the ongoing safety monitoring, until approximately 270 subjects are randomized. In the LABR-312 group, 3 doses will therefore be tested, resulting in 6 possibilities: Group 1: Low dose 0.01 mg LABR-312 or equivalent volume of placebo (saline) administered IV. Group 2: Intermediate dose Up to 0.03 mg LABR-312 or equivalent volume of placebo (saline) administered IV. Group 3: High dose Up to 0.08 mg LABR-312 or equivalent volume of placebo (saline) administered IV. The duration of subject participation will be 1 year; clinical follow-up will be performed at 30 days, 9 months, and 1year post randomization. OCT follow-up will be performed at 9 months.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
QUADRUPLE
Enrollment
270
administered intravenously at the time of percutaneous coronary intervention (PCI) with a drug eluting stent
administered intravenously at the time of percutaneous coronary intervention (PCI) with a drug eluting stent
Kaplan Medical Center
Rehovot, Israel
%NIH volume
NIH volume/stent volume × 100 at 9 months as measured by the OCT core laboratory (all doses pooled vs. placebo).
Time frame: at 9 months
%NIH at minimum lumen area (MLA) site
Secondary OCT endpoint evaluated at 9 months as measured by the OCT core laboratory
Time frame: 9 months
MLA
Secondary OCT endpoint evaluated at 9 months as measured by the OCT core laboratory
Time frame: 9 months
% area stenosis
Secondary OCT endpoint evaluated at 9 months as measured by the OCT core laboratory
Time frame: 9 months
% stent strut coverage
Secondary OCT endpoint evaluated at 9 months as measured by the OCT core laboratory
Time frame: 9 months
In-stent late loss
Secondary angiographic endpoint evaluated at 9 months
Time frame: 9 months
In-segment percent diameter stenosis (%DS) (within 5mm margins proximal and distal to stent)
Secondary angiographic endpoint evaluated at 9 months
Time frame: 9 months
In-stent %DS
Secondary angiographic endpoint evaluated at 9 months
Time frame: 9 months
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In-segment late loss
Secondary angiographic endpoint evaluated at 9 months
Time frame: 9 months
In-stent late loss compared between the 3 doses of the study drug
Secondary angiographic endpoint evaluated at 9 months
Time frame: 9 months
In-segment binary restenosis (stenosis of >50% of the vessel diameter)
Secondary angiographic endpoint evaluated at 9 months
Time frame: 9 months
In-stent minimum lumen diameter (MLD)
Secondary angiographic endpoint evaluated at 9 months
Time frame: 9 months
Length and patterns of angiographic restenosis (Mehran classification)
Secondary angiographic endpoint evaluated at 9 months
Time frame: 9 months
MACE
Clinical: The composite rate of cardiac death, any MI or ischemia-driven TLR
Time frame: 30 days, 9 months, 1 year
Clinically driven TLR
Clinical: Defined as re-intervention (PCI or CABG) due to stenosis of ≥50% at the level of the index-targeted lesion(s) (inside 5mm proximal and distal to the implanted stent), by quantitative coronary angiography (QCA), with ischemic signs and/or symptoms
Time frame: 30 days, 9 months, 1 year
Clinically driven target vessel revascularization (TVR)
Clinical: Defined as re-intervention (PCI or CABG) due to stenosis of ≥50% inside the targeted epicardial vessel, by QCA, with ischemic signs and/or symptoms
Time frame: 30 days, 9 months, 1 year
TVF
Clinical: Defined as the composite of cardiac death, target vessel MI, or clinically driven TVR
Time frame: 30 days, 9 months, 1 year
TLF
Clinical: Defined as the composite of cardiac death, target vessel MI, or clinically driven TLR
Time frame: 30 days, 9 months, 1 year
Target Vessel Related MI
Clinical: The number of patients who suffer a MI that is related to the target vessel of the procedure.
Time frame: 30 days, 9 months, 1 year
Stroke
Clinical: Major, minor and transient ischemic attack; secondary clinical endpoint evaluated at 30 days, 9 months, and 1 year post procedure
Time frame: 30 days, 9 months, 1 year
All death
Clinical: The number of patients who die from all causes
Time frame: 30 days, 9 months, 1 year
MI
Clinical: The number of patients who suffer a myocardial infarction
Time frame: 30 days, 9 months, 1 year
Composite endpoint of cardiac death or MI
Clinical: The number of patients who die of cardiac-related causes or myocardial infarction
Time frame: 30 days, 9 months, 1 year
Definite or probable ARC defined stent thrombosis
Time frame: 30 days, 9 months, 1 year