The goal of this clinical trial is to learn if drug atibuclimab (IC14) works to treat adults hospitalized with acute decompensated heart failure (ADHF). It will also learn about the safety of IC14. The main questions it aims to answer are: Is the drug IC14 safe in patients with ADHF? What are the IC14 drug levels in the bloodstream after treatment with IC14? What is the impact of IC14 treatment on markers of disease in the bloodstream? What is the impact of IC14 treatment on measures of heart failure? There is no placebo arm in this study. Participants will: Take drug IC14 once via an intravenous infusion After the infusion, be visited in the hospital or visit the clinic 5 times for checkups and tests Answer questions about their medical status via a phone call 3 months after the infusion
The proposed investigation is a pilot study to evaluate the safety and exploratory efficacy of IC14 administered via IV infusion in patients with ADHF. The primary objective of this study is to determine safety of intravenous IC14 in patients acute decompensated heart failure. Exploratory biomarkers, clinical outcomes, and pharmacokinetic/pharmacodynamic measurements will be used to design further study of clinical efficacy of IC14 in the treatment of ADHF. To characterize safety of IC14 administered via IV infusion, the following assessments are to be performed: treatment-emergent adverse events (AEs), safety laboratory studies, serious adverse events (SAEs), and presence of anti-drug antibodies. To evaluate the effect of IC14, biomarkers including high-sensitivity C-reactive protein (hsCRP), B-type natriuretic peptide (BNP), urine sodium, and estimated glomerular filtration rate (eGFR) are measured at baseline and repeatedly after IC14 treatment. CRP is an established prognostic marker in heart failure that reflects systemic interleukin-6 as well as interleukin-1 activities. Measuring CRP area-under-the-curve allows for integrating measurements across multiple time points to quantify the acute inflammatory response more accurately. Preliminary clinical efficacy will be measured by evaluating heart failure and cardiac performance outcomes at Day 10, including Dyspnea Visual Analogue Scale, Congestion Score, Doppler echocardiogram, non-invasive hemodynamics, bioimpedance analysis, cardiopulmonary exercise test and Kansas City Cardiomyopathy Questionnaire. Pharmacokinetics will determine the serum concentration of IC14 over time. Pharmacokinetic measurements will be correlated with pharmacodynamic markers of IC14 biologic effect, including monocyte CD14 receptor occupancy.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
10
Atibuclimab (IC14) is a monoclonal antibody against human cluster of differentiation (CD)14, a key signaling molecule of the innate immune system
University of Virginia
Charlottesville, Virginia, United States
Virginia Commonwealth University
Richmond, Virginia, United States
Safety of IC14 treatment
safety measured by treatment-emergent adverse events, including abnormal laboratory values
Time frame: 0-28 days
Anti-Drug Antibodies following IC14 treatment
anti-drug antibodies
Time frame: 0-28 days
C-reactive protein, biomarker of inflammation
area under the curve (0 \[normal\]; 1-10 mg/dL \[moderate elevation\]; \> 10 mg/dL \[marked elevation\] per time)
Time frame: baseline, 24 hours, 72 hours or discharge, Day 10, Day 29
B-type natriuretic peptide, biomarker of heart failure
absolute value (\<100 pg/mL \[normal\], \>=100 pg/mL \[heart failure\])
Time frame: baseline, 24 hours, 72 hours or discharge, Day 10, Day 29
Estimated glomerular filtration rate, biomarker of heart failure
absolute value(\>=90 ml/min/1.73 m2 \[normal\]; 60-89 \[possible impairment\]; 15-59 \[impairment\]; \<15 \[renal failure\])
Time frame: baseline, 72 hours or discharge, Day 10, Day 29
Urine sodium
absolute value (40-220 milliequivalents/day)
Time frame: baseline, 24 hours, 72 hours or discharge
Dyspnea Visual Analogue Scale
10-cm Visual Analogue Scale
Time frame: baseline, 24 hours, 72 hours, Day 10, Day 29, and 3 months (virtual).
Congestion Score
a composite score of one point for peripheral edema, jugular venous distension ≥10 cm, pulmonary rales, or S3 gallop (0 \[good\] to 4 \[poor\])
Time frame: baseline, 24 hours, 72 hours, Day 10, and Day 29
Loop diuretic requirement
total loop diuretic requirement (in furosemide equivalents) as calculated from concomitant medication listings
Time frame: during the first 72 hours of hospitalization
Doppler echocardiogram
Change from baseline in left ventricular ejection fraction (left ventricular ejection fraction (\>52% male, \>54% female \[normal\])
Time frame: baseline, Day 10
Echocardiogram
Change from baseline in left ventricular global longitudinal strain (normal 21%)
Time frame: baseline, Day 10
Non-invasive hemodynamic assessment
Measure of cardiac output
Time frame: baseline, 24 hours, 72 hours, Day 1
Bioimpedance analysis
Measure of extracellular fluid as a marker of heart failure
Time frame: baseline, 24 hours, 72 hours, Day 1
Cardiopulmonary exercise test
aerobic exercise capacity (peak oxygen consumption \[VO2\]; \<30 mL/kg/min \[sedentary\])
Time frame: Day 10
Pharmacokinetic determination of half-life, maximum concentration and area-under-the-curve
serum IC14 level
Time frame: baseline, 15 minutes, 6 hours, 24 hours, 72 hours, Day 10, Day 29
Pharmacodynamics
Duration of monocyte CD14 receptor occupancy \>90%
Time frame: Day 10, Day 29
Ex-vivo leukocyte release assay
Lipopolysaccharide-stimulated release of interleukin 6
Time frame: Day 10
Kansas City Cardiomyopathy Questionnaire
Questionnaire for the patient that reports on 23 aspects of how heart failure affects the patient's life (0\[worst symptoms/limitations\]-100\[least symptoms/limitations and excellent quality of life\])
Time frame: baseline to 3 months
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