Short-Term Exposure to Lipophilic Anti-proliferative Drugs Delivered by Angiographic Contrast Media

University Hospital, Saarland

Status and phase: Completed; Phase 2; Phase 1

Conditions: Coronary Artery Disease

Treatments: Device: Implantation of a bare metal stent

Study type: Interventional

Funder types: Other

Identifiers

NCT01140204

1-325-02

Details and patient eligibility

About

This was a randomized, placebo-controlled, multi-centre study, double-blind within each dose level, with four ascending dose levels to test the tolerability and safety of iopromide-paclitaxel in patients with de novo lesions in coronary arteries. Thirty-two patients were included into the trial, which were divided into four treatment groups. A total of four concentration levels of paclitaxel-iopromide concentrations were investigated. In each treatment group, six patients received iopromide-paclitaxel and two patients placebo (iopromide without paclitaxel). In each patient, the doses were adjusted individually as needed.

Full description

Background: Non-stent-based immediate release formulations of paclitaxel have been shown to reduce in-stent restenosis in animal experiments and initial clinical trials. Paclitaxel dissolved in the angiographic contrast agent iopromide was well tolerated and inhibited neointimal proliferation in a dose-dependent manner after injection into porcine coronary arteries.

Methods: As a first step in entering clinical development, a phase I trial was performed using 4 ascending paclitaxel dose/concentration levels: samples of up to 100 ml of the contrast agent containing 10, 50, 100 or 200 μM paclitaxel were randomly administered to 6 adult patients each assigned to bare metal stent implantation for single de novo coronary artery lesions, while 8 patients treated with plain contrast medium served as controls. Safety variables and tolerability as well as angiographic parameters were assessed.

Enrollment: 32 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• male and postmenopausal female patients
• aged 18 years and older
• clinical evidence of stable or unstable angina, a positive functional test and a stentable de novo lesion in a native coronary artery
• diameter stenosis > 70% (visual estimate), lesion length < 25 mm, and a vessel diameter ≥ 2.5 mm.

Exclusion criteria

• acute myocardial infarction
• left ventricular ejection fraction of < 30%
• aorto-ostial lesion
• unprotected left main lesion or a bypass graft
• clear angiographic calcification in the target lesion
• visible thrombus proximal to the lesion
• chronic total occlusion
• platelet count <100,000 cells/mm3 or >700,000 cells/mm3
• WBC <3,000 cells/mm3
• known hypersensitivity or contraindication to aspirin, heparin, clopidogrel, abciximab, paclitaxel, stainless steel
• sensitivity to contrast media not amenable to adequate premedication
• medical illness (i.e. cancer, liver disease or congestive heart failure) associated with a life expectancy of less than two years

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Quadruple Blind

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32 participants in 5 patient groups, including a placebo group

Placebo control

Placebo Comparator group

Description:

Contrast medium without Paclitaxel

Treatment:

Device: Implantation of a bare metal stent

Iopromide Paclitaxel 0.85 mg

Active Comparator group

Description:

Iopromide Paclitaxel 0.85 mg

Treatment:

Device: Implantation of a bare metal stent

Iopromide Paclitaxel 4.27 mg

Active Comparator group

Description:

Iopromide Paclitaxel 4.27 mg

Treatment:

Device: Implantation of a bare metal stent

Iopromide Paclitaxel 8.54 mg

Active Comparator group

Description:

Iopromide Paclitaxel 8.54 mg

Treatment:

Device: Implantation of a bare metal stent

Iopromide Paclitaxel 17.08 mg

Active Comparator group

Description:

Iopromide Paclitaxel 17.08 mg

Treatment:

Device: Implantation of a bare metal stent