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Eligibility
for people ages 18 years and up
Location
at Fresno, California and other locations
Dates
study started
estimated completion:

Description

Summary

The Cardiovascular Inflammation Reduction Trial (CIRT) is a randomized clinical trial investigating whether taking low-dose methotrexate reduces heart attacks, strokes, or death in people with type 2 diabetes or metabolic syndrome that have had a heart attack or multiple coronary blockages. This trial is funded by the National Heart, Lung, and Blood Institute (NHLBI)/National Institutes of Health (NIH).

Official Title

A Randomized, Double-blind, Placebo-controlled, Event-driven Trial of Weekly Low-dose Methotrexate (LDM) in the Prevention of Cardiovascular Events Among Stable Coronary Artery Disease Patients With Type 2 Diabetes or Metabolic Syndrome

Details

While inflammation contributes crucially to atherothrombosis, it is unknown whether inhibition of inflammation per se will lower vascular event rates. The primary aim of the Cardiovascular Inflammation Reduction Trial (CIRT) is to directly test the inflammatory hypothesis of atherothrombosis by evaluating whether or not low-dose methotrexate (LDM) will reduce rates of myocardial infarction, stroke, and cardiovascular death among stable coronary artery disease patients with type 2 diabetes or metabolic syndrome, conditions associated with an enhanced pro-inflammatory response. CIRT is a randomized, double-blind, placebo-controlled, multi-center, event-driven trial that will randomize 7,000 men and women from the United States and Canada. Following a five- to six-week open-label run-in (maximum 8 weeks), eligible participants who have either suffered documented myocardial infarction in the past or have angiographically demonstrated multivessel coronary artery disease in the past will be randomly allocated over a three to four year period to usual care plus placebo or usual care plus LDM. The target methotrexate dose among those allocated to active therapy is 15 to 20 mg po per week, a dose within the range of that commonly used for the treatment of rheumatoid arthritis. All study participants will additionally receive 1.0 mg oral folate to be taken daily six days per week. LDM complications will be minimized through education programs for all investigators and coordinators, through enhanced communication with study participants, by limiting enrollment to those with no evidence of malignancy, hepatitis, renal dysfunction, chronic infection, pulmonary disease, or other risk factors for toxicity; by conducting an initial 5- to 6-week active-therapy run-in (maximum 8 weeks) designed to eliminate individuals who are either intolerant of or unable to adhere to treatment before randomization; and through regular monitoring of liver function and hematologic indices using a centralized methodology designed to ensure participant safety, allow for dose adjustments while maintaining the study blind, and provide an efficient method to address issues of compliance and follow-up on a cost-effective centralized basis. The primary trial endpoint is the rate of myocardial infarction, stroke, or cardiovascular death. Secondary and tertiary endpoints include all-cause mortality, coronary revascularization, incident congestive heart failure, incident peripheral artery disease, incident venous thrombosis, clinically significant aortic stenosis, incident atrial fibrillation, incident diabetes among those with metabolic syndrome but not diabetes at study entry, and hemoglobin A1c (HbA1c) control among those with diabetes at study entry. The trial is event driven such that in the absence of extreme effects, the trial will conclude after accrual of at least 530 primary endpoints, an effect estimated to provide 90 percent power to detect a 25 percent relative risk reduction. The potential clinical impact of CIRT is broad as it has sufficient power to directly address core issues in the inflammatory hypothesis of atherothrombosis, and thus, if successful, will open major new directions for cardiovascular treatment.

Keywords

Cardiovascular Disease Myocardial Infarction Stroke Cardiovascular death Type 2 Diabetes Metabolic Syndrome Cardiovascular Inflammation Atherothrombosis Methotrexate

Eligibility

You can join if…

Open to people ages 18 years and up

  • Age ≥ 18 years at screening
  • Documented past history of myocardial infarction OR past evidence of multivessel coronary artery disease by angiography.
  • To qualify on the basis of past history of myocardial infarction, the event must be documented either by hospital records or by evidence on current ECG of Q waves in two contiguous leads and/or an imaging test demonstrating wall motion abnormality or scar. The patient must also have completed any planned coronary revascularization procedures associated with the qualifying event, and be clinically stable for at least 60 days prior to screening.
  • To qualify on the basis of multivessel coronary disease, there must be past angiographic evidence of atherosclerosis in at least 2 major epicardial vessels defined either as the presence of a stent, a coronary bypass graft, or an angiographic lesion of 60% or greater. Left main coronary artery disease that has been revascularized with a stent or bypass graft will qualify as multivessel disease, as will the presence of a 50% or greater isolated left main stenosis.The patient must also have completed any planned coronary revascularization procedures associated with the qualifying event, and be clinically stable for at least 60 days prior to screening.
  • History of type 2 diabetes or metabolic syndrome at time of study enrollment
  • Willingness to participate as evidenced by signing the study informed consent

You CAN'T join if...

  • Prior history of chronic infectious disease, tuberculosis, or severe fungal disease;chronic hepatitis B or C infection; renal insufficiency; interstitial pneumonitis,bronchiectasis, or pulmonary fibrosis; known chronic pericardial effusion, pleural effusion, or ascites; chronic liver disease; myeloproliferative disorders in the past 5 years; non-basal cell malignancy or treated lymphoproliferative disease within the past 5 years; known HIV positive; life expectancy of < 3 years;
  • Chronic inflammatory condition such as lupus or rheumatoid arthritis, ulcerative colitis or Crohn's disease
  • White blood cell count < 3,500/ul, hematocrit < 32 percent, or platelet count <75,000/ul
  • Liver transaminase levels (AST or ALT)>upper limit of normal (ULN) or albumin < the lower limit of normal (LLN);
  • Creatinine clearance < 40 ml/min as estimated with the Cockroft-Gault equation;
  • History of alcohol abuse or unwillingness to limit alcohol consumption to less than 4 drinks per week
  • Women of child bearing potential, even if they are currently using contraception, and women intending to breastfeed.
  • Men who plan to father children during the study period or who are unwilling to use effective forms of contraception.
  • Requirement for use of drugs that alter folate metabolism(trimethoprim/sulfamethoxazol) or reduce tubular excretion (probenecid) or known allergies to antibiotics making avoidance of trimethoprim impossible;
  • Current indication for methotrexate therapy;
  • Chronic use of oral steroid therapy or other immunosuppressive or biologic response modifiers. Eligible study participants will be encouraged to have up to date pneumococcal and influenza vaccinations as recommended based on their age and underlying medical conditions.
  • Chest X-ray evidence in the past 12 months of interstitial pneumonitis,bronchiectasis, or pulmonary fibrosis. For participants who do not have a chest X-ray in the prior 12 months, a chest X-ray will be obtained at baseline as part of the study protocol.
  • New York Heart Association Class IV congestive heart failure.

Locations

  • Touro University California- Solano County Affiliated Clinics accepting new patients
    Fairfield, California, 94533, USA
  • Center for Cardiovascular Care accepting new patients
    San Jose, California, 95116, USA
  • Pacific Heart and Vascular Medical Group accepting new patients
    Stockton, California, 95210, USA
  • Touro University California- Solano Public Health Affiliated Clinics accepting new patients
    Vallejo, California, 94592, USA
  • Oracle Clinical Research, Inc. accepting new patients
    Anaheim, California, 92801, USA
  • Central Cardiology Medical Clinic withdrawn
    Bakersfield, California, 93308, USA
  • Ram Dandillaya MD, Inc. withdrawn
    Beverly Hills, California, 90211, USA
  • Matin - Landmark Clinical Trials, LLC accepting new patients
    Culver City, California, 90230, USA
  • Medical Group of Culver City accepting new patients
    Culver City, California, 90230, USA
  • Sun Valley Research Center withdrawn
    Imperial, California, 92251, USA
  • UCSD Sulpizio Cardiovascular Center accepting new patients
    La Jolla, California, 92037, USA
  • University Of California San Diego accepting new patients
    La Jolla, California, 92093, USA
  • Kumar Medical Corporation accepting new patients
    Lancaster, California, 93534, USA
  • Loma Linda University Health accepting new patients
    Loma Linda, California, 92354, USA
  • Torrance Clinical Research Inc withdrawn
    Lomita, California, 90717, USA
  • Long Beach Center for Clinical Research accepting new patients
    Long Beach, California, 90807, USA
  • Cardiovascular Innovation and Research accepting new patients
    Long Beach, California, 90813, USA
  • Los Alamitos Cardiovascular accepting new patients
    Los Alamitos, California, 90720, USA
  • Faye Montegrande Md. Clinical Research accepting new patients
    Los Angeles, California, 90004, USA
  • Axis Clinical Trials withdrawn
    Los Angeles, California, 90017, USA
  • University of Southern California accepting new patients
    Los Angeles, California, 90033, USA
  • Axis Clinical Trials withdrawn
    Los Angeles, California, 90036, USA
  • West LA VA Medical Center accepting new patients
    Los Angeles, California, 90049, USA
  • Shervin Eshaghian M.D., Inc. (Beverly Hills Cardiology) withdrawn
    Los Angeles, California, 90067, USA
  • Anthony Mills M.D., Inc. withdrawn
    Los Angeles, California, 90096, USA
  • Central Coast Cardiology accepting new patients
    Monterey, California, 93940, USA
  • Spectrum Clinical Research Institute, Inc. withdrawn
    Moreno Valley, California, 92553, USA
  • Albert Sharf, MD withdrawn
    National City, California, 91950, USA
  • Valley Clinical Trials, Inc. accepting new patients
    Northridge, California, 91325, USA
  • Orange County Heart Institute & Research accepting new patients
    Orange, California, 92868, USA
  • University of CA Irvine Medical Center accepting new patients
    Orange, California, 92868, USA
  • Diverse Research Solutions accepting new patients
    Oxnard, California, 93030, USA
  • Huntington Memorial Hospital accepting new patients
    Pasadena, California, 91105, USA
  • Arroya Medical Group withdrawn
    Pismo Beach, California, 93449, USA
  • Eisenhower Desert Cardiology Center withdrawn
    Rancho Mirage, California, 92270, USA
  • Central Coast Cardiology accepting new patients
    Salinas, California, 93901, USA
  • Richard G. Friedman, MD accepting new patients
    San Diego, California, 92103, USA
  • Ritchken and First MDs accepting new patients
    San Diego, California, 92117, USA
  • Foundation for Cardiovascular Medicine accepting new patients
    San Diego, California, 92121, USA
  • San Diego Cardiac Center accepting new patients
    San Diego, California, 92123, USA
  • Veterans Affairs San Diego Healthcare System accepting new patients
    San Diego, California, 92161, USA
  • Coastal Heart Medical Group, Inc. accepting new patients
    Santa Ana, California, 92704, USA
  • Comprehensive Cardiovascular Care accepting new patients
    Santa Maria, California, 93454, USA
  • Manoj D. Aswani M.D. accepting new patients
    Thousand Oaks, California, 91360, USA
  • Shiva Heart Center withdrawn
    Wildomar, California, 92595, USA

Details

Status
accepting new patients
Start Date
Completion Date
(estimated)
Sponsor
Brigham and Women's Hospital
ID
NCT01594333
Phase
Phase 3
Study Type
Interventional
Last Updated
November 2016