Trial to Assess Chelation Therapy 2 (TACT2)
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Detailed Description
The primary objective of TACT2, therefore, is to determine if the chelation-based strategy increases the time to the first occurrence of any of the components of the TACT2 primary endpoint: all-cause mortality, myocardial infarction, stroke, coronary revascularization, or hospitalization for unstable angina compared to the placebo chelation strategy.
TACT2 is a 2x2 factorial trial testing 40-weekly edetate disodium-based chelation infusions and twice daily high-dose oral multivitamins and multiminerals (OMVM) in a placebo-controlled design.
TACT2 is being carried out to replicate the findings of TACT1, which found a striking reduction of recurrent cardiovascular events in post-MI diabetic patients receiving edetate disodium-based chelation therapy.
Study Type
Study Type
Enrollment (Actual)
Enrollment
Phase
Phase
- Phase 3
Contacts and Locations
Study Locations
-
-
Florida
-
Miami Beach, Florida, United States, 33132
- Mount Sinai Medical Center
-
-
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Age: ≥ 50 years
- History of diabetes, defined as medical record evidence or patient report of currently using insulin or oral hypoglycemic agents, or with a history of fasting blood glucose measurement of 126 mg/dL or higher, or a history of HbA1c of 6.5% or higher.
History of myocardial infarction based on the Universal Definition of MI.
- When information about the MI hospitalization is available, all MI types except Type 2 qualify for study entry.
- When information about the MI hospitalization is not available, a wall motion abnormality on imaging or a perfusion defect on scan that corresponds to a coronary distribution, whether or not accompanied by pathological Q waves in the appropriate distribution, will qualify the patient for study entry. This criterion requires a call to the CCC for case review.
Exclusion Criteria:
- Baseline serum creatinine >2.0 mg/dL.
- HbA1C >11%.
- Myocardial infarction within 6 weeks of randomization.
- History of allergic reactions to EDTA or any other components of the chelation solution, including heparin. Site personnel are to call the CCC to discuss heparin allergy.
- Coronary or peripheral arterial revascularization procedure performed within the last 6 months.
- Planned revascularization procedure in the 6 months following enrollment.
- Heart failure hospitalization within 6 months prior to enrollment or in clinical heart failure at the time of proposed enrollment (such as NYHA Class 3 dyspnea + rales >basilar, and additional signs of fluid overload). Such patients may be treated with diuretics and enrolled when stable.
- Poor or no venous access in the upper extremities.
a. Prior intravenous chelation therapy consisting of > 1 infusion within 5 years; if only 1 infusion took place, patient cannot be enrolled for at least 12 months after said infusion.
b. Oral chelation therapy with an approved oral chelating agent within 2 years.
- Prior participation in TACT.
- Baseline platelet count <100,000.
- History of cigarette smoking within the last 3 months.
- ALT or AST > 2.0 times the upper limit of normal.
- Wilson's disease, hemochromatosis, or parathyroid disease.
- Any medical condition including a current diagnosis of cancer (except non-melanoma skin cancer) that will limit patient survival over the duration of the trial.
- Any factor that suggests that the potential participant will not be able to adhere to the protocol.
- Women of child-bearing potential including those with plans for post-menopausal in vitro fertilization or other reproductive technology.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Factorial Assignment
- Masking: Triple
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Active Comparator: Active/Active
Active disodium EDTA (chelation) + Active Oral Multi Vitamins/Minerals (OMVM)
|
IV Disodium Ethylene diamine tetra acetic acid in 500 cc
Other Names:
6 tablets of Multi-vitamin/Multimineral daily
|
|
Active Comparator: Active/Placebo
Active disodium EDTA (chelation) + Placebo Oral Multi Vitamins/Minerals (OMVM)
|
IV Disodium Ethylene diamine tetra acetic acid in 500 cc
Other Names:
|
|
Active Comparator: Placebo/ Active
Placebo disodium EDTA (chelation) + Active Oral Multi Vitamins/Minerals (OMVM)
|
6 tablets of Multi-vitamin/Multimineral daily
IV Placebo comparator- 500 normal saline
|
|
Placebo Comparator: Placebo/Placebo
Placebo disodium EDTA (chelation) + Placebo Oral Multi Vitamins/Minerals (OMVM)
|
IV Placebo comparator- 500 normal saline
6 tablets of a placebo Multi-vitamin/Multimineral daily
|
What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Primary Composite Outcome
Time Frame: 48 month follow-up (median)
|
Time to first event: myocardial infarction, stroke, hospitalization for unstable angina, coronary revascularization, or death from any cause
|
48 month follow-up (median)
|
Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Secondary Composite Outcome
Time Frame: 48 month follow-up (median)
|
Time to first event: myocardial infarction, stroke, or death from cardiovascular causes
|
48 month follow-up (median)
|
|
Secondary Outcome
Time Frame: All-Cause Mortality was assessed through study completion, up to 48 months (median)
|
Time to All-Cause mortality
|
All-Cause Mortality was assessed through study completion, up to 48 months (median)
|
Collaborators and Investigators
Sponsor
Sponsor
Collaborators
Collaborators
Investigators
Investigators
- Study Chair: Gervasio A Lamas, MD, Mount Sinai Medical Center of Florida
- Principal Investigator: Kevin J Anstrom, PhD, University of North Carolina, Chapel Hill
- Principal Investigator: Daniel B Mark, MD, Duke University (Duke Clinical Research Institute)
Publications and helpful links
General Publications
- Lamas GA, Goertz C, Boineau R, Mark DB, Rozema T, Nahin RL, Drisko JA, Lee KL. Design of the Trial to Assess Chelation Therapy (TACT). Am Heart J. 2012 Jan;163(1):7-12. doi: 10.1016/j.ahj.2011.10.002.
- Escolar E, Lamas GA, Mark DB, Boineau R, Goertz C, Rosenberg Y, Nahin RL, Ouyang P, Rozema T, Magaziner A, Nahas R, Lewis EF, Lindblad L, Lee KL. The effect of an EDTA-based chelation regimen on patients with diabetes mellitus and prior myocardial infarction in the Trial to Assess Chelation Therapy (TACT). Circ Cardiovasc Qual Outcomes. 2014 Jan;7(1):15-24. doi: 10.1161/CIRCOUTCOMES.113.000663. Epub 2013 Nov 19.
- Lamas GA, Goertz C, Boineau R, Mark DB, Rozema T, Nahin RL, Lindblad L, Lewis EF, Drisko J, Lee KL; TACT Investigators. Effect of disodium EDTA chelation regimen on cardiovascular events in patients with previous myocardial infarction: the TACT randomized trial. JAMA. 2013 Mar 27;309(12):1241-50. doi: 10.1001/jama.2013.2107.
- Lamas GA, Boineau R, Goertz C, Mark DB, Rosenberg Y, Stylianou M, Rozema T, Nahin RL, Terry Chappell L, Lindblad L, Lewis EF, Drisko J, Lee KL. EDTA chelation therapy alone and in combination with oral high-dose multivitamins and minerals for coronary disease: The factorial group results of the Trial to Assess Chelation Therapy. Am Heart J. 2014 Jul;168(1):37-44.e5. doi: 10.1016/j.ahj.2014.02.012. Epub 2014 Apr 2.
- Lamas GA, Anstrom KJ, Navas-Acien A, Boineau R, Kim H, Rosenberg Y, Stylianou M, Jones TLZ, Joubert BR, Santella RM, Escolar E, Aude YW, Fonseca V, Elliott T, Lewis EF, Farkouh ME, Nathan DM, Mon AC, Gosnell L, Newman JD, Mark DB; TACT2 Investigators. The trial to assess chelation therapy 2 (TACT2): Rationale and design. Am Heart J. 2022 Oct;252:1-11. doi: 10.1016/j.ahj.2022.05.013. Epub 2022 May 19.
- Navas-Acien A, Santella RM, Joubert BR, Huang Z, Lokhnygina Y, Ujueta F, Gurvich I, LoIacono NJ, Ravalli F, Ward CD, Jarrett JM, Salazar AL, Boineau R, Jones TLZ, Mark DB, Newman JD, Nathan DM, Anstrom KJ, Lamas GA. Baseline characteristics including blood and urine metal levels in the Trial to Assess Chelation Therapy 2 (TACT2). Am Heart J. 2024 Jul;273:72-82. doi: 10.1016/j.ahj.2024.04.005. Epub 2024 Apr 15.
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Actual)
Primary Completion
Study Completion (Actual)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Estimated)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Vascular Diseases
- Cardiovascular Diseases
- Pathologic Processes
- Heart Diseases
- Necrosis
- Myocardial Ischemia
- Ischemia
- Myocardial Infarction
- Infarction
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Micronutrients
- Protective Agents
- Antidotes
- Anticoagulants
- Chelating Agents
- Sequestering Agents
- Iron Chelating Agents
- Calcium Chelating Agents
- Vitamins
- Edetic Acid
- Pentetic Acid
Other Study ID Numbers
Other Study ID Numbers
- AT009149-01
- UH3AT009149 (U.S. NIH Grant/Contract)
- UH3AT009150 (U.S. NIH Grant/Contract)
- R01AT009273 (U.S. NIH Grant/Contract)
- U24AT009150 (U.S. NIH Grant/Contract)
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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