A Study to Assess the Safety, Tolerability, and Effects of MK-0974 (Telcagepant) on Exercise Tolerance in Patients With Stable Angina (MK-0974-014)

A Double-Blind, Randomized, Placebo-Controlled, 2-Period Crossover Study to Assess the Safety, Tolerability, and Effects of MK-0974 on Exercise Tolerance in Patients With Stable Angina

This study will assess the safety of telcagepant in coronary artery disease (CAD) participants with stable angina during exercise treadmill testing and evaluate whether calcitonin gene-related peptide (CGRP) receptor antagonism by telcagepant reduces exercise tolerance in these participants. Primary hypothesis is that telcagepant does not significantly decrease exercise duration compared to placebo, as measured by a treadmill exercise test; that is, the true treatment difference in exercise duration (MK-0974 - Placebo) >= -60 seconds.

Study Overview

• Status: Completed
• Conditions: Angina Pectoris; Coronary Heart Disease; Calcitonin Gene-related Peptide Receptor
• Intervention / Treatment: Drug: telcagepant; Drug: Placebo to telcagepant

Detailed Description

Amendment 3 of the protocol reduced the dose of telcagepant to be administered from a single dose of 900 mg to a single dose of 600 mg. Pooled data from both the 600-mg and the 900-mg group wiil be utilized in the analyses. Also due to supply issues regarding the 300 mg telcagepant capsules, 280 mg telcagepant tablets with demonstrated bioequivalence to the 300 mg telcagepant capsules, could be administered to participants enrolled after the implementation of Amendment 3.

• Study Type: Interventional
• Enrollment (Actual): 64
• Phase: Phase 1

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 85 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion:

• Participant has clinically documented stable coronary artery disease as demonstrated by coronary angiography, echocardiogram, or stress test, etc., or participant is on stable doses of current medication for the treatment of coronary artery disease for a minimum of 30 days.
• Participant has a history of stable angina (chronic stable angina pectoris that is triggered by physical effort and relieved by rest and/or sublingual nitroglycerin) for at least 3 months prior to study start, with no intervening symptoms of unstable angina.
• Participant is able to demonstrate reproducibly positive exercise tests by completing treadmill tests on 2 separate days, within 1-8 days.
• Participant agrees to refrain from drinking alcohol from 24 hours prior to study drug administration, on study procedure days, and until release from the study facility.
• Participants agrees to refrain from smoking from midnight before study procedures until study procedures are complete for the day.
• Participant has no clinically significant abnormality on screening laboratory safety assessment.
• Participant agrees to refrain from unaccustomed strenuous physical activity from the prestudy (screening) visit, throughout the study, and until the post-study visit.

Exclusion:

• Participant is pregnant (positive serum beta-human chorionic gonadotropin [β-hCG] test at prestudy), breast-feeding, or is a female expecting to conceive within the projected duration of the study. Postmenopausal women who are currently using hormone replacement therapy are excluded from participation in the study.
• Participant has electrocardiogram (ECG) findings that interfere with ECG interpretation or may cause false positive stress test (e.g., > 1 mm horizontal or downsloping ST-segment depression at rest in any standard electrocardiographic lead, Lown-Ganong-Levine syndrome, Wolff-Parkinson-White (WPW), left bundle branch block (LBBB), left ventricular hypertrophy (LVH) with repolarization abnormality, pectus excavatum, ventricular pacemaker, etc.). Note: these ECG findings may affect stress test results; there may be other findings that have not been included which may affect test results. These ECG findings are exclusions only if these findings may jeopardize interpretation of stress test results.
• Participant has heart rate-corrected QT interval (QTc) (Bazett) > 500 ms on resting ECG.
• Participant has uncontrolled high blood pressure at prestudy screening.
• Participant has a baseline heart rate of <40 or >96 beats per minute at screening.
• Participant has unstable angina, hypertrophic cardiomyopathy, valvular heart disease, congenital cardiac defect, severe aortic stenosis, class III or IV heart failure.
• Participant has diabetes and is, in the opinion of the investigator, unable to comply with the pre-and post-dosing fasting requirements of the study due to risks of hypoglycemia.
• Participant is unable to withhold acetohexamide, chlorpropamide, glimepride, glimepiride and pioglitazone, glimepride and rosiglitazone, glipizide, glipizide and metformin, glyburide, glyburide and metformin, tolazamide, tolbutamide, or any other medication, that in the opinion of the investigator is likely to result in hypoglycemia within 8 hours of dosing.
• Participant has had myocardial infarction or coronary revascularization within the prior 2 months.
• Participant has acute myocarditis or pericarditis.
• Participant is obese, with adipose tissue which may interfere with ECG interpretation, or in the opinion of the investigator, whose obesity puts the participant at medical risk.
• Participant has clinically significant hypokalemia or hypomagnesemia.
• Participant has a history of any illness that, in the opinion of the investigator, might confound the results of the study or poses an additional risk to the participant by their participation in the study.
• Participant must not have taken any of the following medications in the time frame specified: Participant is unable to refrain from or anticipates the use of any herbal remedies beginning approximately 2 weeks (or 5 half-lives) prior to administration of the initial dose of study drug, throughout the study (including washout intervals between treatments), until the post-study visit; participant is unable to refrain from taking a drug metabolized by cytochrome P450 3A4 (CYP3A4) until at least 48 hours post dose (the exact length of time a specific drug metabolized by CYP3A4 is withheld is dependent on the therapeutic index of the drug and the extent to which it is metabolized by CYP3A4); participant consumes excessive amounts of alcohol which, in the opinion of the investigator, puts the participant at medical risk by participating in the study (participant has clinical [e.g., enlarged liver] or laboratory evidence [e.g., elevated alanine aminotransferase (ALT)], of chronic alcoholism or drug abuse, in the opinion of the investigator); participants is currently a regular user (including: recreational use") of any illicit drugs or has a history of drug (including alcohol) abuse within approximately 6 months; participant has taken potent CYP3A4 inhibitors, including but not limited to cyclosporine, systemic (oral/intravenous) itraconazole, ketoconazole, erythromycin, clarithromycin, telithromycin, nefazodone, human immunodeficiency virus (HIV) protease inhibitors within 1 month prior to dosing with MK-0974 or placebo and throughout the study period; participant has taken moderate CYP3A4 inhibitors, including but not limited to verapamil, diltiazem, fluconazole, fluvoxamine, fluoxetine, aprepitant within 2 weeks prior to dosing with MK-0974 or placebo and throughout the study period; participant has taken potent CYP3A4 inducers, including but not limited to rifampicin, rifabutin, carbamazepine, phenytoin, barbiturates, systemic glucocorticoids (replacements and inhaled are permitted), nevirapine, efavirenz, pioglitazone, primidone, St. John's wort within 1 month prior to dosing MK-0974 or placebo and throughout the study period; participant has taken triptans, ergot alkaloids within 48 hours prior to dosing MK-0974 or placebo and throughout the study period; participant has taken digoxin, medications that prolong QTc interval such as Class IA and Class III anti-arrhythmics (quinidine, procainamide, amiodarone, sotalol, etc), Seldane (terfenadine), Hismanal (astemizole), Propulsid (cisapride) within 1 month prior to dosing MK-0974 or placebo and throughout the study period; participant has received an investigational medication within 4 weeks prior to the prestudy (screening) visit.
• Participant has a history of multiple and/or severe allergies, or has had an anaphylactic reaction or intolerability to prescription or non-prescription drugs or food.
• There is any concern by the investigator regarding the safe participation of a participant in the study, or for any other reason the investigator considers the participant inappropriate to participate in the study.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Telcagepant/ Placebo; Participants receive single oral dose of 600 mg (two 300 mg capsules or two bioequivalent 280 mg tablets) or 900 mg telcagepant (three 300 mg capsules) in Period 1 and single oral dose of two capsules or tablets of placebo for telcagepant (or three capsules of placebo for telcagepant) in Period 2 of the crossover. Each treatment period is separated by a washout of 96-240 hours.	Drug: telcagepant; Other Names: MK-0974; Drug: Placebo to telcagepant
Experimental: Placebo/Telcagepant; Participants receive single oral dose of two capsules or tablets of placebo for telcagepant (or three capsules of placebo for telcagepant) in Period 1 and a single oral dose of 600 mg (two 300 mg capsules or two bioequivalent 280 mg tablets) or 900 mg telcagepant (three 300 mg capsules) in Period 2 of the crossover. Each treatment period is separated by a washout of 96-240 hours.	Drug: telcagepant; Other Names: MK-0974; Drug: Placebo to telcagepant

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of Participants With Clinical Adverse Events (AEs)	An AE was defined as any unfavorable and unintended change in the structure, function, or chemistry of the body temporally associated with the use of the product, whether or not considered related to the use of the product. Any worsening (i.e., any clinically significant adverse change in frequency and/or intensity) of a preexisting condition which was temporally associated with the use of the product, was also an AE. A clinical AE was an AE reported as a result of a clinical examination or reported by the participant.	Up to 10 days post dose in Period 1 and up to 14 days post dose in Period 2
Number of Participants With Laboratory Adverse Events	An AE was defined as any unfavorable and unintended change in the structure, function, or chemistry of the body temporally associated with the use of the product, whether or not considered related to the use of the product. Any worsening (i.e., any clinically significant adverse change in frequency and/or intensity) of a preexisting condition which was temporally associated with the use of the product, was also an AE. A laboratory AE was an AE reported as a result of a laboratory assessment or test.	Up to 10 days post dose in Period 1 and up to 14 days post dose in Period 2
Total Exercise Duration on the Treadmill Test	Bruce (and Modified Bruce) Protocol was used to assess the exercise duration on a treadmill. This protocol consists of a standardized gradual incremental increase in external workload every 3 minutes while the participant's electrocardiogram (ECG), symptoms, and arm blood pressure were continuously monitored. Regardless of whether the participant believed he or she could continue, the test was discontinued upon evidence of chest discomfort, severe shortness of breath, dizziness, fatigue, ST-segment depression of greater than 2 mm, a fall in systolic blood pressure exceeding 10 mmHg, or the development of a ventricular tachyarrhythmia	2.5 to approximately 2.75 hours post dose of each treatment period

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
ST Segment Depression at Peak Exercise	Bruce (and Modified Bruce) Protocol was used to assess the exercise duration on a treadmill. This protocol consists of a standardized gradual incremental increase in external workload every 3 minutes while the participant's ECG, symptoms, and arm blood pressure were continuously monitored. The time of peak exercise was considered the time at which the participant reached at least one of the criteria for stopping the treadmill test (evidence of chest discomfort, severe shortness of breath, dizziness, fatigue, ST-segment depression of greater than 2 mm, a fall in systolic blood pressure exceeding 10 mmHg, or the development of a ventricular tachyarrhythmia). The ECG for that timepoint (time of peak exercise) was evaluated and the amount of ST segment depression was determined.	2.5 to approximately 2.75 hours post dose of each treatment period
Time to 1 mm ST Segment Depression	Bruce (and Modified Bruce) Protocol was used to assess the exercise duration on a treadmill. This protocol consists of a standardized gradual incremental increase in external workload every 3 minutes while the participant's ECG, symptoms, and arm blood pressure were continuously monitored. The ECG was reviewed and the time to the first ST segment depression of 1 mm was recorded.	2.5 to approximately 2.75 hours post dose of each treatment period

Collaborators and Investigators

• Sponsor: Merck Sharp & Dohme LLC

Publications and helpful links

General Publications

• Chaitman BR, Ho AP, Behm MO, Rowe JF, Palcza JS, Laethem T, Heirman I, Panebianco DL, Kobalava Z, Martsevich SY, Free AL, Bittar N, Chrysant SG, Ho TW, Chodakewitz JA, Murphy MG, Blanchard RL. A randomized, placebo-controlled study of the effects of telcagepant on exercise time in patients with stable angina. Clin Pharmacol Ther. 2012 Mar;91(3):459-66. doi: 10.1038/clpt.2011.246. Epub 2012 Jan 25.

Study record dates

Study Major Dates

• Study Start (Actual): February 12, 2008
• Primary Completion (Actual): February 28, 2009
• Study Completion (Actual): March 13, 2009

Study Registration Dates

• First Submitted: February 10, 2011
• First Submitted That Met QC Criteria: February 10, 2011
• First Posted (Estimate): February 11, 2011

Study Record Updates

• Last Update Posted (Actual): October 18, 2018
• Last Update Submitted That Met QC Criteria: September 18, 2018
• Last Verified: September 1, 2018

More Information

Terms related to this study

• Keywords: coronary artery disease; angina pectoris; calcitonin gene-related peptide; exercise tolerance,
• Additional Relevant MeSH Terms: Cardiovascular Diseases; Vascular Diseases; Arteriosclerosis; Arterial Occlusive Diseases; Pain; Neurologic Manifestations; Chest Pain; Heart Diseases; Coronary Artery Disease; Myocardial Ischemia; Coronary Disease; Angina Pectoris; Angina, Stable
• Other Study ID Numbers: 0974-014

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: Yes
• IPD Plan Description: https://www.merck.com/clinical-trials/pdf/ProcedureAccessClinicalTrialData.pdf

Study Data/Documents

1. CSR Synopsis