ASSessing the Effect of Anti-IL-6 Treatment in Myocardial Infarction: The ASSAIL-MI Trial (ASSAIL-MI)

February 28, 2021 updated by: Lars Gullestad, Oslo University Hospital
The main goal of this study is to evaluate the ability of a single administration of tocilizumab to reduce myocardial damage in patients presenting with an acute ST-segment elevation myocardial infarction (STEMI). Secondary objectives are to assess the impact of treatment on: (i) final infarct size, (ii) left ventricular size and function, (iii) inflammation, (iv) extracellular matrix remodeling, (v) lipid parameters, (vi) platelet activation and additional pro- and anti-thrombotic parameters, and (vii) study drug safety and tolerability.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Myocardial infarction (MI) is a major contributor to morbidity and mortality in the Western world. The main determinant of death and complications is infarct size, and limitation of the infarct size has therefore been an important objective for strategies to improve outcome. In patients presenting with an acute ST segment elevation myocardial infarction (STEMI), urgent myocardial reperfusion with percutaneous coronary intervention (PCI) is the most effective treatment to this end. However, despite PCI, the morbidity and mortality in patients with STEMI remain substantial. This fact suggests that other, adjuvant strategies are required to reduce infarct size and improve outcome. The inflammatory cytokine interleukin (IL)-6 is an important mediator of plaque destabilisation and rupture in acute coronary syndrome (ACS) and may contribute to the ischemia-reperfusion injury succeeding revascularisation. Experimental studies suggest that IL-6 inhibition can limit infarct size through anti-inflammatory mechanisms.(ref)

The investigators recently conducted a double blind, placebo controlled trial in 117 patients with non-ST segment elevation myocardial infarction (NSTEMI) who presented within 72 hour after the onset of chest pain. In this study, a single, intravenous dose of the IL-6 antagonist tocilizumab reduced the inflammatory activity by more than 50% in the days subsequent to the intervention. Importantly, tocilizumab also reduced troponin T (TnT) levels, suggesting that patients receiving tocilizumab sustained less myocardial damage than patients who received placebo.1

Interleukin-6 inhibition might limit infarct size through reduced myocardial inflammation, but theoretically, it could also inhibit the repair process within the injured area. While the recent study suggests that IL-6 inhibition has largely favourable effects in NSTEMI, it remains to be seen if similar, beneficial effects can be obtained in patients with STEMI. On this background, the investigators want to investigate the effect of tocilizumab in patients with acute STEMI. The postulate is that a single dose of tocilizumab (RoActemra®) will have favourable effects on infarct size, as assessed by markers of myocardial necrosis and cardiac magnetic resonance imaging (CMR), without negative consequences for the repair process in these patients. The hypothesis will be tested in a randomised, double blind, placebo controlled trial comprising 200 patients with acute STEMI.

This is a phase 2 study on a new and exciting anti-inflammatory strategy in cardiovascular disease. It will be conducted at three experienced, high volume centres in Norway, and will target new and yet unmodified mechanisms during myocardial infarction. The ambition is to improve the prognosis of patients with ACS, with potential to change clinical practice.

Study Type

Interventional

Enrollment (Actual)

200

Phase

  • Phase 2

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Norway
      • Oslo, Norway, 0424
        • Oslo University Hospital, Rikshospitalet
      • Oslo, Norway, 0424
        • Oslo University Hospital, Ullevål
      • Trondheim, Norway, 7006
        • St. Olav Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years to 80 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

Patients will be screened for eligibility upon admittance due to acute STEMI at either participating site. All of the following conditions must apply to the prospective patient at screening prior to receiving study agent:

  • New ST elevation at the J-point in two contiguous leads (cut-points: 0.2mV in men and >0.15 mV in women in leads V2-V3 and/or >0.1 mV in other leads) in combination with symptoms consistent with acute MI.
  • Presentation within 6 hours of chest pain.
  • Indication for urgent coronary angiography with intent to reperfuse presumed occluded vessel.
  • Age between 18 and 80 years.
  • Informed consent obtained and documented according to ICH/GCP, and national/local regulations.

Exclusion Criteria:

Patients will be excluded from the study if they meet any of the following criteria:

  • NSTEMI (non-ST segment elevation in ECG).
  • Left bundle branch block in ECG
  • History of previous MI
  • Cardiogenic shock.
  • Fibrinolytic therapy within 72 hours prior to admission.
  • Cardiac arrest / ventricular fibrillation.
  • History of severe renal failure with estimated glomerular filtration rate < 30 ml/minutes.
  • Known, current liver disease
  • History of concurrent inflammatory, biliary obstructive or malignant disease
  • A history of chronic or concurrent infectious disease, including a history of HIV, tuberculosis, or hepatitis B or C.
  • Known, uncontrolled lower gastrointestinal (GI) disease such as diverticulitis, Crohn's disease, ulcerative colitis, or other symptomatic lower GI conditions that could predispose to GI perforations
  • Major surgery within 8 weeks prior or after baseline
  • History of central nervous system demyelinating or seizure disorders
  • History of primary or secondary immunodeficiency
  • Treatment with immunosuppressants other than low dose corticosteroids (equivalent to 5 mg of prednisone or less) at the time of randomisation
  • Immunization with a live/attenuated vaccine within 4 weeks prior to baseline
  • History of severe allergic or anaphylactic reactions to humanized or murine monoclonal antibodies or to tocilizumab
  • Other contraindications to study medication
  • Pregnancy, possible pregnancy or breast-feeding - women of child-bearing potential or breastfeeding mothers cannot participate. A woman is considered of childbearing potential following menarche and until becoming post-menopausal unless permanently sterile. Permanent sterilisation methods include hysterectomy, bilateral salpingectomy and bilateral oophorectomy. A postmenopausal state is defined as no menses for 12 months without an alternative medical cause.
  • Contraindications to CMR (pacemaker, CRT, ICD, certain ferromagnetic implants, severe claustrophobia, allergy to contrast medium).
  • Any condition/circumstances believed to interfere with the ability to comply with protocol.
  • Any reason why, in the opinion of the investigator, the patient should not participate.
  • Failure to obtain written, informed consent by patient or next of kin, for instance in case of patient death after consent has been provided in oral.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Quadruple

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Active drug
Tocilizumab, 20 mg/ml; 14 ml (280 mg) dissolved in 100 ml NaCl 0.9 % i.v. once.
Drug: Tocilizumab
Active drug: Tocilizumab, 20 mg/ml; 14 ml (280 mg) dissolved in 100 ml NaCl 0.9 % i.v. once.
Other Names:
  • RoActemra®,
Placebo Comparator: Placebo
Sodium chloride 0.9%; 100 ml i.v. once.
Drug: Sodium chloride 0.9%
Placebo: Sodium chloride 0.9%; 100 ml i.v. once.
Other Names:
  • NaCl 0.9%

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Time Frame
The primary endpoint will be the between-group difference in the myocardial salvage index as measured in the acute phase by cardiac magnetic resonance (CMR) imaging with late gadolinium enhancement (LGE).
Time Frame: 6 months
6 months

Secondary Outcome Measures

Outcome Measure
Time Frame
The between-group difference in the AUC for Troponin T (TnT) during index hospitalisation
Time Frame: 24 -72 hours after randomisation
24 -72 hours after randomisation
The extent of microvascular obstruction as measured by CMR after 3 - 7 days
Time Frame: 3 - 7 days after randomisation
3 - 7 days after randomisation
Final infarct size as measured by CMR 6 months after randomisation
Time Frame: 6 months after randomisation
6 months after randomisation
Left ventricular size as assessed by CMR 6 months after randomisation
Time Frame: 6 months after randomisation
6 months after randomisation
Baseline-adjusted NT-proBNP at 6 months after randomisation
Time Frame: 6 months after randomisation
6 months after randomisation
The AUC of Creatine Kinase-MB (CK-MB) during index hospitalisation
Time Frame: 24-72 hours after randomisation
24-72 hours after randomisation
The AUC of C-reactive protein (CRP) during index hospitalisation
Time Frame: 24-72 hours after randomisation
24-72 hours after randomisation

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Oslo University Hospital

Collaborators

University of Oslo
Norwegian University of Science and Technology
St. Olavs Hospital
South-Eastern Norway Regional Health Authority

Investigators

  • Principal Investigator: Lars Gullestad, Professor, MD, PhD, Oslo University Hospital
  • Study Chair: Bjørn Bendz, Associate Professor, MD, PhD, Oslo University Hospital
  • Study Chair: Pål Aukrust, Professor, MD, PhD, Oslo University Hospital
  • Study Chair: Svend Aakhus, Professor, MD, PhD, Oslo University Hospital
  • Study Chair: Rune Wiseth, Professor, MD, PhD, St. Olavs Hospital
  • Study Chair: Jan Kristian Damaas, Professor, MD, PhD, St. Olavs Hospital
  • Study Chair: Geir Øystein Andersen, MD, PhD, Oslo University Hospital, Ullevål
  • Study Chair: Nils Einar Kløw, Professor, MD, PhD, Oslo University Hospital, Ullevål
  • Study Chair: Anders Opdahl, MD, PhD, Oslo University Hospital, Ullevål

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

March 16, 2017

Primary Completion (Actual)

February 19, 2020

Study Completion (Actual)

February 10, 2021

Study Registration Dates

First Submitted

December 20, 2016

First Submitted That Met QC Criteria

December 23, 2016

First Posted (Estimate)

December 29, 2016

Study Record Updates

Last Update Posted (Actual)

March 2, 2021

Last Update Submitted That Met QC Criteria

February 28, 2021

Last Verified

February 1, 2021

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • ASSAIL-MI 2.0
  • 2016-002581-31 (EudraCT Number)

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

IPD Plan Description

Undecided

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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