PASSIvation of Vulnerable Plaque With AZD5718 in AcuTe Coronary syndromE (PASSIVATE)

This is a multi-center study conducted at 8 sites in 2 countries (Singapore, New Zealand). Patients with an acute myocardial infarction (AMI) were randomized in a ratio of 1:1 ratio to receive AZD5718 (Atuliflapon) 125 mg or placebo for 12 months to assess the efficacy of AZD5718 to prevent coronary plaque progression as measured on serial computer tomographic coronary angiography.

Study Overview

• Status: Terminated
• Conditions: Acute Coronary Syndrome
• Intervention / Treatment: Drug: AZD5718; Drug: Placebo

Detailed Description

PASSIVATE is a randomized, double-blind, placebo-controlled Phase IIa trial that investigates how 12 months of treatment with AZD5718 modifies coronary plaque volume. Patients with recent STEMI or NSTEMI will receive an additional oral dose of AZD5718 (or placebo) once daily to standard clinical care for 12 months. The primary hypothesis being tested in PASSIVATE is that 12 months of treatment with AZD5718 attenuates the progression of non-calcified plaque (NCP) volume on serial computed tomography coronary angiography (CTCA) studies.

Patients who gave consent (within 60 days after their index event) will undergo a CTCA scan and start treatment (AZD5718 or Placebo). The treatment duration will be 12 months. During the treatment period, patients will come to the clinic for follow-ups. At 12 months (end treatment), the patients will undergo their 2nd CTCA scan. A follow-up visit will be performed 4 weeks after the last dose in order to ensure the safety and well-being of the patients.

• Study Type: Interventional
• Enrollment (Actual): 243
• Phase: Phase 2

Contacts and Locations

Study Locations

• New Zealand
  • Auckland, New Zealand
    • North Shore Hospital
  • Christchurch, New Zealand
    • Christchurch Heart Institute (CHI)
• Singapore
  • Singapore, Singapore
    • National Heart Centre Singapore (NHCS)
  • Singapore, Singapore
    • Changi General Hospital (CGH)
  • Singapore, Singapore
    • Khoo Teck Puat Hospital (KTPH)
  • Singapore, Singapore
    • National University Heart Centre, Singapore (NUHCS)
  • Singapore, Singapore
    • Ng Teng Fong General Hospital (NTFGH)
  • Singapore, Singapore
    • Tan Tock Seng Hospital (TTSH)

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 17 years to 76 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• hospitalised for STEMI or non-STEMI, as defined by the 4th universal definition of MI
• underwent coronary angiography during the index hospitalisation showing at least one epicardial coronary artery with ≥50% stenosis and a 2nd epicardial coronary artery with ≥20% stenosis on the coronary angiogram
• Body Mass Index (BMI) ≥18 to ≤40 kg/m2
• White Blood Cell count ≥ 7.0 X 103/uL during admission

Exclusion Criteria:

• Prior coronary artery bypass grafting (CABG)
• CABG planned within 12 months of admission
• Known history of drug or alcohol abuse within 5 years of screening
• History of QT prolongation associated with other medications that required discontinuation of that medication
• Congenital long QT syndrome
• Systolic blood pressure persistently <90 mm Hg or HR<40 beats per minute at time of enrolment
• ALT >2 x ULN, cirrhosis, recent hepatitis, or positive screening test for hepatitis B (hepatitis B surface antigen) or other viral hepatitis
• Uncontrolled Type 1 or Type 2 DM defined as HbA1c >10% or 74.9 mmol/mol (by IFCC)
• Any planned coronary revascularisation, valve surgery, or cardiac resynchronisation within 7 months after randomisation
• Any concomitant medications known to be associated with Torsades de Pointes or potent inducers of cytochrome P450 3A4 (CYP3A4)
• Planned treatment with zileuton, leukotriene receptor antagonists (e.g., montelukast) during trial
• Participated in another interventional clinical study with an investigational pharmaceutical product during the last 3 months
• Known hypersensitivity to drugs with a similar chemical structure or class of study drugs or any of the excipients of the product
• Known conditions that either increase the risk of performing the CT or make the procedure technically impractical
• No severe asthma attack that require emergency treatment or hospitalisation in the past 6 months
• Had severe course of COVID-19 (extracorporeal membrane oxygenation, mechanically ventilated), and/or had a confirmed case of COVID-19 within 4 weeks of Screening Visit

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: AZD5718; Patients will receive once daily oral dose of AZD5718 for 12 months	Drug: AZD5718; Oral dose of AZD5718 (tablet) once daily for 12 months
Placebo Comparator: Placebo; Patients will receive once daily oral dose of placebo matched to AZD5718 for 12 months	Drug: Placebo; Oral dose of matching placebo (tablet) once daily for 12 months

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in noncalcified coronary artery plaque volume (NCPV)	Percent change in NCPV (in mm3), as assessed by CT coronary angiography, from baseline (before treatment) to after 12-month of treatment	Baseline (before treatment) and after 12 months of treatment

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in total plaque volume (mm3)	Percent change in total plaque volume (in mm3), as assessed by CT coronary angiography, from baseline (before treatment) to after 12-month of treatment	Baseline (before treatment) and after 12 months of treatment
Echocardiographic assessment: Change in left ventricular ejection fraction (LVEF)	Percent change in LVEF (%), as assessed by 2D echocardiography, from baseline (before treatment) to after 12-month of treatment	Baseline (before treatment) and after 12 months of treatment
Change in levels of urinary LTE4 (u-LTE4)	To assess the pharmacodynamics (PD) effect of AZD5718 by assessment of u-LTE4 in AMI patients	12 months
Change in CT peri vascular (coronary) adipose tissue (PVAT)	To assess whether AZD5718 reduces coronary inflammation	Baseline (before treatment) and after 12 months of treatment

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in low attenuation plaque burden	Percent change in low attenuation (<30 HU) plaque volume (mm3), as assessed by CT coronary angiography, from baseline (before treatment) to after 12-month of treatment	Baseline (before treatment) and after 12 months of treatment
Change in plasma hs-CRP concentration	To assess the changes in circulating hs-CRP concentrations from baseline (before treatment) to after 12-month of treatment	Baseline (before treatment) and after 12 months of treatment
Echocardiographic assessment: Change in LV global longitudinal strain	Percent change in LV global longitudinal strain, as assessed by 2D echocardiography, from baseline (before treatment) to after 12-month of treatment	Baseline (before treatment) and after 12 months of treatment
Echocardiographic assessment: Change in global circumferential strain	Percent change in global circumferential strain, as assessed by 2D echocardiography, from baseline (before treatment) to after 12-month of treatment	Baseline (before treatment) and after 12 months of treatment
Echocardiographic assessment: Change in longitudinal early diastolic strain rate	Percent change in longitudinal early diastolic strain rate, as assessed by 2D echocardiography, from baseline (before treatment) to after 12-month of treatment	Baseline (before treatment) and after 12 months of treatment

Collaborators and Investigators

• Sponsor: National University Heart Centre, Singapore
• Collaborators: AstraZeneca; University of Otago
• Investigators: Study Chair: A. Mark Richards, National University Heart Centre, Singapore; Principal Investigator: Mark Chan, National University Heart Centre, Singapore; Principal Investigator: Derek Hausenloy, National Heart Centre Singapore

Publications and helpful links

General Publications

• Ericsson H, Nelander K, Lagerstrom-Fermer M, Balendran C, Bhat M, Chialda L, Gan LM, Heijer M, Kjaer M, Lambert J, Lindstedt EL, Forsberg GB, Whatling C, Skrtic S. Initial Clinical Experience with AZD5718, a Novel Once Daily Oral 5-Lipoxygenase Activating Protein Inhibitor. Clin Transl Sci. 2018 May;11(3):330-338. doi: 10.1111/cts.12546. Epub 2018 Mar 8.
• Pettersen D, Broddefalk J, Emtenas H, Hayes MA, Lemurell M, Swanson M, Ulander J, Whatling C, Amilon C, Ericsson H, Westin Eriksson A, Granberg K, Plowright AT, Shamovsky I, Dellsen A, Sundqvist M, Nagard M, Lindstedt EL. Discovery and Early Clinical Development of an Inhibitor of 5-Lipoxygenase Activating Protein (AZD5718) for Treatment of Coronary Artery Disease. J Med Chem. 2019 May 9;62(9):4312-4324. doi: 10.1021/acs.jmedchem.8b02004. Epub 2019 Mar 26.

Study record dates

Study Major Dates

• Study Start (Actual): July 12, 2021
• Primary Completion (Actual): May 27, 2024
• Study Completion (Actual): August 14, 2024

Study Registration Dates

• First Submitted: September 11, 2020
• First Submitted That Met QC Criteria: October 19, 2020
• First Posted (Actual): October 23, 2020

Study Record Updates

• Last Update Posted (Actual): April 27, 2025
• Last Update Submitted That Met QC Criteria: April 23, 2025
• Last Verified: April 1, 2025

More Information

Terms related to this study

• Keywords: Acute Myocardial Infarction; Computed Tomography Coronary Angiography
• Additional Relevant MeSH Terms: Vascular Diseases; Cardiovascular Diseases; Pathologic Processes; Heart Diseases; Disease; Myocardial Ischemia; Syndrome; Acute Coronary Syndrome
• Other Study ID Numbers: 2020/

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: We will share anonmyised IPD upon reasonable request from academic investigators employed by universities and/or healthcare organisations to the study PIs.
• IPD Sharing Time Frame: Start date and end date will be specified upon publication of the primary trial results
• IPD Sharing Access Criteria: Only investigators employed by universities or healthcare organisations upon reasonable request to the study PIs.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF; ANALYTIC_CODE; CSR

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No