- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04706429
The Efficacy and Mechanism of Trientine in Patients With Hypertrophic Cardiomyopathy (TEMPEST)
A Randomised, Double-blind, Placebo-controlled, Phase 2 Evaluation of the Efficacy and Mechanism of Trientine in Patients With Hypertrophic Cardiomyopathy
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
HCM is the most common inherited cardiovascular disorder. It is characterised by left ventricular (LV) myocardial hypertrophy and fibrosis. Patients can experience symptoms of effort intolerance, progressive heart failure and abnormal heart rhythms. There are currently no treatments that alter the natural history of HCM. Patients and the cardiovascular field have identified a "critical need" for clinical studies of drug therapies that target HCM pathophysiological mechanisms.
Trientine dihydrochloride is a copper-chelating agent licensed for Wilson disease, a genetic disorder of copper excretion, in which patients exhibit a cardiac phenotype that mimics HCM. Proof of concept has been established through an MRC-funded study to suggest that use of trientine may also be beneficial in HCM.
Study Type
Enrollment (Actual)
Phase
- Phase 2
Contacts and Locations
Study Contact
- Name: Carly Lawrence
- Phone Number: 00 44 (0) 151 794 9763
- Email: tempest@liverpool.ac.uk
Study Locations
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Aberdeen, United Kingdom, AB25 2ZN
- NHS Grampian
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Leicester, United Kingdom, LE3 9QP
- University Hospitals of Leicester NHS Foundation Trust
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Liverpool, United Kingdom, L14 3PE
- Liverpool Heart and Chester Hospital NHS Foundation Trust
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London, United Kingdom, SW3 6NP
- Royal Brompton and Harefield NHS Foundation Trust
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Manchester, United Kingdom, M23 9LT
- Manchester University NHS Foundation Trust
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North Shields, United Kingdom, NE29 8NH
- Northumbria Healthcare NHS Foundation Trust
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Oxford, United Kingdom, OX3 9DU
- Oxford University Hospitals Nhs Foundation Trust
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Written informed consent.
- Age 18-75 inclusive.
- Hypertrophic cardiomyopathy (HCM), as defined by the European Society of Cardiology HCM guidelines as: "a wall thickness ≥15 mm in one or more LV myocardial segments that is not explained solely by loading conditions". The same definition is applied to first-degree relatives of patients with HCM i.e. all participants are required to have a LV wall thickness ≥15 mm. Wall thickness is as measured on the most recent cardiovascular magnetic resonance (CMR) scan performed prior to the baseline visit. If CMR has not been performed previously, wall thickness measurement should be taken from the most recent echocardiogram performed prior to the baseline visit. (It is recognised that in the European Society of Cardiology guidelines a clinical diagnosis of HCM in first-degree relatives requires a wall thickness that is less than this value, however ≥15 mm is applied here in order to ensure that all participants have an unequivocal phenotype).
- New York Heart Association class I, II or III at the most recent clinical assessment performed prior to the baseline visit.
Exclusion Criteria:
- Previous or planned septal reduction therapy.
- Previously documented myocardial infarction or severe coronary artery disease.
- Uncontrolled hypertension, defined as a systolic blood pressure of >180mmHg or a diastolic blood pressure of > 100mmHg at Visit 1.
- Known LV EF < 50%, as measured on the most recent CMR scan performed prior to the baseline visit. If CMR has not been performed previously, the most recent echocardiogram performed prior to the baseline visit should be used.
- Previously documented persistent atrial fibrillation.
- Anaemia, defined as haemoglobin being below the local site normal reference range, at Visit 1.
- Iron deficiency, defined as serum iron being below the local site normal reference range, at Visit 1.
- Copper deficiency, defined as serum copper being below the normal reference range, at Visit 1.
- Pacemaker or implantable cardioverter defibrillator.
- Known severe valvular heart disease, as demonstrated on the most recent heart imaging performed prior to the baseline visit.
- Previously documented other cardiomyopathic cause of myocardial hypertrophy (e.g. amyloidosis, Fabry disease, mitochondrial disease).
- History of hypersensitivity to any of the components of the investigational medicinal product (IMP).
- Known contraindication to MRI scanning.
- Pregnancy, lactation or planning pregnancy. Women of childbearing capacity are required to have a negative serum pregnancy test before treatment, must agree to pregnancy tests at study visits as defined in the Section 8 and must agree to maintain highly effective contraception as defined in Section 8 during the study.
- Any medical condition, which in the opinion of the Investigator, may place the patient at higher risk from his/her participation in the study, or is likely to prevent the patient from complying with the requirements of the study or completing the study.
Study Plan
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 |
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Active Comparator: Trientine
Trientine dihydrochloride 1200 mg per day.
This shall be taken orally as two Cufence 200mg hard capsules two times per day.
The IMP will be dispensed to participants every 13 weeks for the duration of the study period (52 weeks).
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Trientine dihydrochloride is a white to pale yellow crystalline hygroscopic powder.
Other Names:
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Placebo Comparator: Placebo
The placebo shall be taken orally as two capsules two times per day.
This will be dispensed to participants every 13 weeks for the duration of the study period (52 weeks).
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Placebo capsule, manufactured with the exact components of the trientine capsules, without the active ingredient / investigational medicinal product.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Left ventricular mass indexed to body surface area (LVMi)
Time Frame: 12 months
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Change in LVMi (g/m2), measured using CMR, from baseline to week 52.
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12 months
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Urine copper excretion
Time Frame: 12 months
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Cumulative urine copper excretion, measured using urinary copper, assessed from baseline to weeks 13, 26, 39 and 52.
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12 months
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Exercise capacity
Time Frame: 12 months
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Change in exercise capacity, measured using cardiopulmonary exercise testing (CPET), assessed from baseline to week 52.
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12 months
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Number of non-sinus supraventricular heart beats, presence and amount of atrial fibrillation, number of ventricular-origin beats and presence and amount of non-sustained ventricular tachycardia
Time Frame: 12 months
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Change in number of non-sinus supraventricular heart beats, presence and amount of atrial fibrillation, number of ventricular-origin beats and presence and amount of non-sustained ventricular tachycardia, in 24 hours, measured using ambulatory heart monitoring, assessed from baseline to week 52.
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12 months
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Circulating high sensitivity troponin
Time Frame: 12 months
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Change in circulating high sensitivity troponin, assessed from baseline to week 52.
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12 months
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Peak left ventricular outflow
Time Frame: 12 months
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Change in peak left ventricular outflow tract gradient, measured using CMR, assessed from baseline to week 52.
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12 months
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Atrial volume and function
Time Frame: 12 months
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Change in atrial volume and function, measured using CMR, assessed from baseline to week 52.
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12 months
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LV global longitudinal strain, wall thickness, mass, volumes and ejection fraction (EF)
Time Frame: 12 months
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Change in LV global longitudinal strain, wall thickness, mass, volumes and ejection fraction (EF) measured using CMR, assessed from baseline to week 52.
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12 months
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Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
LV myocardial cellular mass
Time Frame: 12 months
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Change in LV myocardial cellular mass, measured using CMR, from baseline to week 52.
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12 months
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LV myocardial extracellular mass
Time Frame: 12 months
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Change in LV myocardial extracellular mass, measured using CMR, from baseline to week 52.
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12 months
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LV myocardial extracellular volume
Time Frame: 12 months
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Change in LV myocardial extracellular volume, measured using CMR, from baseline to week 52.
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12 months
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LV late gadolinium enhancement
Time Frame: 12 months
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Change in LV late gadolinium enhancement, measured using CMR, from baseline to week 52.
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12 months
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PCr/ATP ratio
Time Frame: 12 months
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Change in PCr/ATP ratio, measured using 31P MRS (sub-group), from baseline to week 52.
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12 months
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Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: Chris Miller, Manchester University NHS Foundation Trust
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Heart Diseases
- Cardiovascular Diseases
- Pathological Conditions, Anatomical
- Aortic Valve Disease
- Heart Valve Diseases
- Aortic Stenosis, Subvalvular
- Aortic Valve Stenosis
- Hypertrophy
- Cardiomyopathies
- Cardiomyopathy, Hypertrophic
- Molecular Mechanisms of Pharmacological Action
- Chelating Agents
- Sequestering Agents
- Trientine
Other Study ID Numbers
- B00844
- 2020-002242-17 (EudraCT Number)
- ISRCTN57145331 (Registry Identifier: ISRCTN)
- NIHR127575 (Other Grant/Funding Number: NIHR EME Programme)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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.
Clinical Trials on Hypertrophic Cardiomyopathy
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French Cardiology SocietyCompleted1- Primary (Sarcomeric) Hypertrophic Cardiomyopathy | 2- Obstructive Hypertrophic Cardiomyopathy | 3- Non Obstructive Hypertrophic CardiomyopathyFrance
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Montreal Heart InstituteCanadian Institutes of Health Research (CIHR)Enrolling by invitationCardiomyopathies | Hypertrophic Cardiomyopathy | Hypertrophic Obstructive Cardiomyopathy | Familial Hypertrophic CardiomyopathyCanada
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University of Sao PauloCompletedNon-obstructive Hypertrophic Cardiomyopathy | Obstructive Hypertrophic CardiomyopathyBrazil
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Bristol-Myers SquibbActive, not recruitingHypertrophic Cardiomyopathy | Non-obstructive Hypertrophic Cardiomyopathy | Obstructive Hypertrophic CardiomyopathyDenmark, United States, Belgium, Czechia, France, Germany, Israel, Italy, Netherlands, Poland, Portugal, Spain, United Kingdom
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Yonsei UniversityCompletedFamilial Hypertrophic CardiomyopathyKorea, Republic of
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Hangzhou Valgen Medtech Co., LtdNot yet recruitingObstructive Hypertrophic CardiomyopathyChina
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China National Center for Cardiovascular DiseasesNot yet recruitingObstructive Hypertrophic Cardiomyopathy
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Bristol-Myers SquibbNot yet recruitingObstructive Hypertrophic CardiomyopathyKorea, Republic of
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Ji Xing Pharmaceuticals (Shanghai) Co., Ltd.RecruitingObstructive Hypertrophic CardiomyopathyChina
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Xiang WeiRecruitingNonobstructive Hypertrophic CardiomyopathyChina
Clinical Trials on Trientine
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Univar BVAptiv SolutionsCompleted
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University of British ColumbiaTerminated
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Univar BVUnknownWilson DiseaseUnited Kingdom, Germany, Greece, Italy
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Yale UniversityBausch Health Americas, Inc.CompletedWilson DiseaseUnited States
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Duke UniversityWithdrawn
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M.D. Anderson Cancer CenterCompleted
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University of British ColumbiaWithdrawnMacular Edema Following Cataract SurgeryCanada
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National Center for Research Resources (NCRR)University of MichiganCompleted
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OrphalanCompletedWilson DiseaseUnited States, United Kingdom, Belgium, Brazil, Denmark, France, Germany, Italy, Poland
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ExcelsiorCompletedTrientine Treatment for Wilson's DiseaseTaiwan