Colchicine for Primary Prevention of Cardiovascular Disease in Adults With Type 2 Diabetes (Col-DM)
The Role of Colchicine in Preventing Atherosclerotic Cardiovascular Disease in Type 2 Diabetes (Col-DM Study)
This study will test whether a low-cost anti-inflammatory medicine called colchicine can help protect the blood vessels of people with type 2 diabetes. Diabetes speeds up hardening of the arteries (atherosclerosis), partly because of ongoing low-grade inflammation. Colchicine has already been shown to help prevent heart attacks and strokes in people who already have heart disease; this study looks at whether it can also help prevent early blood vessel damage before heart disease develops. Around 300 adults with type 2 diabetes will be randomly assigned to take colchicine or a placebo (dummy pill) once daily for 24 weeks, in addition to their usual diabetes and heart-risk medications. Neither participants nor the study team will know who is taking colchicine or placebo. The main measurement will be the change in the thickness of the wall of the neck (carotid) artery, measured by ultrasound, which is an early sign of blood vessel disease. The study will also look at markers of inflammation in the blood, blood vessel stiffness and function, and changes in the gut bacteria.
Přehled studie
Postavení
Postavení
Podmínky
Podmínky
Intervence / Léčba
Intervence / Léčba
Detailní popis
Cardiovascular disease remains the leading cause of death in T2DM, occurring earlier and at substantially higher rates than in the general population. Despite optimisation of conventional risk factors, residual cardiovascular risk remains high, with chronic low-grade inflammation driven by dysregulated neutrophil activity recognised as a key contributor. Patients with T2DM exhibit a distinct pro-inflammatory neutrophil phenotype characterised by increased neutrophil extracellular trap (NET) formation, heightened endothelial adherence, and altered rolling kinetics, which correlates with impaired vascular function and subclinical atherosclerosis.
Colchicine inhibits neutrophil activation, migration, and NET formation, and has demonstrated efficacy in secondary cardiovascular prevention in large randomised trials. Evidence in primary prevention, particularly in T2DM, remains limited. Col-DM takes a precision medicine approach, hypothesising that colchicine's benefit will be concentrated among T2DM patients with a high-risk inflamed neutrophil signature rather than being uniform across the broader population.
Col-DM is a 24-week, parallel-group, Phase 2 randomised controlled trial. Adults with T2DM and no prior atherosclerotic cardiovascular disease are randomised 1:1 to colchicine 0.5 mg daily or matched placebo, stratified by neutrophil inflammatory phenotype classified using a microfluidic organ-on-chip platform. The primary outcome is progression of carotid intima-media thickness (CIMT), estimated overall and separately within each neutrophil-signature stratum. Secondary outcomes cover vascular function, inflammatory and oxidative stress biomarkers, and thrombotic potential. Gut microbiome composition is examined as an exploratory outcome. All outcome measures are estimated overall and separately within each neutrophil-signature stratum. Safety is monitored by an independent Data and Safety Monitoring Committee.
Typ studie
Typ studie
Zápis (Odhadovaný)
Zápis
Fáze
Fáze
- Fáze 2
Kontakty a umístění
Studijní kontakt
Studijní kontakt
- Jméno: Sanchalika Acharyya, PhD, MPH
- Telefonní číslo: 96150202
- E-mail: sanchalika.acharyya@nhghealth.com.sg
Studijní záloha kontaktů
- Jméno: Shirley Lin Shangmei
- E-mail: ttsh.p2p.research@nhghealth.com.sg
Studijní místa
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Singapore
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Singapore, Singapore, Singapur, 308433
- Nábor
- Tan Tock Seng Hospital
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Kontakt:
- Rinkoo Dalan, MD, PhD
- Telefonní číslo: 65-6357100
- E-mail: rinkoo.dalan@nhghealth.com.sg
-
Vrchní vyšetřovatel:
- Rinkoo Dalan, MD, PhD
-
Dílčí vyšetřovatel:
- Ying Jie Chee, MD
-
Dílčí vyšetřovatel:
- Rupesh Agrawal, M Med (Ophth), MD (Research)
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Dílčí vyšetřovatel:
- Huiling Liew, MD
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Dílčí vyšetřovatel:
- Ying Shan Lee, MBBS
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Dílčí vyšetřovatel:
- Eugene Fan, MD
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Kritéria účasti
Kritéria způsobilosti
Kritéria způsobilosti
Věk způsobilý ke studiu
Přijímá zdravé dobrovolníky
Pohlaví způsobilá ke studiu
Popis
Inclusion Criteria:
- T2DM on stable diabetes medications (no change in last 3 months)
- At least one other comorbidity of hypertension, dyslipidaemia and/or obesity (BMI ≥27), with no previous history of ASCVD
- Able to provide informed consent
Exclusion Criteria:
- Recent hospitalization or acute infections within last 2 weeks.
- Current Treatment with corticosteroids or immunosuppressive agents
- Pre-existing malignancies or other terminal conditions with limited prognosis
- Pregnancy
- Breastfeeding
- Inability to provide written consent
- Renal impairment (eGFR< 60ml/min)
- Liver cirrhosis or ALT/AST >3x ULN
- Pharmacogenomics indicative of adverse effects
- Hypersensitivity to the active substance or to the following excipients: Lactose, Maize starch, Sodium laurilsulfate, Magnesium stearate
- Known blood dyscrasia
- Women of childbearing age who are keen to conceive in the next 1 year
- Taking a strong P-glycoprotein inhibitor (e.g. cyclosporine, ranolazine) or a strong CYP3A4 inhibitor
- Known myositis with raised creatine kinase with statins (statin myopathy).
- Gout attack within the last 1 year
- Currently taking Aspirin
- Taking any oral contraceptives
Studijní plán
Jak je studie koncipována?
Detaily designu
- Primární účel: Prevence
- Přidělení: Randomizované
- Intervenční model: Paralelní přiřazení
- Maskování: Čtyřnásobek
Počet zbraní
Zbraně a zásahy
Skupina účastníků / ArmSkupina účastníků / Arm |
Intervence / LéčbaIntervence / Léčba |
|---|---|
|
Experimentální: Colchicine
Colchicine 0.5 mg orally once daily for 24 weeks, in addition to usual risk-factor-based therapy |
For 24 weeks |
|
Komparátor placeba: Placebo
Matched placebo orally once daily for 24 weeks, in addition to usual risk-factor-based therapy |
Matched placebo tablets (identical in size, shape, taste, and packaging to colchicine), once daily, for 24 weeks |
Co je měření studie?
Primární výstupní opatření
Primární výstupní opatření
Měření výsledku |
Popis opatření |
Časové okno |
|---|---|---|
|
Change from Baseline in Mean-Maximum Carotid Intima-Media Thickness (Mean-Maximum CIMT)
Časové okno: Baseline and 24 weeks
|
Mean-maximum CIMT is defined as the average of the maximum CIMT values obtained from the far wall of the left and right common carotid arteries, each derived from six measurements taken across three projections (lateral, anterior, and posterior) at 1 cm proximal to the carotid bifurcation, measured by high-resolution B-mode carotid ultrasonography. |
Baseline and 24 weeks
|
Sekundární výstupní opatření
Sekundární výstupní opatření
Měření výsledku |
Popis opatření |
Časové okno |
|---|---|---|
|
Change from Baseline in Mean Carotid Intima-Media Thickness (avgCIMT)
Časové okno: Baseline and 24 weeks
|
Mean CIMT (avgCIMT) is defined as the average of all twelve individual IMT measurements obtained from the far wall of the left and right common carotid arteries (six measurements per side), measured by high-resolution B-mode carotid ultrasonography. |
Baseline and 24 weeks
|
|
Change from Baseline in Carotid Plaque Volume
Časové okno: Baseline and 24 weeks
|
Carotid plaque volume is measured using 3D plaque volume software following standard acquisition protocol in participants with identified carotid plaque on ultrasonography. |
Baseline and 24 weeks
|
|
Change from Baseline in Endothelial Function (Flow-Mediated Dilation)
Časové okno: Baseline and 24 weeks
|
Endothelial function is assessed by flow-mediated dilation (FMD) of the brachial artery using high-resolution ultrasound, expressed as the percentage change in brachial artery diameter following reactive hyperaemia. |
Baseline and 24 weeks
|
|
Change from Baseline in Microvascular Reactivity (Reactive Hyperaemia Index)
Časové okno: Baseline and 24 weeks
|
Microvascular reactivity is assessed by the reactive hyperaemia index (RHI) measured using EndoPAT, a non-invasive device that quantifies peripheral arterial tone response to forearm occlusion. |
Baseline and 24 weeks
|
|
Change from Baseline in Arterial Stiffness (Pulse Wave Velocity)
Časové okno: Baseline and 24 weeks
|
Arterial stiffness is assessed by carotid-femoral pulse wave velocity (PWV) measured using SphygmoCor XCEL, a validated applanation tonometry-based device. |
Baseline and 24 weeks
|
|
Change from Baseline in Arterial Stiffness (Cardio-Ankle Vascular Index)
Časové okno: Baseline and 24 weeks
|
Arterial stiffness is additionally assessed by the cardio-ankle vascular index (CAVI), a measure of arterial stiffness from the origin of the aorta to the ankle that is less dependent on blood pressure at the time of measurement. |
Baseline and 24 weeks
|
|
Change from Baseline in Skin Advanced Glycation End Products (Skin Autofluorescence)
Časové okno: Baseline and 24 weeks
|
Tissue advanced glycation end product (AGE) accumulation is measured non-invasively using the AGE Reader, which quantifies skin autofluorescence using ultraviolet light excitation. |
Baseline and 24 weeks
|
|
Change from Baseline in Retinal Layer Thickness (Optical Coherence Tomography)
Časové okno: Baseline and 24 weeks
|
Retinal layer thickness is measured by optical coherence tomography (OCT) as a surrogate of retinal and systemic microvascular health. |
Baseline and 24 weeks
|
|
Change from Baseline in Retinal Microvascular Density (Optical Coherence Tomography Angiography)
Časové okno: Baseline and 24 weeks
|
Retinal microvascular density is measured by optical coherence tomography angiography (OCTA) as a surrogate of systemic microvascular health. |
Baseline and 24 weeks
|
|
Change from Baseline in High-Sensitivity C-Reactive Protein (hsCRP)
Časové okno: Baseline and 24 weeks
|
Serum high-sensitivity C-reactive protein (hsCRP) is measured as a marker of systemic inflammation. |
Baseline and 24 weeks
|
|
Change from Baseline in Interleukin-6 (IL-6)
Časové okno: Baseline and 24 weeks
|
Plasma interleukin-6 (IL-6) is measured as a marker of systemic inflammation and cytokine activity. |
Baseline and 24 weeks
|
|
Change from Baseline in Plasminogen Activator Inhibitor-1 (PAI-1)
Časové okno: Baseline and 24 weeks
|
Plasma plasminogen activator inhibitor-1 (PAI-1) is measured as a marker of impaired fibrinolysis and endothelial dysfunction. |
Baseline and 24 weeks
|
|
Change from Baseline in Cell-Free DNA (NETosis Marker)
Časové okno: Baseline and 24 weeks
|
Plasma cell-free DNA is measured as a marker of neutrophil extracellular trap (NET) formation and neutrophil-mediated inflammatory activity. |
Baseline and 24 weeks
|
|
Change from Baseline in Citrullinated Histone H3 (NETosis Marker)
Časové okno: Baseline and 24 weeks
|
Plasma citrullinated histone H3 is measured as a specific marker of neutrophil extracellular trap (NET) formation and NETosis. |
Baseline and 24 weeks
|
|
Change from Baseline in E-selectin
Časové okno: Baseline and 24 weeks
|
Plasma E-selectin is measured as a marker of endothelial activation and inflammation. |
Baseline and 24 weeks
|
|
Change from Baseline in Intercellular Adhesion Molecule-1 (ICAM-1)
Časové okno: Baseline and 24 weeks
|
Plasma ICAM-1 is measured as a marker of endothelial activation and leucocyte adhesion. |
Baseline and 24 weeks
|
|
Change from Baseline in Vascular Cell Adhesion Molecule-1 (VCAM-1)
Časové okno: Baseline and 24 weeks
|
Plasma VCAM-1 is measured as a marker of endothelial activation and vascular inflammation. |
Baseline and 24 weeks
|
|
Change from Baseline in Oxidative Stress Index
Časové okno: Baseline and 24 weeks
|
An integrated oxidative stress index is derived from nuclear magnetic resonance (NMR)-based redox profiling of plasma and erythrocytes, providing a composite measure of systemic oxidative stress. |
Baseline and 24 weeks
|
|
Change from Baseline in Thrombotic Potential (Clot Waveform Analysis)
Časové okno: Baseline and 24 weeks
|
Clot waveform analysis is performed to characterise the kinetics of clot formation and fibrinolysis in plasma as a measure of overall thrombotic potential. |
Baseline and 24 weeks
|
|
Change from Baseline in Von Willebrand Factor Antigen (VWF:Ag)
Časové okno: Baseline and 24 weeks
|
Plasma von Willebrand factor antigen (VWF:Ag) is measured as a marker of endothelial activation and thrombotic risk. |
Baseline and 24 weeks
|
|
Change from Baseline in Von Willebrand Factor Activity (VWF:Act)
Časové okno: Baseline and 24 weeks
|
Plasma von Willebrand factor activity (VWF:Act) is measured as a functional marker of thrombotic risk and platelet adhesion capacity. |
Baseline and 24 weeks
|
|
Change from Baseline in Factor VIII
Časové okno: Baseline and 24 weeks
|
Plasma factor VIII levels are measured as a marker of coagulation activation and thrombotic potential. |
Baseline and 24 weeks
|
|
Change from Baseline in Thrombin Generation
Časové okno: Baseline and 24 weeks
|
Thrombin generation is measured using a calibrated automated thrombogram to assess overall coagulation potential and thrombotic risk. |
Baseline and 24 weeks
|
|
Change from Baseline in Oxidised LDL (Ox-LDL)
Časové okno: Baseline and 24 weeks
|
Plasma oxidised LDL (Ox-LDL) is measured by nuclear magnetic resonance (NMR) spectroscopy as a marker of lipid oxidation and atherogenic risk. |
Baseline and 24 weeks
|
|
Change from Baseline in Atherogenic Lipid Subfractions
Časové okno: Baseline and 24 weeks
|
Atherogenic lipid subfractions are characterised by nuclear magnetic resonance (NMR) spectroscopy, providing detailed lipoprotein particle profiling beyond standard lipid panels. |
Baseline and 24 weeks
|
Další výstupní opatření
Další výstupní opatření
Měření výsledku |
Popis opatření |
Časové okno |
|---|---|---|
|
Change from Baseline in Gut Microbiome Composition
Časové okno: Baseline and 24 weeks
|
Gut microbiome composition is characterised from stool samples by metagenomic sequencing, to examine whether colchicine-associated shifts in microbial composition relate to treatment response. |
Baseline and 24 weeks
|
|
Change from Baseline in Plasma Metabolite Profile (Metabolomics)
Časové okno: Baseline and 24 weeks
|
As an exploratory analysis, plasma metabolomic profiling will be performed on stored blood samples to characterise changes in the metabolite profile over 24 weeks. |
Baseline and 24 weeks
|
|
Incidence of Adverse Events and Serious Adverse Events
Časové okno: From randomisation through 24 weeks
|
Safety is assessed by the incidence of adverse events (AEs) and serious adverse events (SAEs), defined per standard regulatory criteria, ascertained at each study visit and telephone contact, and adjudicated by an independent Data and Safety Monitoring Committee. |
From randomisation through 24 weeks
|
Spolupracovníci a vyšetřovatelé
Sponzor
Sponzor
Spolupracovníci
Spolupracovníci
Vyšetřovatelé
Vyšetřovatelé
- Vrchní vyšetřovatel: Rinkoo Dalan, MD, PhD, Tan Tock Seng Hospital
Termíny studijních záznamů
Hlavní termíny studia
Začátek studia (Aktuální)
Začátek studia
Primární dokončení (Odhadovaný)
Primární dokončení
Dokončení studie (Odhadovaný)
Dokončení studie
Termíny zápisu do studia
První předloženo
První předloženo
První předloženo, které splnilo kritéria kontroly kvality
První předloženo, které splnilo kritéria kontroly kvality
První zveřejněno (Aktuální)
První zveřejněno
Aktualizace studijních záznamů
Poslední zveřejněná aktualizace (Aktuální)
Poslední zveřejněná aktualizace
Odeslaná poslední aktualizace, která splnila kritéria kontroly kvality
Odeslaná poslední aktualizace, která splnila kritéria kontroly kvality
Naposledy ověřeno
Naposledy ověřeno
Více informací
Termíny související s touto studií
Klíčová slova
Další relevantní podmínky MeSH
- Onemocnění endokrinního systému
- Cévní onemocnění
- Patologické procesy
- Metabolické choroby
- Poruchy metabolismu glukózy
- Diabetes Mellitus
- Arterioskleróza
- Arteriální okluzivní onemocnění
- Patologické stavy, příznaky a symptomy
- Nutriční a metabolické nemoci
- Diabetes mellitus, typ 2
- Kardiovaskulární choroby
- Zánět
- Ateroskleróza
- Heterocyklické sloučeniny
- Alkaloidy
- Kolchicin
Další identifikační čísla studie
Další identifikační čísla studie
- NHG Health DSRB Ref: 2024-3120
Plán pro data jednotlivých účastníků (IPD)
Plánujete sdílet data jednotlivých účastníků (IPD)?
Popis plánu IPD
The individual participant data will not be publicly shared due to patient confidentiality restrictions and institutional data governance requirements. Researchers seeking access for secondary analyses may contact the study team to discuss feasibility, subject to a formal data sharing or research collaboration agreement with the institution.
Informace o lécích a zařízeních, studijní dokumenty
Studuje lékový produkt regulovaný americkým FDA
Studuje produkt zařízení regulovaný americkým úřadem FDA
produkt vyrobený a vyvážený z USA
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