Overview

Low-dose Interleukin-2 for the Reduction of Vascular Inflammation in Acute Coronary Syndromes - IVORY

Status:
Recruiting
Trial end date:
2024-01-01
Target enrollment:
0
Participant gender:
All
Summary
Acute coronary syndromes (ACS) result from coronary plaque(s) disruption, which initiates a thrombotic process leading to partial or complete obstruction of the vessel lumen with subsequent myocardial ischaemia and necrosis. The mainstay of treatment is currently focused on the re-establishment and maintenance of coronary artery patency using anti-platelets and anticoagulants with or without mechanical dilatation and stenting of the culprit artery. Despite important advances in management, ACS still carries a risk of substantial morbidity and mortality. The improved efficacy of novel anti-platelet and anticoagulant agents have been limited by increased risk of haemorrhagic events. Future breakthroughs in management are most likely to arise from targeting other relevant pathophysiological pathways. Particularly, the immune response which is an important process that has been neglected in the management of patients with ACS. In this trial the investigators investigate the efficacy of low dose IL-2 compared with placebo in patients with ACS.
Phase:
Phase 2
Accepts Healthy Volunteers?
No
Details
Lead Sponsor:
Cambridge University Hospitals NHS Foundation Trust
Treatments:
Aldesleukin
Interleukin-2
Criteria
Inclusion Criteria:

- Able to provide written informed consent to participate.

- Current admission (on the screening visit) with an acute coronary syndrome - ST
elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction
(NSTEMI), or unstable angina (UA) with symptoms suggestive of myocardial ischaemia
lasting 10 minutes or longer with the patient at rest or with minimal effort AND
EITHER i. elevated levels of TnI on admission OR ii. dynamic changes in ECG (new ST-T
changes or T-wave inversion).

- Where applicable, to be included in the trial women must be:

i) Postmenopausal (for the purposes of this trial, postmenopausal is defined as being
amenorrhoeic for greater than 2 years with an appropriate clinical profile, e.g. age
appropriate, history of vasomotor symptoms) OR ii) Have had a documented hysterectomy
and/or bilateral oophorectomy or sterilised OR iii) Peri-menopausal with a negative
pregnancy test at screening (for the purposes of inclusion in this trial.
Peri-menopausal is defined as women with an appropriate clinical profile, e.g. age
appropriate, history of vasomotor symptoms, irregular periods). They will also have to
comply with the use of contraception for the duration of the trial and undergo
additional pregnancy tests during and after treatment.

- High sensitivity C-reactive protein of >2 mg/L at screening.

- Willingness and possibility to start dosing within 8 days from initial date of
admission to the primary hospital for ACS.

- Able to comply with all trial mandated visits.

Exclusion Criteria:

- Current presentation (at screening) with cardiogenic shock (systolic blood pressure
<80 mm Hg, unresponsive to fluids, or necessitating catecholamines).

- Current presentation with cardiac arrest.

- Signs or symptoms of active infection requiring intravenous antibiotic treatment at
screening.

- History of malignancies requiring active treatment (However, patients with a history
of treated localised basal or squamous cell skin cancer are not excluded from
participation in this trial).

- History of solid organ transplantation or other bone marrow transplantation.

- History of recurrent epileptic seizures in the previous 4 years; repetitive or
difficult to control seizures, coma or toxic psychosis lasting >48 hours.

- Uncontrolled hypotension (Systolic BP (SBP)<80mmHg or DBP<50mmHg) OR uncontrolled
hypertension (SBP>180 or DBP>120 mmHg) at screening.

- Average corrected QT interval (QTc) > 450 msecs using Bazett's formula from average of
triplicate ECGs (or > 480 msecs if bundle branch block).

- Renal impairment defined as Creatinine clearance [Cockcroft-Gault] <45ml/min at
screening.

- Liver dysfunction (defined as ALT > 2xULN) at screening.

- Evidence of cholestasis defined as elevated Total Bilirubin Levels, (TBL > 1.5 x ULN)
and Alkaline Phosphatase, ALP (ALP > 1.5 x ULN), at screening.

- Known hypothyroidism or hyperthyroidism.

- Known autoimmune disease requiring active immunosuppressive treatment.

- Any oral or intravenous immunosuppressive treatment including regular prednisolone,
hydrocortisone or disease modifying drugs. [Inhaled or topical steroids are
permissible].

- Patients on cytotoxic drugs and interferon-alpha.

- Known Type 1 or Type 2 diabetes mellitus.

- Contraindication to IL-2 treatment or hypersensitivity to IL-2 or to any of its
excipients.

- Participation in a previous research trial in the last 3 years which involved exposure
to significant ionising radiation (i.e. cumulative research radiation dose >5 mSv)

- Participation in a clinical trial where the patient has received a drug or new
chemical entity within 30 days or 5 half-lives, or twice the duration of the
biological effect of the drug (whichever is longer) prior to the first dose of trial
medication, Visit 3 (Day 1).

- Any medical history or clinically relevant abnormality that is deemed by the principal
investigator/delegate to make the patient ineligible for inclusion because of a safety
concern.

- Pregnant women or breast feeding women.