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Ability of Late Sodium or Calcium Current Block to Balance the ECG Effects of Potassium Current Block

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ClinicalTrials.gov Identifier: NCT02308748
Recruitment Status : Completed
First Posted : December 4, 2014
Results First Posted : June 8, 2016
Last Update Posted : June 8, 2016
Sponsor:
Collaborator:
Information provided by (Responsible Party):

Study Description
Brief Summary:
The primary objective of this research study is to test the hypothesis that late sodium current blocking drugs (mexiletine or lidocaine) can attenuate the effect of hERG potassium channel blocking drugs (dofetilide) on ventricular repolarization (QTc) by shortening early repolarization (J-Tpeakc). The secondary object is to assess the ability of calcium channel block (diltiazem) to reduce the QTc prolongation associated with hERG block (moxifloxacin).

Condition or disease Intervention/treatment Phase
Drug-induced QT Prolongation Pharmacokinetics Pharmacodynamics Drug: Dofetilide Drug: Mexiletine Drug: Lidocaine Drug: Moxifloxacin Drug: Diltiazem Drug: Placebo Phase 1

Detailed Description:
This is a randomized, double-blind, 5-period crossover study in healthy male and female subjects, 18 to 35 years of age, to compare the electrophysiological response of hERG potassium channel blocking drugs with and without the addition of late sodium or calcium channel blocking drugs. The 5 treatment periods are 1) dofetilide alone, 2) mexiletine with and without dofetilide, 3) lidocaine with and without dofetilide, 4) moxifloxacin with and without diltiazem and 5) placebo. During each treatment period, 12 blood samples for pharmacokinetic measurements are obtained with matched 12-lead ECG recordings.

Study Design

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 22 participants
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Basic Science
Official Title: Five Period Crossover Study of the Ability of Late Sodium or Calcium Current Block (Mexiletine, Lidocaine, or Diltiazem) to Balance the Electrocardiographic Effects of hERG Potassium Current Block (Dofetilide or Moxifloxacin)
Study Start Date : May 2014
Primary Completion Date : June 2014
Study Completion Date : June 2014


Arms and Interventions

Arm Intervention/treatment
Active Comparator: Dofetilide
Dofetilide alone arm
Drug: Dofetilide
  • 8 am: Placebo
  • 12 pm (noon): 250 µg
  • 5:30 pm: 250 µg
Other Name: Tikosyn
Active Comparator: Dofetilide + Mexiletine
Dofetilide combined with mexiletine
Drug: Dofetilide
  • 8 am: Placebo
  • 12 pm (noon): 250 µg
  • 5:30 pm: 250 µg
Other Name: Tikosyn
Drug: Mexiletine
  • 8 am: weight x 4 mg/kg
  • 12 pm (noon): Same as at 8 am
  • 5:30 pm: Same as at 8 am
Other Name: Mexitil
Active Comparator: Dofetilide + Lidocaine
Dofetilide combined with lidocaine
Drug: Dofetilide
  • 8 am: Placebo
  • 12 pm (noon): 250 µg
  • 5:30 pm: 250 µg
Other Name: Tikosyn
Drug: Lidocaine
  • 9 am : 30 µg/min per kg (loading) for 60 minutes and 10 µg/min per kg (maintenance) for 30 minutes
  • 2 pm: 55 µg/min per kg (loading) for 60 minutes and 20 µg/min per kg (maintenance) for 30 minutes
  • 7:30 pm: 52 µg/min per kg (loading) for 60 minutes and 20 µg/min per kg (maintenance) for 30 minutes
Other Name: Lidocaine hydrochloride
Active Comparator: Moxifloxacin + Diltiazem
Moxifloxacin with and without diltiazem.
Drug: Moxifloxacin
  • 9 am: 5.63 mg/h per kg (loading) for 1 hour and 0.26 mg/h per kg (maintenance for 30 minutes)
  • 2 pm: 6.14 mg/h per kg (loading) for 1 hour and 0.49 mg/h per kg (maintenance for 30 minutes)
  • 7:30 pm: 2.23 mg/h per kg (loading) for 1 hour and 0.49 mg/h per kg (maintenance for 30 minutes)
Other Name: Avelox
Drug: Diltiazem
• 7:30 pm: 330 µg/h per kg (loading) for 60 minutes and 61 µg/h per kg (maintenance) for 30 minutes
Other Name: Diltiazem hydrochloride
Placebo Comparator: Placebo
Placebo (#2 gelcap and intravenous saline)
Drug: Placebo
Placebo (#2 Gelcap or IV saline)
Other Name: #2 Gelcaps or IV saline


Outcome Measures

Primary Outcome Measures :
  1. Change in Placebo Corrected Change From Baseline QTc and J-Tpeakc Intervals on the ECG Measured in Milliseconds When Dofetilide is Administered With Mexiletine or Lidocaine Compared to When Dofetilide is Administered Alone at Evening Dose on Treatment Day [ Time Frame: 5 weeks ]
    After 3rd dose of mexiletine or lidocaine (evening dose) on treatment day when combined with dofetilide to evening dose on dofetilide alone day.


Secondary Outcome Measures :
  1. Change in Placebo Corrected Change From Baseline QTc Interval on the ECG Measured in Milliseconds When Moxifloxacin is Administered With Diltiazem at the Evening Dose Compared to When Moxifloxacin is Administered Alone at Afternoon Dose on Treatment Day. [ Time Frame: 5 weeks ]
    Evening dose (moxifloxacin+diltiazem) versus afternoon dose (diltiazem alone).


Eligibility Criteria

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 35 Years   (Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

  1. Subject is a healthy man or woman, 18 to 35 years of age, inclusive, who weighs at least 50 kg (110 pounds), no more than 85 kg (197 pounds) and has a body mass index of 18 to 27 kg/m2, inclusive, at Screening.
  2. Subject has normal medical history findings, clinical laboratory results, vital sign measurements, 12 lead ECG results, and physical examination findings at Screening or, if abnormal, the abnormality is not considered clinically significant (as determined and documented by the investigator or designee).
  3. Male or female subjects must agree to practice 2 highly effective methods of birth control (as determined by the investigator or designee; one of the methods must be a barrier technique) from Screening until 30 days after the last dose of study drug.

Exclusion Criteria:

  • 1. Subject has a 12 lead safety ECG result at Screening or Check in of Period 1 with evidence of any of the following abnormalities:

    • QT corrected interval (QTc) using Fridericia correction (QTcF) >430 milliseconds (ms)
    • PR interval >220 ms or <120 ms
    • QRS duration >110 ms
    • Second- or third-degree atrioventricular block
    • Complete left or right bundle branch block or incomplete right bundle branch block
    • Heart rate <50 or >90 beats per minute
    • Pathological Q-waves (defined as Q wave >40 ms)
    • Ventricular pre-excitation

      2. Subject has more than 12 ectopic beats during the 3 hour Holter ECG at Screening.

      3. Subject has a history of unexplained syncope, structural heart disease, long QT syndrome, heart failure, myocardial infarction, angina, unexplained cardiac arrhythmia, torsades de pointes, ventricular tachycardia, or placement of a pacemaker or implantable defibrillator. Subjects will also be excluded if there is a family history of long QT syndrome (genetically proven or suggested by sudden death of a close relative due to cardiac causes at a young age) or Brugada syndrome.

      4. Subject has a history or current evidence of any clinically significant (as determined by the investigator) cardiovascular, dermatologic, endocrine, gastrointestinal, hematologic, hepatic, immunologic, metabolic, neurologic, psychiatric, pulmonary, renal, urologic, and/or other major disease or malignancy (excluding nonmelanoma skin cancer). The investigator may allow exceptions to these criteria (e.g., stable mild joint disease [that will not interfere with or influence the activities required by the protocol, in the opinion of the investigator], cholecystectomy, childhood asthma) following discussion with the medical monitor.

      5. Subject has a history of thoracic surgery.

      6. Subject has any condition possibly affecting study drug absorption (e.g., gastrectomy, Crohn's disease, irritable bowel syndrome).

      7. Subject has a skin condition likely to compromise ECG electrode placement.

      8. Subject is a female with breast implants.

      9. Subject's laboratory test results at Screening or Check in of Period 1 are outside the reference ranges provided by the clinical laboratory and considered clinically significant (as determined and documented by the investigator or designee).

      10. Subject's laboratory test results at Screening or Check in of Period 1 indicate hypokalemia, hypocalcemia, or hypomagnesemia according to lower limits of the reference ranges provided by the clinical laboratory.

      11. Subject's laboratory test results at Screening or Check in of Period 1 are >2 × the upper limit of normal (ULN) for alanine aminotransferase or aspartate aminotransferase, >1.5 × ULN for bilirubin, or >1.5 × ULN for creatinine.

      12. Subject has a positive test result at Screening for human immunodeficiency virus, hepatitis C antibodies, or hepatitis B surface antigen.

      13. Subject has a mean systolic blood pressure <90 or >140 mmHg or a mean diastolic blood pressure <50 or >90 mmHg at either Screening or Check in of Period 1.

Contacts and Locations

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02308748


Sponsors and Collaborators
Food and Drug Administration (FDA)
Spaulding Clinical Research LLC
Investigators
Principal Investigator: Carlos Sanabria, MD Spaulding Clinical
More Information

Publications:
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: Food and Drug Administration (FDA)
ClinicalTrials.gov Identifier: NCT02308748     History of Changes
Other Study ID Numbers: 14-022D
SCR-003 ( Other Identifier: Spaulding Clinical Research )
First Posted: December 4, 2014    Key Record Dates
Results First Posted: June 8, 2016
Last Update Posted: June 8, 2016
Last Verified: June 2016

Additional relevant MeSH terms:
Long QT Syndrome
Arrhythmias, Cardiac
Heart Diseases
Cardiovascular Diseases
Heart Defects, Congenital
Cardiovascular Abnormalities
Congenital Abnormalities
Pathologic Processes
Lidocaine
Dofetilide
Mexiletine
Diltiazem
Moxifloxacin
Fluoroquinolones
Norgestimate, ethinyl estradiol drug combination
Anesthetics, Local
Anesthetics
Central Nervous System Depressants
Physiological Effects of Drugs
Sensory System Agents
Peripheral Nervous System Agents
Anti-Arrhythmia Agents
Voltage-Gated Sodium Channel Blockers
Sodium Channel Blockers
Membrane Transport Modulators
Molecular Mechanisms of Pharmacological Action
Anti-Bacterial Agents
Anti-Infective Agents
Topoisomerase II Inhibitors
Topoisomerase Inhibitors