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IvaBRAdine blocK of Funny Current for Heart Rate Control in permanEnt Atrial Fibrillation. (BRAKE-AF Study). (BRAKE-AF)

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ClinicalTrials.gov Identifier: NCT03718273
Recruitment Status : Recruiting
First Posted : October 24, 2018
Last Update Posted : January 15, 2019
Sponsor:
Collaborators:
Spanish Clinical Research Networt (SCReN)
Carlos III Health Institute
Information provided by (Responsible Party):
Adolfo Fontenla, Hospital Universitario 12 de Octubre

Brief Summary:
The BRAKE-AF Study is a phase III, randomised, controlled, multicentric, open-label clinical trial to prove the noninferiority of ivabradine versus digoxin in the treatment of permanent atrial fibrillation. The total duration of the study is 3 years, with 24 months of enrolment, treatment and follow-up.

Condition or disease Intervention/treatment Phase
Atrial Fibrillation Heart Diseases Drug: Ivabradine Drug: Digoxin Phase 3

Detailed Description:

This is a non-commercial, investigator-driven clinical study funded through a public competitive call by Instituto de Salud Carlos III, Spanish Ministry of Economy (PI17/01272).

The study is coordinated by the main investigator from Hospital Universitario 12 de Octubre in Madrid; the sponsorship is performed by Dr. Adolfo Fontenla (Hospital Universitario 12 de Octubre). Several responsibilities are delegated to the Clinical Research Unit (Hospital 12 de Octubre, Madrid, Spain).

The study was planned according to the Good Clinical Practices. BRAKE-AF Study has been approved by the Ethics Committee and Spanish Health Authorities. All participating patients must give written informed consent before any study procedure occur.


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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 232 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase III Clinical Trial to Compare Ivabradine Versus Digoxin in the Heart Rate Control in Patients With Permanent Atrial Fibrillation Under Treatment With Beta-blockers or Calcium Antagonists.
Actual Study Start Date : October 19, 2018
Estimated Primary Completion Date : August 31, 2021
Estimated Study Completion Date : December 31, 2021

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Active Comparator: Digoxin
Digoxin 0,25 mg. The initial dose will be based on whether there are factors such as age over 80 years, weight under 60 kg and creatinine clearance <60ml / min,
Drug: Digoxin
The initial dose will be based on whether there are factors such as age over 80 years, weight less than 60 kg and creatinine clearance <60ml / min, if there is no factor, the oral dose will be 0.25mg / 24h. If there are 2 factors, the dose will be 0.15 mg / 24 h. and if there are 2 or 3 factors, the dose will be 0.10 mg / 24 h.
Other Name: Digoxin 0,25 mg

Experimental: Ivabradine
Ivabradine 5 mg, twice a day the first month administered by mouth. If the tolerance is good, the dose will be increased to 7.5 mg on month 2 and will continue until the third month.
Drug: Ivabradine

Ivabradine 5 mg, twice a day the first month administered by mouth. If the tolerance is good, the dose will be increased to 7.5 mg on month 2 and will continue until the third month.

Patients with 75 or more years of age will receive an initial dose of 2.5 mg / twice a day, which can be increased to 5 mg / twice a day in week 7 and to 7.5 mg in month 1 if the tolerance has been good

Other Name: Ivabradine 5 mg




Primary Outcome Measures :
  1. Heart rate reduction. [ Time Frame: 3 months ]
    Reduction of the mean daytime heart rate registered in Holter- electrocardiogram (ECG) after treatment with Ivabradine or Digoxin.

  2. Serious adverse events [ Time Frame: 3 months ]
    Proportion of patients experiencing syncope, severe bradycardia or any serious adverse reaction requiring hospitalization, emergency visit or death of the patient during treatment with Ivabradine or Digoxin.


Secondary Outcome Measures :
  1. Reduction in the scale of atrial fibrillation (AF) symptoms according to the European Hearth Rhythm Association (EHRA) Score modified. [ Time Frame: Months 1 and 3. ]
    Percentage of patients who experience a reduction in the scale of atrial fibrillation. symptoms according to the EHRA Score modified.

  2. 6 minute walk test (6MWT). [ Time Frame: Baseline and after 3 months. ]
    Increase in meters in the 6MWT.

  3. Quality-of-Life Short Form 36 Health Survey (QoL SF-36) Score. [ Time Frame: At baseline and 3 months. ]
    Increase in the score obtained in global quality of life parameters analyzed by the SF-36 questionnaire.

  4. The Atrial Fibrillation Effect on Quality-of-Life (QoL AFEQT) score. [ Time Frame: At baseline and 3 months ]
    Increase in the score obtained in parameters of quality of life quality of life associated with AF analyzed by the AFEQT questionnaire.

  5. Reduction of the daytime Health rate. [ Time Frame: 1 month ]
    Reduction of the average daytime Heart Rate (HR) recorded in Holter-ECG

  6. Reduction of resting Health Rate. [ Time Frame: 1 and 3 months ]
    Reduction of resting heart rate (HR) recorded on one electrocardiogram (ECG).

  7. Reduction of the maximum heart rate (HR) recorded. [ Time Frame: 1 and 3 months ]
    Reduction of the maximum HR recorded in Holter-ECG

  8. Reduction of the mean HR recorded. [ Time Frame: 1 and 3 months ]
    Reduction of the mean HR in 24 hours recorded in Holter-ECG .

  9. Reduction of the HR delta. [ Time Frame: 1 and 3 months ]
    Reduction of the HR delta (difference between maximum HR and mean HR in 24 hours) recorded in Holter-ECG.

  10. Reduction of HR in moderate exercise. [ Time Frame: 3 months ]
    Reduction of HR in moderate exercise (maximum HR measured by Holter-ECG during the 6-minute walk test.

  11. Percentage of patients with non-severe bradycardia. [ Time Frame: 1 and 3 months ]
    Percentage of patients who experience non-severe bradycardia during the study treatment.

  12. Percentage of patients who experience any adverse reaction. [ Time Frame: 1 and 3 months ]
    Percentage of patients who experience any adverse reaction to the study drugs.

  13. Percentage of patients who voluntarily abandon the study drugs. [ Time Frame: 3 months ]
    Percentage of patients who voluntarily abandon the study drugs.

  14. Proportion of hospitalizations, emergency visits and mortality due to a major cardiovascular event. [ Time Frame: 3 months ]
    Proportion of patients experiencing hospitalizations, emergency visits and mortality due to a major cardiovascular event during treatment with the study drug.



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Age ≥ 18 years.
  2. Permanent Atrial Fibrillation (AF) at the time of randomization, with no prospect of cardioversion, antiarrhythmic treatment with group I or III drugs, or pulmonary vein ablation.
  3. Symptoms attributable to AF associated with the presence of at least one of the following inadequate FC control criteria:

    1. Heart rate (HR) at rest > 110 bpm (on ECG -electrocardiogram- performed in the 14 days prior to inclusion).
    2. HR at rest between 80 and 110 bpm (on ECG performed in the 14 days prior to inclusion) and at least one of the following criteria:

    i. HR in exercise of moderate intensity > 130 bpm (measured in an ergometry or in a Holter-ECG performed in the 60 days prior to inclusion).

    ii. Average daytime HR > 80 bpm (measured on a Holter-ECG performed in the 60 days prior to inclusion).

  4. Be receiving treatment with beta-blockers or non-dihydropyridine calcium channel blockers (verapamil or diltiazem) at the maximum dose recommended or tolerated by the patient.
  5. Be able to voluntarily give their informed consent.
  6. B|ood test carried out in the 6 months prior to inclusion' including: blood count, thyroid hormones and creatinine, in order to rule out secondary causes of poor HR control. The creatinine figure will be used to calculate the creatinine clearance in order to adjust the dose of patients who are randomized to the Digoxin group.
  7. Transthoracic echocardiogram to rule out, eg, severe valvular heart disease, hypertrophic cardiomyopathy. The one performed in the year prior to inclusion in the study will be considered acceptable provided that the patient's clinical situation has been stable in that period of time.

Exclusion Criteria:

  1. Previous treatment or patients with a known contraindication to Ivabradine or Digoxin or to any excipient of both drugs.
  2. Paroxysmal or intermittent complete atrioventricular (AV) block in patients not carrying a pacemaker.
  3. Decompensated heart failure requiring inotropic and I or intravenous diuretics in the week prior to randomization or in New York Heart Association (NYHA) functional class IV or on the cardiac transplant waiting list,
  4. Acute pericarditis, acute myocarditis or constrictive pericarditis.
  5. Obstructive hypertrophic cardiomyopathy.
  6. Valvular disease requiring surgical or percutaneous correction.
  7. Medical causes that justify poor control of heart rate: fever' anemia, hyperthyroidism, pheochromocytoma' etc.
  8. Severe hypotension (blood pressure <90/50 mmHg).
  9. Concomitant treatment with potent cytochrome P450 3A4 inhibitors such as azole antifungals (ketoconazole, itraconazole), macrolide antibiotics (clarithromycin, oral erythromycin, josamycin, telithromycin) HIV protease inhibitors (nelfinavir, ritonavir) and nefazodone.
  10. Severe renal insufficiency (CrCl <30 ml/Kg/min) or in a hemodialysis program.
  11. Severe hepatic insufficiency.
  12. Major surgery (including cardiac surgery) in the month prior to randomization.
  13. Severe concomitant illness that supposes a llfe expectancy of less than one year.
  14. Impossibility of carrying out scheduled visits to the protocol.
  15. Woman of childbearing age (under 50 years of age, except for those who present a gynecological report that proves the presence of menopause) and women who are breastfeeding.
  16. Participation in a clinical trial in the previous 6 months.
  17. Patients with acute myocardial infarction or unstable angina.
  18. Patient with a recent stroke.
  19. Patients with congenital long QT syndrome or treated with drugs that prolong this interval.

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): NCT03718273


Contacts
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Contact: Adolfo Fontenla, MD, PhD +34 91 390 80 70 adolforamon.fontela@salud.madrid.org
Contact: María López Gil, MD, PhD +34 91 390 80 70 mlopezgil@secardiologia.es

Locations
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Spain
Hospital Universitario de Burgos Recruiting
Burgos, Spain, 09006
Contact: Ricardo Salgado Aranda, MD, PhD    +34 94 721 33 40      
Hospital Universitario Puerta de Hierro Not yet recruiting
Madrid, Spain, 28022
Contact: Jorge Toquero Ramos, MD, PhD    +34 91 191 74 08    jorgetoquero@secardiologia.es   
Hospital Universitario Ramón y Cajal Recruiting
Madrid, Spain, 28034
Contact: Roberto Matía Francés, MD, PhD    +34 91 336 80 00    roberto.matia@salud.madrid.org   
Fundación Jiménez Díaz Recruiting
Madrid, Spain, 28040
Contact: Ángel L. Miracle Blanco, MD, PhD.    +34 91 550 48 00    angel.miracle@quironsalud.es   
Hospital Universitario 12 de Octubre Recruiting
Madrid, Spain, 28041
Contact: Adolfo Fontenla Cerezuela, MD, PhD    +34 91 390 80 70    adolforamon.fontela@salud.madrid.org   
Contact: María López Gil, MD, PhD    +34 91 390 80 70    mlopezgil@secardiología.es   
Hospital Universitario La Paz Recruiting
Madrid, Spain, 28046
Contact: Juan R. Rey Blas, MD, PhD    +34 91 7277000    juanr.rey@salud.madrid.org   
Hospital Universitario de Getafe Not yet recruiting
Madrid, Spain, 28905
Contact: Agustín Pastor, MD, PhD    +34 91 683 93 60    agustin.pastor@salud.madrid.org   
Hospital Universitario Rey Juan Carlos Recruiting
Madrid, Spain, 28933
Contact: Elena Mejía Martínez, MD, PhD    +34 91 481 62 25      
Hospital Virgen de la Salud Not yet recruiting
Toledo, Spain, 45004
Contact: Miguel A. Arias Palomares, MD, PhD    +34 92 526 92 00    maapalomares@secardiologia.es   
Sponsors and Collaborators
Adolfo Fontenla
Spanish Clinical Research Networt (SCReN)
Carlos III Health Institute
Investigators
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Study Chair: Adolfo Fontenla, MD, PhD Hospital Universitario 12 de Octubre

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Responsible Party: Adolfo Fontenla, Adolfo Fontenla, MD, PhD, Hospital Universitario 12 de Octubre
ClinicalTrials.gov Identifier: NCT03718273     History of Changes
Other Study ID Numbers: BRAKE-AF
2018-001936-23 ( EudraCT Number )
First Posted: October 24, 2018    Key Record Dates
Last Update Posted: January 15, 2019
Last Verified: January 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No

Keywords provided by Adolfo Fontenla, Hospital Universitario 12 de Octubre:
Ivabradine
Digoxin
Atrial Fibrillation
Heart rate control

Additional relevant MeSH terms:
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Atrial Fibrillation
Heart Diseases
Arrhythmias, Cardiac
Cardiovascular Diseases
Pathologic Processes
Digoxin
Anti-Arrhythmia Agents
Cardiotonic Agents
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Protective Agents
Physiological Effects of Drugs