Endovascular Ablation of the Right Greater Splanchnic Nerve in Subjects Having HFpEF (Rebalance-HF)

• ClinicalTrials.gov Identifier: NCT04592445
• Recruitment Status: Recruiting
• First Posted: October 19, 2020
• Last Update Posted: January 4, 2022
• Sponsor: Axon Therapies, Inc.
• Information provided by (Responsible Party): Axon Therapies, Inc.

Study Description

Brief Summary:

The objective of this clinical evaluation is to assess the safety and initial effectiveness of catheter-based unilateral ablation of the right greater splanchnic nerve (GSN) in subjects having heart failure with preserved ejection fraction (HFpEF).

Condition or disease	Intervention/treatment	Phase
Heart Failure With Preserved Ejection Fraction	Device: Satera GSN Ablation; Device: Sham Control	Not Applicable

Detailed Description:

This clinical investigation is a prospective, multi-center randomized, sham control, double blinded feasibility clinical study. Both the subject and the noninvasive cardiologist that is caring for the subject will be blinded to the assigned cohort (treatment or sham). The interventional cardiologist who performs the index procedure will not be blinded.

Subjects who meet the eligibility criteria and are enrolled will be randomized 1:1 to either ablation of the right GSN using the Axon System (treatment cohort) or sham (control cohort) at the time of the procedure.

This study will enroll up to 100 subjects at an anticipated 20 US sites. Subject follow up is at 1, 3, 6, and 12 months

Study Design

• Study Type: Interventional (Clinical Trial)
• Estimated Enrollment: 80 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Intervention Model Description: Subjects randomized 1:1 (treatment to sham control); cross-over offered
• Masking: Double (Participant, Outcomes Assessor)
• Masking Description: Subject and HF Cardiologist providing care are blinded. Interventionalist who performs the Index procedure is not
• Primary Purpose: Treatment
• Official Title: ENDOVASCULAR ABLATION OF THE RIGHT GREATER SPLANCHNIC NERVE IN Endovascular Ablation of the Right Greater Splanchnic Nerve in Subjects Having HFpEF: Feasibility Study: Randomized Controlled Feasibility Trial- Rebalance HF Study
• Actual Study Start Date: December 18, 2020
• Estimated Primary Completion Date: April 2022
• Estimated Study Completion Date: March 2023

Arms and Interventions

Arm	Intervention/treatment
Active Comparator: Axon Treatment Arm; Subjects will receive treatment with the Satera Ablation System following administration of anesthesia access to the R GSN and ablation of the GSN at 1-2 levels will occur.	Device: Satera GSN Ablation; The Axon procedure consists of a small needle puncture made in the groin to pass standard sheaths, wires, and access devices into the femoral vein, using standard access methods. The right GSN will be ablated transvenously from the right intercostal veins where it crosses at the 10th and 11th thoracic vertebrae from the intercostal vein intersection with the azygos vein. Placement of the access devices and Axon catheter is confirmed using standard fluoroscopic imaging. Once positioning is confirmed, GSN ablation can commence accordingly .
Sham Comparator: Sham Control Arm; Following administration of anesthesia subjects will have femoral vein access only. Procedure choreography to mimic procedure steps and length.	Device: Sham Control; The sham procedure consists of a small needle puncture made in the groin to pass a standard femoral introducer sheath approximately 10 cm into the femoral vein, using standard access methods. The Axon Catheter and associated access accessories will not be inserted into the patient. The sham procedure duration will be similar to the treatment time for subject receiving the Axon therapy (~30 minutes).

Outcome Measures

Primary Outcome Measures :

1. Primary Outcome Endpoint [ Time Frame: 1 Month ]
   Change in mean PCWP at 1 month follow up evaluated as a repeated measure at rest, legs up and exercise (20W) as compared to the baseline PCWP evaluation. This reduction will be assessed in all subjects (both treated and control) to explore mechanism of action
2. Primary Safety Outcome [ Time Frame: 1 month ]
   Evaluation of device or procedure-related serious adverse events at 1-month follow up based on Clinical Events Committee (CEC) assessment.

Secondary Outcome Measures :

1. Secondary Outcome Endpoints [ Time Frame: 1, 3, 6, and 12 months ]
   * Quality of Life: Change in KCCQ score evaluated over time from baseline and 1, 3, 6, and 12-months follow up.
2. Secondary Outcome Endpoints [ Time Frame: 1, 3, 6, and 12 months ]
   *Change in 6MWT distance evaluated over time from baseline and 1, 3, 6, and 12 months follow up.
3. Secondary Outcome Endpoints [ Time Frame: 1, 3, 6, and 12 months ]
   *Incidence of heart failure hospitalization through 12 months
4. Secondary Outcome Endpoints [ Time Frame: 1 month ]
   *Reduction in PCWP at 1 month follow up at rest, legs up, exercise at 20W and peak exercise as compared to the baseline PCWP evaluation.

Eligibility Criteria

• Ages Eligible for Study: 40 Years and older (Adult, Older Adult)
• Sexes Eligible for Study: All
• Gender Based Eligibility: Yes
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

1. Subjects ≥ 40 years of age

2. Chronic heart failure defined as at least one of the following:

   1. Symptoms of HF requiring current treatment with diuretics (intermittent or continuous) for > 30 days, AND
   2. NYHA class II with a history of > NYHA class II in the past year, NYHA class III, or ambulatory NYHA class IV symptoms (paroxysmal nocturnal dyspnea, orthopnea, dyspnea on mild or moderate exertion) at screening; or signs of HF (any rales post cough, chest x-ray demonstrating pulmonary congestion), AND

   3. > 1 HF hospital admission (with HF as the primary, or secondary diagnosis);

      • OR - treatment with intravenous (IV) diuretics, or intensification of oral diuresis for HF in a healthcare facility within the 12 months prior to study entry;
      • OR - NT-pro BNP value > 150 pg/ml in normal sinus rhythm, > 450 pg/ml in atrial fibrillation within the past 6 months;
      • OR - BNP value > 50 pg/ml in normal sinus rhythm, > 150 pg/ml in atrial fibrillation within the past 6 months.
3. Ongoing stable GDMT HF management (unless unable to tolerate GDMT) and management of potential comorbidities according to the 2017 ACCF/AHA Guideline for the Management of Heart Failure, with no significant changes [>100% increase or 50% decrease] for a minimum of 1 month prior to screening, that is expected to be maintained without change for at least 3 months.
4. LVEF ≥ 50 % (site determined by TTE) in the past 3 months.

5. Site determined elevated PCWP documented by right heart catheterization by PCWP ≥ 25 mmHg during supine ergometer exercise

   a. PCWP to be evaluated by a Swan Ganz procedure performed either prior to the day of the index procedure or on the day of the index procedure

6. Subject is willing and able to provide appropriate study-specific informed consent, follow protocol procedures, and comply with follow-up visit requirements.

Exclusion Criteria:

1. MI (type I) and/or percutaneous cardiac intervention within past 3 months; CABG in past 3 months, or current indication for coronary revascularization.
2. Cardiac Resynchronization Therapy initiated within the past 3 months prior to screening.

3. Advanced heart failure defined as one or more of the below:

   1. ACC/AHA/ESC Stage D heart failure, non-ambulatory NYHA Class IV HF
   2. Cardiac index < 2.0 L/min/m2
   3. Inotropic infusion (continuous or intermittent) for LV EF< 30% within the past 6 months prior to screening
   4. Subject is on the cardiac transplant waiting list
4. BMI > 45 kg/m2
5. Inability to perform 6-minute walk test (distance < 100 meters), OR ability to perform 6-minute walk test distance > 450 meters.
6. Admission for HF within the 30 days prior to planned index procedure.
7. In the last 3 years an ejection fraction (EF) below 40
8. Systolic BP < 100 mmHg or > 170 mmHg despite appropriate medical management.
9. Symptomatic orthostatic hypotension or orthostatic hypotension requiring treatment (orthostatic hypotension is defined as systolic blood pressure decrease of >20mmHg and/or increase in heart rate >20 bpm upon going from supine to standing position).
10. Arterial oxygen saturation < 90 % on room air.

11. Presence of significant valve disease defined by the site cardiologist as:

    1. Mitral valve stenosis defined as <1.5 cm2 (or greater than mild)
    2. Mitral valve regurgitation defined as grade > 3+ MR
    3. Tricuspid valve regurgitation defined as grade > 3+ TR
    4. Aortic valve disease defined as > 3+ AR or > severe AS
12. Hypertrophic cardiomyopathy, restrictive cardiomyopathy, constrictive pericarditis, cardiac amyloidosis, or other infiltrative cardiomyopathy (e.g., hemochromatosis, sarcoidosis)
13. Vessel tortuosity or variant vascular anatomy that could preclude the access or maneuvering of the interventional device from the access site to target vessel. This includes previous spine surgery that may impact the ability to access and treat the target sites of T11 and T10.
14. Mean resting right atrial pressure (RAP) > 20 mmHg based upon screening right heart catheterization.
15. History of severe liver cirrhosis
16. Dialysis dependent; or estimated-GFR <25 ml/min/1.73 m2 by MDRD equation.
17. Baseline status of persistent atrial fibrillation with resting HR >100 beats per minute that could obfuscate RHC interpretation.
18. Chronic pulmonary disease requiring continuous home oxygen OR hospitalization for exacerbation (including intubations) in the 12 months before study entry OR known history of GOLD Class II or higher COPD.
19. Currently participating in conflicting investigational drug or device study.
20. Life expectancy <12 months for non-cardiovascular reasons.
21. Any condition, or history of illness or surgery that, in the opinion of the Investigator, might confound the results of the study or pose additional risks to the patient.
22. Females who are not pregnant or lactating and not or planning to become pregnant for the duration of the study during the next year.

Contacts and Locations

Contacts

Contact: Sierra Yearsley; 16508670927; s.yearsley@axontherapies.com

Locations

United States, Alabama

Cardiology PC; Recruiting

Birmingham, Alabama, United States, 35211

Principal Investigator: Farrell Mendelsohn, MD

United States, Arizona

Arizona Cardiovascular Research Center; Recruiting

Phoenix, Arizona, United States, 85016

Principal Investigator: Vijendra Swarup, MD

United States, California

Scripps Health; Recruiting

La Jolla, California, United States, 92037

Principal Investigator: Rajeev Mohan, MD

Principal Investigator: Matthew Price, MD

University of California, San Francisco; Recruiting

San Francisco, California, United States, 94143

Principal Investigator: Liviu Klein, MD

United States, Illinois

Bluhm Cardiovascular Institute of Northwestern University; Recruiting

Chicago, Illinois, United States, 60611

Principal Investigator: Ravi Patel, MD

University of Chicago Medical Center; Not yet recruiting

Chicago, Illinois, United States, 60637

Principal Investigator: Sean Pinney, MD

Prairie Education and Research Cooperative; Recruiting

Springfield, Illinois, United States, 62701

Principal Investigator: Krishna Rocha-Singh, MD

United States, Louisiana

Cardiovascular Institute of the South; Recruiting

Houma, Louisiana, United States, 70360

Principal Investigator: Peter Fail, MD

United States, Michigan

Michigan Medicine, University of Michigan; Recruiting

Ann Arbor, Michigan, United States, 48109

Principal Investigator: Scott Hummel, MD

United States, Minnesota

Mayo Clinic; Recruiting

Rochester, Minnesota, United States, 55905

Principal Investigator: Barry Borlaug, MD

United States, New York

Weill Cornell Medicine; Recruiting

New York, New York, United States, 10021

Principal Investigator: Parag Goyal, MD

Icahn School of Medicine at Mount Sinai; Recruiting

New York, New York, United States, 10029

Principal Investigator: Sumeet Mitter, MD

Center for Advanced Cardiac Care, Columbia University Medical Center; Recruiting

New York, New York, United States, 10032

Principal Investigator: Nir Uriel, MD

United States, North Carolina

Duke University Medical Center; Recruiting

Durham, North Carolina, United States, 27710

Principal Investigator: Marat Fudim, MD, MHS

United States, Ohio

Ohio State University Wexner Medical Center; Recruiting

Columbus, Ohio, United States, 43210

Principal Investigator: Ralph Augostini, MD

United States, South Carolina

Medical University of South Carolina, Gazes Cardiac Research Institute; Recruiting

Charleston, South Carolina, United States, 29425

Principal Investigator: Sheldon Litwin, MD

United States, Virginia

Virginia Commonwealth University Medical Center; Not yet recruiting

Richmond, Virginia, United States, 23298

Principal Investigator: Keyur Shah, MD

Sponsors and Collaborators

Axon Therapies, Inc.

More Information

• Responsible Party: Axon Therapies, Inc.
• ClinicalTrials.gov Identifier: NCT04592445
• Other Study ID Numbers: 09868
• First Posted: October 19, 2020
• Last Update Posted: January 4, 2022
• Last Verified: December 2021

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: No

• Studies a U.S. FDA-regulated Drug Product: No
• Studies a U.S. FDA-regulated Device Product: Yes
• Device Product Not Approved or Cleared by U.S. FDA: Yes

Additional relevant MeSH terms:

Heart Failure; Heart Diseases; Cardiovascular Diseases