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Ranolazine Implantable Cardioverter-Defibrillator Trial (RAID)

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ClinicalTrials.gov Identifier: NCT01215253
Recruitment Status : Completed
First Posted : October 6, 2010
Results First Posted : June 15, 2018
Last Update Posted : June 15, 2018
Sponsor:
Information provided by (Responsible Party):
Wojciech Zareba, University of Rochester

Brief Summary:
The purpose of the study is to see how effective a drug called ranolazine is in reducing the risk of ventricular arrhythmia and death in people with implantable cardioverter-defibrillators (ICDs). This drug will be used with standard medications that is routinely prescribed in enrolled patients.

Condition or disease Intervention/treatment Phase
Ischemic Cardiomyopathy Nonischemic Cardiomyopathy Heart Failure Drug: Ranolazine Phase 3

Detailed Description:

There are limited treatment options for patients at high risk of ventricular arrhythmic events. Beta-blockers alone do not provide enough protection, sotalol has limited effectiveness, and amiodarone although effective in some groups of patients is used infrequently due to its side effects and limitations of a long-term use. Ischemia and cardiomyopathies are associated with a sodium overload of myocardial cells. Late sodium current plays a pivotal role in this process. Sodium overload leads to calcium overload of myocardial cells with consequent increased vulnerability of myocardium to ventricular tachyarrhythmias as well as increased impairment of diastolic relaxation of myocardium thereby augmenting the risk of ischemia and myocardial damage.

Ranolazine is a novel drug with anti-ischemic and antiarrhythmic properties that uniquely blocks late sodium current, decreases intracellular calcium overload, and improves diastolic relaxation of the ventricles. The antiischemic and antiarrhythmic properties of ranolazine might decrease the likelihood of arrhythmic events and improve the clinical course of patients with ventricular arrhythmias.

We designed a randomized double-blind placebo-controlled clinical trial enrolling 1,440 high-risk ICD patients who will be treated with ranolazine or placebo in addition to optimal medical therapy to test the hypothesis that late sodium current blockade contributes to significant reduction in the risk of arrhythmic events or death in high-risk ICD/CRT-D patients.


Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 1012 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Late Sodium Current Blockade in High-Risk ICD Patients
Study Start Date : September 2011
Actual Primary Completion Date : February 28, 2017
Actual Study Completion Date : February 28, 2017


Arm Intervention/treatment
Active Comparator: Ranolazine
At enrollment, patients will be randomized to ranolazine or placebo. In the active drug arm each patient will be started on a 500 mg twice a day dose for one week with subsequent increase to 1000 mg twice a day at end of first week. For patients on anti-arrhythmic therapy at the time of randomization, their ECG will be checked at end of first week on 500 mg dose and again at end of second week on 1000 mg dose. For patients with CrCl <60ml/min prior to randomization, their CrCl will be checked again at 2 weeks and study drug discontinued if <30ml/min. For patients with CrCl <60ml/min at 2 weeks, their CrCl will be checked again at 4 weeks and study drug discontinued if <30ml/min.
Drug: Ranolazine
At enrollment, patients will be randomized to ranolazine or placebo. In the active drug arm each patient will be started on a 500 mg twice a day dose for one week with subsequent increase to 1000 mg twice a day at beginning of second week.
Other Name: Ranexa

Placebo Comparator: Placebo
At enrollment, patients will be randomized to ranolazine or placebo. In the active drug arm each patient will be started on a 500 mg twice a day dose for one week with subsequent increase to 1000 mg twice a day at end of first week. For patients on anti-arrhythmic therapy at the time of randomization, their ECG will be checked at end of first week on 500 mg dose and again at end of second week on 1000 mg dose. For patients with CrCl <60ml/min prior to randomization, their CrCl will be checked again at 2 weeks and study drug discontinued if <30ml/min. For patients with CrCl <60ml/min at 2 weeks, their CrCl will be checked again at 4 weeks and study drug discontinued if <30ml/min.
Drug: Ranolazine
At enrollment, patients will be randomized to ranolazine or placebo. In the active drug arm each patient will be started on a 500 mg twice a day dose for one week with subsequent increase to 1000 mg twice a day at beginning of second week.
Other Name: Ranexa




Primary Outcome Measures :
  1. Number of Patients With Ventricular Tachycardia or Ventricular Fibrillation or Death [ Time Frame: 2 years of follow-up on average ]
    Primary endpoint of the study will be defined as a composite endpoint consisting of Ventricular Tachycardia or Ventricular Fibrillation requiring ATP therapy, ICD shock, or death, whichever occurs first.


Secondary Outcome Measures :
  1. Number of Patients With VT or VF Requiring ICD Shock or or Death [ Time Frame: 2 years of follow-up on average ]
    Implantable cardioverter-defibrillator (ICD) shock for VT or VF or death, whichever occurs first.

  2. Number of Recurrent Episodes of VT or VF Requiring ATP or ICD Shock Therapies [ Time Frame: 2 years of follow-up on average ]
    Total number of recurrent ICD therapies requiring ATP or shock will be analyzed, not just first event

  3. Number of Patients With First Inappropriate ICD Shocks [ Time Frame: 2 years of follow-up on average ]
    Number of patients with first inappropriate ICD shocks

  4. Number of Patients With Hospitalization for Cardiac Causes or Death, Whichever Occurred First. [ Time Frame: 2 years of follow-up on average ]
    Number of patients with a composite endpoint of cardiovascular hospitalization or death, whichever occurred first.

  5. Number of Patients With Heart Failure Hospitalization or Death, Whichever Occurred First [ Time Frame: 2 years of follow-up on average ]
    Number of patients with a composite endpoint of heart failure hospitalization or death, whichever occurred first.

  6. Death [ Time Frame: 2 years of follow-up on average ]
    Death as a safety endpoint of the trial

  7. Mean Meters Walked in 6 Minutes [ Time Frame: 1 year of follow-up ]
    Exercise capacity measured by the 6-minute walk test

  8. Quality of Life Measured by the Kansas City Cardiomyopathy Questionnaire (KCCQ) [ Time Frame: 1 year follow-up ]
    The Kansas City Cardiomyopathy Questionnaire (KCCQ) is a new, self-administered, 23-item questionnaire that quantifies physical limitations, symptoms, self-efficacy, social interference and quality of life. The scale ranges from 0-100 with lower scores indicating worse outcomes.

  9. Number of Patients With Recurrent Inappropriate ICD Shocks [ Time Frame: 2 years of follow-up on average ]
    Number of patients with recurrent inappropriate ICD shocks


Other Outcome Measures:
  1. Number of Patients Whose First VT/VF Required Antitachycardia Pacing (ATP) [ Time Frame: 2 years of follow-up on average ]
    Number of patients whose first VT or VF required antitachycardia pacing (ATP)

  2. Number of Patients Whose First VT/VF Required ICD Shock [ Time Frame: 2 years of follow-up on average ]
    number of patients whose first VT or VF required ICD shock



Information from the National Library of Medicine

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Ages Eligible for Study:   21 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

1,440 high-risk patients with ischemic/nonischemic cardiomyopathy who receive their ICDs as standard of care for primary or secondary prevention of mortality following approved indications for ICD therapy. High-risk patients will be defined as:

Secondary Prevention Patients Subjects with ischemic or nonischemic cardiomyopathy, qualified for or with existing ICD (or CRT-D) after documented VT/VF or cardiac arrest (secondary prevention of mortality). Secondary prevention subjects with existing implants are eligible regardless of when the implant was received (subjects could be recruited from outpatient clinics or from inpatient activity including during re-implant or other procedures).

Primary Prevention Patients

  1. Patients with primary prevention indications for ischemic or non-ischemic cardiomyopathy with EF≤35%, with existing devices (ICD/CRT-D), regardless of when the device was implanted, who have experienced at least ONE episode of VT/VF appropriately treated with ICD therapy (ATP or shock) or had untreated NSVT lasting at least 10 beats with heart rate of at least 170 bpm, documented by electrogram of their implanted device.
  2. Patients with ischemic or non-ischemic cardiomyopathy with EF≤35%, who have been implanted within the last 2 years (initial ICD/CRT-D implants, including upgrades from pacemakers) who have NOT experienced VT/VF treated with ICD therapy (ATP or shock), AND who have ONE of the following additional criteria: BUN≥26 mg/dl or QRS>120ms or Atrial Fibrillation or NSVT documented by ECG/Holter or >500 Ventricular Premature Beats (VPBs)documented in a 24-hour Holter.

    • Stable optimal pharmacologic therapy for the cardiac condition
    • Age: equal to 21 years without upper limit

Exclusion Criteria:

  • Patient receiving first device with coronary artery bypass graft surgery within the last 3 calendar months prior to date consent obtained
  • Patients receiving first device with percutaneous coronary intervention within the last 1 calendar month prior to date consent obtained
  • Patient receiving first device with enzyme-positive myocardial infarction with the past 3 calendar months prior to date consent obtained
  • Patient receiving first device with angiographic evidence of coronary disease who are candidates for coronary revascularization and are likely to undergo coronary artery bypass graft surgery or percutaneous coronary intervention in the foreseeable future
  • Patient in NYHA Class IV
  • Patients receiving prophylactic ablation of ventricular substrate
  • Patients with preexisting QTc prolongation >550ms
  • Patients on strong CYP3A inhibitors (including ketoconazole, itraconazole, clarithromycin, nefazodone, nelfinavir, ritonavir, indinavir and saquinavir and moderate CYP3A inhibitors, including, diltiazem, verapamil, aprepitant, erythromycin, fluconazole and grapefruit juice or grapefruit-containing products.
  • Patients on CYP3A inducers such as rifampin, rifabutin, rifapentine, phenobarbital, phenytoin, carbamazepine and St.John's wort
  • Patients with inherited arrhythmia disorders such as Brugada's, ARVD, LQTS or hypertrophic cardiomyopathy
  • Patient who is pregnant or plans to become pregnant during the course of the trial (patients at child bearing age who use prescribed pharmaceutical contraceptives could be enrolled)
  • Patient with irreversible brain damage from preexisting cerebral disease
  • Patient with presence of any disease, other than the patient's cardiac disease, associated with a reduced likelihood of survival for the duration of the trial, e.g., cancer, uremia, liver failure, etc.
  • Patient with chronic renal disease with creatinine >2.5 mg/dl or creatinine clearance <30 ml/min
  • Patient participating in any other clinical trial
  • Patient unwilling or unable to cooperate with the protocol
  • Patient who lives at such a distance from the clinic that travel for follow-up visits would be unusually difficult
  • Patient who does not anticipate being a resident of the area for the scheduled duration of the trial
  • Patients who are decisionally impaired adults, those of questionable capacity, and those who cannot consent for themselves will not be recruited for this study.
  • Patient unwilling to sign the consent for participation

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): NCT01215253


  Show 90 Study Locations
Sponsors and Collaborators
University of Rochester
Investigators
Principal Investigator: Wojciech Zareba, MD PhD University of Rochester
  Study Documents (Full-Text)

Documents provided by Wojciech Zareba, University of Rochester:
Study Protocol  [PDF] September 5, 2014
Statistical Analysis Plan  [PDF] January 4, 2017


Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: Wojciech Zareba, MD PhD, University of Rochester
ClinicalTrials.gov Identifier: NCT01215253     History of Changes
Other Study ID Numbers: U01HL096607 ( U.S. NIH Grant/Contract )
First Posted: October 6, 2010    Key Record Dates
Results First Posted: June 15, 2018
Last Update Posted: June 15, 2018
Last Verified: May 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No
Plan Description: The RAID PI and Steering Committee with investigators from enrolling sites have designed a series of secondary substudies that will be disseminated as abstracts and manuscripts. External proposal of analyses of the RAID trial data will be reviewed bye the Steering Committee and analyses will be conducted by the Data Coordinating Center (DCC) of the trial.

Studies a U.S. FDA-regulated Drug Product: Yes
Product Manufactured in and Exported from the U.S.: No

Keywords provided by Wojciech Zareba, University of Rochester:
Sudden Death
Ranolazine
Heart failure
Ventricular tachycardia
Ventricular fibrillation
Implantable cardioverter-defibrillator

Additional relevant MeSH terms:
Heart Failure
Cardiomyopathies
Heart Diseases
Cardiovascular Diseases
Ranolazine
Sodium Channel Blockers
Membrane Transport Modulators
Molecular Mechanisms of Pharmacological Action