Safety and Tolerability of the Chymase Inhibitor Fulacimstat in Patients With Left Ventricular Dysfunction After Myocardial Infarction-Results of the CHIARA MIA 1 Trial.

Abstract

The chymase inhibitor fulacimstat is developed as a first-in-class treatment option for the inhibition of adverse cardiac remodeling in patients with left ventricular dysfunction (LVD) after acute myocardial infarction (MI). The aim of the study was to examine the safety and tolerability of fulacimstat in patients with LVD after remote MI. A multicenter, multinational randomized, placebo-controlled study was performed in clinically stable patients (40-79 years of age, left ventricular ejection fraction ≤ 45% because of MI in medical history) who were on stable evidence-based standard-of-care therapies for LVD post-MI including an angiotensin converting enzyme inhibitor or angiotensin receptor blocker at doses of at least half the recommended target dose. Patients were treated for 2 weeks with either placebo (n = 12) or 4 different doses of fulacimstat (5 mg twice daily, n = 9; 10 mg twice daily, n = 9; 25 mg twice daily, n = 10; 50 mg once daily, n = 9). Fulacimstat was safe and well tolerated at all examined doses. There were no clinically relevant effects on vital signs or potassium levels compared with placebo treatment. Mean plasma concentrations of fulacimstat increased with the administered dose and reached exposures predicted to be therapeutically active. The safety profile and the absence of effects on blood pressure or heart rate in a chronic patient population having similar comorbidities and receiving similar comedication as patients after acute MI support future clinical trials with fulacimstat in patients after acute MI.

• Authors: Hans-Dirk Düngen, Lars Kober, Savina Nodari, Morten Schou, Christiane Otto, Michael Becka, Friederike Kanefendt, Bernhard R Winkelmann, Gunnar Gislason, Frank Richard, Olav Wendelboe Nielsen, Mihai Gheorghiade, Michele Senni
• Journal: Clinical pharmacology in drug development (Clin Pharmacol Drug Dev) Vol. 8 Issue 7 Pg. 942-951 (10 2019) ISSN: 2160-7648 [Electronic] United States
• PMID: 30452784 (Publication Type: Clinical Trial, Phase I, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: © 2018, The American College of Clinical Pharmacology.

Chemical References

• Angiotensin Receptor Antagonists
• Angiotensin-Converting Enzyme Inhibitors
• Carboxylic Acids
• Indenes
• Pyrimidines
• Chymases
• fulacimstat

Topics

• Adult
• Aged
• Angiotensin Receptor Antagonists (therapeutic use)
• Angiotensin-Converting Enzyme Inhibitors (therapeutic use)
• Carboxylic Acids (administration & dosage, adverse effects, pharmacokinetics)
• Chymases (antagonists & inhibitors)
• Drug Administration Schedule
• Female
• Heart Failure (etiology, prevention & control)
• Humans
• Indenes (administration & dosage, adverse effects, pharmacokinetics)
• Male
• Middle Aged
• Myocardial Infarction (complications)
• Pyrimidines (administration & dosage, adverse effects, pharmacokinetics)
• Treatment Outcome
• Ventricular Dysfunction, Left (drug therapy, etiology)