Genetically Targeted Therapy for the Prevention of Symptomatic Atrial Fibrillation in Patients With Heart Failure

NCT ID: NCT01970501

Last Updated: 2022-09-26

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE2

Total Enrollment

267 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-04-30

Study Completion Date

2017-12-28

Brief Summary

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This study is being done to compare the effects of bucindolol hydrochloride (bucindolol) to metoprolol succinate (Toprol-XL) on the recurrence of symptomatic atrial fibrillation/atrial flutter in patients with heart failure who have a specific genotype for the beta-1 adrenergic receptor.

Detailed Description

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The goal of the GENETIC-AF trial is to demonstrate the superiority of pharmacogenetically targeted bucindolol compared to metoprolol for the prevention of symptomatic atrial fibrillation or atrial flutter in a genotype-defined population with heart failure and/or reduced left ventricular ejection fraction at high risk of atrial fibrillation/atrial flutter recurrence.

Conditions

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Current or Recent History of Atrial Fibrillation

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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bucindolol hydrochloride

bucindolol hydrochloride (bucindolol)

Participants were randomized (1:1) to blinded treatment with bucindolol or metoprolol and titrated weekly to target doses of 50 mg twice daily (BID; \< 75 kg) or 100 mg BID (≥ 75 kg) for bucindolol or 200 mg once daily (QD) for metoprolol. 84% of bucindolol participants attained target dose and 72% of metoprolol participants attained target dose.

The lowest starting dose of bucindolol was 6.25 mg BID with weekly dose titrations to the weight-based target dose or to the maximum tolerated dose. The starting dose assigned was based on the patient's beta-blocker treatment prior to randomization. Capsules for titration were available in the following dosage strengths to be taken twice daily (with or without food): 6.25mg, 12.5mg, 25mg, 50mg, and 100mg.

Group Type EXPERIMENTAL

bucindolol hydrochloride

Intervention Type DRUG

metoprolol succinate

metoprolol succinate (Toprol-XL)

Participants were randomized (1:1) to blinded treatment with bucindolol or metoprolol and titrated weekly to target doses of 50 mg twice daily (BID; \< 75 kg) or 100 mg BID (≥ 75 kg) for bucindolol or 200 mg once daily (QD) for metoprolol. 84% of bucindolol participants attained target dose and 72% of metoprolol participants attained target dose.

The lowest starting dose of metoprolol was 25 mg QD with weekly dose titrations to the target dose or to the maximum tolerated dose. The starting dose assigned was based upon the patient's beta-blocker treatment prior to randomization. Capsules for titration were available in the following dosage strengths to be taken twice daily (with or without food): 25mg, 50mg, 100mg, 200mg and/or matching placebo oral capsule to maintain blinded dosing.

Group Type ACTIVE_COMPARATOR

metoprolol succinate

Intervention Type DRUG

Placebo oral capsule

Intervention Type OTHER

Interventions

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bucindolol hydrochloride

Intervention Type DRUG

metoprolol succinate

Intervention Type DRUG

Placebo oral capsule

Intervention Type OTHER

Other Intervention Names

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bucindolol Toprol-XL metoprolol placebo

Eligibility Criteria

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Inclusion Criteria

* Must weigh at least 40 kg
* Possess the β1389 Arg/Arg genotype
* Left Ventricular Ejection Fraction (LVEF) \< 0.50 assessed within 12 months prior to Screening
* At least one episode of symptomatic paroxysmal or persistent AF within 180 days of Screening
* Clinically appropriate for electrical cardioversion (ECV) if AF/AFL is present after study drug initiation
* Receiving appropriate anticoagulation therapy prior to Randomization

Exclusion Criteria

* NYHA Class IV symptoms at the time of Randomization
* Significant fluid overload at Randomization
* Permanent AF at Screening
* More than two previous ECV within 6 months of Randomization or if the most recent ECV failed to produce SR
* Presence of an LVAD, or likely to requirement LVAD placement within 6 months of Randomization
* History of a successful atrioventricular (AV) node ablation
* History of an AF/AFL ablation within 30 days of Randomization
* Evidence of an appropriate firing of an implanted cardioverter-defibrillator (ICD) device for ventricular tachycardia (VT) or ventricular fibrillation (VF) within 90 days of Randomization
Minimum Eligible Age

18 Years

Maximum Eligible Age

85 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Medtronic

INDUSTRY

Sponsor Role collaborator

ARCA Biopharma, Inc.

INDUSTRY

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Jonathan Piccini, MD

Role: PRINCIPAL_INVESTIGATOR

Duke University

Michael Bristow, MD,PhD

Role: STUDY_DIRECTOR

ARCA Biopharma, Inc.

Locations

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ARCA Clinical Research Site #157

Anchorage, Alaska, United States

Site Status

ARCA Clinical Research Site #383

Phoenix, Arizona, United States

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ARCA Clinical Research Site #385

Phoenix, Arizona, United States

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ARCA Clinical Research Site #381

East Palo Alto, California, United States

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ARCA Clinical Research Site #186

Loma Linda, California, United States

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ARCA Clinical Research Site #320

Pasadena, California, United States

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ARCA Clinical Research Site #390

Stanford, California, United States

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ARCA Clinical Research Site #153

Aurora, Colorado, United States

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ARCA Clinical Research Site #380

Denver, Colorado, United States

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ARCA Clinical Research Site #195

Miami, Florida, United States

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ARCA Clinical Research Site #184

Tampa, Florida, United States

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ARCA Clinical Research Site #351

Athens, Georgia, United States

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ARCA Clinical Research Site #389

Atlanta, Georgia, United States

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ARCA Clinical Research Site #342

Oakbrook Terrace, Illinois, United States

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ARCA Clinical Research Site #303

Hammond, Indiana, United States

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ARCA Clinical Research Site #388

Iowa City, Iowa, United States

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ARCA Clinical Site #396

New Orleans, Louisiana, United States

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ARCA Clinical Research Site #398

Baltimore, Maryland, United States

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ARCA Clinical Research Site #127

Ypsilanti, Michigan, United States

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ARCA Clinical Research Site #156

Minneapolis, Minnesota, United States

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ARCA Clinical Research Site #174

Saint Paul, Minnesota, United States

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ARCA Clinical Research Site #108

St Louis, Missouri, United States

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ARCA Clinical Research Site #201

St Louis, Missouri, United States

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ARCA Clinical Research Site #152

Lincoln, Nebraska, United States

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ARCA Clinical Research Site #161

Elmer, New Jersey, United States

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ARCA Clinical Research Site #202

Hillsborough, New Jersey, United States

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ARCA Clinical Research Site # 179

Albany, New York, United States

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ARCA Clinical Research Site #397

New York, New York, United States

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ARCA Clinical Research Site #181

Durham, North Carolina, United States

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ARCA Clinical Research Site #349

Greensboro, North Carolina, United States

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ARCA Clinical Research Site #173

Akron, Ohio, United States

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ARCA Clinical Research Site #392

Cincinnati, Ohio, United States

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ARCA Clinical Research Site #322

Cleveland, Ohio, United States

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ARCA Clinical Research Site #151

Columbus, Ohio, United States

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ARCA Clinical Research Site #399

Oklahoma City, Oklahoma, United States

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ARCA Clinical Research Site #115

Portland, Oregon, United States

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ARCA Clinical Research Site # 189

Hershey, Pennsylvania, United States

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ARCA Clinical Research Site #109

Lancaster, Pennsylvania, United States

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ARCA Clinical Research Site #133

Philadelphia, Pennsylvania, United States

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ARCA Clinical Site #393

Germantown, Tennessee, United States

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ARCA Clinical Research Site #198

Jackson, Tennessee, United States

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ARCA Clinical Research Site #387

Dallas, Texas, United States

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ARCA Clinical Research Site #379

Salt Lake City, Utah, United States

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ARCA Clinical Site #391

Charlottesville, Virginia, United States

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ARCA Clinical Research Site #386

Falls Church, Virginia, United States

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ARCA Clinical Research Site #200

Manassas, Virginia, United States

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ARCA Research Site #131

Norfolk, Virginia, United States

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ARCA Clinical Research Site #196

Puyallup, Washington, United States

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ARCA Clinical Research Site #612

Calgary, Alberta, Canada

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ARCA Clinical Research Site #624

Vancouver, British Columbia, Canada

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ARCA Clinical Research Site #611

Cambridge, Ontario, Canada

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ARCA Clinical Research Site #621

Cambridge, Ontario, Canada

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ARCA Clinical Research Site #601

Hamilton, Ontario, Canada

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ARCA Clinical Research Site #609

London, Ontario, Canada

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ARCA Clinical Research Site #623

Newmarket, Ontario, Canada

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ARCA Clinical Research Site #618

Oshawa, Ontario, Canada

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ARCA Clinical Research Site #613

Ottawa, Ontario, Canada

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ARCA Clinical Research Site #619

Toronto, Ontario, Canada

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ARCA Clinical Research Site #616

Waterloo, Ontario, Canada

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ARCA Clinical Research Site #614

Montreal, Quebec, Canada

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ARCA Clinical Research Site #607

Montreal, Quebec, Canada

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ARCA Clinical Research Site #603

Montreal, Quebec, Canada

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ARCA Clinical Research Site #625

Saint-Jérôme, Quebec, Canada

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ARCA Clinical Research Site #602

Sherbrooke, Quebec, Canada

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ARCA Clinical Research Site #626

Trois-Rivières, Quebec, Canada

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ARCA Clinical Research Site #615

Québec, , Canada

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ARCA Clinical Research Site #726

Budapest, , Hungary

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ARCA Clinical Research Site #727

Budapest, , Hungary

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ARCA Clinical Research Site #728

Budapest, , Hungary

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ARCA Clinical Research Site #729

Budapest, , Hungary

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ARCA Clinical Research Site #733

Debrecen, , Hungary

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ARCA Clinical Research Site #732

Kaposvár, , Hungary

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ARCA Clinical Research Site #730

Pécs, , Hungary

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ARCA Clinical Research Site #731

Szeged, , Hungary

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ARCA Clinical Research Site #734

Szolnok, , Hungary

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ARCA Clinical Research Site #781

Capelle aan den IJssel, , Netherlands

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ARCA Clinical Research Site #779

Gorinchem, , Netherlands

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ARCA Clinical Research Site #776

Groningen, , Netherlands

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ARCA Clinical Research Site #780

Helmond, , Netherlands

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ARCA Clinical Research Site #782

Leiderdorp, , Netherlands

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ARCA Clinical Research Site #786

Roosendaal, , Netherlands

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ARCA Clinical Research Site #777

Sneek, , Netherlands

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ARCA Clinical Research Site #783

Stadskanaal, , Netherlands

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ARCA Clinical Research Site #784

Tiel, , Netherlands

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ARCA Clinical Research Site #752

Bialystok, , Poland

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ARCA Clinical Research Site #757

Gdansk, , Poland

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ARCA Clinical Research Site #753

Krakow, , Poland

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ARCA Clinical Research Site #755

Lodz, , Poland

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ARCA Clinical Research Site #751

Lodz, , Poland

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ARCA Clinical Research Site #758

Lublin, , Poland

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ARCA Clinical Research Site #754

Warsaw, , Poland

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ARCA Clinical Research Site #756

Wroclaw, , Poland

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ARCA Clinical Research Site #807

Belgrade, , Serbia

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ARCA Clinical Research Site #806

Belgrade, , Serbia

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ARCA Clinical Research Site #801

Kragujevac, , Serbia

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ARCA Clinical Research Site #804

Niš, , Serbia

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ARCA Clinical Research Site #805

Niš, , Serbia

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Countries

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United States Canada Hungary Netherlands Poland Serbia

References

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Liggett SB, Mialet-Perez J, Thaneemit-Chen S, Weber SA, Greene SM, Hodne D, Nelson B, Morrison J, Domanski MJ, Wagoner LE, Abraham WT, Anderson JL, Carlquist JF, Krause-Steinrauf HJ, Lazzeroni LC, Port JD, Lavori PW, Bristow MR. A polymorphism within a conserved beta(1)-adrenergic receptor motif alters cardiac function and beta-blocker response in human heart failure. Proc Natl Acad Sci U S A. 2006 Jul 25;103(30):11288-93. doi: 10.1073/pnas.0509937103. Epub 2006 Jul 14.

Reference Type BACKGROUND
PMID: 16844790 (View on PubMed)

O'Connor CM, Fiuzat M, Carson PE, Anand IS, Plehn JF, Gottlieb SS, Silver MA, Lindenfeld J, Miller AB, White M, Walsh R, Nelson P, Medway A, Davis G, Robertson AD, Port JD, Carr J, Murphy GA, Lazzeroni LC, Abraham WT, Liggett SB, Bristow MR. Combinatorial pharmacogenetic interactions of bucindolol and beta1, alpha2C adrenergic receptor polymorphisms. PLoS One. 2012;7(10):e44324. doi: 10.1371/journal.pone.0044324. Epub 2012 Oct 10.

Reference Type BACKGROUND
PMID: 23071495 (View on PubMed)

Aleong RG, Sauer WH, Davis G, Murphy GA, Port JD, Anand IS, Fiuzat M, O'Connor CM, Abraham WT, Liggett SB, Bristow MR. Prevention of atrial fibrillation by bucindolol is dependent on the beta(1)389 Arg/Gly adrenergic receptor polymorphism. JACC Heart Fail. 2013 Aug;1(4):338-344. doi: 10.1016/j.jchf.2013.04.002.

Reference Type BACKGROUND
PMID: 24159564 (View on PubMed)

Kao DP, Davis G, Aleong R, O'Connor CM, Fiuzat M, Carson PE, Anand IS, Plehn JF, Gottlieb SS, Silver MA, Lindenfeld J, Miller AB, White M, Murphy GA, Sauer W, Bristow MR. Effect of bucindolol on heart failure outcomes and heart rate response in patients with reduced ejection fraction heart failure and atrial fibrillation. Eur J Heart Fail. 2013 Mar;15(3):324-33. doi: 10.1093/eurjhf/hfs181. Epub 2012 Dec 7.

Reference Type BACKGROUND
PMID: 23223178 (View on PubMed)

Carroll IA, Piccini JP, Steinberg BA, Tzou WS, Richards JC, DeMets DL, Bristow MR. Symptoms Burden as a Clinical Outcomes Assessment in Heart Failure Patients With Atrial Fibrillation. JACC Heart Fail. 2025 Apr;13(4):573-585. doi: 10.1016/j.jchf.2024.08.023. Epub 2024 Nov 20.

Reference Type DERIVED
PMID: 39570238 (View on PubMed)

Piccini JP, Dufton C, Carroll IA, Healey JS, Abraham WT, Khaykin Y, Aleong R, Krueger SK, Sauer WH, Wilton SB, Rienstra M, van Veldhuisen DJ, Anand IS, White M, Camm AJ, Ziegler PD, Marshall D, Bristow MR, Connolly SJ; Genotype-Directed Comparative Effectiveness Trial of Bucindolol and Toprol-XL for Prevention of Atrial Fibrillation/Atrial Flutter in Patients with Heart Failure Trial Investigators*. Bucindolol Decreases Atrial Fibrillation Burden in Patients With Heart Failure and the ADRB1 Arg389Arg Genotype. Circ Arrhythm Electrophysiol. 2021 Aug;14(8):e009591. doi: 10.1161/CIRCEP.120.009591. Epub 2021 Jul 16.

Reference Type DERIVED
PMID: 34270905 (View on PubMed)

Piccini JP, Connolly SJ, Abraham WT, Healey JS, Steinberg BA, Al-Khalidi HR, Dignacco P, van Veldhuisen DJ, Sauer WH, White M, Wilton SB, Anand IS, Dufton C, Marshall DA, Aleong RG, Davis GW, Clark RL, Emery LL, Bristow MR. A genotype-directed comparative effectiveness trial of Bucindolol and metoprolol succinate for prevention of symptomatic atrial fibrillation/atrial flutter in patients with heart failure: Rationale and design of the GENETIC-AF trial. Am Heart J. 2018 May;199:51-58. doi: 10.1016/j.ahj.2017.12.001. Epub 2017 Dec 6.

Reference Type DERIVED
PMID: 29754666 (View on PubMed)

Provided Documents

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Document Type: Study Protocol

View Document

Document Type: Statistical Analysis Plan

View Document

Document Type: Informed Consent Form

View Document

Other Identifiers

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BUC-CLIN-303

Identifier Type: -

Identifier Source: org_study_id

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