Effects of IL-1 Beta Inhibition on Vascular Inflammation in TET2 Clonal Hematopoiesis

NCT ID: NCT06691217

Last Updated: 2026-01-26

Basic Information

• Recruitment Status: NOT_YET_RECRUITING
• Clinical Phase: PHASE2
• Total Enrollment: 120 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2026-02-16
• Study Completion Date: 2030-04-01

Brief Summary

The primary goal of this clinical trial is to test the hypothesis that the drug canakinumab (anti-IL-1B monoclonal antibody) decreases vascular inflammation when used by people with a history of coronary artery disease, including those with and without clonal hematopoiesis driven by mutations in TET2.

Detailed Description

This is a prospective, randomized, double-blind, placebo-controlled study to test the effects of canakinumab, an inhibitor of interleukin-1B, on vascular inflammation in individuals with coronary artery disease. Half of the trial population will have clonal hematopoiesis of indeterminate potential (CHIP) driven by mutations in TET2. Participants (total N=120) will be randomized 1:1 to receive canakinumab (n=60) versus placebo (n=60). Baseline assessment in all participants will include coronary CT angiography, and a subset of participants in each group (n=16 per group) will undergo SPECT imaging to assess macrophage-specific vascular inflammation. After randomization, participants will have injection/safety visits at Week 0, Week 12, Week 24, and Week 36. Repeat imaging assessments for vascular inflammation will occur during the Week 48 visit(s). Participants will undergo final study and safety assessments at Week 60. The primary endpoint is change in the fat attenuation index (FAI) as measured by coronary CT angiography between baseline and Week 48. Other key endpoints are change in macrophage-specific inflammation by SPECT between baseline and Week 48 and change in TET2 clonal variant allele fraction among participant with TET2 clonal hematopoiesis.

Conditions

Vascular Inflammation; ASCVD; ASCVD Management

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: QUADRUPLE

Study Groups

Placebo: Control

Participants with and without TET2 CHIP will receive placebo injection every 3 months for 4 doses as part of the randomized clinical trial part of this proposal.

Group Type: PLACEBO_COMPARATOR

Saline (NaCl 0,9 %) (placebo)

Intervention Type: DRUG

Participants with and without TET2 CHIP will receive placebo injection every 3 months for 4 doses as part of the randomized clinical trial part of this proposal.

Treatment: Canakinumab

Participants with and without TET2 CHIP will receive 150mg of canakinumab every 3 months for 4 doses as part of the randomized clinical trial part of this proposal.

Group Type: EXPERIMENTAL

CANAKINUMAB (ILARIS®)

Intervention Type: DRUG

Participants with and without TET2 CHIP will receive 150mg of canakinumab every 3 months for 4 doses as part of the randomized clinical trial part of this proposal.

Interventions

CANAKINUMAB (ILARIS®)

Participants with and without TET2 CHIP will receive 150mg of canakinumab every 3 months for 4 doses as part of the randomized clinical trial part of this proposal.

Intervention Type: DRUG

Saline (NaCl 0,9 %) (placebo)

Participants with and without TET2 CHIP will receive placebo injection every 3 months for 4 doses as part of the randomized clinical trial part of this proposal.

Intervention Type: DRUG

Eligibility Criteria

Inclusion Criteria

• 18 years or older
• Prior heart attack or coronary stent procedure >180 days before baseline imaging
• Presence of either TET2 CHIP or no CHIP variants on prior sequencing

Exclusion Criteria

• placement of a drug-eluting stent in a proximal coronary arterial segment <180 days before baseline imaging
• prior coronary artery bypass grafting
• pregnancy or breastfeeding
• history of blood malignancy or current solid-tumor malignancy
• history of organ or stem cell transplantation
• current treatment with prescription, systemic (oral, IV [intravenous], or IM [intramuscular]) steroids or anti-inflammatory/immune suppressant medical therapies (including colchicine but excluding topical therapies, UV therapy, ASA-derivative therapies, or NSAIDS) for autoimmune/inflammatory diseases, post-transplant care, asthma, or pain
• use of oral steroids or prescription oral anti-inflammatory/immune suppressant medication for >7 days within the past 1 month
• use of IV or IM steroids or IV or IM anti-inflammatory/immune suppressant medication within the past 3 months
• known allergy to dextran's and/or DTPA and/or radiometals and/or severe allergy to iodinated contrast media
• estimated glomerular filtration rate (eGFR) < 45 ml/min/1.73 m2
• contraindications to nitroglycerin known narrow angle glaucoma, or known severe aortic stenosis
• use of phosphodiesterase type 5 inhibitor AND refusal to abstain from use of these medications within the 5 days prior to scheduled CCTA scan
• significant radiation exposure (40msV) received within the past 12 months
• concurrent enrollment in another research study judged by the investigators to interfere with the current study
• known active or recurrent hepatic disease (including cirrhosis or ALT/AST levels >3 times the upper limit oof or total bilirubin >2 times the upper limits of normal)
• history or evidence of tuberculosis (TB) (active or latent) infection or risk factor for TB
• history of ongoing, chronic or recurrent infectious disease
• suspected or proven immunocompromised state
• live vaccinations within 3 months prior to randomization visit or live vaccinations planned during the trial

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

National Institutes of Health (NIH)

NIH

Sponsor Role: collaborator

Broad Institute of MIT and Harvard

OTHER

Sponsor Role: collaborator

Yale University

OTHER

Sponsor Role: collaborator

Massachusetts General Hospital

OTHER

Sponsor Role: lead

Responsible Party

Michael C. Honigberg

MD, MPP

Responsibility Role: PRINCIPAL_INVESTIGATOR

Locations

Massachusetts General Hospital

Boston, Massachusetts, United States

Countries

United States

Central Contacts

Michael C Honigberg, MD MPP

Role: CONTACT

mhonigberg@mgh.harvard.edu

617-726-1843

Mabel Toribio, MD

Role: CONTACT

mptoribio@mgh.harvard.edu

(617)-724-2826

Facility Contacts

Victoria R Viscosi, MS

Role: primary

vviscosi@mgh.harvard.edu

617-724-2996

Jack H.A. Miller, BS

Role: backup

jmiller90@mgh.harvard.edu

617-643-7546

Other Identifiers

2024P002825

Identifier Type: -

Identifier Source: org_study_id