October 11, 2017TrialsOpen Access

CXCR2 Inhibition – a novel approach to treating CoronAry heart DiseAse (CICADA): study protocol for a randomised controlled trial

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Why the study?

Does AZD5069 improve coronary flow reserve in patients with coronary artery disease undergoing percutaneous coronary intervention?

Structured PICO

Does AZD5069 improve coronary flow reserve in patients with coronary artery disease undergoing percutaneous coronary intervention?

Population

90 subjects with coronary artery disease undergoing percutaneous coronary intervention

Intervention

AZD5069 (40 mg) administered orally twice daily for 24 weeks

Comparator

Placebo for 24 weeks

Outcome

Change in coronary flow reserve as determined by 13N-ammonia positron emission tomography-computed tomographysurrogate

This study protocol outlines a trial to investigate whether CXCR2 inhibition with AZD5069 improves coronary flow reserve and plaque structure in patients with coronary artery disease.

Implication

AZD5069 effect on coronary flow reserve in CAD remains untested; this RCT will deliver the first direct evidence.

Abstract

There is emerging evidence of the central role of neutrophils in both atherosclerotic plaque formation and rupture. Patients with lower neutrophil counts following acute coronary syndromes tend to have a greater coronary flow reserve, which is a strong predictor of long-term cardiovascular health. But so far, no data are available regarding the impact of neutrophil inhibition on cardiovascular clinical or surrogate endpoints. Therefore, the aim of this study is to investigate the effects of AZD5069, a cysteine-X-cysteine chemokine receptor 2 (CXCR2) inhibitor, on coronary flow reserve and coronary structure and function in patients with coronary artery disease. Ninety subjects with coronary artery disease undergoing percutaneous coronary intervention will be included in this investigator-driven, randomised, placebo-controlled, double-blind, phase IIa, single-centre study. Participants will be randomised to receive either AZD5069 (40 mg) administered orally twice daily or placebo for 24 weeks. Change in coronary flow reserve as determined by 13N-ammonia positron emission tomography-computed tomography will be the primary outcome. Change in the inflammatory component of coronary plaque structure and the backward expansion wave, an invasive coronary physiological measure of diastolic function, will be assessed as secondary outcomes. Cardiovascular surrogate parameters, such as coronary flow reserve, may provide insights into the potential mechanisms of the cardiovascular effects of CXCR2 inhibitors. Currently, ongoing trials do not specifically focus on neutrophil function as a target of intervention, and we therefore believe that our study will contribute to a better understanding of the role of neutrophil-mediated inflammation in coronary artery disease. EudraCT, 2016-000775-24 . Registered on 22 July 2016. International Standard Randomised Controlled Trial Number, ISRCTN48328178 . Registered on 25 February 2016.