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Double-blind, placebo-controlled evaluation of biorest liposomal alendronate in diabetic patients undergoing PCI: The BLADE-PCI trial - 23/05/22

Doi : 10.1016/j.ahj.2022.03.004 
Philippe Généreux, MD a, , , Gil Chernin, MD b, , Abid R. Assali, MD c, Jan Z. Peruga, MD, PhD d, Simon D. Robinson, MD e, Erick Schampaert, MD f, Rodrigo Bagur, MD, PhD g, Samer Mansour, MD h, Josep Rodés-Cabau, MD i, Margaret McEntegart, MD, PhD j, Robert Gerber, MD k, Philippe L'Allier, MD l, Ranil de Silva, MD m, Benoit Daneault, MD n, Suneil K. Aggarwal, MD o, Vladimír Džavík, MD p, M. Ozgu Ozan, MS q, Ori Ben-Yehuda, MD q, r, s, Akiko Maehara, MD q, r, Gregg W. Stone, MD q, t, Michael Jonas, MD u
a Morristown Medical Center, Gagnon Cardiovascular Institute, Morristown, NJ 
b Kaplan Medical Center, Nephrology Institute, Hebrew University School of Medicine, Rehovot, Israel 
c Department of Cardiology, Rabin Medical Center, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel 
d Department of Cardiology, Medical University of Lodz, Lodz, Poland 
e Royal Jubilee Hospital, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada 
f Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada 
g Division of Cardiology, Department of Medicine, London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada 
h Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada 
i Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, Québec, Canada 
j Golden Jubilee National Hospital, Glasgow, United Kingdom 
k Conquest Hospital, London, United Kingdom 
l Montreal Heart Institute, Montreal, Québec, Canada 
m National Heart and Lung Institute, Imperial College London and Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom 
n Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada 
o Liverpool Heart and Chest Hospital, Liverpool, United Kingdom 
p Peter Munk Cardiac Centre, Toronto General Hospital Research Institute, Toronto, Ontario, Canada 
q Clinical Trials Center, Cardiovascular Research Foundation, New York, NY 
r Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY 
s University of California - San Diego, San Diego, CA 
t The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY 
u Heart Institute, Kaplan Medical Center, Hebrew University School of Medicine, Rehovot, Israel 

Reprint requests: Philippe Généreux, MD, Gagnon Cardiovascular Institute, Morristown Medical Center, 100 Madison Avenue, Morristown, NJ 07960.Gagnon Cardiovascular InstituteMorristown Medical Center100 Madison AvenueMorristownNJ07960

Riassunto

Background

Diabetes mellitus (DM) is an important predictor of neointimal hyperplasia (NIH) and adverse clinical outcomes after percutaneous coronary intervention (PCI). LABR-312, a novel intravenous formulation of liposomal alendronate, has been shown in animal models to decrease NIH at vascular injury sites and around stent struts. The aim of the Biorest Liposomal Alendronate Administration for Diabetic Patients Undergoing Drug-Eluting Stent Percutaneous Coronary Intervention trial was to assess the safety, effectiveness, and dose response of LABR-312 administered intravenously at the time of PCI withDES in reducing NIH as measured by optical coherence tomography postprocedure in patients with DM.

Methods

Patients with DM were randomized to a bolus infusion of LABR-312 vs placebo at the time of PCI. Dose escalation of LABR-312 in the study arm was given: 0.01 mg, 0.03 mg, and 0.08 mg. The primary endpoint was the in-stent %NIH volume at 9 months as measured by optical coherence tomography.

Results

From September 2016 to December 2017, 271 patients with DM undergoing PCI were enrolled; 136 patients were randomized to LABR-312 infusion and 135 patients were randomized to placebo. At 9-month follow-up, no difference was seen in the primary endpoint of %NIH between LABR-312 and placebo (13.3% ± 9.2 vs 14.6% ± 8.5, P = .35). No differences were present with the varying LABR-312 doses. Clinical outcomes at 9 months were similar between groups.

Conclusions

Among patients with DM undergoing PCI with drug-eluting stents, a bolus of LABR-312 injected systematically at the time of intervention did not result in a lower rate in-stent %NIH volume at 9-month follow-up.

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 ClinicalTrials.gov identifier: NCT02645799.


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