Effect of Losmapimod on Cardiovascular Outcomes in Patients Hospitalized With Acute Myocardial Infarction
Year: 2016
Type: article
Study designs: Randomized Controlled Trial, Clinical Trial
Abstract: IMPORTANCE: p38 Mitogen-activated protein kinase (MAPK)-stimulated inflammation is implicated in atherogenesis, plaque destabilization, and maladaptive processes in myocardial infarction (MI). Pilot data in a phase 2 trial in non-ST elevation MI indicated that the p38 MAPK inhibitor losmapimod attenuates inflammation and may improve outcomes. OBJECTIVE: To evaluate the efficacy and safety of losmapimod on cardiovascular outcomes in patients hospitalized with an acute myocardial infarction. DESIGN, SETTING, AND PATIENTS: LATITUDE-TIMI 60, a randomized, placebo-controlled, double-blind, parallel-group trial conducted at 322 sites in 34 countries from June 3, 2014, until December 8, 2015. Part A consisted of a leading cohort (n = 3503) to provide an initial assessment of safety and exploratory efficacy before considering progression to part B (approximately 22,000 patients). Patients were considered potentially eligible for enrollment if they had been hospitalized with an acute MI and had at least 1 additional predictor of cardiovascular risk. INTERVENTIONS: Patients were randomized to either twice-daily losmapimod (7.5 mg; n = 1738) or matching placebo (n = 1765) on a background of guideline-recommended therapy. Patients were treated for 12 weeks and followed up for an additional 12 weeks. MAIN OUTCOMES AND MEASURES: The primary end point was the composite of cardiovascular death, MI, or severe recurrent ischemia requiring urgent coronary revascularization with the principal analysis specified at week 12. RESULTS: In part A, among the 3503 patients randomized (median age, 66 years; 1036 [29.6%] were women), 99.1% had complete ascertainment for the primary outcome. The primary end point occurred by 12 weeks in 123 patients treated with placebo (7.0%) and 139 patients treated with losmapimod (8.1%; hazard ratio, 1.16; 95% CI, 0.91-1.47; P = .24). The on-treatment rates of serious adverse events were 16.0% with losmapimod and 14.2% with placebo. CONCLUSIONS AND RELEVANCE: Among patients with acute MI, use of losmapimod compared with placebo did not reduce the risk of major ischemic cardiovascular events. The results of this exploratory efficacy study did not justify proceeding to a larger efficacy trial in the existing patient population. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT02145468.
Source: JAMA
Authors: Michelle L. O’Donoghue, Ruchira Glaser, Matthew A. Cavender, Philip E. Aylward, Marc P. Bonaca, Andrzej Budaj, Richard Y. Davies, Mikael Dellborg, Keith A. A. Fox, Jorge Antonio T. Gutierrez, Christian Hamm, Robert G. Kiss, František Kovar, Julia F. Kuder, Kyung Ah Im, John J. Lepore, Jose L. Lopez-Sendon, Ton Oude Ophuis, Alexandr Parkhomenko, Jennifer B. Shannon, Jindrich Spinar, Jean-Francois Tanguay, Mikhail Ruda, P. Gabriel Steg, Pierre Theroux, Stephen D. Wiviott, Ian Laws, Marc S. Sabatine, David A. Morrow, for the LATITUDE-TIMI 60 Investigators
Institutions: Brigham and Women's Hospital, Novartis (Switzerland), Amgen (United States), Thrombolysis in Myocardial Infarction Study Group, GlaxoSmithKline (United States), Flinders University, South Australian Health and Medical Research Institute, Grochowski Hospital, Sahlgrenska University Hospital, University of Gothenburg, University of Edinburgh, Justus-Liebig-Universität Gießen, Comenius University Bratislava, Hospital Universitario La Paz, Canisius-Wilhelmina Ziekenhuis, National Scientific Center "M.D. Strazhesko Institute of Cardiology", PAREXEL International (United States), University Hospital Brno, Montreal Heart Institute, Université de Montréal, Assistance Publique – Hôpitaux de Paris, Hôpital Bichat-Claude-Bernard, Université Paris Diderot
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2337488815