The Effect of Allopurinol on the Risk of Cardiovascular Events in Patients with Cardiovascular Risk

Official title

A Randomized, Double-blind, Placebo-controlled Study Evaluating the Effect of Allopurinol on the Risk of Cardiovascular Events in Patients with High and Very High Cardiovascular Risk, Including the Presence of Long-COVID Syndrome.

Overview

Numerous studies, but not all, have suggested a positive effect of allopurinol on the cardiovascular system. The ALL-VASCOR study aims to evaluate the efficacy of allopurinol therapy for improving cardiovascular outcomes in patients at high and very high cardiovascular risk, excluding ischemic heart disease. This is particularly important due to the high cost of cardiovascular disease treatment and its status as one of the leading causes of death.

Detailed description

The ALL-VASCOR study is a randomized, double-blind, placebo-controlled, multi-center trial that examines the effect of allopurinol therapy (200-500mg of allopurinol daily) versus an equivalent dose of placebo on the risk of cardiovascular events in 1,116 patients aged 40-70, with serum uric acid levels above 5mg/dL and with high and very high risk for cardiovascular disease. The ALL-VASCOR study is further designed to assess the occurrence of long-COVID syndrome. The study is directed toward both primary and secondary as well as additional endpoints. Due to the duration of the study, the planned intervention will end on July 31,2028, unless the Safe Monitoring Board or other applicable authorities decide about it. Participant recruitment for the ALL-VASCOR study is set to begin in August of 2023 and will be conducted only within Poland.

Interventions

• Drug Allopurinol 200 mg
  The intervention will occur after randomly allocating participants to the first group (G1), in which patients will receive allopurinol at an initial daily dose of 200 mg, or to the second group (G2), where they will receive a placebo. The placebo will be prepared as tablets with the same shape and appearance as the tested drug tablets, in the appropriate doses, and containing the same excipients. Participants will initially take one tablet of the medication daily in the morning. The physicians w
• Drug Optional intervention
  Approximately 26 weeks(+/-2 weeks) after the start of the intervention, the efficacy of the treatment will be evaluated at the follow-up visit V2. Efficacy is defined as achieving a serum UA level below 5.0mg/dL for those with baseline levels \>5.0 to 7.0mg/dL or below 5.5mg/dL for those with baseline levels ≥7.0mg/dL. If insufficient therapy efficacy is noted, the initial allopurinol dose will be increased by 100mg (up to 300mg during V2). The dose may be increased by another 100mg at visit 3 a

Primary outcome measures

• The occurrence of a major adverse cardiovascular event (MACE) [Time frame: Baseline up to approximately 5 years]

Secondary outcome measures (9)

• Percentage of Participants of all-cause death [Time frame: Baseline up to approximately 5 years]
• Percentage of Participants With Cardiac Death [Time frame: Baseline up to approximately 5 years]
• Percentage of Participants With stroke [Time frame: Baseline up to approximately 5 years]
• Percentage of Participants With transient ischemic attack [Time frame: Baseline up to approximately 5 years]
• Percentage of Participants With acute coronary syndrome [Time frame: Baseline up to approximately 5 years]
• Percentage of Participants With coronary angioplasty or revascularization [Time frame: Baseline up to approximately 5 years]
• Percentage of Participants With peripheral arterial angioplasty [Time frame: Baseline up to approximately 5 years]
• Percentage of Participants With hospitalization for unstable angina or worsening heart failure [Time frame: Baseline up to approximately 5 years]
• Percentage of Participants With Hospitalization [Time frame: Baseline up to approximately 5 years]

Eligibility criteria

Inclusion criteria

• Age: between 40-70 years old.
• Giving informed consent to participate in the study.
• Serum UA levels above 5 mg/dl within the last six months before the screening visit.
• Meeting at least one of the criteria defining high or very high CV risk includes:

• calculated 10-year cardiovascular mortality risk based on SCORE2 >2.5% for patients under 50 years old or ≥5% for patients 50 years old or older
• documented occurrence of CV diseases (cerebrovascular disease: ischemic stroke, intracerebral bleeding, TIA; heart failure regardless of the etiology NYHA I - II (without IHD), PAD, atrial fibrillation (de novo or ever)
• diabetes or arterial hypertension complicated by organ damage:

• increase in vascular stiffness: pulse pressure ≥ 60 mmHg, and/or cervicofemoral PWV > 10 m/s;
• features of left ventricular hypertrophy on echocardiography or electrocardiography;
• increased urine albumin-creatinine ratio (30-300 mg/g);
• ankle-brachial index < 0.9.

Exclusion criteria

• Taking allopurinol, febuxostat or other hypouricemic drugs.
• Contraindications to taking allopurinol.
• Pregnant women, breastfeeding or planning pregnancy during the duration of the study.
• Hormonal therapy containing oestrogens.
• Active cancer process or disease in the last five years, excluding locally malignant tumours.
• Uncontrolled hypertension (mean value ≥ 180/110 mmHg seven days before screening visit) in home measurements despite using hypotensive drugs.
• 7\. Renal insufficiency with an eGFR <45 ml/ min/1.73m2 (according to 2009 CKD-EPI recommendations: stage G3b, G4 and G5).
• Hypothyroidism or hyperthyroidism not in a state of euthyroidism.
• Confirmed coronary artery disease (defined as prior AMI, revascularization of the myocardium, confirmed presence of atherosclerotic plaques in coronary arteries on imaging studies).
• Heart failure in NYHA class III and IV.
• Taking preparations: azathioprine, mercaptopurine or cyclosporin. Participation in another clinical trial of a medicinal product or medical device within the last three months or five half-lives, whichever period is longer.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Quadruple blind

Primary purpose

Treatment

Study locations

Poland · 1 center

• Poznan University of Medical Sciences — Poznan

Publications

• Lewandowska K, Lipski D, Uruski P, Narkiewicz K, Januszewicz A, Wolf J, Prejbisz A, Rajzer M, Wiecek A, Tykarski A. Randomised, double-blind, placebo-controlled study evaluating the effect of allopurinol on the risk of cardiovascular events in patients with high and very high cardiovascular risk, including the presence of long-COVID-19 syndrome: the ALL-VASCOR study protocol. BMJ Open. 2024 Jul 24 PMID 39053954

Identifiers

NCT: NCT05943821 · 2022/ABM/01/00027

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗