Trial Review

Technical difficulties have been reported by some users of the search function and is being investigated by technical staff. Thank you for your patience and apologies for any inconvenience caused.

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been endorsed by the ANZCTR. Before participating in a study, talk to your health care provider and refer to this information for consumers
Trial registered on ANZCTR


Registration number
ACTRN12614000093684
Ethics application status
Approved
Date submitted
20/01/2014
Date registered
24/01/2014
Date last updated
22/03/2021
Date data sharing statement initially provided
10/05/2019
Date results information initially provided
10/05/2019
Type of registration
Prospectively registered

Titles & IDs
Public title
"The LoDoCo2 Trial":Low Dose Colchicine for secondary prevention of cardiovascular disease.
Scientific title
The LoDoCo2 Trial: A randomised controlled trial on the effect of low dose Colchicine for secondary prevention of cardiovascular disease in patients with established, stable coronary artery disease
Secondary ID [1] 282028 0
Nil
Universal Trial Number (UTN)
U1111-1139-8608
Trial acronym
LoDoCo2
Linked study record

Health condition
Health condition(s) or problem(s) studied:
Cardiovascular death 288476 0
Myocardial infarction 290986 0
Ischemic Stroke 314502 0
Ischemia-driven coronary revascularization 314503 0
Condition category
Condition code
Cardiovascular 288822 288822 0 0
Coronary heart disease

Intervention/exposure
Study type
Interventional
Description of intervention(s) / exposure
Colchicine 0.5mg tablet taken orally each day for the duration of the trial, It is expected that some participants randomized earlier in the trial will receive treatment for up to 5 years, whereas others randomized later in the trial will be on the trial medication for a minimum of 1 year. LoDoCo2 is an event driven intention to treat trial: participation continues until the requisite number of primary events have occurred and with the requirement of a minimal follow-up of 1 year.
Adherence will be determined by questionnaire every 6 months at the time of collection of the new supply of the trial medication, No serum levels of colchicine metabolites are being measured
Intervention code [1] 286616 0
Treatment: Drugs
Intervention code [2] 286617 0
Prevention
Comparator / control treatment
Placebo [Glucose] tablet taken orally each day for the duration of the trial
Control group
Placebo

Outcomes
Primary outcome [1] 288960 0
The time to the first occurrence of any of the elements of the composite of cardiovascular death, myocardial infarction, ischemic stroke, and ischemia-driven coronary revascularisation.
Timepoint [1] 288960 0
Minimum follow up of 1 year for each individual. Expected maximum follow up of 5 years for some participants. Estimated median follow up of 3 years or 331 primary outcome events
Secondary outcome [1] 301442 0
the composite of cardiovascular death, myocardial infarction or ischemic stroke
Timepoint [1] 301442 0
Minimum follow up of 1 year for each individual. Expected maximum follow up of 5 years for some participants. Estimated median follow up of 3 years or 331 primary outcome events
Secondary outcome [2] 301443 0
the composite of myocardial infarction or ischemia-driven coronary revascularization
Timepoint [2] 301443 0
Minimum follow up of 1 year for each individual. Expected maximum follow up of 5 years for some participants. Estimated median follow up of 3 years or 331 primary outcome events
Secondary outcome [3] 301444 0
the composite of cardiovascular death or myocardial infarction
Timepoint [3] 301444 0
Minimum follow up of 1 year for each individual. Expected maximum follow up of 5 years for some participants. Estimated median follow up of 3 years or 331 primary outcome events
Secondary outcome [4] 301445 0
Ischemia-driven coronary revascularization
Timepoint [4] 301445 0
Minimum follow up of 1 year for each individual. Expected maximum follow up of 5 years for some participants. Estimated median follow up of 3 years or 331 primary outcome events
Secondary outcome [5] 375006 0
Myocardial infarction
Timepoint [5] 375006 0
Minimum follow up of 1 year for each individual. Expected maximum follow up of 5 years for some participants. Estimated median follow up of 3 years or 331 primary outcome events
Secondary outcome [6] 375007 0
Ischemic stroke
Timepoint [6] 375007 0
Minimum follow up of 1 year for each individual. Expected maximum follow up of 5 years for some participants. Estimated median follow up of 3 years or 331 primary outcome events
Secondary outcome [7] 375008 0
Death from any cause
Timepoint [7] 375008 0
Minimum follow up of 1 year for each individual. Expected maximum follow up of 5 years for some participants. Estimated median follow up of 3 years or 331 primary outcome events
Secondary outcome [8] 393137 0
Cardiovascular Death
Timepoint [8] 393137 0
Minimum follow up of 1 year for each individual. Expected maximum follow up of 5 years for some participants. Estimated median follow up of 3 years or 331 primary outcome events

Eligibility
Key inclusion criteria
Patients with coronary heart disease diagnosed by coronary angiography or CT coronary angiogram who are clinically stable [no cardiovascular related hospital admission in the prior 6 months] and Patients with CABG>10 years ago, unless evidence of graft failure or the need for angioplasty since surgery
Minimum age
35 Years
Maximum age
82 Years
Sex
Both males and females
Can healthy volunteers participate?
No
Key exclusion criteria
1] Serious Non-Cardiac Co-morbidity; including prior history of myopathy, leucopenia or thrombocytopenia , renal dysfunction with eGFR <50mL/min or serum Creatinine>150mmol/l, advanced liver disease, severe intestinal disease, advanced cancer 2] history of noncompliance with medical therapy or known to be poor clinic attendee, 3] A need for regular drugs known to be potent CYP inhibitors (e.g., ketaconazole or clarithromycin), 4] Other advanced Cardiac Disease; Advanced valvular heart disease, Severe LV dysfunction or symptomatic heart failure or Severe Pulmonary hypertension, 5] Women of child bearing age; 6] Current on-going use of long term colchicine therapy for any other reason, 6] Known intolerance to colchicine, 7] Enrollment in a competing trial, 8] Unwilling or unable to be consented for inclusion into the study for any reason.

Study design
Purpose of the study
Prevention
Allocation to intervention
Randomised controlled trial
Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Enrollment: By usual Cardiologist at the time of routine review.

Open label run in period: Participants who are enrolled in the study will trial open label colchicine for 30 days to determine their tolerance to therapy. During this time the Cardiologist and the participant know that active treatment is being administered

Randomization: Only patients who are tolerant of therapy will be randomised into the study. Randomisation will be double blinded. The names of participants who are tolerant to therapy will be allocated to either study arm by the holder of the allocation schedule who is off site at the central administrative office located in the Heart Research Insistuite.
Methods used to generate the sequence in which subjects will be randomised (sequence generation)
A simple randomisation table will be created by a computerised sequence generation.
Masking / blinding
Blinded (masking used)
Who is / are masked / blinded?
The people receiving the treatment/s
The people administering the treatment/s
The people assessing the outcomes
The people analysing the results/data
Intervention assignment
Parallel
Other design features
Update
1] 30 day run in period of open label therapy to determine tolerance to therapy. 2] Only participants who are tolerant of therapy and willing to continue in the study will be randomized. 3] Participants may withdraw at any time and may re-enter the trial later if they choose. 4] Caring physicians can decide whether the trial medication should be ceased if there is clinical concern about possible effects of therapy. 5] Doctors and participants are warned to avoid clarithromycin (Australia and The Netherlands) and Verapamil and Azithromycin (The Netherlands) during the trial but if required to temporarily cease the TM 6] An interim analysis is planned when 75% of the requisite number of events have occurred to examine drug safety
Phase
Phase 3
Type of endpoint/s
Safety/efficacy
Statistical methods / analysis
The sample size determination for the study was event-driven, i.e. based on a requirement for the number of patients reaching the primary efficacy endpoint. Design assumptions included a 10% drop-out rate after the open label run-in phase, a per annum rate for the composite primary endpoint in the control group of 2.6% and a hazard ratio of 0.70. It was estimated that the occurrence of at least 331 composite primary endpoints would provide the trial with 90% power to statistically detect the expected treatment benefit at a two-sided significance level of 0.05. Based on these assumptions the sample size was set at 5447 randomized participants.

In accordance with the intent-to-treat principle outlined in the International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for human use – the ICH Harmonised Tripartite Guideline Statistical Principles for Clinical Trials E9, the primary analyses for efficacy will be based on time to first event for the primary composite end-point in all randomized patients who took at least 1 tablet of their assigned trial medication using events adjudicated by the Clinical Events Committee. In addition, a per protocol analysis for the primary outcome in patients who remained compliant with the trial medication through the duration of the trial will be conducted. The occurrence of the primary endpoint over time will be depicted with Kaplan-Meier curves. The hazard ratio (HR), its 95% confidence interval (CI) and the corresponding P – value will be derived from a Cox proportional hazards model with a factor for treatment group (colchicine versus control). P < 0.05 for the primary endpoint will be considered statistically significant. Secondary endpoints will be analyzed in a similar fashion using HRs and 95% CIs derived from a Cox proportional hazards model. The testing of the primary and secondary endpoints will be assessed in a closed testing procedure to preserve alpha as specified in the statistical analysis plan.

Recruitment
Recruitment status
Completed
Date of first participant enrolment
Anticipated
17/02/2014
Actual
14/09/2014
Date of last participant enrolment
Anticipated
31/10/2018
Actual
3/12/2018
Date of last data collection
Anticipated
1/05/2020
Actual
17/02/2020
Sample size
Target
5500
Accrual to date
Final
5522
Recruitment in Australia
Recruitment state(s)
WA
Recruitment postcode(s) [1] 6428 0
6000 - Perth Gpo
Recruitment outside Australia
Country [1] 9000 0
Netherlands
State/province [1] 9000 0
Utrecht

Funding & Sponsors
Funding source category [1] 288477 0
Government body
Name [1] 288477 0
National Health and Medical Research Coucil of Australia
Country [1] 288477 0
Australia
Funding source category [2] 296767 0
Commercial sector/Industry
Name [2] 296767 0
Aspen Pharamcare Australia
Country [2] 296767 0
Australia
Funding source category [3] 296768 0
Commercial sector/Industry
Name [3] 296768 0
GenesisCare
Country [3] 296768 0
Australia
Funding source category [4] 296769 0
Government body
Name [4] 296769 0
ZonMW
Country [4] 296769 0
Netherlands
Funding source category [5] 296770 0
Charities/Societies/Foundations
Name [5] 296770 0
Withering Stichting Nederland
Country [5] 296770 0
Netherlands
Funding source category [6] 296771 0
Commercial sector/Industry
Name [6] 296771 0
Teva
Country [6] 296771 0
Netherlands
Funding source category [7] 296772 0
Commercial sector/Industry
Name [7] 296772 0
Disphar
Country [7] 296772 0
Netherlands
Funding source category [8] 296773 0
Commercial sector/Industry
Name [8] 296773 0
Tiofarma
Country [8] 296773 0
Netherlands
Funding source category [9] 303866 0
Charities/Societies/Foundations
Name [9] 303866 0
Nederlandse Hartstichting
Country [9] 303866 0
Netherlands
Primary sponsor type
Other
Name
Heart Research Institute, Sir Charles Gairdner Hospital
Address
QE2 Medical Center
Hospital Avenue
Nedlands 6009
Western Australia
Country
Australia
Secondary sponsor category [1] 295756 0
Other Collaborative groups
Name [1] 295756 0
Dutch Network for Cardiovascular Research (WCN)
Address [1] 295756 0
Utrecht
P.O. Box 19008
3501 DA Utrecht
The Netherlands
Country [1] 295756 0
Netherlands

Ethics approval
Ethics application status
Approved
Ethics committee name [1] 297995 0
Sir Charles Gairdner Group HREC
Ethics committee address [1] 297995 0
Level 2 A Block
Hospital Ave
Nedlands
WA 6009
Ethics committee country [1] 297995 0
Australia
Date submitted for ethics approval [1] 297995 0
25/11/2013
Approval date [1] 297995 0
27/02/2014
Ethics approval number [1] 297995 0
2013-236
Ethics committee name [2] 297996 0
Medical Reseach Ethics Committees United
Ethics committee address [2] 297996 0
Postbus 2500 3430 EM Nieuwegein
Ethics committee country [2] 297996 0
Netherlands
Date submitted for ethics approval [2] 297996 0
01/07/2016
Approval date [2] 297996 0
18/08/2016
Ethics approval number [2] 297996 0
R16.027/LoDoCo2

Summary
Brief summary
The primary objective of this study is to evaluate clinical efficacy of treatment with colchicine 0.5mg once daily as compared to placebo in patients with stable coronary artery disease on the incidence of first occurrence of the composite of cardiovascular death, myocardial infarction, ischemic stroke or ischemia-driven coronary revascularisation.
Trial website
Trial related presentations / publications
Nidorf M, Thompson PL. Effect of colchicine (0.5 mg twice daily) on high-sensitivity C-reactive protein independent of aspirin and atorvastatin in patients with stable coronary artery disease. Am J Cardiol. 2007 Mar 15;99(6):805-7.

Nidorf SM, Eikelboom JW, Budgeon CA, Thompson PL. Low-Dose Colchicine for Secondary Prevention of Cardiovascular Disease. J Am Coll Cardiol. 2012 Dec 13. doi:pii: S0735-1097(12)05478-2. JACC Jan 13

Nidorf SM, Eikelboom JW, Thompson PL Targeting Cholesterol Crystal-Induced Inflammation for the Secondary Prevention of Cardiovascular Disease Journal of Cardiovascular. Pharmacology and Therapeutics Volume 19 Issue 1 January 2014 pp. 45 - 52.

Nidorf SM, Eikelboom JW, Thompson PL Colchicine for Secondary Prevention of Cardiovascular Disease [In Press] Curr Atheroscler Rep (2014) 16:391
Public notes

Contacts
Principal investigator
Name 38142 0
Prof Peter L Thompson
Address 38142 0
Heart Research Institute of Western Australia
Floor 2 Harry Perkins Institute
Sir Charles Gairdner Hospital,
Perth 6009
Western Australia
Country 38142 0
Australia
Phone 38142 0
+61 407970090
Fax 38142 0
Email 38142 0
peter.thompson@health.wa.gov.au
Contact person for public queries
Name 38143 0
Prof Peter L Thompson
Address 38143 0
Heart Research Institute of Western Australia
Floor 2 Harry Perkins Institute
Sir Charles Gairdner Hospital,
Perth 6009
Western Australia
Country 38143 0
Australia
Phone 38143 0
+61 407970090
Fax 38143 0
Email 38143 0
peter.thompson@health.wa.gov.au
Contact person for scientific queries
Name 38144 0
Dr Mark Nidorf
Address 38144 0
GenisisCare 3/140 Mounts Bay Rd Perth 6000 Western Australia
Country 38144 0
Australia
Phone 38144 0
+61 413145410
Fax 38144 0
Email 38144 0
smnidorf@gmail.com

Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
Yes
What data in particular will be shared?
All collected coded data
When will data be available (start and end dates)?
6 months after publication
No end-date
Available to whom?
Raw data will not be shared but parties can apply a scientific request for data sharing and data analysis that will be discussed at the publication meeting of the Steering Committee
Available for what types of analyses?
To be determined
How or where can data be obtained?
Written request to the LoDoCo2 Steering Committee


What supporting documents are/will be available?

Doc. No.TypeCitationLinkEmailOther DetailsAttachment
4967Study protocoln/ahttps://www.wcn.lifea.schut@wcn.life Request the LoDoCo2 steering committee
4968Ethical approvalN/Ahttps://wcn.lifeA.Schut@wcn.life N/A
4969Clinical study reportNAhttps://www.wcn.lifeA.Schut@wcn.life NA



Results publications and other study-related documents

Documents added manually
No documents have been uploaded by study researchers.

Documents added automatically
SourceTitleYear of PublicationDOI
EmbaseInflammation and beyond: new directions and emerging drugs for treating atherosclerosis.2017https://dx.doi.org/10.1080/14728214.2017.1269743
EmbaseInflammation, Superadded Inflammation, and Out-of-Proportion Inflammation in Atherosclerosis.2018https://dx.doi.org/10.1001/jamacardio.2018.2760
EmbaseColchicine in cardiac disease: A systematic review and meta-analysis of randomized controlled trials.2015https://dx.doi.org/10.1186/s12872-015-0068-3
EmbaseDoes low-density lipoprotein cholesterol induce inflammation? if so, does it matter? Current insights and future perspectives for novel therapies.2019https://dx.doi.org/10.1186/s12916-019-1433-3
EmbaseWhy Colchicine Should Be Considered for Secondary Prevention of Atherosclerosis: An Overview.2019https://dx.doi.org/10.1016/j.clinthera.2018.11.016
EmbaseColchicine Attenuates Inflammation Beyond the Inflammasome in Chronic Coronary Artery Disease A LoDoCo2 Proteomic Substudy.2020https://dx.doi.org/10.1161/CIRCULATIONAHA.120.050560
EmbaseTargeted anti-inflammatory therapy is a new insight for reducing cardiovascular events: A review from physiology to the clinic.2020https://dx.doi.org/10.1016/j.lfs.2020.117720
EmbaseColchicine in patients with chronic coronary disease.2020https://dx.doi.org/10.1056/NEJMoa2021372
EmbaseColchicine for acute and chronic coronary syndromes.2020https://dx.doi.org/10.1136/heartjnl-2020-317108
EmbaseColchicine in the Management of Acute and Chronic Coronary Artery Disease.2021https://dx.doi.org/10.1007/s11886-021-01560-w
EmbaseTargeting inflammation in atherosclerosis - from experimental insights to the clinic.2021https://dx.doi.org/10.1038/s41573-021-00198-1
EmbaseColchicine reduces extracellular vesicle NLRP3 inflammasome protein levels in chronic coronary disease: A LoDoCo2 biomarker substudy.2021https://dx.doi.org/10.1016/j.atherosclerosis.2021.08.005
EmbaseThe Effect of Years-Long Exposure to Low-Dose Colchicine on Renal and Liver Function and Blood Creatine Kinase Levels: Safety Insights from the Low-Dose Colchicine 2 (LoDoCo2) Trial.2022https://dx.doi.org/10.1007/s40261-022-01209-8
EmbaseHearts on Fire: The Role of Inflammation in the Pathogenesis of Atherosclerotic Cardiovascular Disease and How We Can Tend to the Flames.2022https://dx.doi.org/10.1016/j.cjca.2022.05.023
EmbaseTargeting Microtubules for the Treatment of Heart Disease.2022https://dx.doi.org/10.1161/CIRCRESAHA.122.319808
EmbaseAssociation of Low-Dose Colchicine With Incidence of Knee and Hip Replacements: Exploratory Analyses From a Randomized, Controlled, Double-Blind Trial.2023https://dx.doi.org/10.7326/M23-0289
EmbaseDrivers of mortality in patients with chronic coronary disease in the low-dose colchicine 2 trial.2023https://dx.doi.org/10.1016/j.ijcard.2022.12.026
Dimensions AICost-effectiveness of low-dose colchicine in patients with chronic coronary disease in the netherlands2024https://doi.org/10.1093/ehjqcco/qcae021
Dimensions AILong-Term Efficacy of Colchicine in Patients With Chronic Coronary Disease: Insights From LoDoCo22022https://doi.org/10.1161/circulationaha.121.058233
Dimensions AIWhat’s Old is New Again – A Review of the Current Evidence of Colchicine in Cardiovascular Medicine2017https://doi.org/10.2174/1573403x12666161014094159
Dimensions AISignaling pathways and targeted therapy for myocardial infarction2022https://doi.org/10.1038/s41392-022-00925-z
N.B. These documents automatically identified may not have been verified by the study sponsor.