• 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, and LATITUDE-TIMI 60 Investigators.
• TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
• JAMA. 2016 Apr 19; 315 (15): 1591-9.

Importancep38 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.ObjectiveTo evaluate the efficacy and safety of losmapimod on cardiovascular outcomes in patients hospitalized with an acute myocardial infarction.Design, Setting, And PatientsLATITUDE-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.InterventionsPatients 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 MeasuresThe 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.ResultsIn 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 RelevanceAmong 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 Registrationclinicaltrials.gov Identifier: NCT02145468.

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