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Coronary Artery StenosisBIONICSNCT01995487

Study of BioNIR Drug Eluting Stent System in Coronary Stenosis

A study testing BioNIR and Resolute in people with Coronary Artery Stenosis, run by Medinol Ltd. at 8 sites in 8 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The BioNIR study aims to show that the BioNIR ridaforolimus eluting stent is non-inferior to the Resolute zotarolimus-eluting stent for the primary clinical endpoint of target lesion failure (TLF) at 12 months; that it is non-inferior to the Resolute for the secondary endpoint of angiographic in-stent late loss at 13… Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Coronary Artery Stenosis
What is being tested?
BioNIR and Resolute
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
1,919 participants
Where
8 sitesin 8 countries
Study dates
Jan 2014to 30 Nov 2020
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patient with indication for PCI including angina/silent ischemia/NSTEMI/recent STEMI
  • Non-target vessel PCI allowed prior to randomization depending on time interval and certain conditions
  • Patient/legal guardian willing \& able to provide informed written consent \& comply with follow-up visits \& testing schedule
  • Target lesion(s) must be located in native coronary artery/bypass graft conduit w/visually estimated diameter ≥2.5mm to ≤4.25mm.
  • Complex lesions allowed, including calcified, presence of thrombus, CTO, bifurcation (except as per exclusion criteria #30), ostial RCA, tortuous, bare metal stent restenotic, protected left main, and saphenous vein graft

Who cannot join

  • STEMI within 24 hours of init. time of presentation to first treating hospital, or in whom enzyme levels (either CK-MB or Troponin) have not peaked
  • PCI within 24 hours preceding baseline procedure
  • Non-target lesion PCI in target vessel within 12 months of baseline procedure
  • History of stent thrombosis
  • Cardiogenic shock (persistent hypotension [systolic blood pressure <90mm/Hg for MT 30 min] or requiring pressors/hemodynamic support, including IABP)
  • Subject is intubated
Show all 33Show fewer
  • Known LVEF <30%
  • Relative/absolute contraindication to DAPT for 12 months (including planned surgeries that cannot be delayed, or subject indicated for chronic oral anticoagulant treatment)
  • Calculated creatinine clearance <30 mL/min per Cockcroft-Gault equation (<40mL/min for subjects participating in angiographic follow-up sub-study)
  • Hemoglobin <10g/dL
  • Platelet count <100,000 cells/mm3 or >700,000 cells/mm3
  • White blood cell (WBC) count <3,000 cells/mm3
  • Clinically significant liver disease
  • Active peptic ulcer/active bleeding from any site
  • Bleeding from any site within prior 8 wks requiring active medical/surgical attention
  • If femoral access is planned, significant peripheral arterial disease that precludes safe insertion of 6F sheath
  • History of bleeding diathesis/coagulopathy/will refuse blood transfusions
  • Cerebrovascular accident/transient ischemic attack within past 6 months, or any permanent neurologic defect attributed to CVA
  • Known allergy to study stent components, BioNIR or Resolute
  • Known allergy to protocol-required concomitant medications: aspirin/DAPT (clopidogrel, prasugrel, ticagrelor)/heparin and bivalirudin/iodinated contrast that cannot be adequately pre-medicated
  • Any co-morbid condition that may cause non-compliance with protocol (e.g. dementia, substance abuse) /reduced life expectancy to <24 months (e.g. cancer, severe heart failure, severe lung disease)
  • Patient participating/plans to participate in another investigational drug/device clinical trial that has not reached its primary endpoint
  • Pregnant/breastfeeding women (women of child-bearing potential must have a negative pregnancy test within 1 wk before treatment)
  • Women who intend to become pregnant within 12 months after baseline procedure (sexually active women of child-bearing potential must agree to use a reliable method of contraception from time of screening through 12 months post baseline procedure)
  • Patient has received/is on a waiting list for an organ transplant
  • Patient receiving/scheduled to receive chemotherapy within 30 days before/any time after the baseline procedure
  • Patient receiving oral/intravenous immunosuppressive therapy or has known life-limiting immunosuppressive/autoimmune disease (e.g. HIV); corticosteroids are allowed
  • More than 100mm length of planned stenting in the entire coronary tree
  • Unprotected left main lesions ≥30%, or planned left main intervention
  • Ostial LAD/LCX lesions (stenting of any diseased segment within 5mm of the unprotected left main coronary artery)
  • Bifurcation lesions with planned dual stent implantation
  • Stenting of lesions due to DES restenosis
  • Another lesion in a target/non-target vessel (including all side branches) is present that requires/has high probability of requiring PCI within 12 months after baseline procedure

Trial locations and contacts

8 sites in 8 countries.

8 sites in 8 countries

United States1 site
  • Piedmont Healthcare

    Atlanta, Georgia, 30309

Other trials in United States

Belgium1 site
  • ZNA Middelheim

    Antwerp

Other trials in Belgium

Canada1 site
  • Queen Elizabeth II Health Sciences Centre

    Halifax, Nova Scotia, B3H 3A7

Other trials in Canada

Israel1 site
  • Hadassah Hebrew University Medical Center

    Jerusalem, 91120

Other trials in Israel

Italy1 site
  • San Raffaele Hospital

    Milan, 20162

Other trials in Italy

Netherlands1 site
  • Maasstad Ziekenhuis

    Rotterdam, 3079 DZ

Other trials in Netherlands

Poland1 site
  • PAKS, II Oddzial Kardiologiczny

    Bielsko-Biala, 43-316

Other trials in Poland

Spain1 site
  • Hospital Meixoeiro

    Pontevedra, VIGO, 36200

Other trials in Spain

About this study

Official title: BioNIR Ridaforolimus Eluting Coronary Stent System (BioNIR) In Coronary Stenosis Trial

The BioNIR study aims to show that the BioNIR ridaforolimus eluting stent is non-inferior to the Resolute zotarolimus-eluting stent for the primary clinical endpoint of target lesion failure (TLF) at 12 months; that it is non-inferior to the Resolute for the secondary endpoint of angiographic in-stent late loss at 13 months; and that it is more cost-effective.

Read the detailed description

The BioNIR is a prospective, multi-center, single-blind, two-arm, randomized clinical trial. The population will consist of subjects undergoing PCI for angina (stable or unstable), silent ischemia, NSTEMI, and recent STEMI. Complex lesions are allowed. There is no limit to the number of lesions per vessel or individual lesion length; however, the total planned stenting in the coronary tree cannot exceed 100mm.

Randomization will be stratified by the presence of medically treated diabetes vs. no medically treated diabetes, acute coronary syndrome (ACS) vs. non-ACS, and by site. Lesions planned to be treated must be declared and recorded at time of randomization. Planned staged procedures, if necessary, must be declared immediately post procedure.

Clinical follow-up will be performed at 30 days, 6 months, and 1, 2, 3, 4, and 5 years post randomization. 200 patients at participating North American sites will be consented for planned angiographic follow-up at 13 months after enrollment, with 100 of these patients consented to undergo planned IVUS at baseline and at 13 months following randomization.

The primary endpoint is Target Lesion Failure (TLF) at 12 months, defined as the composite of cardiac death, target vessel-related myocardial infarction, or ischemia-driven target lesion revascularization.

Clinical Secondary Endpoints to be evaluated at 30 days, 6 months, and 1, 2, 3, 4 and 5, except as noted:

  • Device, Lesion, and Procedure Success at time of baseline procedure
  • TLF at 30 days, 6 months, and 2, 3, 4 and 5 years defined as the composite of cardiac death, target vessel-related MI, or ischemia-driven TLR.
  • Major adverse cardiac events (MACE; the composite rate of cardiac death, any MI or ischemia-driven TLR)
  • Target vessel failure (TVF; the composite rate of death, target vessel related MI or ischemia-driven TVR)
  • All-cause mortality
  • Cardiac death
  • Myocardial Infarction
  • Target Vessel Related MI
  • Ischemia-driven TLR
  • Ischemia-driven TVR
  • Stent Thrombosis (ARC definite and probable)

Angiographic Sub-Study Secondary Endpoint to be evaluated at 13 months:

  • Angiographic in-stent and in-segment late loss

IVUS Sub-Study Secondary Endpoint to be evaluated at 13 months:

  • In-stent percent neointimal hyperplasia
  • Stent mal-apposition

A key component of this trial will be a prospective assessment of health care resource utilization, costs and cost effectiveness. A separate cost effectiveness assessment plan describes the data collection and analysis.

Sample Size Consideration: From recent US trials of best in class DES (Xience V, Promus Element and Resolute), the 1-year TLF rate in patients with non-complex lesions not undergoing routine angiographic follow-up is approximately 3.8%. Using the assumption of the more-comers' design, the 1-year event rate will be conservatively increased by 50% (assuming enrollment rate for complex patients/lesions is 50% with double the standard event rate) - thus 5.8%. Therefore, with a one-sided 95% upper bound of the confidence interval of 3.3% (a relative 57% margin) and 1:1 randomization, enrolling 1810 patients (905 per group) provides 90% power to demonstrate non-inferiority. Assuming 95% follow-up rate at 1 year, approximately 1906 patients will be enrolled (953 in each group).

Being tested
BioNIR, Resolute
Keywords
more comers, DES, BioNIR, ACS, non ACS, complex lesions
Medical subject headings
Coronary Stenosis

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • BioNIRDevice

    drug-eluting stent

  • ResoluteDevice

    drug-eluting stent

Study groups in NCT01995487
Study groupRoleWhat they receive
BioNIRExperimentalThe BioNIR Ridaforolimus Eluting Coronary Stent System is a single use device/drug combination product comprising: * Stent - a mounted Cobalt Chromium (CoCr) alloy based stent * Delivery System - Rapid Exchange (RX) Coronary System * Polymer matrix coating - Poly n-butyl methacrylate (PBMA) and CarboSil® * Ridaforolimus drug - CAS Registry Number: 572924-54-0 The drug Ridaforolimus is utilized on the stent system at a dose of 1.1 μg/mm2 (with a drug load of 100 μg per 2.75/3.00 x 17 mm stent).
Receives: Device: BioNIR
ResoluteActive comparatorThe Endeavor Resolute Zotarolimus-Eluting Stent System consists of four subsystems: 1. Endeavor Resolute Stent- a pre-mounted cobalt alloy based stent 2. Delivery system (Rapid Exchange [RX] Coronary System) 3. Polymer system 4. Zotarolimus - drug The Resolute has a nominal drug dose of 1.6µg Zotarolimus per mm2 of the stent surface area.
Receives: Device: Resolute

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Target Lesion Failure (TLF)

    The primary endpoint of TLF at 12 months was defined as the composite of cardiac death, target vessel-related MI, or ischemia-driven TLR.

    Measured: 12 months

Secondary outcomes (16)
  1. Device Success

    Clinical: Acute secondary endpoint determined at time of baseline procedure

    Measured: Determined at time of baseline procedure

  2. TLF

    Clinical secondary endpoint to be evaluated at 30 days, 6 months, and 2, 3, 4 and 5 years, defined as the composite of cardiac death, target vessel-related MI, or ischemia-driven TLR

    Measured: 30 days, 6 months, and 1, 2, 3, 4 and 5 years

  3. Major Adverse Cardiac Events

    Clinical: MACE; the composite rate of cardiac death, any MI or ischemia-driven TLR

    Measured: 30 days, 6 months, and 1, 2, 3, 4 and 5 years

  4. Target Vessel Failure

    Clinical: TVF; the composite rate of death, target vessel related MI or ischemia-driven TVR

    Measured: 30 days, 6 months, and 1, 2, 3, 4 and 5 years

  5. All Cause Mortality

    Clinical: The number of patients who die from all causes

    Measured: 30 days, 6 months, and 1, 2, 3, 4 and 5 years

  6. Cardiac Death

    Clinical: The number of patients who die of cardiac-related causes

    Measured: 30 days, 6 months, and 1, 2, 3, 4 and 5 years

  7. Myocardial Infarction

    Clinical: The number of patients who suffer a myocardial infarction.

    Measured: 30 days, 6 months, and 1, 2, 3, 4 and 5 years

  8. Target Vessel Related MI

    Clinical: The number of patients who suffer a MI that is related to the target vessel of the procedure.

    Measured: 30 days, 6 months, and 1, 2, 3, 4 and 5 years

  9. Ischemia Driven TLR

    Clinical:

    Measured: 30 days, 6 months, and 1, 2, 3, 4 and 5 years

  10. Ischemia Driven TVR

    Clinical:

    Measured: 30 days, 6 months, and 1, 2, 3, 4 and 5 years

  11. Stent Thrombosis

    Clinical: ARC definite and probable

    Measured: 30 days, 6 months, and 1, 2, 3, 4 and 5 years

  12. Angiographic Sub-Study: In-stent and In-segment Late Loss

    Secondary Endpoint for angiographic in-stent and in-segment late loss

    Measured: 13 months

  13. IVUS Sub-Study: In-stent Percent Neointimal Hyperplasia

    IVUS: In-stent percent neointimal hyperplasia

    Measured: 13 months

  14. IVUS Sub-Study: Stent Mal-apposition

    IVUS Sub-Study: Stent mal-apposition

    Measured: 13 months

  15. Lesion Success

    Measures whether the lesion was successfully treated.

    Measured: Determined at time of baseline procedure

  16. Procedure Success

    Acute clinical endpoint: The success of the procedure as determined at time of baseline procedure

    Measured: Determined at time of baseline procedure

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted26 Nov 2013 (estimated)
  2. Study startJan 2014
  3. Primary completion28 Aug 2016
  4. Study completion30 Nov 2020

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
This is a Drug-Device combination Product.
Masking
Single blind
Who is masked
Participant
Enrolment
1,919 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01995487
Sponsor's protocol ID
BioNIR-001
Acronym
BIONICS
Status last verified
Oct 2023
First submitted
12 Nov 2013
Last updated
16 Oct 2023
Data monitoring committee
Yes

Publications

  • Kandzari DE, Smits PC, Love MP, Ben-Yehuda O, Banai S, Robinson SD, Jonas M, Kornowski R, Bagur R, Iniguez A, Danenberg H, Feldman R, Jauhar R, Chandna H, Parikh M, Perlman GY, Balcells M, Markham P, Ozan MO, Genereux P, Edelman ER, Leon MB, Stone GW. Randomized Comparison of Ridaforolimus- and Zotarolimus-Eluting Coronary Stents in Patients With Coronary Artery Disease: Primary Results From the BIONICS Trial (BioNIR Ridaforolimus-Eluting Coronary Stent System in Coronary Stenosis). Circulation. 2017 Oct 3;136(14):1304-1314. doi: 10.1161/CIRCULATIONAHA.117.028885. Epub 2017 Aug 9.

    PubMed 28794001

Questions about this trial

What is this clinical trial studying?

A study testing BioNIR and Resolute in people with Coronary Artery Stenosis, run by Medinol Ltd. at 8 sites in 8 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 33 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 16 Oct 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 8 sites in United States, Belgium, Canada, Israel, Italy and 3 more countries. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 25 Feb 2021). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Target Lesion Failure (TLF) (time frame: 12 months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT01995487, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 16 Oct 2023.

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