Testing rituximab after a heart attack in people with ST-elevation myocardial infarction

Trial details

Who runs it

Assistance Publique - Hôpitaux de Paris

Trial code

NCT05211401EU 2022-501893-21-00

Record updated

10 November 2026

Original description

The main objective is to compare the effect of a single injection of two doses of rituximab versus placebo on 6 months left ventricular systolic function, using CMR, in patients who have had an acute anterior STEMI. Following the sponsor's decision to stop enrolment in the 200 mg arm, the primary objective of the study is to evaluate the efficacy of a single 1000 mg dose of rituximab versus placebo.Read full original descriptionShow less

Rituximab in Patients With ST-elevation Myocardial Infarction: A Phase 2 Placebo-controlled Randomized Clinical Trial: RITA-MI 2

The main objective is to compare the effect of a single injection of two doses of rituximab versus placebo on 6 months left ventricular systolic function, using CMR, in patients who have had an acute anterior STEMI. Following the sponsor's decision to stop enrolment in the 200 mg arm, the primary objective of the study is to evaluate the efficacy of a single 1000 mg dose of rituximab versus placebo.

The primary endpoint is the left ventricular ejection fraction (LVEF) by CMR at 6 months.

Inclusion: Age ≥ 18 years with no upper limit (women must be either postmenopausal defined as being amenorrhoeic for greater than 2 years with an appropriate clinical profile, e.g. age appropriate (>55 years old), history of vasomotor symptoms) or having documented hysterectomy and/or bilateral oophorectomy) ; Clinical evidence at presentation of anterior ST-elevation myocardial infarction (STEMI) ) involving the proximal or mid left anterior descending (LAD) defined as symptoms suggestive of acute myocardial ischemia, an electrocardiogram showing ST-segment elevation ≥2 mm in ≥2 contiguous leads in V1 to V4 or a large inferior MI (right coronary artery (RCA), or left circumflex (LCx) coronary artery) with evidence of low-ejection fraction (LVEF<45%); Complete occlusion (i.e. TIMI flow 0-1) of proximal or mid left anterior descending (LAD) right coronary artery (RCA), or left circumflex (LCx) coronary artery on urgent angiography interpreted as the infarct-related artery (IRA); Onset of worse symptoms within 48 hours before primary PCI; Patients with neutrophils >1.5 x 109/L at the moment of admission; Patients with platelet counts >75 x 109 /L at the moment of admission; Plan to provide primary percutaneous angioplasty (PPCI) for the patient within 2 hours of ECG diagnosis; confirmed before enrollment; Ability to start infusion of rituximab within 3 hours of PPCI ; confirmed before enrollment; Written informed consent.

Exclusion: Any oral or intravenous immunosuppressive treatment, immune modulatory monoclonal antibodies or immunodepleting therapy at any time (inhalers and topical creams with corticosteroids are permitted); Previous history of major organ transplant including renal transplant; Any contraindications to any of the rituximab premedication drugs; Expected need for vaccination with a live attenuated vaccine during the study, including incomplete vaccination courses (in case, life, attenuated vaccine must be administered at least 30 days before inclusion in study); Previous history of progressive multifocal leukoencephalopathy; Inclusion in other interventional drug study within the previous 3 months; Presentation with cardiac arrest; Cardiac electrical instability (defined as complete heart block needing temporary pacing or any tachyarrhythmia needing cardioversion); Patients with Killip class III heart failure; History of hepatitis B, HIV or tuberculosis; Severe, progressive infections documented; Active COVID-19 infection or COVID-19 infection within 3 months; Presence, or history in ≤ five years, of an ongoing cancer, (except in situ cancer of the cervix or basal cell carcinoma); Known hypersensitivity to the active substance of rituximab or to proteins of murine origin, or to any of the other excipients; Contraindications to injectable Polaramine:; Risk of closed-angle glaucoma, Risk of urinary retention linked to urethro-prostatic disorders; Absence of a complete COVID-19 vaccination scheme (including recovery from documented COVID infection) as approved at the time of enrollment in the country where the patient is recruited; Any obvious contraindications for MRI or conditions which will impede image acquisition for example:; Severe claustrophobia; Non-MRI compatible permanent pacemaker; Patients who have a metallic foreign body (metal silver) in their eye, or who have an aneurysm clip in their brain; Patients who have had metallic devices placed in their back; Known hypersensitivity to imaging products (gadoteric acid, meglumin or any drug containing gadolinium); Known hepatic failure; History of previous MI without documented preserved left ventricular ejection fraction (LVEF >50%) prior to the current admission will be an exclusion criterion; History of severe chronic renal failure (define as stage 4 (GFR = 15-29 mL/min) or worse); Cardiogenic shock (defined as systolic blood pressure <90 mmHg for >30minutes, or necessitating vasopressors to achieve a blood pressure ≥90 mmHg); Patient positive for point of care bedside test of Ag HBs; Patient with documented severe immune deficiency; QTcF> 450 msecs in males, > 470msecs in females; Inability to comply with study procedures; Patients under guardianship or curatorship.

ClinicalTrials.gov NCT05211401 · EU CTIS 2022-501893-21-00