Design and rationale of the PREVENT III clinical trial

Edifoligide for the prevention of infrainguinal vein graft failure

Michael S. Conte, Todd J. Lorenz, Dennis F. Bandyk, Alexander W. Clowes, Gregory (Greg) Moneta, B. Lynn Seely

    Research output: Contribution to journalArticle

    41 Citations (Scopus)

    Abstract

    Surgical bypass of peripheral arterial occlusive disease with autologous vein grafts provides an effective means of restoring blood flow to the lower extremity, and has been a standard therapy for patients with disabling claudication or critical limb ischemia (CLI). However, failure rates may run as high as 50% within 5 years. These graft failures occur as a result of neointimal hyperplasia, a ubiquitous biologic response of blood vessel walls to injury, which is characterized by the migration and proliferation of smooth muscle cells (SMC). The E2F family of transcription factors regulates the expression of genes controlling SMC proliferation. Edifoligide (E2F Decoy) is a novel therapy that inhibits E2F function, thus attenuating neointimal hyperplasia. Its use in conjunction with a patented drug delivery pressurization chamber is under investigation. Using this system, edifoligide is administered to vein grafts in a single, ex vivo treatment following vein harvest and before implantation, resulting in minimal systemic drug exposure and excellent patient compliance. This Phase 3, randomized, double-blind, multicenter clinical trial is designed to evaluate the safety and efficacy of edifoligide in a population of approximately 1400 patients with CLI undergoing infrainguinal bypass for peripheral arterial disease (PAD). The primary outcome measure will be the time to occurrence of non-technical graft failure resulting in either graft revision or major amputation at 12 months after enrollment. A governing Clinical Events Classification committee (CEC) will adjudicate each graft failure to determine its etiology. The PREVENT III trial is the largest multicenter trial ever performed in patients receiving autologous vein bypass grafts for CLI. This landmark study will determine if edifoligide is safe and effective at preventing vein graft failure in patients undergoing lower extremity bypass, but it also provides a unique opportunity to observe current treatment practices in vascular surgery.

    Original languageEnglish (US)
    Pages (from-to)15-23
    Number of pages9
    JournalVascular and Endovascular Surgery
    Volume39
    Issue number1
    DOIs
    StatePublished - Jan 2005

    Fingerprint

    Veins
    Clinical Trials
    Transplants
    Ischemia
    Extremities
    Peripheral Arterial Disease
    Multicenter Studies
    Smooth Muscle Myocytes
    Hyperplasia
    Blood Vessels
    Lower Extremity
    E2F Transcription Factors
    Arterial Occlusive Diseases
    edifoligide
    Therapeutics
    Patient Compliance
    Amputation
    Pharmaceutical Preparations
    Cell Proliferation
    Outcome Assessment (Health Care)

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine

    Cite this

    Design and rationale of the PREVENT III clinical trial : Edifoligide for the prevention of infrainguinal vein graft failure. / Conte, Michael S.; Lorenz, Todd J.; Bandyk, Dennis F.; Clowes, Alexander W.; Moneta, Gregory (Greg); Seely, B. Lynn.

    In: Vascular and Endovascular Surgery, Vol. 39, No. 1, 01.2005, p. 15-23.

    Research output: Contribution to journalArticle

    Conte, Michael S. ; Lorenz, Todd J. ; Bandyk, Dennis F. ; Clowes, Alexander W. ; Moneta, Gregory (Greg) ; Seely, B. Lynn. / Design and rationale of the PREVENT III clinical trial : Edifoligide for the prevention of infrainguinal vein graft failure. In: Vascular and Endovascular Surgery. 2005 ; Vol. 39, No. 1. pp. 15-23.
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