On 23 January 2013, Medtronic announced completion of enrolment in IN.PACT SFA II, the US arm of its clinical study for the IN.PACT Admiral drug-eluting balloon as a treatment for peripheral artery disease in the superficial femoral and proximal popliteal arteries.
IN.PACT SFA II is a prospective, multicentre, randomised controlled trial that enrolled 181 patients at more than 40 US sites and randomised them 2:1 to treatment with either the IN.PACT Admiral drug-eluting balloon (study arm) or a traditional, non-coated angioplasty balloon (control arm). Its primary efficacy endpoint is primary patency, a measure of blood flow through the treated arterial segment, at 12 months.
The principal investigators of IN.PACT SFA II are interventional cardiologist John Laird, professor of medicine at the University of California Davis and medical director of the UC Davis Vascular Center, and vascular surgeon Peter Schneider, chief of the vascular therapy division at Kaiser Foundation Hospital and Hawaii Permanente Medical Group in Honolulu.
Results of IN.PACT SFA II will be combined with those from IN.PACT SFA I, which previously completed enrollment of 150 patients in Europe, to support a premarket approval application to the FDA.
“The European experience with IN.PACT drug-eluting balloons shows a promising interventional treatment for peripheral artery disease in the lower extremities,” said Prakash Krishnan, assistant professor of medicine and director of endovascular intervention at Mount Sinai Heart in New York, and the highest enroller of patients in IN.PACT SFA II. “We look forward to sharing the US experience of this innovative medical technology as the results of IN.PACT SFA II become available.”
PACIFIER trial results
Meanwhile, results of European studies involving IN.PACT drug-eluting balloons continue to be reported. For example, findings from the PACIFIER trial appeared in the December 2012 issue of Circulation: Cardiovascular Interventions, showing a clinically-driven target lesion revascularisation rate at 12 months of 7.1% for the IN.PACT Pacific drug-eluting balloon versus 27.9% for the non-coated balloon control arm (p=0.02).
The prospective, multicentre, corelab-adjudicated, randomised controlled PACIFIER trial enrolled 85 patients with femoropopliteal lesions. Conducted in three German institutions, it included 91 randomised cases––44 treated with a drug-eluting balloon (study arm); 47 treated with a non-coated balloon (control arm).
The study met its primary endpoint by showing a statistically significant difference in reduction of late lumen loss at six months for the cases that used a drug-eluting balloon as compared to those that used a non-coated balloon (−0.01mm vs. 0.65mm, p=0.001).
The PACIFIER trial defined major adverse events as death, amputation or target lesion revascularisation. At 12 months, there were significantly fewer major adverse events in the study arm as compared to the control arm (7.1% vs. 34.9%, p=0.003). All three of the major adverse events in the study arm were target lesion revascularisations; the control arm included 15 target lesion revascularisations and three deaths. None of the patients in the study had an amputation.
IN.PACT clinical programme
“With seven femoropopliteal trials featuring IN.PACT drug-eluting balloons presented at medical meetings and five of them already published in peer-reviewed journals, Medtronic is on track to deliver this technology to US physicians in a timely manner with an unprecedented volume of high-quality clinical data to support its adoption,” said Tony Semedo, senior vice president of Medtronic and president of the company’s Endovascular Therapies business.
The ongoing global IN.PACT clinical programme includes 29 studies involving more than 4,600 patients at approximately 230 sites worldwide. Through these company-sponsored and physician-initiated studies, Medtronic’s portfolio of IN.PACT drug-eluting balloons will be investigated thoroughly for the treatment of arterial disease in a variety of vessel beds. As part of this programme, Medtronic is currently enrolling the IN.PACT Global study, a first-of-its kind “real-world” evaluation of the company’s IN.PACT drug-eluting balloons involving 1,500 patients with femoropopliteal lesions of any length at up to 80 sites worldwide.
IN.PACT drug-eluting balloons feature a proprietary coating called FreePac that is a formulation of paclitaxel and urea, an excipient that facilitates absorption of the drug into the vessel wall. They received the CE mark in 2008 and 2009 and are available in many countries around the world.
In the United States, the IN.PACT Admiral drug-eluting balloon is limited to investigational use under an investigational device exemption granted by the FDA and, like every drug-eluting balloon, is not yet commercially available.