Pharmacological treatment of coronary artery disease with recombinant fibroblast growth factor-2: double-blind, randomized, controlled clinical trial.
BACKGROUND
Single-bolus intracoronary administration of fibroblast growth factor-2 (FGF2) improved symptoms and myocardial function in a phase I, open-label trial in patients with coronary artery disease. We conducted the FGF Initiating RevaScularization Trial (FIRST) to evaluate further the efficacy and safety of recombinant FGF2 (rFGF2).


RESULTS
FIRST is a multicenter, randomized, double-blind, placebo-controlled trial of a single intracoronary infusion of rFGF2 at 0, 0.3, 3, or 30 microg/kg (n=337 patients). Efficacy was evaluated at 90 and 180 days by exercise tolerance test, myocardial nuclear perfusion imaging, Seattle Angina Questionnaire, and Short-Form 36 questionnaire. Exercise tolerance was increased at 90 days in all groups and was not significantly different between placebo and FGF-treated groups. rFGF2 reduced angina symptoms as measured by the angina frequency score of the Seattle Angina Questionnaire (overall P=0.035) and the physical component summary scale of the Short-Form 36 (pairwise P=0.033, all FGF groups versus placebo). These differences were more pronounced in highly symptomatic patients (baseline angina frequency score < or =40 or Canadian Cardiovascular Society score of III or IV). None of the differences were significant at 180 days because of continued improvement in the placebo group. Adverse events were similar across all groups, except for hypotension, which occurred with higher frequency in the 30-microg/kg rFGF2 group.


CONCLUSIONS
A single intracoronary infusion of rFGF2 does not improve exercise tolerance or myocardial perfusion but does show trends toward symptomatic improvement at 90 (but not 180) days.
Simons
Michael
M
Section of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA. Michael.Simons@Dartmouth.edu
Annex
Brian H
BH
Laham
Roger J
RJ
Kleiman
Neal
N
Henry
Timothy
T
Dauerman
Harold
H
Udelson
James E
JE
Gervino
Ernesto V
EV
Pike
Marilyn
M
Whitehouse
M J
MJ
Moon
Thomas
T
Chronos
Nicolas A
NA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000150:complications / Q000188:drug therapy*; D003324:Coronary Artery Disease / Q000150:complications / Q000188:drug therapy*; D003326:Coronary Circulation / Q000187:drug effects; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005080:Exercise Test; D017079:Exercise Tolerance / Q000187:drug effects; D005128:Eye Diseases / Q000209:etiology; D005260:Female; D016222:Fibroblast Growth Factor 2 / Q000008:administration & dosage* / Q000009:adverse effects; D006304:Health Status; D006801:Humans; D007022:Hypotension / Q000209:etiology; D007261:Infusions, Intra-Arterial; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins / Q000008:administration & dosage* / Q000009:adverse effects; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D011994:Recombinant Proteins; D016222:Fibroblast Growth Factor 2