IPAC
Trial question
What is the effect of ivabradine for the prevention of cardiac dysfunction in patients with lymphoma or sarcoma scheduled for anthracycline chemotherapy?
Study design
Multi-center
Double blinded
RCT
Population
Characteristics of study participants
43.0% female
57.0% male
N = 107
107 patients (46 female, 61 male).
Inclusion criteria: patients with lymphoma or sarcoma scheduled for anthracycline chemotherapy.
Key exclusion criteria: inability to assess LV function; prior chemotherapy with anthracycline or radiation; HF symptoms; existing cardiomyopathy, coronary or valve disease; AF; bradycardia; chronic renal disease; COVID-19 infection; allergy or contraindication to ivabradine.
Interventions
N=51 ivabradine (at a dose of 5 mg BID until 30 days after completing treatment).
N=56 placebo (matching placebo until 30 days after completing treatment).
Primary outcome
Cardiotoxicity at 12 months
57%
50%
57.0 %
42.8 %
28.5 %
14.3 %
0.0 %
Ivabradine
Placebo
No significant
difference ↔
No significant difference in cardiotoxicity at 12 months (57% vs. 50%; OR 1.32, 95% CI 0.61 to 2.83).
Secondary outcomes
No significant difference in death, acute MI, symptomatic cancer therapy-related cardiovascular dysfunction, arrhythmias at 12 months (11.8% vs. 17.9%; OR 0.61, 95% CI 0.21 to 1.83).
No significant difference in ≥ 10% reduction in LVEF to < 55% at 12 months (5.9% vs. 7.1%; OR 0.81, 95% CI 0.17 to 3.82).
Significant decrease in troponin T ≥ 14 ng/L at 6 months (39% vs. 62.2%; OR 0.39, 95% CI 0.16 to 0.97).
Safety outcomes
No significant difference in adverse events.
Conclusion
In patients with lymphoma or sarcoma scheduled for anthracycline chemotherapy, ivabradine was not superior to placebo with respect to cardiotoxicity at 12 months.
Reference
Stephanie Itala Rizk, Isabela Bispo Santos da Silva Costa, Cecília Beatriz Bittencourt Viana Cruz et al. Randomized, Placebo-Controlled, Triple-Blind Clinical Trial of Ivabradine for the Prevention of Cardiac Dysfunction During Anthracycline-Based Cancer Therapy. J Am Heart Assoc. 2025 May 20;14(10):e039745.
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