Notice Changes RFA-AG-19-020 Clinical Trial Effects Statins Older Adults without Clinical Cardiovascular Disease U19 Clinical Trial Required)" Notice Number: NOT-AG-18-038 Key Dates Release Date: November 8, 2018 Related Announcements RFA-AG-19-020 Issued National Institute Aging NIA) National Heart, Lung, Blood Institute NHLBI) National Institute Neurological Disorders Stroke NINDS) Purpose Notice being issued inform potential applicants changes RFA-AG-19-020 Clinical Trial Effects Statins Older Adults without Clinical Cardiovascular Disease U19 Clinical Trial Required)". NIA increasing funding contribution commitments NHLBI NINDS remaining same). a result, key dates, scope, funds available anticipated number awards, award budget, application instructions being revised described below. changes ensure the future clinical trial be sufficiently powered assess effects statins mild cognitive impairment dementia MCI+D) the study population defined the RFA. is anticipated achieving power require enrollment substantially than originally projected 17,000 participants. Having larger number participants important several reasons: larger number participants increase power the primary outcome will provide a greater power assess effects statins in a priori defined subgroups e.g. minorities, older age groups, participants frailty, etc.). larger sample size crucial assessing effects statins the important secondary outcomes MCI+D composite clinical cardiovascular disease events. narrower confidence intervals around hazard ratios treatment the larger sample provide, even no significant effect dementia MCI+D found, provide definitive evidence benefit lack benefit. larger sample size associated increase funding provide enhanced ascertainment MCI+D outcomes, further increasing power measuring effects MCI+D ensuring fewer events been missed. participants fail screening test not only referred a healthcare professional, they also contacted the study staff confirm diagnosis addition review the electronic health records. following revisions been to RFA-AG-19-020 revised text italicized): Part 1. Overview Information, Key Dates Open Date Earliest Submission Date): January 4, 2019 Letter Intent Due Date(s): January 4, 2019 Application Due Date(s): February 4, 2019, 5:00 PM local time applicant organization. All types non-AIDS applications allowed this funding opportunity announcement due this date. late applications be accepted this Funding Opportunity Announcement. Applicants encouraged apply early allow adequate time make any corrections errors found the application during submission process the due date. Scientific Merit Review: May 2019 Advisory Council Review: August 2019 Earliest Start Date: September 2019 Expiration Date: February 5, 2019 Part 2. Full Text Announcement, Section I. Funding Opportunity Description Scope Research Requested NIA, NHLBI NINDS request applications a pragmatic trial a network consortium health care delivery systems HCS), together cover most the geographic regions the United States, a data coordinating center assess overall risks benefits statins adults = 75 years without clinical cardiovascular disease. Specifically, proposed trial should designed to: conducted a real-life healthcare delivery system setting Introduction pragmatic clinical trials" Rethinking Clinical Trials: Living Textbook Pragmatic Trials"). broad inclusion criteria use minimization, stratification another technique ensure enrollment a high number women, minorities, participants frailty, mobility limitations, cognitive impairment, comorbidities very old adults. Test effects moderate- high-intensity statin legally marketed the US approved the FDA) vs placebo administered up five years a blinded fashion the health care providers members the HCS participating the trial). Test effects interventions the universal primary health outcome survival free dementia persistent physical disability. Test effects the intervention two co-secondary outcomes: 1) composite clinical CVD events acute myocardial infarction, ischemic stroke transient ischemic attack, heart failure, death attributed cardiovascular disease) 2) MCI+D 90% power detect risk reduction 15%. secondary composite cardiovascular outcome should include acute myocardial infarction, stroke, heart failure may include cardiovascular components such to death attributed cardiovascular disease, urgent revascularization, acute coronary syndrome requiring hospitalization. Characterization the type heart failure well stroke subtype should considered. Assess effects interventions exploratory outcomes, including not limited health-related quality life, muscle-related symptoms, incident diabetes, hospitalization any cause, medication adherence, major sources health care resource utilization. Ascertain outcomes a cost-efficient manner a high degree accuracy. sufficient power assess effects interventions high degree confidence. applicants strongly encouraged propose trial has 90% power assess effects interventions both primary secondary outcomes. Sample size calculations should designed accommodate high crossover rates between study treatment groups. Obtain biological samples at least 17,000 the participants that analysis biomarkers predictive harms benefits feasible the future. Periodically obtain sufficient number biological samples assess difference the serum LDL-cholesterol levels between two trial arms. Include pre-specified analyses adequate power assess treatment risks benefits important subgroups e.g., men/women, older/younger, differing baseline health status, differing ethnicity). See Section VIII. Information for award authorities regulations. Part 2. Full Text Announcement, Section II. Award Information Funds Available Anticipated Number Awards: The number awards contingent upon NIH appropriations the submission a sufficient number meritorious applications. NIA intends commit to 6.0 million direct costs FY 2019 fund award. Across seven-year project period, issuing IC partner components intend commit estimated 60.2 million direct costs fund award. Award Budget: Application budgets cannot exceed 60.2 million direct costs across seven years need reflect actual needs the proposed project. Part 2. Full Text Announcement, Section IV. Application Submission Information PHS 398 Research Plan Overall) Specific Aims: Describe overall scientific objective the proposed trial; individual aims the proposed study; the individual components contribute these aims; the overall trial objective. For example, of aims propose test effects moderate- high-intensity statin is legally marketed the US approved the FDA vs placebo the primary universal health outcome survival free dementia persistent physical disability on co-secondary outcomes: composite clinical CVD events acute myocardial infarction, ischemic stroke transient ischemic attack, heart failure, death attributed cardiovascular disease) MCI+D 90% power detect 15% effect. The secondary composite cardiovascular outcome should include acute myocardial infarction, stroke, heart failure may include cardiovascular components such to death attributed cardiovascular disease, urgent revascularization, acute coronary syndrome requiring hospitalization. Characterization the type heart failure well stroke subtype should considered. Exploratory outcomes, including not limited health-related quality life, muscle-related symptoms, incident diabetes, hospitalization any cause, medication adherence, major sources health care resource utilization also proposed. Research Strategy: The scientific rationale need a clinical trial test proposed hypothesis intervention should well supported preliminary data, clinical and/or preclinical studies, information the literature and/or knowledge biological mechanisms. trials focusing clinical public health endpoints, need a trial testing safety, efficacy effectiveness an intervention could lead a change clinical practice, community behaviors health care policy should justified. trials focusing mechanistic, behavioral, physiological, biochemical, other biomedical endpoints, need a trial advance scientific understanding should also justified. Focus the project a whole address i) importance the problem the field the proposed trial addresses, ii) this trial improve scientific knowledge clinical practice geriatrics cardiology, iii) the preventive interventions target population be changed the proposed aims achieved. Describe preliminary data which trial based. applicants required include both description a table graph the overall project timeline key milestones. overall study timeline should include description key milestones need be met throughout lifecycle the clinical trial ensure success to advance through defined study phases described projects elsewhere this FOA. milestone defined a scheduled event the project timeline signifies completion a major project stage activity. Milestones must relevant, measurable, results-focused time-bound. applicants should clearly define justify selection the target population. is expected the study enroll adults 75 years age older without clinical cardiovascular disease. study should propose justify selection broad inclusion criteria use minimization, stratification another technique would result enrollment a high number women, minorities, participants frailty, mobility limitations, cognitive impairment, comorbidities very old adults applicants required justify proposed definitions the primary secondary outcomes their components. Selection definitions the exploratory outcomes, any, should also justified. plan should detail assumptions obtaining bio-specimens baseline at least 17,000 participants, in subset participants periodic intervals during trial the masked determination LDL cholesterol levels arm. PHS 398 Research Plan Vanguard Phase) Research Strategy: A one-year vanguard phase follow protocol refinement study start-up phase. Objectives this phase to demonstrate study's ability recruit retain participants; deliver intervention; ascertain adjudicate outcomes. Regarding outcomes, detailed description how primary composite study outcome two co-secondary outcomes -- composite clinical CVD events MCI+D -- be collected. Any validation studies the secondary cardiovascular outcome be initiated the characterization the types heart failure. During phase, study also confirm loss follow-up cross-over rates; primary secondary outcome event rates the control group the intercluster coefficient correlation used sample size power calculations. one more these differ the original estimate, investigators required amend power calculations. the end the vanguard phase, grantees should submit the DSMB review its semi-annual meeting report justifying transitioning the study implementation phase. NIA NHLBI consider DSMB's recommendations will the following criteria evaluate whether vanguard phase reached objectives the study should continue: actual recruitment rate not lower 75% the target. rates between 75% 90% the target, DSMB report should include plan describing detail and the recruitment goal be met within allocated study budget. revised study power calculated based upon observed: a) loss follow-up cross over rates; b) primary secondary outcome event rates the control group; c) intercluster coefficient correlation; d) estimated final N not lower 85%. other aspects this FOA remain unchanged. Inquiries Please direct inquiries to: Sergei Romashkan, MD, Ph.D. National Institute Aging NIA) Telephone: 301-435-3047 Email:
romashks@nia.nih.gov