Varespladib and cardiovascular events in patients with an acute coronary syndrome: the VISTA-16 randomized clinical trial

IMPORTANCE: Secretory phospholipase A2(sPLA2) generates bioactive phospholipid products implicated in atherosclerosis. The sPLA2inhibitor varespladib has favorable effects on lipid and inflammatory markers; however, its effect on cardiovascular outcomes is unknown. OBJECTIVE: To determine the effects of sPLA2inhibition with varespladib on cardiovascular outcomes. DESIGN, SETTING, AND PARTICIPANTS: A double-blind, randomized, multicenter trial at 362 academic and community hospitals in Europe, Australia, New Zealand, India, and North America of 5145 patients randomized within 96 hours of presentation of an acute coronary syndrome (ACS) to either varespladib (n = 2572) or placebo (n = 2573) with enrollment between June 1, 2010, and March 7, 2012 (study termination on March 9, 2012). INTERVENTIONS: Participants were randomized to receive varespladib (500 mg) or placebo daily for 16 weeks, in addition to atorvastatin and other established therapies. MAIN OUTCOMES AND MEASURES: The primary efficacy measurewas a composite of cardiovascular mortality, nonfatal myocardial infarction (MI), nonfatal stroke, or unstable angina with evidence of ischemia requiring hospitalization at 16 weeks. Six-month survival status was also evaluated. RESULTS: At a prespecified interim analysis, including 212 primary end point events, the independent data and safety monitoring board recommended termination of the trial for futility and possible harm. The primary end point occurred in 136 patients (6.1%) treated with varespladib compared with 109 patients (5.1%) treated with placebo (hazard ratio [HR], 1.25; 95%CI, 0.97-1.61; log-rank P = .08). Varespladib was associated with a greater risk of MI (78 [3.4%] vs 47 [2.2%]; HR, 1.66; 95%CI, 1.16-2.39; log-rank P = .005). The composite secondary end point of cardiovascular mortality, MI, and stroke was observed in 107 patients (4.6%) in the varespladib group and 79 patients (3.8%) in the placebo group (HR, 1.36; 95% CI, 1.02-1.82; P = .04). CONCLUSIONS AND RELEVANCE: In patients with recent ACS, varespladib did not reduce the risk of recurrent cardiovascular events and significantly increased the risk of MI. The sPLA2inhibition with varespladib may be harmful and is not a useful strategy to reduce adverse cardiovascular outcomes after ACS. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01130246. Copyright 2014 American Medical Association. All rights reserved

a randomized, open, multicenter phase III trial of lenalidomide/dexamethasone versus lenalidomide/dexamethasone plus subsequent autologous stem cell transplantation and lenalidomide maintenance in patients with relapsed multiple myeloma

Background Despite novel therapeutic agents, most multiple myeloma (MM) patients eventually relapse. Two large phase III trials have shown significantly improved response rates (RR) of lenalidomide/dexamethasone compared with placebo/dexamethasone in relapsed MM (RMM) patients. These results have led to the approval of lenalidomide for RMM patients and lenalidomide/dexamethasone has since become a widely accepted second-line treatment. Furthermore, in RMM patients consolidation with high-dose chemotherapy plus autologous stem cell transplantation has been shown to significantly increase progression free survival (PFS) as compared to cyclophosphamide in a phase III trial. The randomized prospective ReLApsE trial is designed to evaluate PFS after lenalidomide/dexamethasone induction, high-dose chemotherapy consolidation plus autologous stem cell transplantation and lenalidomide maintenance compared with the well-established lenalidomide/dexamethasone regimen in RMM patients. Methods/Design ReLApsE is a randomized, open, multicenter phase III trial in a planned study population of 282 RMM patients. All patients receive three lenalidomide/dexamethasone cycles and - in absence of available stem cells from earlier harvesting - undergo peripheral blood stem cell mobilization and harvesting. Subsequently, patients in arm A continue on consecutive lenalidomide/dexamethasone cycles, patients in arm B undergo high dose chemotherapy plus autologous stem cell transplantation followed by lenalidomide maintenance until discontinuation criteria are met. Therapeutic response is evaluated after the 3rd (arm A + B) and the 5th lenalidomide/dexamethasone cycle (arm A) or 2 months after autologous stem cell transplantation (arm B) and every 3 months thereafter (arm A + B). After finishing the study treatment, patients are followed up for survival and subsequent myeloma therapies. The expected trial duration is 6.25 years from first patient in to last patient out. The primary endpoint is PFS, secondary endpoints include overall survival (OS), RR, time to best response and the influence of early versus late salvage high dose chemotherapy plus autologous stem cell transplantation on OS. Discussion This phase III trial is designed to evaluate whether high dose chemotherapy plus autologous stem cell transplantation and lenalidomide maintenance after lenalidomide/dexamethasone induction improves PFS compared with the well-established continued lenalidomide/dexamethasone regimen in RMM patients. Trial registration: ISRCTN16345835 (date of registration 2010-08-24)

Tetrazolyl and tetrazolylidene complexes of gold: A synthetic and structural study

Lithiation of 1-benzyl-1H-tetrazole followed by transmetallation with [AuCl(PPh3)], [Au(C6F5)(tht)] or [AuCl(tht)] (tht = tetrahydrothiophene) and subsequent alkylation afforded cationic 1-benzyl-4-methyl-4,5-dihydro-1H-1,2,3,4-tetrazol-5-ylidene(triphenylphosphine) gold(i), 1, neutral 1-benzyl-4-methyl-4,5-dihydro-1H-1,2,3,4-tetrazol-5- ylidene(pentafluorophenyl)gold(i), 2, and a cationic biscarbene complex, bis(1-benzyl-4-methyl-4,5-dihydro-1H-1,2,3,4-tetrazol-5-ylidene)gold(i), 3. The first complex underwent a homoleptic rearrangement in solution to form 3. Reaction of [Au(N3)PPh3] with the three isocyanides (CH3)2C6H3NC, tBuNC and CyNC, respectively, yielded the corresponding neutral tetrazolyl(phosphine) complexes of gold, [1-(2,6-dimethylphenyl)-1H-tetrazol-5-yl](triphenylphosphine) gold(i), 4, [1-(tert-butyl)-1H-tetrazol-5-yl](triphenylphosphine)gold(i), 6, and [1-(cyclohexyl)-1H-tetrazol-5-yl](triphenylphosphine)gold(i), 7. Alkylation of 4 with methyl triflate on N4 allowed isolation of the crystalline carbene complex 1-(2,6-dimethylphenyl)-4-methyl-4,5-dihydro-1H-1,2,3,4-tetrazol- 5-ylidene)(triphenylphosphine)gold(i), 5. Complex 7 was not isolable in pure form but converts by isocyanide substitution of triphenylphosphine into [1-cyclohexylisocyanide][1-(cyclohexyl)-1H-tetrazol-5-yl]gold(i), 8. From a product mixture of 7 and 8 the transformed molecules [(cyclohexylamino)(ethoxy) carbene](1-cyclohexyl-1H-tetrazol-5-yl)gold(i), 9, and [bis(cyclohexylamino) carbene](1-cyclohexyltetrazol-5-yl)gold(i), 10, co-crystallised spontaneously after a long time at -20 °C. © 2009 The Royal Society of Chemistry and the Centre National de la Recherche Scientifique.Lithiation of 1-benzyl-1H-tetrazole followed by transmetallation with [AuCl(PPh3)], [Au(C6F5)(tht)] or [AuCl(tht)] (tht = tetrahydrothiophene) and subsequent alkylation afforded cationic 1-benzyl-4-methyl-4,5-dihydro-1H-1,2,3,4-tetrazol-5-ylidene(triphenylphosphine) gold(i), 1, neutral 1-benzyl-4-methyl-4,5-dihydro-1H-1,2,3,4-tetrazol-5- ylidene(pentafluorophenyl)gold(i), 2, and a cationic biscarbene complex, bis(1-benzyl-4-methyl-4,5-dihydro-1H-1,2,3,4-tetrazol-5-ylidene)gold(i), 3. The first complex underwent a homoleptic rearrangement in solution to form 3. Reaction of [Au(N3)PPh3] with the three isocyanides (CH3)2C6H3NC, tBuNC and CyNC, respectively, yielded the corresponding neutral tetrazolyl(phosphine) complexes of gold, [1-(2,6-dimethylphenyl)-1H-tetrazol-5-yl](triphenylphosphine) gold(i), 4, [1-(tert-butyl)-1H-tetrazol-5-yl](triphenylphosphine)gold(i), 6, and [1-(cyclohexyl)-1H-tetrazol-5-yl](triphenylphosphine)gold(i), 7. Alkylation of 4 with methyl triflate on N4 allowed isolation of the crystalline carbene complex 1-(2,6-dimethylphenyl)-4-methyl-4,5-dihydro-1H-1,2,3,4-tetrazol- 5-ylidene)(triphenylphosphine)gold(i), 5. Complex 7 was not isolable in pure form but converts by isocyanide substitution of triphenylphosphine into [1-cyclohexylisocyanide][1-(cyclohexyl)-1H-tetrazol-5-yl]gold(i), 8. From a product mixture of 7 and 8 the transformed molecules [(cyclohexylamino)(ethoxy) carbene](1-cyclohexyl-1H-tetrazol-5-yl)gold(i), 9, and [bis(cyclohexylamino) carbene](1-cyclohexyltetrazol-5-yl)gold(i), 10, co-crystallised spontaneously after a long time at -20 °C. © 2009 The Royal Society of Chemistry and the Centre National de la Recherche Scientifique.ArticleArticl

A second polymorph of (2-thiazolidinethionato)-(triphenylphosphine)gold(I)

The title compound, [Au(C3H4NS2)(C 18H15P)], contains a thiazolidinethione ligand coordinated to an AuI atom through the S atom. A triphenylphosphine ligand completes the linear coordination geometry around the Au atom. The compound contains two molecules in the asymmetric unit and is a polymorphic form of a previously reported structure [Grant, Forward & Fackler Jr (1996). Z. Kristallogr. 211, 483-484]. The composite molecules in the two forms exhibit nearly identical bond distances and angles. © 2006 International Union of Crystallography. All rights reserved.Articl

1,3-Dimesitylimidazolidinium tetra-chloridogold(III) dichloro-methane solvate

The title ionic compound, (C21H27N2)[AuCl4]·CH2Cl2, was obtained from the reaction of 1,3-dimesitylimidazolidinium chloride with t-BuOK and a solution of AuCl3 in tetra-hydro-furan. In the crystal structure, numerous weak C - H⋯Cl hydrogen bonds form double layers parallel to (100), which are further stabilized by π-π inter-actions between mesitylene rings [centroid-centroid distance = 4.308 (4) Å], resulting in the formation of a three-dimensional supra-molecular assembly.Articl

1,1,2,2-Tetrakis(1,3-benzothiazol-2-yl)ethene chloroform disolvate

The asymmetric unit of the title solvate, C30H 16N4S4·2CHCl3, contains one half-molecule of tetrakis(2-benzothiazolyl)ethene, the complete molecule being generated by inversion symmetry, and one molecule of chloroform. Pairs of the benzothiazole rings attached to the same carbon atom are almost perpendicular to each other, with an angle between planes of 85.74 (4)°. In the crystal, weak C-H⋯N and C-H⋯Cl interactions generate a three-dimensional network.Articl

1,3-Benzothia-zolium tetra-chlorido-aurate(III) tetra-hydro-furan solvate

In the crystal structure of the title ionic compound (C7H 6NS)[AuCl4]·C4H8O, the [AuCl4]- anion shows a typical square-planar geometry. Numerous weak C - H⋯Cl hydrogen bonds between [AuCl4] - and the 1,3-benzothia-zolium units form layers comprised of 24-membered rings in which hydrogen-bonded tetra-hydro-furan (THF) solvent mol-ecules are accommodated. C - H⋯Cl inter-actions between THF and [AuCl4]- from adjacent layers result in bilayers. These are further stabilized by π-π inter-actions between the thia-zole and benzene rings [centroid-centroid distance = 3.971 (3) Å], resulting in the formation of a three-dimensional supra-molecular assembly.Articl

Neutral mononuclear and dinuclear complexes of gold(I) featuring azole ligands: Synthesis, structure and cytotoxicity

The aim of this work was to extend the small library of existing compounds of gold(I) that contain pentafluorophenyl and thiazole ligands and to determine the biological activity of such compounds against a well-known cancer cell line. Seven mono and dinuclear new compounds that contain imidazole, thiazole and tetrazole rings were isolated and characterised. Three of the crystal structures determined indicated Au...Au interactions between constituent complex molecules. A simple adduct, [Au(C 6F 5)(N-methyl-imidazole)] , exhibits a relatively high anti-tumour specificity indicating the viability of selected phosphine-free gold complexes as cytotoxic agents. © 2012 Elsevier Ltd. All rights reserved