Randomised placebo controlled multicentre trial to assess short term clarithromycin for patients with stable coronary heart disease: CLARICOR trial

Abstract

Objective: To determine if the macrolide clarithromycin affects mortality and cardiovascular morbidity in patients with stable coronary heart disease.

Design: Centrally randomised multicentre trial. All parties at all stages were blinded. Analyses were by intention to treat.

Setting: Five Copenhagen University cardiology departments and a coordinating centre.

Participants: 13,702 patients aged 18 to 85 years who had a discharge diagnosis of myocardial infarction or angina pectoris in 1993-9 and alive in August 1999 were invited by letter; 4373 were randomised.

Interventions: Two weeks' treatment with clarithromycin 500 mg/day or matching placebo.

Primary outcome: composite of all cause mortality, myocardial infarction, or unstable angina pectoris during three years' follow-up. Secondary outcome: composite of cardiovascular mortality, myocardial infarction, or unstable angina pectoris. The outcomes were obtained from Danish registers and were blindly assessed by the event committee.

Results: 2172 participants were randomised to clarithromycin and 2201 to placebo. We found no significant effects of clarithromycin on the primary outcome (hazard ratio 1.15, 95% confidence interval 0.99 to 1.34) or secondary outcome (1.17, 0.98 to 1.40). Mortality was significantly higher in the clarithromycin arm (1.27, 1.03 to 1.54; P = 0.03) as a result of significantly higher cardiovascular mortality (1.45, 1.09 to 1.92; P = 0.01).

Conclusions: Short term clarithromycin in patients with stable coronary heart disease may cause significantly higher cardiovascular mortality. The long term safety of clarithromycin in patients with stable ischaemic heart disease should be examined. Trial registration ClinicalTrials.gov NCT00121550.

Fig 1

Flow of participants through enrolment, randomisation, and follow-up of CLARICOR trial

Fig 2

Kaplan-Meier estimate (with 95% confidence intervals) of the primary outcome measure (composite of all cause mortality, myocardial infarction, or unstable angina pectoris) according to intervention. Figures below the diagram are biannual numbers at risk in the clarithromycin and placebo groups

Fig 3

Kaplan-Meier estimate (with 95% confidence intervals) of cardiovascular mortality according to intervention. Figures below the diagram are biannual number at risk in the clarithromycin and placebo groups