AI Article Synopsis
- The Metformin Aneurysm Trial (MAT) aims to determine if metformin can lower the risk of complications like rupture or surgery in patients with asymptomatic abdominal aortic aneurysms (AAA).
- The study is a double-blind, placebo-controlled trial involving participants with a AAA of at least 35mm, assessing outcomes such as AAA events, growth, and quality of life, requiring a substantial number of participants for robust results.
- MAT is particularly significant as it specifically investigates metformin's effects on AAA outcomes, in contrast to previous trials focused on other medications, amidst challenges posed by the ongoing COVID-19 pandemic.
Article Abstract
Background: Multiple observational studies have associated metformin prescription with reduced progression of abdominal aortic aneurysm (AAA). The Metformin Aneurysm Trial (MAT) will test whether metformin reduces the risk of AAA rupture-related mortality or requirement for AAA surgery (AAA events) in people with asymptomatic aneurysms.
Methods: MAT is an international, multi-centre, prospective, parallel-group, randomised, placebo-controlled trial. Participants must have an asymptomatic AAA measuring at least 35 mm in maximum diameter, no diabetes, no contraindication to metformin and no current plans for surgical repair. The double-blind period is preceded by a 6-week, single-blind, active run-in phase in which all potential participants receive metformin. Only patients tolerating metformin by taking at least 80% of allocated medication will enter the trial and be randomised to 1500 mg of metformin XR or an identical placebo. The primary outcome is the proportion of AAA events defined as rupture-related mortality or need for surgical repair. Secondary outcomes include AAA growth, major adverse cardiovascular events and health-related quality of life. In order to test if metformin reduced the risk of AAA events by at least 25%, 616 primary outcome events will be required (power 90%, alpha 0.05).
Discussion: Currently, there is no drug therapy for AAA. Past trials have found no convincing evidence of the benefit of multiple blood pressure lowering, antibiotics, a mast cell inhibitor, an anti-platelet drug and a lipid-lowering medication on AAA growth. MAT is one of a number of trials now ongoing testing metformin for AAA. MAT, unlike these other trials, is designed to test the effect of metformin on AAA events. The international collaboration needed for MAT will be challenging to achieve given the current COVID-19 pandemic. If this challenge can be overcome, MAT will represent a trial unique within the AAA field in its large size and design.
Trial Registration: Australian Clinical Trials ACTRN12618001707257 . Registered on 16 October 2018.
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|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8710921 | PMC |
| http://dx.doi.org/10.1186/s13063-021-05915-0 | DOI Listing |
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