Clinical trial NCT00143676: Efficacy of Lapaquistat Acetate and Atorvastatin on Blood Cholesterol Levels in Subjects With Primary Hypercholesterolemia
Official title: A Double-blind, Randomized Placebo-controlled Study to Evaluate the Efficacy and Safety of TAK-475 50 mg, 100 mg, or Placebo When Co-administered With Atorvastatin (10 mg to 40 mg) in Subjects With Primary Hypercholesterolemia
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE3
Conditions: Hypercholesterolemia
Keywords: Hyperlipidemia
Dyslipidemia
Drug Therapy
Lead sponsor: Takeda
Sponsor class: INDUSTRY
First posted: 2005-09-02
Enrollment: 448
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: The purpose of this study is to determine the efficacy of lapaquistat acetate, once daily (QD), on lowering cholesterol in subjects already taking atorvastatin.

Detailed description: According to the World Health Organization, CHD is now the leading cause of death worldwide. In 2001, CHD caused 7.2 million deaths and estimates for 2020 indicate that annual CHD deaths will increase to 11.1 million. These statistics suggest that improved options are needed to treat hypercholesterolemia and dyslipidemia.

The balance among cholesterol synthesis, dietary intake, and degradation is normally adequate to maintain healthy cholesterol plasma levels. However, in patients with hypercholesterolemia, elevated low-density lipoprotein cholesterol leads to atherosclerotic deposition of cholesterol in the arterial walls. Consequently, in this population it has been established that lowering low-density lipoprotein cholesterol plasma concentrations effectively reduces cardiovascular morbidity and mortality. The National Cholesterol Education Program Adult Treatment Panel III has therefore identified control of low-density lipoprotein cholesterol as essential in the prevention and management of CHD. Additional lipid risk factors designated by National Cholesterol Education Program Adult Treatment Panel III include elevated triglycerides, elevated non-high-density lipoprotein cholesterol (atherogenic lipoproteins), and low levels of high-density lipoprotein cholesterol. Lipoproteins rich in triglycerides, such as very-low-density lipoprotein cholesterol, appear to contribute to atherosclerosis, whereas the apparent protective effect of high-density lipoprotein cholesterol, which is likely related to high-density lipoprotein cholesterol-facilitated transport of cholesterol away from atherosclerotic deposits, may be limited at low high-density lipoprotein cholesterol concentrations.

Initial dietary and lifestyle measures taken to control dyslipidemia are often inadequate, and most patients require pharmacologic intervention. Currently, 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) are the first-line monotherapies most often prescribed to reduce low-density lipoprotein cholesterol, after diet and therapeutic lifestyle change. However, with statin monotherapy, many patients fail to reach National Cholesterol Education Program Adult Treatment Panel III recommended levels of low-density lipoprotein cholesterol reduction. As a result, the statin dosage must be increased or an additional treatment added to achieve treatment goals. Increasing the statin dosage may result in decreased tolerability and potential safety concerns, contributing to the high discontinuation rates of statins and their prescription at low and often ineffective doses. Further, although the effectiveness of increasing the dose varies among the statins, in general, doubling of the dose above the minimum effective dose has been found to decrease serum low-density lipoprotein cholesterol by only an additional 6 percent.

TGRD is developing an orally active squalene synthase inhibitor, TAK-475 (lapaquistat acetate) for the treatment of dyslipidemia. Lapaquistat acetate inhibits the biosynthesis of cholesterol by inhibiting the enzyme squalene synthase, which catalyzes the conversion of farnesyl diphosphate to squalene-a precursor in the final steps of cholesterol production.

This study will assess the effects of co-administration of lapaquistat acetate with atorvastatin, the most commonly prescribed statin in the United States, on LDL-C and associated lipid variables in subjects with hypercholesterolemia. Study Participation is anticipated to be up to 24 weeks.

Eligibility criteria: Inclusion Criteria:

* Female subjects of childbearing potential must not be pregnant as determined by a negative serum human chorionic gonadotropin, lactating, or planning on becoming pregnant, and agrees to use acceptable forms of contraception during the study.
* Must have a mean low density lipoprotein cholesterol value greater than or equal to 2.590 mmol/L (100 mg/dL) for 2 consecutive samples
* Must have a mean triglyceride value less than or equal to 4.516 mmol/L (400 mg/dL) for 2 consecutive samples.
* Has taken a stable dose of atorvastatin (10 to 40 mg)
* Has clinical laboratory evaluations within reference range for the testing laboratory.
* Is willing and able to continue to comply with a standardized low-cholesterol diet.

Exclusion Criteria:

* Has an alanine aminotransferase or aspartate aminotransferase level greater than 1.5 times the upper limit of normal, active liver disease or jaundice.
* Has a serum creatinine level greater than 135 μmol/L (1.5 mg/dL).
* Has a creatine phosphokinase level greater than 3 times the upper limit of normal
* Has diabetes with a hemoglobin A1c level greater than 8% at Visit 1.
* Has a history of cancer in remission for less than 5 years prior to the first dose of study drug.
* Has an endocrine disorder, such as Cushing's syndrome, hyperthyroidism, or inappropriately treated hypothyroidism, affecting lipid metabolism.
* Has a history of myocardial infarction, unstable angina, transient ischemic attacks, cerebrovascular accident, percutaneous coronary intervention, or coronary or peripheral arterial surgery.
* Has a positive hepatitis B surface antigen, or hepatitis C virus antibody, as determined by medical history and/or the subject's verbal report.
* Has a positive human immunodeficiency virus status or was taking antiretroviral medications as determined by medical history and/or the subject's verbal report.
* Has had exposure to lapaquistat acetate in other studies, was participating in another investigational study, or had participated in an investigational study within the past 30 days or, for drugs with a long half-life, within a period of less than 5 times the drug's half-life.
* Has a known hypersensitivity or history of adverse reaction to atorvastatin.
* Has a history or presence of clinically significant food allergy that would prevent adherence to the recommended diet.
* Has a known homozygous familial hypercholesterolemia or known type III hyperlipoproteinemia.
* Has fibromyalgia, myopathy, rhabdomyolysis, or unexplained muscle pain.
* Has uncontrolled hypertension
* Has inflammatory bowel disease or any other malabsorption syndrome or has had gastric bypass or any other surgical procedure for weight loss.
* Has a history of drug abuse or a history of alcohol abuse within the past 2 years.
* Has any other serious disease or condition that might reduce life expectancy, impair successful management according to the protocol, or make the subject an unsuitable candidate to receive study drug.

Primary outcomes:
measure: Change from Baseline in Low Density Lipoprotein cholesterol
timeFrame: Week 24 or Final Visit
Secondary outcomes:
measure: Adverse Events
timeFrame: Weeks: 2, 4, 8, 12, 16, 20, and 24 or Final Visit
measure: Physical Examination
timeFrame: Week 24 or Final Visit
measure: Safety Laboratory Tests
timeFrame: Weeks: 2, 4, 8, 12, 16, 20, and 24 or Final Visit
measure: Electrocardiogram assessments
timeFrame: Week 24 or Final Visit
measure: Best Corrected Visual Acuity results
timeFrame: Week 24 or Final Visit
measure: Vital Signs
timeFrame: Weeks: 2, 4, 8, 12, 16, 20, and 24 or Final Visit
measure: Change from Baseline in Triglycerides
timeFrame: Week 24 or Final Visit
measure: Change from Baseline in Total Cholesterol
timeFrame: Week 24 or Final Visit
measure: Change from Baseline in High Density Lipoprotein cholesterol
timeFrame: Week 24 or Final Visit
measure: Change from Baseline in Very Low Density Lipoprotein cholesterol
timeFrame: Week 24 or Final Visit
measure: Change from Baseline in apolipoprotein A1
timeFrame: Week 24 or Final Visit
measure: Change from Baseline in apolipoprotein B
timeFrame: Week 24 or Final Visit
measure: Change from Baseline in non- High Density Lipoprotein cholesterol
timeFrame: Week 24 or Final Visit
measure: Change from Baseline in the ratio of Low Density Lipoprotein cholesterol/High Density Lipoprotein cholesterol
timeFrame: Week 24 or Final Visit
measure: Change from Baseline in the ratio of Total Cholesterol/High Density Lipoprotein cholesterol
timeFrame: Week 24 or Final Visit
measure: Change from Baseline in the ratio of apolipoprotein A1/apolipoprotein B
timeFrame: Week 24 or Final Visit
measure: Change from Baseline in high-sensitivity C-reactive protein
timeFrame: Week 24 or Final Visit
measure: Percentage of subjects who achieve Low Density Lipoprotein cholesterol concentrations less than 1.813 mmol/L (70 mg/dL)
timeFrame: Week 24 or Final Visit
measure: Percentage of subjects who achieve Low Density Lipoprotein cholesterol concentrations less than 2.590 mmol/L (100 mg/dL)
timeFrame: Week 24 or Final Visit
measure: Percentage of subjects who achieve Low Density Lipoprotein cholesterol concentrations less than 3.367 mmol/L (130 mg/dL)
timeFrame: Week 24 or Final Visit
Other outcomes:
Locations:
city: Birmingham
country: United States
state: Alabama
city: Northport
country: United States
state: Alabama
city: Sierra Vista
country: United States
state: Arizona
city: Tucson
country: United States
state: Arizona
city: Jonesboro
country: United States
state: Arkansas
city: Searcy
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state: Arkansas
city: Anaheim
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state: California
city: Carmichael
country: United States
state: California
city: Chula Vista
country: United States
state: California
city: Escondido
country: United States
state: California
city: Pismo Beach
country: United States
state: California
city: Santa Rosa
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state: California
city: Golden
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state: Colorado
city: Waterbury
country: United States
state: Connecticut
city: Clearwater
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state: Florida
city: Daytona Beach
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state: Florida
city: Hollywood
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state: Florida
city: Jacksonville
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city: Jupiter
country: United States
state: Florida
city: Kissimmee
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state: Florida
city: Miami
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state: Florida
city: New Port Richey
country: United States
state: Florida
city: Ocala
country: United States
state: Florida
city: Pembroke Pines
country: United States
state: Florida
city: West Palm Beach
country: United States
state: Florida
city: Honolulu
country: United States
state: Hawaii
city: Arlington Heights
country: United States
state: Illinois
city: Chicago
country: United States
state: Illinois
city: Peoria
country: United States
state: Illinois
city: Bloomington
country: United States
state: Indiana
city: Evansville
country: United States
state: Indiana
city: Indianapolis
country: United States
state: Indiana
city: Waterloo
country: United States
state: Iowa
city: Arkansas City
country: United States
state: Kansas
city: Kansas City
country: United States
state: Kansas
city: Overland Park
country: United States
state: Kansas
city: Wichita
country: United States
state: Kansas
city: Louisville
country: United States
state: Kentucky
city: Auburn
country: United States
state: Maine
city: Livonia
country: United States
state: Michigan
city: Edina
country: United States
state: Minnesota
city: Omaha
country: United States
state: Nebraska
city: Las Vegas
country: United States
state: Nevada
city: Edison
country: United States
state: New Jersey
city: Margate
country: United States
state: New Jersey
city: New Hyde Park
country: United States
state: New York
city: Rochester
country: United States
state: New York
city: Syracuse
country: United States
state: New York
city: Hickory
country: United States
state: North Carolina
city: Raleigh
country: United States
state: North Carolina
city: Statesville
country: United States
state: North Carolina
city: Winston-Salem
country: United States
state: North Carolina
city: Cincinnati
country: United States
state: Ohio
city: Tulsa
country: United States
state: Oklahoma
city: Medford
country: United States
state: Oregon
city: Portland
country: United States
state: Oregon
city: Allentown
country: United States
state: Pennsylvania
city: Altoona
country: United States
state: Pennsylvania
city: Downingtown
country: United States
state: Pennsylvania
city: Sellerville
country: United States
state: Pennsylvania
city: Tipton
country: United States
state: Pennsylvania
city: Warwick
country: United States
state: Rhode Island
city: Charleston
country: United States
state: South Carolina
city: Mt. Pleasant
country: United States
state: South Carolina
city: Simpsonville
country: United States
state: South Carolina
city: Chattanooga
country: United States
state: Tennessee
city: Morristown
country: United States
state: Tennessee
city: Corpus Christi
country: United States
state: Texas
city: Dallas
country: United States
state: Texas
city: Euless
country: United States
state: Texas
city: San Antonio
country: United States
state: Texas
city: The Colony
country: United States
state: Texas
city: Ogden
country: United States
state: Utah
city: Salt Lake City
country: United States
state: Utah
city: Norfolk
country: United States
state: Virginia
city: Richmond
country: United States
state: Virginia
city: Renton
country: United States
state: Washington
city: Madison
country: United States
state: Wisconsin
Study officials:
affiliation: Takeda
name: Medical Director
role: STUDY_DIRECTOR
References:
citation: Stein EA, Bays H, O'Brien D, Pedicano J, Piper E, Spezzi A. Lapaquistat acetate: development of a squalene synthase inhibitor for the treatment of hypercholesterolemia. Circulation. 2011 May 10;123(18):1974-85. doi: 10.1161/CIRCULATIONAHA.110.975284. Epub 2011 Apr 25.