Clinical trial NCT02172040: Study to Evaluate the Effect of Celecoxib on the Efficacy and Safety of Amlodipine in Subjects With Hypertension Requiring Antihypertensive Therapy
Official title: A Prospective Randomized Placebo Controlled Study to Evaluate the Effect of Celecoxib on the Efficacy and Safety of Amlodipine in Subjects With Hypertension Requiring Antihypertensive Therapy
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE3
Conditions: Hypertension
Keywords: High blood pressure
Systolic blood pressure
Diastolic blood pressure
Antihypertensive
Lead sponsor: KitovPharma
Sponsor class: UNKNOWN
First posted: 2014-06-24
Enrollment: 152
Sex: ALL
Minimum age (years): 40
Maximum age (years): 75
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: The purpose of this study was to evaluate the effect of celecoxib on the efficacy and safety of amlodipine besylate in subjects with newly diagnosed hypertension requiring antihypertensive therapy.

This study was conducted to support a future marketing application for KIT-302. Kitov Pharma Ltd. (Kitov) is developing KIT-302, an oral fixed combination drug product (FCDP) consisting of the calcium channel blocker amlodipine besylate and the nonsteroidal anti-inflammatory drug (NSAID) celecoxib, as a "convenience reformulation" FCDP to facilitate and improve patient compliance with the once a day (qd) administration of its individual components, amlodipine and celecoxib.

The formulation of KIT-302 consists of amlodipine besylate and celecoxib co-formulated in a single immediate release tablet. However, for this study, two separate capsules were utilized: one containing a commercial celecoxib capsule (Celebrex®) or matched placebo capsule and one containing a commercial amlodipine besylate tablet (Norvasc®) or matched placebo tablet.

The study hypothesis was that treatment with the amlodipine besylate containing capsule plus the celecoxib containing capsule would reduce blood pressure (BP) in subjects with hypertension with an efficacy that is not substantially inferior to the effect of amlodipine besylate alone (i.e., the amlodipine containing capsule plus the matched placebo for the celecoxib capsule).

The United States (US) Food and Drug Administration (FDA) recently approved KIT-302, under the brand name Consensi® (amlodipine and celecoxib) tablets \[New Drug Application (NDA) 210045\] for the following indication: "patients for whom treatment with amlodipine for hypertension and celecoxib for osteoarthritis are appropriate. Lowering blood pressure reduces the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions."


Eligibility criteria: Inclusion Criteria:

1. Adult 40 to 75 years of age
2. Newly diagnosed hypertension that requires chronic pharmacological therapy. Specifically, the subject must meet both of the following criteria:

   1. Resting systolic BP ≥140 mmHg and ≤179 mmHg (where resting is defined as supine for at least 10 minutes with minimal interaction) at Initial Screening Visit
   2. SBPday \>135 mmHg at Baseline Visit (Day 0)
3. Body Mass Index of 18.5 to 34.9 kg/m2
4. Healthy (other than hypertension) as determined by the Investigator based on medical history, physical examination, vital signs, 12-lead electrocardiogram (ECG), and clinical laboratory tests
5. A negative pregnancy test at Screening
6. Both males and women of child bearing potential agree to use adequate contraceptive methods while on study (from Screening through final study visit)
7. Able to comprehend and sign an informed consent form

Exclusion Criteria:

1. Resting systolic BP \>179 mmHg or a resting diastolic BP \>110 mmHg at Screening (where resting is defined as supine for at least 10 minutes with minimal interaction) or SBP24h \>169 mmHg or DBP24h \>110 mmHg at randomization
2. SBPday ≤135 mmHg at baseline (Day 0)
3. Weight \<55 kg
4. Fragile health
5. Evidence of clinically significant findings on screening evaluations (clinical, laboratory, and ECG) which, in the opinion of the Investigator would pose a safety risk or interfere with appropriate interpretation of safety data
6. Current or recent history (within 4 weeks prior to Screening) of a clinically significant bacterial, fungal, or mycobacterial infection
7. Current clinically significant viral infection
8. History of malignancy, with the exception of cured basal cell or squamous cell carcinoma of the skin
9. Major surgery within 4 weeks prior to Screening
10. Presence of a malabsorption syndrome possibly affecting drug absorption (e.g., Crohn's disease or chronic pancreatitis)
11. Active peptic ulceration or history of gastrointestinal bleeding
12. History of myocardial infarction, congestive heart failure, or stroke
13. Any current cardiovascular disease
14. History of psychotic disorder
15. History of alcoholism or drug addiction or current alcohol or drug use that, in the opinion of the Investigator, will interfere with the subject's ability to comply with the dosing schedule and study evaluations
16. History of any illicit drug use within one year prior to Screening
17. Positive drug screen at Screening. A positive drug screen for opiates only (with all other drug tests negative) will not be a basis for exclusion if the subject took over-the-counter narcotics as indicated on the product label within 24 hours prior to the drug screen
18. Current treatment or treatment within 30 days prior to first dose of study drugs with another investigational drug or current enrollment in another clinical trial
19. Current treatment or treatment within 30 days prior to first dose of study drugs with an NSAID or systemic corticosteroid
20. Known history of human immunodeficiency virus, hepatitis B, or hepatitis C
21. Known hypersensitivity to amlodipine or celecoxib
22. Known hypersensitivity to the inactive ingredients in the over-encapsulated study drugs
23. Asthma, acute rhinitis, nasal polyps, angioneurotic oedema, urticaria or other allergic type reactions after taking acetylsalicylic acid or NSAIDs including cyclooxygenase-2 inhibitors
24. Subjects who, in the opinion of the Investigator, are unable or unlikely to comply with the dosing schedule and study evaluations
25. Pregnant or lactating
26. Unable to correctly use ambulatory blood pressure monitor after instruction on its use
27. Subjects with Child-Pugh Class B or C cirrhosis;
28. Subjects currently taking a calcium channel blocker for any reason including angina. Subjects will not be withdrawn from these drugs to be enrolled in the trial
29. Creatinine clearance \<50 ml/min as estimated by the Cockroft-Gault equation
30. Known cytochrome P450 2C9 poor metabolizer
31. Subjects with allergy or hypersensitivity to sulfonamides

Primary outcomes:
measure: Mean Change in Average Daytime (9:00 to 21:00) Ambulatory Systolic Blood Pressure (SBPday) - Primary Endpoint
timeFrame: Baseline and 2 weeks
measure: Frequency of Adverse Events (Number of Participants Affected/Number of Participants at Risk)
timeFrame: 1 month
Secondary outcomes:
measure: Mean Change in Average 24-hour Ambulatory Systolic Blood Pressure (SBP24h)
timeFrame: Baseline and 2 weeks
measure: Mean Change in Average Night-time (01:00 to 06:00) Ambulatory Systolic Blood Pressure (SBPnight)
timeFrame: Baseline and 2 weeks
measure: Mean Change in Average 24-hour Ambulatory Diastolic Blood Pressure (DBP24h)
timeFrame: Baseline and 2 weeks
measure: Mean Change in Average Daytime (9:00 to 21:00) Ambulatory Diastolic Blood Pressure (DBPday)
timeFrame: Baseline and 2 weeks
measure: Mean Change in Average Night-time (01:00 to 06:00) Ambulatory Diastolic Blood Pressure (DBPnight)
timeFrame: Baseline and 2 weeks
measure: Mean Non-transformed Amlodipine Plasma Concentration
timeFrame: 24 hours post-dose on Day 14
measure: Mean Non-transformed Celecoxib Plasma Concentration
timeFrame: 24 hours post-dose on Day 14
measure: Mean Log-transformed Amlodipine Plasma Concentration
timeFrame: 24 hours post-dose on Day 14
measure: Mean Log-transformed Celecoxib Plasma Concentration
timeFrame: 24 hours post-dose on Day 14
measure: Mean Change in Average Daytime (9:00 to 21:00) Ambulatory Systolic Blood Pressure (SBPday) - Secondary Endpoint
timeFrame: Baseline and 2 weeks
Other outcomes:
Locations:
city: Belfast
country: United Kingdom
facility: Celerion
state: Antrim
city: Manchester
country: United Kingdom
facility: The Medicines Evaluation Unit Ltd.
state: Greater Manchester
city: Ledbury
country: United Kingdom
facility: Reading Clinical Research Aspect
state: Herefordshire
city: Liverpool
country: United Kingdom
facility: Synexus Merseyside Clinical Research Centre
state: Merseyside
city: Bath
country: United Kingdom
facility: Oldfield Surgery
state: North East Somerset
city: Chippenham
country: United Kingdom
facility: Rowden Surgery
state: Wiltshire
city: Birmingham
country: United Kingdom
facility: Synexus Midlands Clinical Research Centre
city: Glasgow
country: United Kingdom
facility: Synexus Scotland Clinical Research Centre
city: London
country: United Kingdom
facility: Barts Health NHS Trust, William Harvey Heart Centre, Barts & The London, Queen Mary School of Medicine and Dentistry, Queen Mary, University of London
city: Reading
country: United Kingdom
facility: Reading Clinical Research Aspect
Study officials:
affiliation: Kitov Pharma Ltd
name: J. Paul Waymack, MD, ScD
role: STUDY_DIRECTOR
affiliation: Celerion
name: Brendan Colgan, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: Reading Clinical Research Aspect
name: Claire Kightley, MB
role: PRINCIPAL_INVESTIGATOR
affiliation: Barts Health NHS Trust, William Harvey Heart Centre, Barts & The London, Queen Mary School of Medicine and Dentistry, Queen Mary, University of London
name: David Collier, MBBS, PhD, BSc
role: PRINCIPAL_INVESTIGATOR
affiliation: Synexus Merseyside Clinical Research Centre
name: Paul Ivan, MBBS
role: PRINCIPAL_INVESTIGATOR
affiliation: Synexus Scotland Clinical Research Centre
name: Veronika Horvathova, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: Synexus Midlands Clinical Research Centre
name: Amit Mathew, MS, MBBS
role: PRINCIPAL_INVESTIGATOR
affiliation: Reading Clinical Research Aspect
name: Alexander Thompson, MB, BS, DRCOG
role: PRINCIPAL_INVESTIGATOR
affiliation: Synexus Manchester Clinical Research Centre
name: Mohamed Okily, MB
role: PRINCIPAL_INVESTIGATOR
affiliation: Rowden Surgery
name: Richard Gaunt, MB, ChB, MRCGP, DRCOG
role: PRINCIPAL_INVESTIGATOR
affiliation: Oldfield Surgery
name: Patrick Eavis, MBBS, DRCOG, DFFP, MRCGP
role: PRINCIPAL_INVESTIGATOR
affiliation: The Medicines Evaluation Unit Ltd.
name: Arjun Ravi, MBBS, MRCP
role: PRINCIPAL_INVESTIGATOR
References: