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Safety, Effectiveness, and Tolerability of Ezetimibe Combined With Statins for the Treatment of High Cholesterol in HIV Infected Adults

Primary Purpose

HIV Infections

Status
Completed
Phase
Not Applicable
Locations
International
Study Type
Interventional
Intervention
Ezetimibe
Sponsored by
National Institute of Allergy and Infectious Diseases (NIAID)
About
Eligibility
Locations
Outcomes
Full info

About this trial

This is an interventional treatment trial for HIV Infections focused on measuring Treatment Experienced

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: HIV infected On ART for at least 3 months prior to study entry, and on stable ART for at least 30 days prior to study entry Taking one of the study-recommended statins for at least 3 months prior to study entry, and on stable statin therapy for at least 30 days immediately prior to study entry On lipid-lowering diet and exercise program for at least 30 days prior to screening, and willing to continue both for the duration of the study LDL-c of 130 mg/dL or greater within 30 days prior to study entry Willing to use acceptable forms of contraception If on hormone replacement therapy, must be on a stable dose or dose-equivalent therapy for at least 30 days prior to study entry, and must be willing to continue the same dose for the duration of the study. People taking physiologic testosterone replacement therapy are not excluded. If taking oral contraceptives, must be on a stable dose or dose-equivalent therapy for at least 30 days prior to study entry, and must be willing to continue the same dose for the duration of the study Exclusion Criteria: Active cancer or new diagnosis of cancer within the last 5 years. People with skin cancers, including Kaposi's sarcoma, that do not require systemic treatment are not excluded. Prior use of ezetimibe Known allergy or sensitivity to ezetimibe or its components Diabetes mellitus or use of any diabetic medications within 30 days prior to study entry History of coronary heart disease History of or current congestive heart failure (New York Heart Association Class III or IV) Known atherosclerotic disease risk (e.g., history of myocardial infection, bypass surgery, angioplasty, angina pectoris with a positive stress test or angiographic documentation) Vascular abnormalities (e.g., cerebrovascular disease, peripheral vascular disease, abdominal aortic aneurysm, or leg artery blockages) Untreated or uncontrolled hypothyroidism Current drug or alcohol abuse that may interfere with the study Testosterone therapy beyond normal physiologic levels of the hormone within 3 months prior to study entry Initiation or change in physiologic testosterone replacement therapy within 3 months prior to study entry Hormonal anabolic therapies within 3 months prior to study entry Systemic cancer chemotherapy or immunomodulators (e.g., growth factors, immune globulin, interleukins, and interferons) within 60 days prior to study entry Lipid-lowering agents (except statins) within 30 days prior to study entry Any corticosteroid therapy above replacement levels within 30 days prior to study entry Untreated or uncontrolled hypertension Active AIDS-defining opportunistic infection (OI) within 30 days prior to study entry. People who have no evidence of active disease and are receiving maintenance therapy for AIDS-related OIs are not excluded. Acute illness that would interfere with the study within 30 days prior to study entry Investigational agents. People using expanded access investigational antiretroviral drugs are not excluded. Decreased mental capacity that may interfere with the study Pregnant or breastfeeding

Sites / Locations

  • University of Alabama at Birmingham
  • UCLA School of Medicine
  • University of Southern California
  • University of California, San Diego Antiviral Research Center
  • San Francisco General Hospital
  • San Mateo County AIDS Program
  • Santa Clara Valley Medical Center
  • Stanford University
  • Willow Clinic
  • Georgetown University Medical Center
  • University of Miami
  • University of Hawaii
  • Feinberg School of Medicine, HIV/ACTU
  • Rush-Presbyterian/St. Lukes (Chicago)
  • Cook County Hospital Core Center
  • Indiana University Hospital
  • Wishard Hospital
  • University of Minnesota
  • Nebraska Health System
  • SUNY - Buffalo (Rochester)
  • Beth Israel Medical Center
  • Chelsea Clinic
  • NYU/Bellevue
  • The Cornell Clinical Trials Unit
  • Columbia University
  • Community Health Network, Inc.
  • University of Rochester Medical Center
  • Duke University Medical Center
  • University of Cincinnati
  • MetroHealth Medical Center
  • Ohio State University
  • Presbyterian Medical Center - Univ. of PA
  • University of Pennsylvania, Philadelphia
  • University of Pittsburgh
  • Rhode Island Hospital
  • Stanley Street Treatment and Resource
  • The Miriam Hospital
  • Comprehensive Care Clinic
  • Dallas VA Medical Center
  • University of Texas, Galveston
  • University of Washington (Seattle)
  • University of Puerto Rico

Outcomes

Primary Outcome Measures

Change in directly measured fasting LDL-c while receiving ezetimibe compared to change while receiving placebo
changes in clinical symptoms and safety labs while receiving ezetimibe compared to changes in clinical symptoms while receiving placebo

Secondary Outcome Measures

Full Information

First Posted
December 17, 2004
Last Updated
October 26, 2012
Sponsor
National Institute of Allergy and Infectious Diseases (NIAID)
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1. Study Identification

Unique Protocol Identification Number
NCT00099684
Brief Title
Safety, Effectiveness, and Tolerability of Ezetimibe Combined With Statins for the Treatment of High Cholesterol in HIV Infected Adults
Official Title
A Pilot Study of the Safety, Efficacy, and Tolerability of Ezetimibe (Zetia) in Combination With Statin Therapy for the Treatment of Elevated LDL Cholesterol in HIV-Infected Subjects
Study Type
Interventional

2. Study Status

Record Verification Date
October 2012
Overall Recruitment Status
Completed
Study Start Date
November 2005 (undefined)
Primary Completion Date
undefined (undefined)
Study Completion Date
May 2007 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
National Institute of Allergy and Infectious Diseases (NIAID)

4. Oversight

5. Study Description

Brief Summary
Anti-HIV drugs, especially protease inhibitors (PIs), have been linked to lipid metabolism problems, including elevations in low density lipoprotein cholesterol (LDL-c), triglycerides, and total cholesterol. Ezetimibe is a lipid-controlling drug; statins are part of another class of lipid-lowering drugs popularly prescribed to people with high cholesterol. The purpose of this study is to determine the safety, effectiveness, and tolerability of ezetimibe in combination with statin therapy in adults who are taking anti-HIV drugs and have high cholesterol. Study hypothesis: In HIV infected adults, ezetimibe in combination with statin therapy will result in significantly lower LDL-c compared to statin therapy alone.
Detailed Description
Lipid metabolism abnormalities are common complications of HIV therapy, particularly with PIs. Statins and other lipid-lowering agents are often prescribed to control elevated cholesterol levels in both HIV infected and uninfected people. However, both antiretroviral therapy (ART) and lipid-lowering drugs may be associated with cardiovascular disease, so there is a clear need to find a lipid-lowering drug with low toxicity. This study will evaluate the safety, efficacy, and tolerability of ezetimibe, a lipid-controlling agent, in combination with ongoing statin therapy in HIV infected people currently on ART. This study will last 28 weeks. All participants will be required to continue their current stable statin therapy and ART for the duration of the study. Participants will be randomly assigned to one of two arms. Arm 1 participants will receive ezetimibe daily for 12 weeks, no treatment for 4 weeks, then placebo daily for 12 weeks. Arm 2 participants will receive placebo daily for 12 weeks, no treatment for 4 weeks, and then ezetimibe daily for 12 weeks. There will be 9 study visits; they will occur at study screening, at study entry, and every 4 weeks thereafter. Clinical assessment and blood collection will occur at all visits. Participants will be asked to complete an adherence questionnaire at Weeks 4, 12, 20, and 28, and will also be encouraged to coenroll in ACTG A5128 (Consent for Use of Stored Patient Specimens for Future Testing).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
HIV Infections
Keywords
Treatment Experienced

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Crossover Assignment
Masking
Double
Allocation
Randomized
Enrollment
44 (Actual)

8. Arms, Groups, and Interventions

Intervention Type
Drug
Intervention Name(s)
Ezetimibe
Primary Outcome Measure Information:
Title
Change in directly measured fasting LDL-c while receiving ezetimibe compared to change while receiving placebo
Title
changes in clinical symptoms and safety labs while receiving ezetimibe compared to changes in clinical symptoms while receiving placebo

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: HIV infected On ART for at least 3 months prior to study entry, and on stable ART for at least 30 days prior to study entry Taking one of the study-recommended statins for at least 3 months prior to study entry, and on stable statin therapy for at least 30 days immediately prior to study entry On lipid-lowering diet and exercise program for at least 30 days prior to screening, and willing to continue both for the duration of the study LDL-c of 130 mg/dL or greater within 30 days prior to study entry Willing to use acceptable forms of contraception If on hormone replacement therapy, must be on a stable dose or dose-equivalent therapy for at least 30 days prior to study entry, and must be willing to continue the same dose for the duration of the study. People taking physiologic testosterone replacement therapy are not excluded. If taking oral contraceptives, must be on a stable dose or dose-equivalent therapy for at least 30 days prior to study entry, and must be willing to continue the same dose for the duration of the study Exclusion Criteria: Active cancer or new diagnosis of cancer within the last 5 years. People with skin cancers, including Kaposi's sarcoma, that do not require systemic treatment are not excluded. Prior use of ezetimibe Known allergy or sensitivity to ezetimibe or its components Diabetes mellitus or use of any diabetic medications within 30 days prior to study entry History of coronary heart disease History of or current congestive heart failure (New York Heart Association Class III or IV) Known atherosclerotic disease risk (e.g., history of myocardial infection, bypass surgery, angioplasty, angina pectoris with a positive stress test or angiographic documentation) Vascular abnormalities (e.g., cerebrovascular disease, peripheral vascular disease, abdominal aortic aneurysm, or leg artery blockages) Untreated or uncontrolled hypothyroidism Current drug or alcohol abuse that may interfere with the study Testosterone therapy beyond normal physiologic levels of the hormone within 3 months prior to study entry Initiation or change in physiologic testosterone replacement therapy within 3 months prior to study entry Hormonal anabolic therapies within 3 months prior to study entry Systemic cancer chemotherapy or immunomodulators (e.g., growth factors, immune globulin, interleukins, and interferons) within 60 days prior to study entry Lipid-lowering agents (except statins) within 30 days prior to study entry Any corticosteroid therapy above replacement levels within 30 days prior to study entry Untreated or uncontrolled hypertension Active AIDS-defining opportunistic infection (OI) within 30 days prior to study entry. People who have no evidence of active disease and are receiving maintenance therapy for AIDS-related OIs are not excluded. Acute illness that would interfere with the study within 30 days prior to study entry Investigational agents. People using expanded access investigational antiretroviral drugs are not excluded. Decreased mental capacity that may interfere with the study Pregnant or breastfeeding
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Susan Koletar, MD
Organizational Affiliation
Division of Infectious Diseases, Ohio State University
Official's Role
Study Chair
First Name & Middle Initial & Last Name & Degree
Dominic Chow, MD, MPH
Organizational Affiliation
University of Hawaii, Hawaii AIDS Clinical Research Program, Leahi Hospital
Official's Role
Study Chair
Facility Information:
Facility Name
University of Alabama at Birmingham
City
Birmingham
State/Province
Alabama
ZIP/Postal Code
35924-2050
Country
United States
Facility Name
UCLA School of Medicine
City
Los Angeles
State/Province
California
ZIP/Postal Code
77555-0435
Country
United States
Facility Name
University of Southern California
City
Los Angeles
State/Province
California
ZIP/Postal Code
90033-1079
Country
United States
Facility Name
University of California, San Diego Antiviral Research Center
City
San Diego
State/Province
California
ZIP/Postal Code
92103
Country
United States
Facility Name
San Francisco General Hospital
City
San Francisco
State/Province
California
ZIP/Postal Code
94110
Country
United States
Facility Name
San Mateo County AIDS Program
City
Stanford
State/Province
California
ZIP/Postal Code
94305-5107
Country
United States
Facility Name
Santa Clara Valley Medical Center
City
Stanford
State/Province
California
ZIP/Postal Code
94305-5107
Country
United States
Facility Name
Stanford University
City
Stanford
State/Province
California
ZIP/Postal Code
94305-5107
Country
United States
Facility Name
Willow Clinic
City
Stanford
State/Province
California
ZIP/Postal Code
94305-5107
Country
United States
Facility Name
Georgetown University Medical Center
City
Washington
State/Province
District of Columbia
ZIP/Postal Code
20007
Country
United States
Facility Name
University of Miami
City
Miami
State/Province
Florida
ZIP/Postal Code
33136-1013
Country
United States
Facility Name
University of Hawaii
City
Honolulu
State/Province
Hawaii
ZIP/Postal Code
96816-2396
Country
United States
Facility Name
Feinberg School of Medicine, HIV/ACTU
City
Chicago, 60611-3015
State/Province
Illinois
ZIP/Postal Code
60611-3015
Country
United States
Facility Name
Rush-Presbyterian/St. Lukes (Chicago)
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60611-3015
Country
United States
Facility Name
Cook County Hospital Core Center
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60612
Country
United States
Facility Name
Indiana University Hospital
City
Indianapolis
State/Province
Indiana
ZIP/Postal Code
46202-5250
Country
United States
Facility Name
Wishard Hospital
City
Indianapolis
State/Province
Indiana
ZIP/Postal Code
46202
Country
United States
Facility Name
University of Minnesota
City
Minneapolis
State/Province
Minnesota
ZIP/Postal Code
55455-0392
Country
United States
Facility Name
Nebraska Health System
City
Omaha
State/Province
Nebraska
ZIP/Postal Code
68198-5130
Country
United States
Facility Name
SUNY - Buffalo (Rochester)
City
Buffalo
State/Province
New York
ZIP/Postal Code
14215
Country
United States
Facility Name
Beth Israel Medical Center
City
New York
State/Province
New York
ZIP/Postal Code
10003
Country
United States
Facility Name
Chelsea Clinic
City
New York
State/Province
New York
ZIP/Postal Code
10011
Country
United States
Facility Name
NYU/Bellevue
City
New York
State/Province
New York
ZIP/Postal Code
10016-6481
Country
United States
Facility Name
The Cornell Clinical Trials Unit
City
New York
State/Province
New York
ZIP/Postal Code
10021
Country
United States
Facility Name
Columbia University
City
New York
State/Province
New York
ZIP/Postal Code
10032-3784
Country
United States
Facility Name
Community Health Network, Inc.
City
Rochester
State/Province
New York
ZIP/Postal Code
14642-0001
Country
United States
Facility Name
University of Rochester Medical Center
City
Rochester
State/Province
New York
ZIP/Postal Code
14642-0001
Country
United States
Facility Name
Duke University Medical Center
City
Durham
State/Province
North Carolina
Country
United States
Facility Name
University of Cincinnati
City
Cincinnati
State/Province
Ohio
ZIP/Postal Code
45267-0405
Country
United States
Facility Name
MetroHealth Medical Center
City
Cleveland
State/Province
Ohio
ZIP/Postal Code
44109-1998
Country
United States
Facility Name
Ohio State University
City
Columbus
State/Province
Ohio
ZIP/Postal Code
43210
Country
United States
Facility Name
Presbyterian Medical Center - Univ. of PA
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19104
Country
United States
Facility Name
University of Pennsylvania, Philadelphia
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19104
Country
United States
Facility Name
University of Pittsburgh
City
Pittsburgh
State/Province
Pennsylvania
ZIP/Postal Code
15213-2582
Country
United States
Facility Name
Rhode Island Hospital
City
Providence
State/Province
Rhode Island
ZIP/Postal Code
02906
Country
United States
Facility Name
Stanley Street Treatment and Resource
City
Providence
State/Province
Rhode Island
ZIP/Postal Code
02906
Country
United States
Facility Name
The Miriam Hospital
City
Providence
State/Province
Rhode Island
ZIP/Postal Code
02906
Country
United States
Facility Name
Comprehensive Care Clinic
City
Nashville
State/Province
Tennessee
ZIP/Postal Code
37203
Country
United States
Facility Name
Dallas VA Medical Center
City
Dallas
State/Province
Texas
ZIP/Postal Code
75235-9173
Country
United States
Facility Name
University of Texas, Galveston
City
Galveston
State/Province
Texas
ZIP/Postal Code
77555-0435
Country
United States
Facility Name
University of Washington (Seattle)
City
Seattle
State/Province
Washington
ZIP/Postal Code
98104
Country
United States
Facility Name
University of Puerto Rico
City
San Juan
ZIP/Postal Code
00936-5067
Country
Puerto Rico

12. IPD Sharing Statement

Citations:
PubMed Identifier
14645323
Citation
Calza L, Manfredi R, Chiodo F. Dyslipidaemia associated with antiretroviral therapy in HIV-infected patients. J Antimicrob Chemother. 2004 Jan;53(1):10-4. doi: 10.1093/jac/dkh013. Epub 2003 Nov 25.
Results Reference
background
PubMed Identifier
14983559
Citation
Colagreco JP. Cardiovascular considerations in patients treated with HIV protease inhibitors. J Assoc Nurses AIDS Care. 2004 Jan-Feb;15(1):30-41. doi: 10.1177/1055329003256922.
Results Reference
background
PubMed Identifier
15535403
Citation
Martinez E, Tuset M, Milinkovic A, Miro JM, Gatell JM. Management of dyslipidaemia in HIV-infected patients receiving antiretroviral therapy. Antivir Ther. 2004 Oct;9(5):649-63.
Results Reference
background
PubMed Identifier
15474625
Citation
Visnegarwala F, Maldonado M, Sajja P, Minihan JL, Rodriguez-Barradas MC, Ong O, Lahart CJ, Hasan MQ, Balasubramanyam A, White AC Jr. Lipid lowering effects of statins and fibrates in the management of HIV dyslipidemias associated with antiretroviral therapy in HIV clinical practice. J Infect. 2004 Nov;49(4):283-90. doi: 10.1016/j.jinf.2003.09.006.
Results Reference
background
Links:
URL
http://clinicaltrials.gov/ct/show/NCT00031408
Description
Click here for more information about ACTG A5128

Learn more about this trial

Safety, Effectiveness, and Tolerability of Ezetimibe Combined With Statins for the Treatment of High Cholesterol in HIV Infected Adults

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