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Efficacy of Lapaquistat Acetate and Simvastatin in Subjects With Primary Dyslipidemia.

Primary Purpose

Hypercholesterolemia

Status
Completed
Phase
Phase 3
Locations
International
Study Type
Interventional
Intervention
Lapaquistat acetate and simvastatin
Lapaquistat acetate and simvastatin
Simvastatin
Sponsored by
Takeda
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Hypercholesterolemia focused on measuring Hyperlipidemia, Drug Therapy

Eligibility Criteria

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

Inclusion Criteria: Females of childbearing potential who are sexually active must agree to use adequate contraception from screening throughout the duration of the study and for 30 days following the last dose. Has a documented history of dyslipidemia with or without cardiovascular risk factors but without type 1 or 2 diabetes. Is on a stable dose of simvastatin, either 20 or 40 mg, for at least 4 weeks prior to Screening. Prior to Randomization, the participant has a mean low density lipoprotein cholesterol level greater than or equal to 100 mg/dL and less than or equal to 190 mg/dL for 2 consecutive samples. Prior to Randomization, the subject has mean triglyceride level greater than or equal to 400 mg/dL for 2 consecutive samples. Is willing and able to comply with the recommended, standardized diet. Exclusion Criteria: Has annine aminotransferase or aspartate aminotransferase level greater than 1.5 times the upper limit of normal, identified during screening. Has a serum creatinine greater than 133 mmol/L, identified during screening. Has a creatine kinase greater than 3 times the upper limit of normal, identified during screening. Has active liver disease or jaundice. Has taken any bile acid sequestrants [eg, cholestyramine], and intestinal cholesterol uptake inhibitors [eg, ezetimibe]) from 30 days before Screening until study completion or any fibrates for 6 weeks before Visit 1. Has a previous history of cancer that has been in remission for less than 5 years prior to the first dose of study medication. Has an endocrine disorder, such as Cushing's syndrome, hyperthyroidism, or inappropriately treated hypothyroidism affecting lipid metabolism. Has a history of myocardial infarction, angina pectoris, unstable angina, transient ischemic attacks, cerebrovascular accident, peripheral vascular disease, abdominal aortic aneurysm, coronary angioplasty, coronary or peripheral arterial surgery, or multiple risk factors that confer a 10-year risk for cardiovascular heart disease greater than 20% based on Framingham risk scoring. Has a positive hepatitis B surface antigen or hepatitis C virus antibody test, as determined by medical history. Has a positive human immunodeficiency virus status or is taking antiretroviral medications, as determined by medical history and/or subject's verbal report. Has received any investigational medication 30 days prior to screening, (for drugs with a long half-life, within a period of less than 5 times the drug's half-life) or is participating in an investigational study. Has received lapaquistat acetate in a previous clinical study or as a therapeutic agent. Has a history or presence of clinically significant food allergy that would prevent adherence to the specialized diet. Has a known heterozygous or homozygous familial hypercholesterolemia or known type III hyperlipoproteinemia (familial dysbetalipoproteinemia). Has fibromyalgia, myopathy, rhabdomyolysis, or unexplained muscle pain. Has uncontrolled hypertension Has had 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 high alcohol intake within the previous 2 years. Has type 1 or 2 diabetes mellitus.

Sites / Locations

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Active Comparator

Arm Label

Lapaquistat Acetate 50 mg QD + Simvastatin

Lapaquistat Acetate 100 mg QD + Simvastatin

Simvastatin

Arm Description

Outcomes

Primary Outcome Measures

Change from Baseline in fasting plasma Low Density Lipoprotein cholesterol

Secondary Outcome Measures

Change from Baseline in Triglycerides
Change from Baseline in Total Cholesterol
Change from Baseline in High Density Lipoprotein cholesterol
Change from Baseline in Very Low Density Lipoprotein cholesterol
Change from Baseline in apolipoprotein A1
Change from Baseline in apolipoprotein B
Change from Baseline in non- High Density Lipoprotein cholesterol
Change from Baseline in the ratio of Low Density Lipoprotein cholesterol/High Density Lipoprotein cholesterol
Change from Baseline in the ratio of Total Cholesterol/High Density Lipoprotein cholesterol
Change from Baseline in the ratio of apolipoprotein A1/apolipoprotein B
Change from Baseline in high-sensitivity C-reactive protein
Percentage of subjects who achieve Low Density Lipoprotein cholesterol concentrations less than 1.81 mmol/L (70 mg/dL)
Percentage of subjects who achieve Low Density Lipoprotein cholesterol concentrations less than 2.59 mmol/L (100 mg/dL)
Percentage of subjects who achieve Low Density Lipoprotein cholesterol concentrations less than 3.37 mmol/L (130 mg/dL)
Best corrected visual acuity
Adverse Events
Clinical Laboratory Tests
Vital Signs
12-lead Electrocardiogram
Physical Examination

Full Information

First Posted
November 16, 2005
Last Updated
May 23, 2012
Sponsor
Takeda
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1. Study Identification

Unique Protocol Identification Number
NCT00256178
Brief Title
Efficacy of Lapaquistat Acetate and Simvastatin in Subjects With Primary Dyslipidemia.
Official Title
A Placebo-controlled, Double-blind, Randomized Study to Evaluate the Efficacy and Safety of TAK-475 50 mg and 100 mg Versus Placebo, When Co-administered With Simvastatin 20 mg or 40 mg in Subjects With Primary Dyslipidemia.
Study Type
Interventional

2. Study Status

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

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Takeda

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The purpose of the study is to determine the efficacy of lapaquistat acetate, once daily (QD), taken with simvastatin on cholesterol levels in subjects with primary dyslipidemia
Detailed Description
In humans, cholesterol is acquired from dietary sources and is produced de novo in the liver, intestine, and various other tissues. Normally, the balance among cholesterol synthesis, dietary intake, and degradation is adequate to maintain healthy cholesterol plasma levels; however, in subjects with hypercholesterolemia, elevation in low-density lipoprotein cholesterol leads to atherosclerotic deposition of cholesterol in the arterial walls (atherosclerosis) and subsequent coronary heart disease. Thus, it has been established that lowering the low-density lipoprotein cholesterol plasma concentrations effectively reduces cardiovascular morbidity and mortality. Additional lipid risk factors for coronary heart disease include elevated triglyceride, very low-density lipoprotein cholesterol and low-density lipoprotein cholesterol levels, and low levels of high-density lipoprotein cholesterol. Despite changes in lifestyle and the availability of potent lipid-lowering agents, cardiovascular disease continues to be the major cause of death in Western Europe and North America. Serum cholesterol levels exceeding 5 mmol/L (193 mg/dL) are common in adults in Britain and much of Europe, the United States, Australia, and New Zealand, representing a serious public health concern. Currently, 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (ie, statins) are the first-line monotherapies prescribed for the treatment of dyslipidemia, after diet and therapeutic lifestyle changes alone fail to reduce low-density lipoprotein cholesterol to desired levels. Statins reduce low-density lipoprotein cholesterol and triglycerides, increase high-density lipoprotein cholesterol, and improve endothelial function. Treatment with statins reduces the risk of a vascular event by about 30% in subjects with and without symptoms of arteriosclerosis; however, many subjects fail to reach recommended levels of low-density lipoprotein cholesterol reduction after receiving low-dose statins as a monotherapy. Consequently, the dosage of statins is often increased or an additional treatment is added; the latter has become an important therapeutic option for achieving increasingly stringent lipid targets set forth by international therapeutic guidelines. Simvastatin, a long-established treatment for dyslipidemia as monotherapy or in combination with other drugs, is a lactone that, once hydrolyzed, inhibits 3-hydroxy-3-methylglutaryl coenzyme A reductase. At the molecular level, the rate of synthesis of cholesterol depends primarily on the highly regulated activity of 3-hydroxy-3-methylglutaryl coenzyme A reductase. TAK-475 (lapaquistat acetate) is a squalene synthase inhibitor currently under development at Takeda for the treatment of dyslipidemia. This study will evaluate the efficacy and safety of lapaquistat acetate taken with simvastatin in subjects with hypercholesterolemia. Total participation time in this study is expected to be up to 24 weeks.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Hypercholesterolemia
Keywords
Hyperlipidemia, Drug Therapy

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
411 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Lapaquistat Acetate 50 mg QD + Simvastatin
Arm Type
Experimental
Arm Title
Lapaquistat Acetate 100 mg QD + Simvastatin
Arm Type
Experimental
Arm Title
Simvastatin
Arm Type
Active Comparator
Intervention Type
Drug
Intervention Name(s)
Lapaquistat acetate and simvastatin
Other Intervention Name(s)
Lapaquistat, Zocor, TAK-475
Intervention Description
Lapaquistat acetate 50 mg, tablets, orally, once daily and stable simvastatin therapy for up to 24 weeks.
Intervention Type
Drug
Intervention Name(s)
Lapaquistat acetate and simvastatin
Other Intervention Name(s)
Lapaquistat, Zocor, TAK-475
Intervention Description
Lapaquistat acetate 100 mg, tablets, orally, once daily and stable simvastatin therapy for up to 24 weeks.
Intervention Type
Drug
Intervention Name(s)
Simvastatin
Other Intervention Name(s)
Zocor
Intervention Description
Lapaquistat acetate placebo-matching tablets, orally, once daily and stable simvastatin therapy for up to 24 weeks.
Primary Outcome Measure Information:
Title
Change from Baseline in fasting plasma Low Density Lipoprotein cholesterol
Time Frame
Week 24 or Final Visit
Secondary Outcome Measure Information:
Title
Change from Baseline in Triglycerides
Time Frame
Week 24 or Final Visit
Title
Change from Baseline in Total Cholesterol
Time Frame
Week 24 or Final Visit
Title
Change from Baseline in High Density Lipoprotein cholesterol
Time Frame
Week 24 or Final Visit
Title
Change from Baseline in Very Low Density Lipoprotein cholesterol
Time Frame
Week 24 or Final Visit
Title
Change from Baseline in apolipoprotein A1
Time Frame
Week 24 or Final Visit
Title
Change from Baseline in apolipoprotein B
Time Frame
Week 24 or Final Visit
Title
Change from Baseline in non- High Density Lipoprotein cholesterol
Time Frame
Week 24 or Final Visit
Title
Change from Baseline in the ratio of Low Density Lipoprotein cholesterol/High Density Lipoprotein cholesterol
Time Frame
Week 24 or Final Visit
Title
Change from Baseline in the ratio of Total Cholesterol/High Density Lipoprotein cholesterol
Time Frame
Week 24 or Final Visit
Title
Change from Baseline in the ratio of apolipoprotein A1/apolipoprotein B
Time Frame
Week 24 or Final Visit
Title
Change from Baseline in high-sensitivity C-reactive protein
Time Frame
Week 24 or Final Visit
Title
Percentage of subjects who achieve Low Density Lipoprotein cholesterol concentrations less than 1.81 mmol/L (70 mg/dL)
Time Frame
Week 24 or Final Visit
Title
Percentage of subjects who achieve Low Density Lipoprotein cholesterol concentrations less than 2.59 mmol/L (100 mg/dL)
Time Frame
Week 24 or Final Visit
Title
Percentage of subjects who achieve Low Density Lipoprotein cholesterol concentrations less than 3.37 mmol/L (130 mg/dL)
Time Frame
Week 24 or Final Visit
Title
Best corrected visual acuity
Time Frame
Week 24 or Final Visit
Title
Adverse Events
Time Frame
Weeks 2, 4, 8, 12, 16, 20, and 24 or Final Visit
Title
Clinical Laboratory Tests
Time Frame
Weeks 2, 4, 8, 12, 16, 20, and 24 or Final Visit
Title
Vital Signs
Time Frame
Weeks 2, 4, 8, 12, 16, 20, and 24 or Final Visit
Title
12-lead Electrocardiogram
Time Frame
Timeframe: Weeks 12 and 24 or Final Visit
Title
Physical Examination
Time Frame
Week 24 or Final Visit

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Females of childbearing potential who are sexually active must agree to use adequate contraception from screening throughout the duration of the study and for 30 days following the last dose. Has a documented history of dyslipidemia with or without cardiovascular risk factors but without type 1 or 2 diabetes. Is on a stable dose of simvastatin, either 20 or 40 mg, for at least 4 weeks prior to Screening. Prior to Randomization, the participant has a mean low density lipoprotein cholesterol level greater than or equal to 100 mg/dL and less than or equal to 190 mg/dL for 2 consecutive samples. Prior to Randomization, the subject has mean triglyceride level greater than or equal to 400 mg/dL for 2 consecutive samples. Is willing and able to comply with the recommended, standardized diet. Exclusion Criteria: Has annine aminotransferase or aspartate aminotransferase level greater than 1.5 times the upper limit of normal, identified during screening. Has a serum creatinine greater than 133 mmol/L, identified during screening. Has a creatine kinase greater than 3 times the upper limit of normal, identified during screening. Has active liver disease or jaundice. Has taken any bile acid sequestrants [eg, cholestyramine], and intestinal cholesterol uptake inhibitors [eg, ezetimibe]) from 30 days before Screening until study completion or any fibrates for 6 weeks before Visit 1. Has a previous history of cancer that has been in remission for less than 5 years prior to the first dose of study medication. Has an endocrine disorder, such as Cushing's syndrome, hyperthyroidism, or inappropriately treated hypothyroidism affecting lipid metabolism. Has a history of myocardial infarction, angina pectoris, unstable angina, transient ischemic attacks, cerebrovascular accident, peripheral vascular disease, abdominal aortic aneurysm, coronary angioplasty, coronary or peripheral arterial surgery, or multiple risk factors that confer a 10-year risk for cardiovascular heart disease greater than 20% based on Framingham risk scoring. Has a positive hepatitis B surface antigen or hepatitis C virus antibody test, as determined by medical history. Has a positive human immunodeficiency virus status or is taking antiretroviral medications, as determined by medical history and/or subject's verbal report. Has received any investigational medication 30 days prior to screening, (for drugs with a long half-life, within a period of less than 5 times the drug's half-life) or is participating in an investigational study. Has received lapaquistat acetate in a previous clinical study or as a therapeutic agent. Has a history or presence of clinically significant food allergy that would prevent adherence to the specialized diet. Has a known heterozygous or homozygous familial hypercholesterolemia or known type III hyperlipoproteinemia (familial dysbetalipoproteinemia). Has fibromyalgia, myopathy, rhabdomyolysis, or unexplained muscle pain. Has uncontrolled hypertension Has had 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 high alcohol intake within the previous 2 years. Has type 1 or 2 diabetes mellitus.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Medical Director
Organizational Affiliation
Takeda
Official's Role
Study Director
Facility Information:
City
Benešov
Country
Czech Republic
City
Holice v Čechách
Country
Czech Republic
City
Kladno
Country
Czech Republic
City
Mladá Boleslav
Country
Czech Republic
City
Olomouc
Country
Czech Republic
City
Praha
Country
Czech Republic
City
Trutnov
Country
Czech Republic
City
Zlín
Country
Czech Republic
City
Ústí nad Orlicí
Country
Czech Republic
City
Pärnu
Country
Estonia
City
Tallinn
Country
Estonia
City
Tartu
Country
Estonia
City
Aura
Country
Finland
City
Helsinki
Country
Finland
City
Hyvinkää
Country
Finland
City
Oulu
Country
Finland
City
Tampere
Country
Finland
City
Turku
Country
Finland
City
Berlin
Country
Germany
City
Bochum
Country
Germany
City
Chemnitz
Country
Germany
City
Dresden
Country
Germany
City
Frankfurt
Country
Germany
City
Goerlitz
Country
Germany
City
Leipzig
Country
Germany
City
Nurnberg
Country
Germany
City
Krakow
Country
Poland
City
Lublin
Country
Poland
City
Niemodlin
Country
Poland
City
Skierniewice
Country
Poland
City
Sroda Wlkp.
Country
Poland
City
Starachowice
Country
Poland
City
Swietokrzyski
Country
Poland
City
Warszawa
Country
Poland
City
Zakopane
Country
Poland
City
Bloemfontein
Country
South Africa
City
Cape Town
Country
South Africa
City
Johannesburg
Country
South Africa
City
Pretoria
Country
South Africa
City
Randburg
Country
South Africa
City
Tongaat
Country
South Africa
City
Bath
Country
United Kingdom
City
Birmingham
Country
United Kingdom
City
Blackpool
Country
United Kingdom
City
Blantyre
Country
United Kingdom
City
Chippenham
Country
United Kingdom
City
Eastwood
Country
United Kingdom
City
Glasgow
Country
United Kingdom
City
Harrow
Country
United Kingdom
City
Hinckley
Country
United Kingdom
City
Newport Isle of Wight
Country
United Kingdom
City
Nottingham
Country
United Kingdom
City
Woolpit
Country
United Kingdom

12. IPD Sharing Statement

Citations:
PubMed Identifier
21518985
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.
Results Reference
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Efficacy of Lapaquistat Acetate and Simvastatin in Subjects With Primary Dyslipidemia.

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