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Efficacy of Lapaquistat Acetate Alone and With Ezetimibe in Subjects With Primary Dyslipidemia.

Primary Purpose

Hypercholesterolemia

Status
Completed
Phase
Phase 3
Locations
International
Study Type
Interventional
Intervention
Lapaquistat acetate
Lapaquistat acetate and ezetimibe
Ezetimibe
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. At Randomization, participants must fulfill the above criteria and also have a mean fasting low density lipoprotein cholesterol levels greater than or equal to 3.36 mmol/L and less than or equal to 5.6 mmol/L and mean triglyceride levels less than or equal to 4.52 mmol/L. Is willing and able to comply with the recommended, standardized diet. Exclusion Criteria: Has active liver disease or jaundice. Has a history of cancer, other than basal cell carcinoma, that had been in remission for less than 5 years prior to the first dose of study drug. Has an endocrine disorder, such as Cushing Syndrome, hyperthyroidism, or inappropriately treated hypothyroidism affecting lipid metabolism. 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 participated in any other clinical studies with lapaquistat acetate, was concurrently participating in another investigational study, 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 intolerance to lapaquistat acetate or ezetimibe. 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 and/or discontinuation of HMG-CoA reductase inhibitors due to myalgia at any time. Has uncontrolled hypertension despite medical treatment. Has inflammatory bowel or any other malabsorption syndrome or had had gastric bypass surgery 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 any other serious disease or condition at Visit 1 or Randomization that might reduce life expectancy, impaired successful management according to the protocol, or make the participant unsuitable to receive study drug. Has a history of coronary heart disease or coronary heart disease-risk factors comprised of: Diabetes mellitus type 1 or 2 History or presence of myocardial infarction, angina pectoris, unstable angina, coronary angioplasty, coronary or peripheral arterial surgery (bypass graft), aortic aneurysm, transient ischemic attacks, or cerebrovascular accident; Multiple risk factors that confer a 10-year risk of coronary heart disease greater than 20% based on the Framingham risk score.

Sites / Locations

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Active Comparator

Arm Label

Lapaquistat Acetate 100 mg QD

Lapaquistat Acetate 100 mg QD + Ezetimibe

Ezetimibe

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 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
December 20, 2005
Last Updated
May 23, 2012
Sponsor
Takeda
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1. Study Identification

Unique Protocol Identification Number
NCT00268697
Brief Title
Efficacy of Lapaquistat Acetate Alone and With Ezetimibe in Subjects With Primary Dyslipidemia.
Official Title
A Double-Blind, Double-Dummy, Randomized, Parallel Group, Multicenter, Phase 3 Study to Evaluate the Efficacy and Safety of Lapaquistat Acetate 100 mg and Lapaquistat Acetate 100 mg Administered in Combination With Ezetimibe 10 mg vs Ezetimibe 10 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
January 2007 (Actual)
Study Completion Date
January 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 ezetimibe 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. Ezetimibe is a lipid-lowering compound that selectively inhibits intestinal absorption of cholesterol at the brush border of the small intestine, leading to a decrease in the delivery of intestinal cholesterol to the liver. Ezetimibe does not affect the absorption of triglycerides, fatty acids, bile acids, progesterone, ethinylestradiol, or fat-soluble vitamins A and D. 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 ezetimibe 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
1267 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Lapaquistat Acetate 100 mg QD
Arm Type
Experimental
Arm Title
Lapaquistat Acetate 100 mg QD + Ezetimibe
Arm Type
Experimental
Arm Title
Ezetimibe
Arm Type
Active Comparator
Intervention Type
Drug
Intervention Name(s)
Lapaquistat acetate
Other Intervention Name(s)
TAK-475
Intervention Description
Lapaquistat acetate 100 mg, tablets, orally, once daily for up to 24 weeks.
Intervention Type
Drug
Intervention Name(s)
Lapaquistat acetate and ezetimibe
Other Intervention Name(s)
TAK-475, Zetia
Intervention Description
Lapaquistat acetate 100 mg, tablets, orally, once daily and stable ezetimibe therapy for up to 24 weeks.
Intervention Type
Drug
Intervention Name(s)
Ezetimibe
Other Intervention Name(s)
Zetia
Intervention Description
Lapaquistat acetate placebo-matching tablets, orally, once daily and stable ezetimibe 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 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
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. At Randomization, participants must fulfill the above criteria and also have a mean fasting low density lipoprotein cholesterol levels greater than or equal to 3.36 mmol/L and less than or equal to 5.6 mmol/L and mean triglyceride levels less than or equal to 4.52 mmol/L. Is willing and able to comply with the recommended, standardized diet. Exclusion Criteria: Has active liver disease or jaundice. Has a history of cancer, other than basal cell carcinoma, that had been in remission for less than 5 years prior to the first dose of study drug. Has an endocrine disorder, such as Cushing Syndrome, hyperthyroidism, or inappropriately treated hypothyroidism affecting lipid metabolism. 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 participated in any other clinical studies with lapaquistat acetate, was concurrently participating in another investigational study, 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 intolerance to lapaquistat acetate or ezetimibe. 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 and/or discontinuation of HMG-CoA reductase inhibitors due to myalgia at any time. Has uncontrolled hypertension despite medical treatment. Has inflammatory bowel or any other malabsorption syndrome or had had gastric bypass surgery 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 any other serious disease or condition at Visit 1 or Randomization that might reduce life expectancy, impaired successful management according to the protocol, or make the participant unsuitable to receive study drug. Has a history of coronary heart disease or coronary heart disease-risk factors comprised of: Diabetes mellitus type 1 or 2 History or presence of myocardial infarction, angina pectoris, unstable angina, coronary angioplasty, coronary or peripheral arterial surgery (bypass graft), aortic aneurysm, transient ischemic attacks, or cerebrovascular accident; Multiple risk factors that confer a 10-year risk of coronary heart disease greater than 20% based on the Framingham risk score.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Medical Director
Organizational Affiliation
Takeda
Official's Role
Study Director
Facility Information:
City
Tallinn
Country
Estonia
City
Tartu
Country
Estonia
City
Riga
Country
Latvia
City
Moscow
Country
Russian Federation
City
Saratov
Country
Russian Federation
City
Smolensk
Country
Russian Federation
City
St. Petersburg
Country
Russian Federation
City
Tyumen
Country
Russian Federation
City
Kragujevac
Country
Serbia

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 Alone and With Ezetimibe in Subjects With Primary Dyslipidemia.

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