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A Safety and Efficacy Study of AEGR-733 to Treat Homozygous Familial Hypercholesterolemia (FH)

Primary Purpose

Homozygous Familial Hypercholesterolemia

Status
Completed
Phase
Phase 3
Locations
International
Study Type
Interventional
Intervention
AEGR-733
Sponsored by
Aegerion Pharmaceuticals, Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Homozygous Familial Hypercholesterolemia

Eligibility Criteria

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

Inclusion Criteria:

  1. Males and females at least 18 years of age
  2. Diagnosis of functional homozygous FH by at least one (a-c) of the following clinical criteria:

    • documented functional mutation(s) in both LDL receptor alleles or alleles known to affect LDL receptor functionality OR
    • skin fibroblast LDL receptor activity less than 20% normal OR
    • untreated TC greater than 500 mg/dL AND TG less then 300 mg/dL AND both parents have documented TC greater than 250 mg/dL
  3. Concurrent lipid lowering medication/apheresis must be stable for at least 6 weeks before the baseline visit and must remain stable for the first 26 weeks.
  4. Body weight at least 40 kg and less than 136 kg
  5. Negative screening pregnancy test if female of child-bearing potential (females of child-bearing potential and all males must be following a medically accepted form of contraception)
  6. Subjects must be willing to comply with all study-related procedures

Exclusion Criteria:

  1. Uncontrolled hypertension
  2. History of chronic renal insufficiency
  3. History of biopsy proven cirrhosis or abnormal LFTs at screening (AST or ALT greater than 2 x upper limit of normal and/or Total Bilirubin greater than or equal to 1.5 mg/dl unless patient has unconjugated hyperbilirubinemia due to Gilbert's syndrome)
  4. Chronic hepatitis B or chronic hepatitis C
  5. Any major surgical procedure occurring less than 3 months prior to the screening visit
  6. Cardiac insufficiency defined by the NYHA classification as functional Class III or Class IV
  7. Previous organ transplantation
  8. History of a non-skin malignancy within the previous 3 years
  9. Male subjects reporting more than 2 drinks per day or females reporting more than 1 drink per day (1 drink= 12 oz beer, 1 oz hard liquor, 5 oz wine).
  10. Participation in an investigational drug study within 6 weeks prior to the screening visit
  11. Known significant gastrointestinal bowel disease or malabsorption such as inflammatory bowel disease or chronic pancreatitis requiring use of daily pancreatic enzymes.
  12. Serious or unstable medical or psychological conditions that, in the opinion of the investigator, would compromise the subject's safety or successful participation in the study.
  13. Certain prohibited medications known to be potentially hepatotoxic, especially those that can induce microvesicular or macrovesicular steatosis. These include but are not limited to: accutane, amiodarone, heavy acetaminophen use (4g/day greater than 3 x q week), methotrexate, tetracyclines,and tamoxifen
  14. Documented diagnosis of any of the following pulmonary conditions: Asthma, Chronic Obstructive Pulmonary Disease (COPD), Idiopathic pulmonary fibrosis
  15. Documented diagnosis of any of the following liver diseases: Nonalcoholic Steatohepatitis, Alcoholic liver disease, Autoimmune hepatitis, primary biliary cirrhosis, primary sclerosing cholangitis, Wilson's disease, hemochromatosis, alpha 1 anti-trypsin deficiency.
  16. Current use of corticosteroids or betaine

Sites / Locations

  • Cedars-Sinai Medical Center
  • University of Pennsylvania
  • Robarts Research Institute
  • Lipid Clinic and University of Montreal Community Genomic Medicine Center
  • Dipartimento di Medicina Clinica e Della Patalogie Emergenti
  • Medicina Interna Universitaria
  • Centro Universitario Dislipidemie
  • Dipartimento di Clinica e Terapia Medica
  • Cardiology Research
  • University of Capetown

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

AEGR-733

Arm Description

Outcomes

Primary Outcome Measures

Percent Change From Baseline in Low-density Lipoprotein Cholesterol (LDL-C)
Percent change from Baseline in LDL-C

Secondary Outcome Measures

Percent Change From Baseline in Total Cholesterol (TC)
Percent change from Baseline in TC
Percent Change From Baseline for Apolipoprotein B (Apo B)
Percent change from Baseline for Apo B
Percent Change From Baseline in Triglycerides
Percent change from Baseline in triglycerides
Percent Change From Baseline in High Density Lipoprotein Cholesterol (HDL-C)
Percent change from Baseline in HDL-C
Percent Change From Baseline in Non-HDL-C
Percent change from Baseline in non-HDL-C
Percent Change From Baseline in Apolipoprotein AI (Apo AI)
Percent change from Baseline in Apo AI
Absolute Change From Baseline in Hepatic Fat Percent
Absolute change from Baseline in hepatic fat percent
Absolute Change From Baseline in Alanine Aminotransferase (ALT)
Absolute change from Baseline in ALT
Absolute Change From Baseline in Aspartate Aminotransferase (AST)
Absolute change from Baseline in AST
Absolute Change From Baseline in Total Bilirubin
Absolute change from Baseline in total bilirubin
Absolute Change From Baseline in Weight
Absolute change from Baseline in weight

Full Information

First Posted
August 6, 2008
Last Updated
February 21, 2018
Sponsor
Aegerion Pharmaceuticals, Inc.
Collaborators
FDA Office of Orphan Products Development
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1. Study Identification

Unique Protocol Identification Number
NCT00730236
Brief Title
A Safety and Efficacy Study of AEGR-733 to Treat Homozygous Familial Hypercholesterolemia (FH)
Official Title
A Phase III Study of Microsomal Triglyceride Transfer Protein (MTP) Inhibitor AEGR-733 in Patients With Homozygous Familial Hypercholesterolemia on Current Lipid-lowering Therapy
Study Type
Interventional

2. Study Status

Record Verification Date
January 2013
Overall Recruitment Status
Completed
Study Start Date
December 2007 (undefined)
Primary Completion Date
September 2010 (Actual)
Study Completion Date
October 2011 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Aegerion Pharmaceuticals, Inc.
Collaborators
FDA Office of Orphan Products Development

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The goal of this trial is to study the effects of AEGR-733 on LDL cholesterol, other lipids as well as measures of safety over the long-term.
Detailed Description
Homozygous familial hypercholesterolemia (FH) is a serious life-threatening genetic disease. Total plasma cholesterol levels are generally over 500 mg/dl and markedly premature cardiovascular disease is the major consequence. Untreated, most patients develop atherosclerosis before age 20 and generally do not survive past age 30. The primary goal of therapy involves reducing cholesterol (specifically, LDL cholesterol) and preventing coronary artery disease. Unfortunately, patients with homozygous FH are minimally responsive or unresponsive to available drug therapy and thus there are limited treatment options. The current standard of care is LDL apheresis, a physical method of removing the plasma of LDL cholesterol which can transiently reduce cholesterol by more than 50%. However, there is rapid re-accumulation of LDL cholesterol in plasma, and therefore apheresis has to be repeated frequently (every 1-2 weeks) and requires 2 separate sites for IV access. Although anecdotally this procedure may delay the onset of atherosclerosis, it is laborious, expensive, and not readily available. Furthermore, although it is a procedure that is generally well tolerated, the fact that it needs frequent repetition and IV access can be challenging for many of these young patients. Therefore, there is a tremendous unmet medical need for new medical therapies for this orphan disease. AEGR-733 is a novel oral therapeutic agent for hypercholesterolemia. Its mechanism involves inhibition of microsomal triglyceride transfer protein, resulting in a reduction of LDL cholesterol. Earlier studies in patients with homozygous FH reveal AEGR-733 is highly effective in lowering LDL cholesterol, yet long term safety and efficacy need to be established.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Homozygous Familial Hypercholesterolemia

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
29 (Actual)

8. Arms, Groups, and Interventions

Arm Title
AEGR-733
Arm Type
Experimental
Intervention Type
Drug
Intervention Name(s)
AEGR-733
Other Intervention Name(s)
lomitapide, BMS-201038
Intervention Description
5-80 mg daily by mouth for 1.5 yrs
Primary Outcome Measure Information:
Title
Percent Change From Baseline in Low-density Lipoprotein Cholesterol (LDL-C)
Description
Percent change from Baseline in LDL-C
Time Frame
Baseline and Week 26
Secondary Outcome Measure Information:
Title
Percent Change From Baseline in Total Cholesterol (TC)
Description
Percent change from Baseline in TC
Time Frame
Baseline and Week 26
Title
Percent Change From Baseline for Apolipoprotein B (Apo B)
Description
Percent change from Baseline for Apo B
Time Frame
Baseline and Week 26
Title
Percent Change From Baseline in Triglycerides
Description
Percent change from Baseline in triglycerides
Time Frame
Baseline and Week 26
Title
Percent Change From Baseline in High Density Lipoprotein Cholesterol (HDL-C)
Description
Percent change from Baseline in HDL-C
Time Frame
Baseline and Week 26
Title
Percent Change From Baseline in Non-HDL-C
Description
Percent change from Baseline in non-HDL-C
Time Frame
Baseline and Week 26
Title
Percent Change From Baseline in Apolipoprotein AI (Apo AI)
Description
Percent change from Baseline in Apo AI
Time Frame
Baseline and Week 26
Title
Absolute Change From Baseline in Hepatic Fat Percent
Description
Absolute change from Baseline in hepatic fat percent
Time Frame
Baseline and Week 78
Title
Absolute Change From Baseline in Alanine Aminotransferase (ALT)
Description
Absolute change from Baseline in ALT
Time Frame
Baseline and Week 78
Title
Absolute Change From Baseline in Aspartate Aminotransferase (AST)
Description
Absolute change from Baseline in AST
Time Frame
Baseline and Week 78
Title
Absolute Change From Baseline in Total Bilirubin
Description
Absolute change from Baseline in total bilirubin
Time Frame
Baseline and Week 78
Title
Absolute Change From Baseline in Weight
Description
Absolute change from Baseline in weight
Time Frame
Baseline and Week 78

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Males and females at least 18 years of age Diagnosis of functional homozygous FH by at least one (a-c) of the following clinical criteria: documented functional mutation(s) in both LDL receptor alleles or alleles known to affect LDL receptor functionality OR skin fibroblast LDL receptor activity less than 20% normal OR untreated TC greater than 500 mg/dL AND TG less then 300 mg/dL AND both parents have documented TC greater than 250 mg/dL Concurrent lipid lowering medication/apheresis must be stable for at least 6 weeks before the baseline visit and must remain stable for the first 26 weeks. Body weight at least 40 kg and less than 136 kg Negative screening pregnancy test if female of child-bearing potential (females of child-bearing potential and all males must be following a medically accepted form of contraception) Subjects must be willing to comply with all study-related procedures Exclusion Criteria: Uncontrolled hypertension History of chronic renal insufficiency History of biopsy proven cirrhosis or abnormal LFTs at screening (AST or ALT greater than 2 x upper limit of normal and/or Total Bilirubin greater than or equal to 1.5 mg/dl unless patient has unconjugated hyperbilirubinemia due to Gilbert's syndrome) Chronic hepatitis B or chronic hepatitis C Any major surgical procedure occurring less than 3 months prior to the screening visit Cardiac insufficiency defined by the NYHA classification as functional Class III or Class IV Previous organ transplantation History of a non-skin malignancy within the previous 3 years Male subjects reporting more than 2 drinks per day or females reporting more than 1 drink per day (1 drink= 12 oz beer, 1 oz hard liquor, 5 oz wine). Participation in an investigational drug study within 6 weeks prior to the screening visit Known significant gastrointestinal bowel disease or malabsorption such as inflammatory bowel disease or chronic pancreatitis requiring use of daily pancreatic enzymes. Serious or unstable medical or psychological conditions that, in the opinion of the investigator, would compromise the subject's safety or successful participation in the study. Certain prohibited medications known to be potentially hepatotoxic, especially those that can induce microvesicular or macrovesicular steatosis. These include but are not limited to: accutane, amiodarone, heavy acetaminophen use (4g/day greater than 3 x q week), methotrexate, tetracyclines,and tamoxifen Documented diagnosis of any of the following pulmonary conditions: Asthma, Chronic Obstructive Pulmonary Disease (COPD), Idiopathic pulmonary fibrosis Documented diagnosis of any of the following liver diseases: Nonalcoholic Steatohepatitis, Alcoholic liver disease, Autoimmune hepatitis, primary biliary cirrhosis, primary sclerosing cholangitis, Wilson's disease, hemochromatosis, alpha 1 anti-trypsin deficiency. Current use of corticosteroids or betaine
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Mark Sumeray, MD
Organizational Affiliation
Aegerion Pharmaceuticals, Inc.
Official's Role
Study Director
First Name & Middle Initial & Last Name & Degree
Marina Cuchel, MD, PhD
Organizational Affiliation
Univerity of Pennsylvania
Official's Role
Principal Investigator
Facility Information:
Facility Name
Cedars-Sinai Medical Center
City
Los Angeles
State/Province
California
ZIP/Postal Code
90048
Country
United States
Facility Name
University of Pennsylvania
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19104
Country
United States
Facility Name
Robarts Research Institute
City
London
State/Province
Ontario
ZIP/Postal Code
N6A 5K8
Country
Canada
Facility Name
Lipid Clinic and University of Montreal Community Genomic Medicine Center
City
Chicoutimi
State/Province
Quebec
ZIP/Postal Code
G7H 5H6
Country
Canada
Facility Name
Dipartimento di Medicina Clinica e Della Patalogie Emergenti
City
Palermo
State/Province
Sicily
Country
Italy
Facility Name
Medicina Interna Universitaria
City
Ferrara
Country
Italy
Facility Name
Centro Universitario Dislipidemie
City
Milano
Country
Italy
Facility Name
Dipartimento di Clinica e Terapia Medica
City
Roma
Country
Italy
Facility Name
Cardiology Research
City
Bloemfontein
ZIP/Postal Code
9300
Country
South Africa
Facility Name
University of Capetown
City
Cape town
ZIP/Postal Code
7925
Country
South Africa

12. IPD Sharing Statement

Citations:
PubMed Identifier
17215532
Citation
Cuchel M, Bloedon LT, Szapary PO, Kolansky DM, Wolfe ML, Sarkis A, Millar JS, Ikewaki K, Siegelman ES, Gregg RE, Rader DJ. Inhibition of microsomal triglyceride transfer protein in familial hypercholesterolemia. N Engl J Med. 2007 Jan 11;356(2):148-56. doi: 10.1056/NEJMoa061189.
Results Reference
background
Citation
Cuchel M, Meagher E, Marais AD, et.al. Abstract 1077: A phase III study of microsomal triglyceride transfer protein inhibitor lomitapide (AEGR-733) in patients with homozygous familial hypercholesterolemia: interim results at 6 months. Circulation, Nov 2009; 120: S441
Results Reference
result
PubMed Identifier
26723464
Citation
Averna M, Cefalu AB, Stefanutti C, Di Giacomo S, Sirtori CR, Vigna G. Individual analysis of patients with HoFH participating in a phase 3 trial with lomitapide: The Italian cohort. Nutr Metab Cardiovasc Dis. 2016 Jan;26(1):36-44. doi: 10.1016/j.numecd.2015.11.001. Epub 2015 Nov 11.
Results Reference
derived
PubMed Identifier
25897792
Citation
Stefanutti C, Blom DJ, Averna MR, Meagher EA, Theron Hd, Marais AD, Hegele RA, Sirtori CR, Shah PK, Gaudet D, Vigna GB, Sachais BS, Di Giacomo S, du Plessis AM, Bloedon LT, Balser J, Rader DJ, Cuchel M; Phase 3 HoFH Lomitapide Study Investigators. The lipid-lowering effects of lomitapide are unaffected by adjunctive apheresis in patients with homozygous familial hypercholesterolaemia - a post-hoc analysis of a Phase 3, single-arm, open-label trial. Atherosclerosis. 2015 Jun;240(2):408-14. doi: 10.1016/j.atherosclerosis.2015.03.014. Epub 2015 Mar 14.
Results Reference
derived

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A Safety and Efficacy Study of AEGR-733 to Treat Homozygous Familial Hypercholesterolemia (FH)

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