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Effect of Lapaquistat Acetate Combined With Fenofibrate on Blood Cholesterol Levels

Primary Purpose

Hyperlipidemias

Status
Completed
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
Lapaquistat acetate and fenofibrate
Fenofibrate
Sponsored by
Takeda
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Hyperlipidemias focused on measuring Drug Therapy, Lipid Metabolism Disorders, Hyperlipidemias, Hypercholesterolemia, Hypertriglyceridemia

Eligibility Criteria

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

Inclusion Criteria:

  • Women of childbearing potential must not be pregnant as determined by a negative serum human chorionic gonadotropin, not lactating, not planning on becoming pregnant between Screening and 30 days following the last dose of study medication, and agreed to use acceptable forms of contraception during the study.
  • Prior to Randomization, must have a mean low density lipoprotein cholesterol greater than or equal to 100 mg/dL (2.59 mmol/L) for 2 consecutive samples. The difference between the two individual low density lipoprotein cholesterol values not to exceed 15% of the higher value.
  • Prior to Randomization, must have mean triglycerides greater than or equal to 150 and less than or equal to 600 mg/dL (1.70 and 6.78 mmol/L, respectively) for 2 consecutive samples. The upper value for either triglycerides sample must have been less than or equal to 650 mg/dL (7.35 mmol/L).
  • Clinical laboratory evaluations (including clinical chemistry [fasted for at least 10 hours], hematology and urinalysis) within the reference range for the testing laboratory unless results deemed not clinically significant or considered within normal limits for this subject by the investigator or the sponsor.
  • Willing and able to continue to comply with a standardized low cholesterol diet.

Exclusion Criteria:

  • Alanine aminotransferase or aspartate aminotransferase level of greater than 1.5 times the upper limit of normal, active liver disease or jaundice.
  • Serum creatinine greater than 1.5 mg/dL (133 μmol/L).
  • Creatine phosphokinase greater than 3 times the upper limit of normal.
  • Diabetes with a hemoglobin A1c greater than 8 % at Visit 1.
  • Previous history of cancer in remission for less than 5 years prior to the first dose of study medication. Does not include those subjects with basal cell or stage I squamous cell carcinoma of the skin.
  • An endocrine disorder, such as Cushing's syndrome, hyperthyroidism, or inappropriately treated hypothyroidism, affecting lipid metabolism. Subjects with hypothyroidism on appropriate replacement therapy (defined as stable thyroid hormone replacement therapy at least 3 months prior to Visit 1 and thyrotropin levels less than 1.5 times the upper limit of normal) are eligible for enrollment. If thyrotropin is greater than 1.5 times upper limit of normal, a free thyroxine level is to be determined. If the free thyroxine is within normal limits for that subject, the subject may continue in the study.
  • History of myocardial infarction, unstable angina, transient ischemic attacks, cerebrovascular accident, percutaneous coronary intervention, coronary or peripheral arterial surgery (bypass graft surgery) in the 6 months prior to Visit 1.
  • Positive hepatitis B surface antigen, or hepatitis C virus antibody, as determined by medical history and/or subject's verbal report.
  • Positive human immunodeficiency virus status or is taking anti-retroviral medications, as determined by medical history and/or subject's verbal report.
  • Unable or unwilling to discontinue excluded medications or to continue stable doses of "stable dose" medications or required treatment with any excluded medication during the study.
  • Exposure to TAK-475 in other studies or currently is participating in another investigational study or has 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 halflife.
  • Known hypersensitivity or history of adverse reaction to any fibrate.
  • History or presence of clinically significant food allergy that would prevent adherence to the therapeutic lifestyle change (or equivalent) diet.
  • Known homozygous familial hypercholesterolemia or known Type III hyperlipoproteinemia (familial dysbetalipoproteinemia).
  • Active cholecystitis or known cholelithiasis (a fibrate risk factor).
  • Severe renal or hepatic dysfunction, including biliary cirrhosis during Run-In or at Randomization (a fibrate risk factor).
  • Fibromyalgia, myopathy, rhabdomyolysis or unexplained muscle pain.
  • Uncontrolled hypertension (defined as resting diastolic blood pressure greater than100 mm Hg or resting systolic blood pressure greater than 160 mm Hg) at Visit 1.
  • Inflammatory bowel disease or any other malabsorption syndrome or has had gastric bypass or any other surgical procedure for weight loss.
  • Unwilling or unable, in the opinion of the investigator, to comply with the protocol or scheduled appointments.
  • Unable to understand verbal or written English or any other language for which a certified translation of the approved informed consent was available.
  • History of drug abuse (defined as illicit drug use) or a history of alcohol abuse (defined as regular or daily consumption of more than 2 alcoholic drinks per day) within the past 2 years.
  • Any other serious disease or condition at Screening or at Randomization that might reduce life expectancy, impair successful management according to the protocol, or make the subject an unsuitable candidate to receive study medication.

Sites / Locations

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Lapaquistat Acetate 100 mg QD + Fenofibrate 145 mg QD

Fenofibrate 145 mg QD

Arm Description

Outcomes

Primary Outcome Measures

Percent change from Baseline in direct fasting plasma low-density lipoprotein cholesterol.

Secondary Outcome Measures

Change from baseline in calculated low-density lipoprotein cholesterol.
Change from baseline in non- high-density lipoprotein cholesterol.
Change from baseline in total cholesterol.
Change from baseline in apolipoprotein B.
Change from baseline in triglycerides.
Change from baseline in high-density lipoprotein cholesterol.
Change from baseline in apolipoprotein A1.
Change from baseline in very-low-density lipoprotein cholesterol.
Change from baseline in derived ratios including total cholesterol/high-density lipoprotein cholesterol, low-density lipoprotein cholesterol/high-density lipoprotein cholesterol, and apolipoprotein B/ apolipoprotein Al.
Change from baseline in high-sensitivity C-reactive protein.
Percentage of Subjects Achieving Target Direct low-density lipoprotein cholesterol Levels.

Full Information

First Posted
December 19, 2008
Last Updated
May 23, 2012
Sponsor
Takeda
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1. Study Identification

Unique Protocol Identification Number
NCT00813527
Brief Title
Effect of Lapaquistat Acetate Combined With Fenofibrate on Blood Cholesterol Levels
Official Title
A Double-blind, Randomized Study to Evaluate the Efficacy and Safety of TAK-475 or Placebo When Coadministered With Fenofibrate in Subjects With Combined Hyperlipidemia
Study Type
Interventional

2. Study Status

Record Verification Date
May 2012
Overall Recruitment Status
Completed
Study Start Date
February 2006 (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 this study is to compare changes in cholesterol levels in patients with elevated blood cholesterol with administration of lapaquistat acetate, once daily (QD), and fenofibrate.
Detailed Description
Elevated plasma cholesterol (hypercholesterolemia) and various other plasma lipid imbalances (dyslipidemias) are major risk factors for coronary heart disease. It has been established that lowering the low-density lipoprotein cholesterol plasma concentration effectively reduces cardiovascular morbidity and mortality. As a result of this finding, the National Cholesterol Education Program Adult Treatment Panel III identifies control of low-density lipoprotein cholesterol as essential in the prevention and management of coronary heart disease. Currently, 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) are the first-line monotherapies prescribed to reduce low-density lipoprotein cholesterol, after diet and therapeutic lifestyle change. However, low doses of statins often fail to produce the Adult Treatment Panel III-recommended levels of low-density lipoprotein cholesterol reduction, making it necessary to increase the dose or add an additional treatment. This in turn may result in decreased tolerability and potential safety concerns. At higher doses, statins are associated with various myopathies ranging from rare occurrences of rhabdomyolysis and myositis to more frequent symptoms of muscle weakness, cramps, or pain; these can occur with mild or no increases in creatine kinase. Statin use also is associated with increases in liver transaminase levels. These tolerability and safety concerns may contribute to the high discontinuation rates of statins and their prescription at low, and often ineffective, doses. TAK-475 (lapaquistat acetate) inhibits the cholesterol synthesis pathway at a different step than statins (acting on squalene synthase rather than 3-hydroxy-3-methylglutaryl coenzyme A); it does not reduce concentrations of isoprenylated intermediates believed to be responsible for the myopathies associated with statin use. This study was conducted to determine whether lapaquistat acetate with fenofibrate has the potential to be more effective than fenofibrate by itself in lowering low-density lipoprotein cholesterol.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Hyperlipidemias
Keywords
Drug Therapy, Lipid Metabolism Disorders, Hyperlipidemias, Hypercholesterolemia, Hypertriglyceridemia

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
213 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Lapaquistat Acetate 100 mg QD + Fenofibrate 145 mg QD
Arm Type
Experimental
Arm Title
Fenofibrate 145 mg QD
Arm Type
Active Comparator
Intervention Type
Drug
Intervention Name(s)
Lapaquistat acetate and fenofibrate
Other Intervention Name(s)
Lapaquistat, TAK-475
Intervention Description
Lapaquistat acetate 100 mg, tablets, orally, once daily and fenofibrate 145 mg, tablets, orally, once daily for up to 12 weeks.
Intervention Type
Drug
Intervention Name(s)
Fenofibrate
Other Intervention Name(s)
Tricor, Trilipix
Intervention Description
Lapaquistat acetate placebo-matching tablets, orally, once daily and fenofibrate 145 mg, tablets, orally, once daily for up to 12 weeks.
Primary Outcome Measure Information:
Title
Percent change from Baseline in direct fasting plasma low-density lipoprotein cholesterol.
Time Frame
Week 12 or Final Visit.
Secondary Outcome Measure Information:
Title
Change from baseline in calculated low-density lipoprotein cholesterol.
Time Frame
Week 12 or Final Visit.
Title
Change from baseline in non- high-density lipoprotein cholesterol.
Time Frame
Week 12 or Final Visit.
Title
Change from baseline in total cholesterol.
Time Frame
Week 12 or Final Visit.
Title
Change from baseline in apolipoprotein B.
Time Frame
Week 12 or Final Visit.
Title
Change from baseline in triglycerides.
Time Frame
Week 12 or Final Visit.
Title
Change from baseline in high-density lipoprotein cholesterol.
Time Frame
Week 12 or Final Visit.
Title
Change from baseline in apolipoprotein A1.
Time Frame
Week 12 or Final Visit.
Title
Change from baseline in very-low-density lipoprotein cholesterol.
Time Frame
Week 12 or Final Visit.
Title
Change from baseline in derived ratios including total cholesterol/high-density lipoprotein cholesterol, low-density lipoprotein cholesterol/high-density lipoprotein cholesterol, and apolipoprotein B/ apolipoprotein Al.
Time Frame
Week 12 or Final Visit.
Title
Change from baseline in high-sensitivity C-reactive protein.
Time Frame
Week 12 or Final Visit.
Title
Percentage of Subjects Achieving Target Direct low-density lipoprotein cholesterol Levels.
Time Frame
Week 12 or Final Visit.

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Women of childbearing potential must not be pregnant as determined by a negative serum human chorionic gonadotropin, not lactating, not planning on becoming pregnant between Screening and 30 days following the last dose of study medication, and agreed to use acceptable forms of contraception during the study. Prior to Randomization, must have a mean low density lipoprotein cholesterol greater than or equal to 100 mg/dL (2.59 mmol/L) for 2 consecutive samples. The difference between the two individual low density lipoprotein cholesterol values not to exceed 15% of the higher value. Prior to Randomization, must have mean triglycerides greater than or equal to 150 and less than or equal to 600 mg/dL (1.70 and 6.78 mmol/L, respectively) for 2 consecutive samples. The upper value for either triglycerides sample must have been less than or equal to 650 mg/dL (7.35 mmol/L). Clinical laboratory evaluations (including clinical chemistry [fasted for at least 10 hours], hematology and urinalysis) within the reference range for the testing laboratory unless results deemed not clinically significant or considered within normal limits for this subject by the investigator or the sponsor. Willing and able to continue to comply with a standardized low cholesterol diet. Exclusion Criteria: Alanine aminotransferase or aspartate aminotransferase level of greater than 1.5 times the upper limit of normal, active liver disease or jaundice. Serum creatinine greater than 1.5 mg/dL (133 μmol/L). Creatine phosphokinase greater than 3 times the upper limit of normal. Diabetes with a hemoglobin A1c greater than 8 % at Visit 1. Previous history of cancer in remission for less than 5 years prior to the first dose of study medication. Does not include those subjects with basal cell or stage I squamous cell carcinoma of the skin. An endocrine disorder, such as Cushing's syndrome, hyperthyroidism, or inappropriately treated hypothyroidism, affecting lipid metabolism. Subjects with hypothyroidism on appropriate replacement therapy (defined as stable thyroid hormone replacement therapy at least 3 months prior to Visit 1 and thyrotropin levels less than 1.5 times the upper limit of normal) are eligible for enrollment. If thyrotropin is greater than 1.5 times upper limit of normal, a free thyroxine level is to be determined. If the free thyroxine is within normal limits for that subject, the subject may continue in the study. History of myocardial infarction, unstable angina, transient ischemic attacks, cerebrovascular accident, percutaneous coronary intervention, coronary or peripheral arterial surgery (bypass graft surgery) in the 6 months prior to Visit 1. Positive hepatitis B surface antigen, or hepatitis C virus antibody, as determined by medical history and/or subject's verbal report. Positive human immunodeficiency virus status or is taking anti-retroviral medications, as determined by medical history and/or subject's verbal report. Unable or unwilling to discontinue excluded medications or to continue stable doses of "stable dose" medications or required treatment with any excluded medication during the study. Exposure to TAK-475 in other studies or currently is participating in another investigational study or has 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 halflife. Known hypersensitivity or history of adverse reaction to any fibrate. History or presence of clinically significant food allergy that would prevent adherence to the therapeutic lifestyle change (or equivalent) diet. Known homozygous familial hypercholesterolemia or known Type III hyperlipoproteinemia (familial dysbetalipoproteinemia). Active cholecystitis or known cholelithiasis (a fibrate risk factor). Severe renal or hepatic dysfunction, including biliary cirrhosis during Run-In or at Randomization (a fibrate risk factor). Fibromyalgia, myopathy, rhabdomyolysis or unexplained muscle pain. Uncontrolled hypertension (defined as resting diastolic blood pressure greater than100 mm Hg or resting systolic blood pressure greater than 160 mm Hg) at Visit 1. Inflammatory bowel disease or any other malabsorption syndrome or has had gastric bypass or any other surgical procedure for weight loss. Unwilling or unable, in the opinion of the investigator, to comply with the protocol or scheduled appointments. Unable to understand verbal or written English or any other language for which a certified translation of the approved informed consent was available. History of drug abuse (defined as illicit drug use) or a history of alcohol abuse (defined as regular or daily consumption of more than 2 alcoholic drinks per day) within the past 2 years. Any other serious disease or condition at Screening or at Randomization that might reduce life expectancy, impair successful management according to the protocol, or make the subject an unsuitable candidate to receive study medication.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Senior Medical Director
Organizational Affiliation
Takeda
Official's Role
Study Director
Facility Information:
City
Huntsville
State/Province
Alabama
Country
United States
City
Sierra Vista
State/Province
Arizona
Country
United States
City
Beverly Hills
State/Province
California
Country
United States
City
Long Beach
State/Province
California
Country
United States
City
Spring Valley
State/Province
California
Country
United States
City
Colorado Springs
State/Province
Colorado
Country
United States
City
Golden
State/Province
Colorado
Country
United States
City
Waterbury
State/Province
Connecticut
Country
United States
City
Jacksonville
State/Province
Florida
Country
United States
City
Kissimmee
State/Province
Florida
Country
United States
City
Miami
State/Province
Florida
Country
United States
City
Ocala
State/Province
Florida
Country
United States
City
Pembroke Pines
State/Province
Florida
Country
United States
City
Pinellas Park
State/Province
Florida
Country
United States
City
West Palm Beach
State/Province
Florida
Country
United States
City
Warner Robins
State/Province
Georgia
Country
United States
City
Chicago
State/Province
Illinois
Country
United States
City
Peoria
State/Province
Illinois
Country
United States
City
Indianapolis
State/Province
Indiana
Country
United States
City
Wichita
State/Province
Kansas
Country
United States
City
Edina
State/Province
Minnesota
Country
United States
City
St. Louis
State/Province
Missouri
Country
United States
City
Raleigh
State/Province
North Carolina
Country
United States
City
Winston-Salem
State/Province
North Carolina
Country
United States
City
Cincinnati
State/Province
Ohio
Country
United States
City
Columbus
State/Province
Ohio
Country
United States
City
Hillsboro
State/Province
Oregon
Country
United States
City
Beaver
State/Province
Pennsylvania
Country
United States
City
Goose Creek
State/Province
South Carolina
Country
United States
City
Nashville
State/Province
Tennessee
Country
United States
City
Norfolk
State/Province
Virginia
Country
United States
City
Richmond
State/Province
Virginia
Country
United States
City
Coquitlam
State/Province
British Columbia
Country
Canada
City
Victoria
State/Province
British Columbia
Country
Canada
City
London
State/Province
Ontario
Country
Canada
City
Toronto
State/Province
Ontario
Country
Canada

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.
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Effect of Lapaquistat Acetate Combined With Fenofibrate on Blood Cholesterol Levels

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