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The Study of Quantitative Serial Trends in Lipids With ApolpoproteinA-I Stimulation (SUSTAIN)

Primary Purpose

Coronary Artery Disease, Dyslipidemia

Status
Completed
Phase
Phase 2
Locations
South Africa
Study Type
Interventional
Intervention
RVX000222
Placebo RVX000222
Sponsored by
Resverlogix Corp
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Coronary Artery Disease focused on measuring ApolipoproteinA1, HDL-C, Atherosclerosis

Eligibility Criteria

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

Inclusion Criteria:

  1. Male and female patient's ≥ 18 years of age with or without documented coronary artery disease
  2. Women of child-bearing potential, that is, women not surgically sterilized and between menarche and 1 year post menopause, must test negative for pregnancy at the time of enrollment based on a serum pregnancy test and agree to use a reliable method of birth control (for example, use of oral contraceptives or levonorgestrel); or a reliable barrier method of birth control (diaphragms with contraceptive jelly; cervical caps with contraceptive jelly; condoms with contraceptive foam; intrauterine devices; partner with vasectomy; or abstinence) during the study and for one month following the last dose of study drug.
  3. HDL-C requirements. Current (Local lab within 60 days or central lab results prior to Visit 1): HDL-C of ≤45 mg/dL (1.17 mmol/L) for females, and HDL-C of ≤40 mg/dL (1.04 mmol/L) for males
  4. Taking statin therapy for at least 30 days prior to screening (Visit 1), and in the investigators opinion, an unlikely need for statin dose adjustment during the course of the study.
  5. In the opinion of the investigator patients currently on statin therapy other than atorvastatin (10mg, 20mg or 40mg) or rosuvastatin (5mg, 10mg or 20 mg) can be switched to rosuvastatin (5mg, 10mg or 20mg) at Visit 1.

Exclusion Criteria:

  1. Clinically significant heart disease which will require coronary bypass, PCI, cardiac transplantation, surgical repair and/or replacement during the course of the study.
  2. Coronary artery bypass graft (CABG) procedure within the past 90 days.
  3. Previous or current diagnosis of severe heart failure (NYHA Class III-IV) or a documented left ventricular ejection fraction (LVEF) of <25% as determined by contrast left ventriculography, radionuclide ventriculography or echocardiography the absence of an LVEF measurement in a patient without a previous or current diagnosis of heart failure does not prohibit entry into the study.
  4. Patients with evidence of cardiac electrophysiologic instability including a history of uncontrolled ventricular arrhythmias, uncontrolled atrial fibrillation/flutter or uncontrolled supraventricular tachycardias with a ventricular response heart rate of >100 beats per minute at rest within 4 weeks prior to Visit 1.
  5. Evidence of renal impairment as determined by any one of the following:

    1. serum creatinine >1.5 mg/dL (>133 micromol/L) at screening Visit 1
    2. a history of dialysis
    3. a history of nephritic syndrome
  6. Have hypertension that is uncontrolled defined as 2 consecutive measurements of sitting blood pressure of systolic >160 mm Hg or diastolic >95 mm Hg at Visit 1.
  7. Pregnant or nursing (lactating) women, where pregnancy is defined as the state of a female after conception and until the termination of gestation, confirmed by a positive beta-hCG laboratory test (≥5 mIU/mL).
  8. Current or recent (within 12 month prior to Visit 1) treatment with immunosuppressants (eg, Cyclosporine).
  9. Triglycerides >400 mg/dL at screening Visit 1.
  10. Atorvastatin >40 mg daily
  11. Rosuvastatin >20 mg daily
  12. Use of fibrates any dose or niacin/nicotinic acid 250 mg or more within 90 days prior to Visit 1.
  13. Any medical or surgical condition which might significantly alter the absorption, distribution, metabolism or excretion of medication including, but not limited to any of the following: cholecystitis, Crohn's disease, ulcerative colitis, or any gastric bypass alteration.
  14. Evidence of hepatic disease as determined by any one of the following:

    • ALT, AST or GGT values >ULN by central lab at screening, Visit 1
    • a history of hepatic encephalopathy,
    • history of Hepatitis B, C or E,
    • a history of esophageal varices, or
    • a history of portocaval shunt.
  15. A total bilirubin that is >ULN by central lab at screening, Visit 1.
  16. History of malignancy of any organ system, treated or untreated, within the past 5 years whether or not there is evidence of local recurrence or metastases, with the exception of localized basal cell carcinoma of the skin.
  17. History or evidence of drug or alcohol abuse within the last 12 months.
  18. Any surgical or medical condition, which in the opinion of the investigator, may place the patient at higher risk from his/her participation in the study, or is likely to prevent the patient from complying with the requirements of the study or completing the study.
  19. Use of other investigational drugs and devices at the time of enrollment, or within 30 days or 5 half-lives of enrollment, whichever is longer.
  20. History of noncompliance to medical regimens or unwillingness to comply with the study protocol.
  21. Any condition that in the opinion of the investigator would confound the evaluation and interpretation of efficacy and/or safety data.
  22. Persons directly involved in the execution of this protocol

Sites / Locations

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

RVX000222, 200 mg daily

Placebo

Arm Description

Outcomes

Primary Outcome Measures

The percent change in HDL-C from baseline to 24 weeks for RVX000222 200 mg daily compared to placebo
To determine whether treatment with RVX000222 produces an increase in HDL-C at 24 weeks compared to placebo.

Secondary Outcome Measures

Within treatment group percent change in HDL-C from baseline to 24 weeks for RVX000222 and placebo groups.
To evaluate changes in other lipids such as HDL-C, LDL-C, non-HDL-C, apoB, TG and HDL subclasses over time within and between treatment groups.
The percent change in plasma apoA-I from baseline to 4 weeks, 12 weeks and 24 weeks for RVX000222 compared to placebo (within and between treatment groups).
To evaluate changes in plasma levels of apoA-I over time within and between treatment groups.
The percent change in LDL-C, non-HDL-C, apoB, TG and HDL subclasses from baseline to 4 weeks, 12 weeks and 24 weeks for RVX000222 compared to placebo (within and between treatment groups)
To evaluate changes in other lipids such as HDL-C, LDL-C, non-HDL-C, apoB, TG and HDL subclasses over time within and between treatment groups.
Incidence of adverse events by treatment group
To evaluate the safety and tolerability of RVX000222.
The percent change in HDL-C from baseline to 4 weeks and 12 weeks for RVX000222 compared to placebo (within and between treatment groups)
To evaluate changes in other lipids such as HDL-C, LDL-C, non-HDL-C, apoB, TG and HDL subclasses over time within and between treatment groups.
The percent change in hsCRP from baseline to 12 weeks and 24 weeks for RVX000222 compared to placebo (within and between treatment groups).
To evaluate changes in hs-CRP over time within and between treatment groups.

Full Information

First Posted
August 22, 2011
Last Updated
September 19, 2012
Sponsor
Resverlogix Corp
Collaborators
The Cleveland Clinic
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1. Study Identification

Unique Protocol Identification Number
NCT01423188
Brief Title
The Study of Quantitative Serial Trends in Lipids With ApolpoproteinA-I Stimulation
Acronym
SUSTAIN
Official Title
Phase IIb Multi-center, Double-blind, Randomized, Parallel Group, Placebo Controlled Clinical Trial for the Assessment of Lipid Trends and Safety of RVX000222 in Statin Treated Subjects With Low Baseline HDL-C Concentrations
Study Type
Interventional

2. Study Status

Record Verification Date
September 2012
Overall Recruitment Status
Completed
Study Start Date
August 2011 (undefined)
Primary Completion Date
June 2012 (Actual)
Study Completion Date
August 2012 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Resverlogix Corp
Collaborators
The Cleveland Clinic

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This study is designed to provide an assessment of the change in baseline lipid parameters with RVX000222 after 12 weeks and 24 weeks of treatment when given in addition to optimized statin background therapy in subjects with low baseline HDL-C.
Detailed Description
One-third of the US population, almost 80 million adults, have cardiovascular disease and mortality associated with heart disease still remains as a leading cause of death around the world. The major risk factors for cardiovascular disease associated with atherosclerosis is dyslipidemia, characterized by high levels of low density lipoprotein (LDL) and/or low levels of high density lipoprotein (HDL). The widespread use of statins in patients at risk for cardiovascular disease has led to lower LDL levels but has had little effect on HDL levels. HDL has a well established role in atherosclerosis and cardiovascular disease protection. HDL mediates the removal of cholesterol from the atherosclerotic plaques for elimination from the body. The major component of HDL consists of apolipoprotein A-I (ApoA I). Recent intervention studies with synthetic HDL particles and recombinant ApoA-I have shown that HDL has the capacity to reverse coronary atherosclerosis. Increasing ApoA-I is likely to have a favorable effect on atherosclerotic plaque stability and size and on cardiovascular diseases. RVX000222 is a member of a novel class of small molecules that are candidates for the treatment of dyslipidemia by increasing plasma levels of HDL through increased ApoA-I transcription.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Coronary Artery Disease, Dyslipidemia
Keywords
ApolipoproteinA1, HDL-C, Atherosclerosis

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
176 (Actual)

8. Arms, Groups, and Interventions

Arm Title
RVX000222, 200 mg daily
Arm Type
Experimental
Arm Title
Placebo
Arm Type
Placebo Comparator
Intervention Type
Drug
Intervention Name(s)
RVX000222
Intervention Description
capsule, 200 mg, administer with food, 100 mg twice daily 10-12 hrs apart, 24 weeks
Intervention Type
Drug
Intervention Name(s)
Placebo RVX000222
Intervention Description
capsule, administer with food, twice daily 10-12 hrs apart, 24 weeks
Primary Outcome Measure Information:
Title
The percent change in HDL-C from baseline to 24 weeks for RVX000222 200 mg daily compared to placebo
Description
To determine whether treatment with RVX000222 produces an increase in HDL-C at 24 weeks compared to placebo.
Time Frame
24 weeks
Secondary Outcome Measure Information:
Title
Within treatment group percent change in HDL-C from baseline to 24 weeks for RVX000222 and placebo groups.
Description
To evaluate changes in other lipids such as HDL-C, LDL-C, non-HDL-C, apoB, TG and HDL subclasses over time within and between treatment groups.
Time Frame
24 weeks
Title
The percent change in plasma apoA-I from baseline to 4 weeks, 12 weeks and 24 weeks for RVX000222 compared to placebo (within and between treatment groups).
Description
To evaluate changes in plasma levels of apoA-I over time within and between treatment groups.
Time Frame
4, 12 and 24 weeks
Title
The percent change in LDL-C, non-HDL-C, apoB, TG and HDL subclasses from baseline to 4 weeks, 12 weeks and 24 weeks for RVX000222 compared to placebo (within and between treatment groups)
Description
To evaluate changes in other lipids such as HDL-C, LDL-C, non-HDL-C, apoB, TG and HDL subclasses over time within and between treatment groups.
Time Frame
4, 12 and 24 weeks
Title
Incidence of adverse events by treatment group
Description
To evaluate the safety and tolerability of RVX000222.
Time Frame
Participants will be followed for the duration of the study: 30 weeks (2 weeks screening, 24 weeks active treatment, 4 week follow-up)
Title
The percent change in HDL-C from baseline to 4 weeks and 12 weeks for RVX000222 compared to placebo (within and between treatment groups)
Description
To evaluate changes in other lipids such as HDL-C, LDL-C, non-HDL-C, apoB, TG and HDL subclasses over time within and between treatment groups.
Time Frame
4, 12 weeks
Title
The percent change in hsCRP from baseline to 12 weeks and 24 weeks for RVX000222 compared to placebo (within and between treatment groups).
Description
To evaluate changes in hs-CRP over time within and between treatment groups.
Time Frame
12, 24 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male and female patient's ≥ 18 years of age with or without documented coronary artery disease Women of child-bearing potential, that is, women not surgically sterilized and between menarche and 1 year post menopause, must test negative for pregnancy at the time of enrollment based on a serum pregnancy test and agree to use a reliable method of birth control (for example, use of oral contraceptives or levonorgestrel); or a reliable barrier method of birth control (diaphragms with contraceptive jelly; cervical caps with contraceptive jelly; condoms with contraceptive foam; intrauterine devices; partner with vasectomy; or abstinence) during the study and for one month following the last dose of study drug. HDL-C requirements. Current (Local lab within 60 days or central lab results prior to Visit 1): HDL-C of ≤45 mg/dL (1.17 mmol/L) for females, and HDL-C of ≤40 mg/dL (1.04 mmol/L) for males Taking statin therapy for at least 30 days prior to screening (Visit 1), and in the investigators opinion, an unlikely need for statin dose adjustment during the course of the study. In the opinion of the investigator patients currently on statin therapy other than atorvastatin (10mg, 20mg or 40mg) or rosuvastatin (5mg, 10mg or 20 mg) can be switched to rosuvastatin (5mg, 10mg or 20mg) at Visit 1. Exclusion Criteria: Clinically significant heart disease which will require coronary bypass, PCI, cardiac transplantation, surgical repair and/or replacement during the course of the study. Coronary artery bypass graft (CABG) procedure within the past 90 days. Previous or current diagnosis of severe heart failure (NYHA Class III-IV) or a documented left ventricular ejection fraction (LVEF) of <25% as determined by contrast left ventriculography, radionuclide ventriculography or echocardiography the absence of an LVEF measurement in a patient without a previous or current diagnosis of heart failure does not prohibit entry into the study. Patients with evidence of cardiac electrophysiologic instability including a history of uncontrolled ventricular arrhythmias, uncontrolled atrial fibrillation/flutter or uncontrolled supraventricular tachycardias with a ventricular response heart rate of >100 beats per minute at rest within 4 weeks prior to Visit 1. Evidence of renal impairment as determined by any one of the following: serum creatinine >1.5 mg/dL (>133 micromol/L) at screening Visit 1 a history of dialysis a history of nephritic syndrome Have hypertension that is uncontrolled defined as 2 consecutive measurements of sitting blood pressure of systolic >160 mm Hg or diastolic >95 mm Hg at Visit 1. Pregnant or nursing (lactating) women, where pregnancy is defined as the state of a female after conception and until the termination of gestation, confirmed by a positive beta-hCG laboratory test (≥5 mIU/mL). Current or recent (within 12 month prior to Visit 1) treatment with immunosuppressants (eg, Cyclosporine). Triglycerides >400 mg/dL at screening Visit 1. Atorvastatin >40 mg daily Rosuvastatin >20 mg daily Use of fibrates any dose or niacin/nicotinic acid 250 mg or more within 90 days prior to Visit 1. Any medical or surgical condition which might significantly alter the absorption, distribution, metabolism or excretion of medication including, but not limited to any of the following: cholecystitis, Crohn's disease, ulcerative colitis, or any gastric bypass alteration. Evidence of hepatic disease as determined by any one of the following: ALT, AST or GGT values >ULN by central lab at screening, Visit 1 a history of hepatic encephalopathy, history of Hepatitis B, C or E, a history of esophageal varices, or a history of portocaval shunt. A total bilirubin that is >ULN by central lab at screening, Visit 1. History of malignancy of any organ system, treated or untreated, within the past 5 years whether or not there is evidence of local recurrence or metastases, with the exception of localized basal cell carcinoma of the skin. History or evidence of drug or alcohol abuse within the last 12 months. Any surgical or medical condition, which in the opinion of the investigator, may place the patient at higher risk from his/her participation in the study, or is likely to prevent the patient from complying with the requirements of the study or completing the study. Use of other investigational drugs and devices at the time of enrollment, or within 30 days or 5 half-lives of enrollment, whichever is longer. History of noncompliance to medical regimens or unwillingness to comply with the study protocol. Any condition that in the opinion of the investigator would confound the evaluation and interpretation of efficacy and/or safety data. Persons directly involved in the execution of this protocol
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Steve Nicholls, MBBS, PhD
Organizational Affiliation
The Cleveland Clinic
Official's Role
Principal Investigator
Facility Information:
City
East Burger Street
State/Province
Bloemfontein
ZIP/Postal Code
9301
Country
South Africa
City
Westdene
State/Province
Bloemfontein
ZIP/Postal Code
9301
Country
South Africa
City
Goodwood
State/Province
Cape Town
ZIP/Postal Code
7460
Country
South Africa
City
Kraaifontein
State/Province
Cape Town
ZIP/Postal Code
7570
Country
South Africa
City
Pinelands
State/Province
Cape Town
ZIP/Postal Code
7405
Country
South Africa
City
Chatsworth
State/Province
Durban
ZIP/Postal Code
4092'
Country
South Africa
City
Congella
State/Province
Durban
ZIP/Postal Code
4001
Country
South Africa
City
Merebank
State/Province
Durban
ZIP/Postal Code
4052
Country
South Africa
City
Sydenham
State/Province
Durban
ZIP/Postal Code
4091
Country
South Africa
City
Tongaat
State/Province
Durban
ZIP/Postal Code
4400
Country
South Africa
City
Umhlanga
State/Province
Durban
ZIP/Postal Code
4321
Country
South Africa
City
Lenasia
State/Province
Johannesburg
ZIP/Postal Code
1827
Country
South Africa
City
Halfway House
State/Province
Midrand
ZIP/Postal Code
1685
Country
South Africa
City
Die Wilgers
State/Province
Pretoria
ZIP/Postal Code
0041
Country
South Africa
City
Eloffsdal
State/Province
Pretoria
ZIP/Postal Code
0084
Country
South Africa
City
Kuils River
State/Province
Western Cape
ZIP/Postal Code
7580
Country
South Africa
City
Parow
State/Province
Western Cape
ZIP/Postal Code
7500
Country
South Africa
City
Somerset West
State/Province
Western Cape
ZIP/Postal Code
7130
Country
South Africa
City
Stellenbosch
State/Province
Western Cape
ZIP/Postal Code
7600
Country
South Africa
City
Worcester
State/Province
Western Cape
ZIP/Postal Code
6850
Country
South Africa
City
Bloemfontein
ZIP/Postal Code
9301
Country
South Africa
City
Cape Town
ZIP/Postal Code
7505
Country
South Africa
City
Cape Town
ZIP/Postal Code
7925
Country
South Africa
City
Johannesburg
ZIP/Postal Code
1460
Country
South Africa
City
Western Cape
ZIP/Postal Code
7646
Country
South Africa

12. IPD Sharing Statement

Citations:
PubMed Identifier
22349989
Citation
Nicholls SJ, Gordon A, Johannson J, Ballantyne CM, Barter PJ, Brewer HB, Kastelein JJ, Wong NC, Borgman MR, Nissen SE. ApoA-I induction as a potential cardioprotective strategy: rationale for the SUSTAIN and ASSURE studies. Cardiovasc Drugs Ther. 2012 Apr;26(2):181-7. doi: 10.1007/s10557-012-6373-5.
Results Reference
derived

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The Study of Quantitative Serial Trends in Lipids With ApolpoproteinA-I Stimulation

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