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Effect of Mipomersen on LDL-Cholesterol Levels in Patients Treated by Regular Apheresis (MICA)

Primary Purpose

Atherosclerosis, LDL-hypercholesterolemia

Status
Completed
Phase
Phase 3
Locations
Germany
Study Type
Interventional
Intervention
mipomersen
Sponsored by
Ludwig-Maximilians - University of Munich
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Atherosclerosis focused on measuring hypercholesterolemia, apheresis, coronary heart disease, cerebrovascular disease, peripheral arterial disease

Eligibility Criteria

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

Inclusion Criteria:

  • The patient fulfils German criteria for regular LDL-apheresis
  • Regular (weekly) LDL-apheresis >/= 3 months
  • The patient has fasting pre-apheresis LDL-C >/= 130 mg/dL at screening.
  • The patient is receiving a stable, maximally tolerated, lipid-lowering regimen
  • The patient has a body mass index (BMI) </= 40 kg/m2 with weight stable (± 4 kg) for > 6 weeks prior to screening.
  • Written informed consent of the patient

Exclusion Criteria:

  • The patient has experienced MI, percutaneous transluminal coronary intervention (PTCI), CABG, cerebrovascular accident, unstable angina, or acute coronary syndrome within 12 weeks of screening.
  • The patient has insulin-dependent diabetes mellitus (Type 1), or if Type 2 diabetes, HbA1c > 8% at screening.
  • The patient has New York Heart Association (NYHA) functional classification III or IV heart failure.
  • The patient has systolic blood pressure > 160 mm Hg or diastolic blood pressure > 95 mm Hg at screening (despite antihypertensive medication/therapy).
  • The patient has an active infection requiring systemic antiviral or antimicrobial therapy unless treatment expected to be completed by day 1.
  • The patient has a positive test for HIV or hepatitis B or C at screening.
  • The patient has any uncontrolled condition that may predispose to secondary hyperlipidemia such as uncontrolled hypothyroidism.
  • The patient has had a malignancy within 5 years, except for basal or squamous cell carcinoma of the skin that has been adequately treated.
  • The patient has clinically significant hepatic (e.g. History of confirmed non-alcoholic steatohepatitis NASH) or renal disease or Gilbert's syndrome.
  • The patient has previously received mipomersen treatment.
  • The patient is on chronic systemic corticosteroids or anabolic agents except for replacement therapy.
  • The patient has received treatment with another investigational drug, biological agent, or device within 4 weeks of screening or 5 half-lives of the study agent, whichever is longer.
  • The patient has a current or a recent history of drug or alcohol abuse, or unwillingness to limit alcohol consumption to within moderate limits (maximum 20 g alcohol per day and 80 g alcohol per week for males; maximum 10 g alcohol per day and 40 g alcohol per week for females).
  • Patient not able to give consent.
  • Patient without legal capacity who is unable to understand the nature, scope, significance and consequences of this clinical trial.
  • Known history of hypersensitivity to the investigational drug or to drugs with a similar chemical structure
  • Simultaneous participation in another clinical trial or participation in any clinical trial involving administration of an investigational medicinal product within 30 days prior to the beginning of the clinical trial.
  • Patient with a physical or psychiatric condition which at the investigator's discretion may put the patient at risk, may confound the trial results, or may interfere with the patient's participation in this clinical trial
  • Known or persistent abuse of medication, drugs or alcohol

Sites / Locations

  • University Munich

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

No Intervention

Arm Label

Mipomersen

Control

Arm Description

Patients randomized to this arm will receive mipomersen 200 mg weekly

patients randomized to this arm will receive no additional drug

Outcomes

Primary Outcome Measures

Change in pre-apheresis LDL-cholesterol (phase 1 of the study)
pre-apheresis LDL-cholesterol concentration will be averaged from 3 subsequent aphereses (exactly 1 week apart) before initiation of mipomersen therapy and after 6 months of weekly apheresis therapy; apheresis conditions will not be changed.
Fraction of patients in whom apheresis conditions can be modified (phase 2 of the study)
In phase 2 of the study mipomersen will be given weekly. It will be evaluated in what fraction of patients this results in a decrease of apheresis time, apheresis frequency or stopping of apheresis.

Secondary Outcome Measures

change in other lipid parameters
a number of additional lipid parameters will be evaluated before and during mipomersen therapy
Number of participants with adverse events
Plasma concentrations of mipomersen
pharmacokinetic sampling will be obtained following mipomersen administration at different time points during the study.

Full Information

First Posted
May 12, 2012
Last Updated
September 1, 2015
Sponsor
Ludwig-Maximilians - University of Munich
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1. Study Identification

Unique Protocol Identification Number
NCT01598948
Brief Title
Effect of Mipomersen on LDL-Cholesterol Levels in Patients Treated by Regular Apheresis
Acronym
MICA
Official Title
Effect of Mipomersen on LDL-Cholesterol Levels in Patients With Severe LDL-Hypercholesterolemia and Atherosclerosis Treated by Regular LDL-Apheresis
Study Type
Interventional

2. Study Status

Record Verification Date
September 2015
Overall Recruitment Status
Completed
Study Start Date
August 2012 (undefined)
Primary Completion Date
May 2015 (Actual)
Study Completion Date
June 2015 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Ludwig-Maximilians - University of Munich

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
Elevated LDL-cholesterol is a major risk factor for heart disease. In patients with heart disease LDL-cholesterol should be lowered to levels below 70 mg/dl to prevent progression of disease. In most patients life style modification together with lipid lowering drug therapy is sufficient to achieve this goal. In some patients with severe forms of hypercholesterolemia, this may not be sufficient to reach goals and regular lipid apheresis (a costly and time intensive form of therapy) may be performed. Mipomersen is a new drug (apoB antisense oligonucleotide) that can lower LDL-cholesterol even in the most severe forms of LDL-hypercholesterolemia by 25-47%. It is unknown whether and to what extent mipomersen can decrease LDL-cholesterol in patients treated with regular apheresis. Phase 1 of the study will test how 6 months of weekly therapy with mipomersen affects LDL-cholesterol in patients with severe LDL-hypercholesterolemia treated with regular apheresis. Phase 2 will test in how many patients this will result in a meaningful reduction of apheresis time, apheresis frequency or if apheresis can be stopped completely.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Atherosclerosis, LDL-hypercholesterolemia
Keywords
hypercholesterolemia, apheresis, coronary heart disease, cerebrovascular disease, peripheral arterial disease

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
17 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Mipomersen
Arm Type
Experimental
Arm Description
Patients randomized to this arm will receive mipomersen 200 mg weekly
Arm Title
Control
Arm Type
No Intervention
Arm Description
patients randomized to this arm will receive no additional drug
Intervention Type
Drug
Intervention Name(s)
mipomersen
Intervention Description
mipomersen 200 mg subcutaneously every week for 37 weeks (phase 1: 26 weeks; phase 2: 11 weeks)
Primary Outcome Measure Information:
Title
Change in pre-apheresis LDL-cholesterol (phase 1 of the study)
Description
pre-apheresis LDL-cholesterol concentration will be averaged from 3 subsequent aphereses (exactly 1 week apart) before initiation of mipomersen therapy and after 6 months of weekly apheresis therapy; apheresis conditions will not be changed.
Time Frame
6 months
Title
Fraction of patients in whom apheresis conditions can be modified (phase 2 of the study)
Description
In phase 2 of the study mipomersen will be given weekly. It will be evaluated in what fraction of patients this results in a decrease of apheresis time, apheresis frequency or stopping of apheresis.
Time Frame
3 months
Secondary Outcome Measure Information:
Title
change in other lipid parameters
Description
a number of additional lipid parameters will be evaluated before and during mipomersen therapy
Time Frame
6 months
Title
Number of participants with adverse events
Time Frame
9 months (phase 1 and 2 of the study)
Title
Plasma concentrations of mipomersen
Description
pharmacokinetic sampling will be obtained following mipomersen administration at different time points during the study.
Time Frame
4 days after injection

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: The patient fulfils German criteria for regular LDL-apheresis Regular (weekly) LDL-apheresis >/= 3 months The patient has fasting pre-apheresis LDL-C >/= 130 mg/dL at screening. The patient is receiving a stable, maximally tolerated, lipid-lowering regimen The patient has a body mass index (BMI) </= 40 kg/m2 with weight stable (± 4 kg) for > 6 weeks prior to screening. Written informed consent of the patient Exclusion Criteria: The patient has experienced MI, percutaneous transluminal coronary intervention (PTCI), CABG, cerebrovascular accident, unstable angina, or acute coronary syndrome within 12 weeks of screening. The patient has insulin-dependent diabetes mellitus (Type 1), or if Type 2 diabetes, HbA1c > 8% at screening. The patient has New York Heart Association (NYHA) functional classification III or IV heart failure. The patient has systolic blood pressure > 160 mm Hg or diastolic blood pressure > 95 mm Hg at screening (despite antihypertensive medication/therapy). The patient has an active infection requiring systemic antiviral or antimicrobial therapy unless treatment expected to be completed by day 1. The patient has a positive test for HIV or hepatitis B or C at screening. The patient has any uncontrolled condition that may predispose to secondary hyperlipidemia such as uncontrolled hypothyroidism. The patient has had a malignancy within 5 years, except for basal or squamous cell carcinoma of the skin that has been adequately treated. The patient has clinically significant hepatic (e.g. History of confirmed non-alcoholic steatohepatitis NASH) or renal disease or Gilbert's syndrome. The patient has previously received mipomersen treatment. The patient is on chronic systemic corticosteroids or anabolic agents except for replacement therapy. The patient has received treatment with another investigational drug, biological agent, or device within 4 weeks of screening or 5 half-lives of the study agent, whichever is longer. The patient has a current or a recent history of drug or alcohol abuse, or unwillingness to limit alcohol consumption to within moderate limits (maximum 20 g alcohol per day and 80 g alcohol per week for males; maximum 10 g alcohol per day and 40 g alcohol per week for females). Patient not able to give consent. Patient without legal capacity who is unable to understand the nature, scope, significance and consequences of this clinical trial. Known history of hypersensitivity to the investigational drug or to drugs with a similar chemical structure Simultaneous participation in another clinical trial or participation in any clinical trial involving administration of an investigational medicinal product within 30 days prior to the beginning of the clinical trial. Patient with a physical or psychiatric condition which at the investigator's discretion may put the patient at risk, may confound the trial results, or may interfere with the patient's participation in this clinical trial Known or persistent abuse of medication, drugs or alcohol
Facility Information:
Facility Name
University Munich
City
Munich
ZIP/Postal Code
81377
Country
Germany

12. IPD Sharing Statement

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Effect of Mipomersen on LDL-Cholesterol Levels in Patients Treated by Regular Apheresis

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