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A Study to Evaluate the Efficacy and Safety of Rosuvastatin in Children and Adolescents With Homozygous Familial Hypercholesterolemia (HYDRA)

Primary Purpose

Homozygous Familial Hypercholesterolemia (HoFH)

Status
Completed
Phase
Phase 3
Locations
International
Study Type
Interventional
Intervention
Rosuvastatin 20mg
Placebo
Sponsored by
AstraZeneca
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Homozygous Familial Hypercholesterolemia (HoFH) focused on measuring LDL-C, HoFH, Hyperlipidemia

Eligibility Criteria

6 Years - 17 Years (Child)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Prior to any study related procedures being performed, provision of written informed consent from a parent/both parents or guardian and statement of assent from the child or adolescent (if required by Institutional Review Board [IRB] or Independent Ethics Committee [EC] according to local regulations and guidelines). Communication between the Investigator, patient/guardian and child/adolescent to confirm understanding and required compliance with the requirements of the study.
  2. Male and female children and adolescents (aged 6 to <18 years) with at least 1 of the following criteria:

    Documentation of genetic testing confirming 2 mutated alleles of the LDL receptor gene locus; and/or

    Documented untreated LDL C >500 mg/dL (12.9 mmol/L) and triglyceride (TG) <300 mg/dL (3.4 mmol/L) and at least 1 of the following criteria:

    1. Tendinous and/or cutaneous xanthoma prior to 10 years of age; or
    2. Documentation of HoFH in both parents by:

      • genetic and/or
      • clinical criteria
  3. Negative pregnancy test (b human chorionic gonadotropin analysis) prior to baseline in females of child bearing potential:

    • Female patients of child bearing potential must adhere to a pregnancy prevention method (abstinence, chemical, or mechanical) during the study and 3 months following the last dose.
    • Male patients should refrain from fathering a child (including sperm donation) during the study and up to 3 months following the last dose; and
  4. Willing to follow all study procedures including adherence to dietary guidelines, study visits, fasting blood draws, and compliance with study treatment regimens.

Exclusion Criteria

  1. History of statin inducted myopathy or serious hypersensitivity reaction to other HMG CoA reductase inhibitors (statins), including rosuvastatin, at Visit 1.
  2. Fasting serum glucose of >9.99 mmol/L (180 mg/dL) or glycosylated hemoglobin >9% at Visit 1 or patients with a history of diabetic ketoacidosis within the past year.
  3. Uncontrolled hypothyroidism defined as thyroid stimulating hormone (TSH) >1.5 times the upper limit of normal (ULN) at Visit 1 or patients whose thyroid replacement therapy was initiated or modified within the last 3 months prior to Visit 2.
  4. Current active liver disease or hepatic dysfunction (except a confirmed diagnosis of Gilbert's disease) as defined as elevations of 1.5 times the upper limit of normal (ULN) for any age in any of the following liver function tests at Visit 1: Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), or bilirubin.
  5. Definite or suspected personal history or family history of clinically significant adverse drug reactions (ADRs), or hypersensitivity to drugs with a similar chemical structure to rosuvastatin as well as other statins.

Sites / Locations

  • Research Site
  • Research Site
  • Research Site
  • Research Site
  • Research Site
  • Research Site
  • Research Site
  • Research Site
  • Research Site

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Placebo Comparator

Arm Label

Rosuvastatin

Placebo

Arm Description

6-week treatment period, and after crossover finished a 12-week efficacy maintenance phase for all patients

6 weeks treatment during crossover

Outcomes

Primary Outcome Measures

LDL-Cholesterol (mg/dL)
Change in low density lipoprotein cholesterol (LDL C) following 6 weeks of rosuvastatin 20 mg compared to 6 weeks of placebo treatment
LDL-Cholesterol (mmol/L)
Change in low density lipoprotein cholesterol (LDL C) following 6 weeks of rosuvastatin 20 mg compared to 6 weeks of placebo treatment

Secondary Outcome Measures

TC (mg/dL)
Efficacy in terms of total cholesterol (TC)
TC (mmol/L)
Efficacy in terms of total cholesterol (TC)
Non-HDL C (mg/dL)
Efficacy in terms of non-high density lipoprotein cholesterol (non-HDL C)
Non-HDL C (mmol/L)
Efficacy in terms of non-high density lipoprotein cholesterol (non-HDL C)
ApoB (mg/dL)
Efficacy in terms of apolipoprotein B (ApoB)
ApoB (g/L)
Efficacy in terms of apolipoprotein B (ApoB)
HDL-C (mg/dL)
Efficacy in terms of high density lipoprotein cholesterol (HDL C)
HDL-C (mmol/L)
Efficacy in terms of high density lipoprotein cholesterol (HDL C)
LDL-C, Not on Apheresis (mg/dL)
Efficacy in terms of low density lipoprotein cholesterol (LDL C) following 6 weeks rosuvastatin 20 mg or placebo treatment in patients not treated with Apheresis
LDL-C, Not on Apheresis (mmol/L)
Efficacy in terms of low density lipoprotein cholesterol (LDL C) following 6 weeks rosuvastatin 20 mg or placebo treatment in patients not treated with Apheresis
LDL-C From End of Placebo (mg/dL)
Change in low density lipoprotein cholesterol (LDL C) from end of placebo period to 6, 12, and 18 weeks of therapy with rosuvastatin 20 mg
LDL-C From End of Placebo (mmol/L)
Change in low density lipoprotein cholesterol (LDL C) from end of placebo period to 6, 12, and 18 weeks of therapy with rosuvastatin 20 mg
Trough Concentrations
Pharmacokinetic profile in terms of trough concentrations. Cross-over phase results based on measurements taken after 6 weeks active treatment (rosuvastatin) in the cross-over phase. Maintenance phase results based on measurements taken after 6 weeks active treatment (rosuvastatin) in the maintenance phase.
Adverse Events
Safety and tolerability will be described in terms of frequency and severity of adverse events
AE's Leading to Discontinuation
Safety and tolerability will be described in terms of rate of discontinuations due to adverse events
Abnormal Serum Levels
Safety and tolerability will be described in terms of abnormal serum laboratory values. The reported parameters are not the only ones measured, but rather those for which abnormailities were found
Height
Safety and tolerability will be described in terms of growth, including height (linear growth [cm and standard deviation (SD) score]), and weight.
Height Z-score
Safety and tolerability will be described in terms of growth, including height (linear growth [cm and standard deviation (SD) score]), and weight.
Weight
Safety and tolerability will be described in terms of growth, including height (linear growth [cm and standard deviation (SD) score]), and weight.
Tanner Stage
Stages for fem (Pubic hair, Breasts): (Preadol,Preadol) (Sparse, lightly pigmented, medial border of labia,Breast and papilla elevated as small mound; areolar diam incr) (Darker, beginning to curl, incr amount, Breast and areola enlarged, no contour separation) (Course, curly, abundant but less amount in adult,Areola and papilla form secondary mound) (Adult fem triangle, spread to medial surface of thighs,Mature, nipple projects, areola part of general breast contour) For males (Pubic hair, Penis, Testes) 1=(None,Preadol,Preadol) 2=(Scanty, long, light pigm,Slight enl,Enl scrotum, pink texture alt) 3=(Darker, starts to curl, small amount,Longer,Larger) 4=(Resembles adult type, but less in quant; course, curly,Larger; glans and breadth increased in size,Larger, scrotum dark) 5=(Adult distr, spread to medial thighs,Adult size,Adult size). Progr at a normal rate is preferred. Regr is not preferred.
TG (mg/dL)
Efficacy in terms of triglycerides (TG)
TG (mmol/L)
Efficacy in terms of triglycerides (TG)
LDL C/HDL C
Efficacy in terms of low density lipoprotein cholesterol (LDL C) / high density lipoprotein cholesterol (HDL C)
TC/HDL C
Efficacy in terms of total cholesterol (TC) / high density lipoprotein cholesterol (HDL C)
Non-HDL C/HDL C
Efficacy in terms of non-high density lipoprotein cholesterol (non-HDL C) / HDL C
ApoB/ApoA
Efficacy in terms of apolipoprotein B (ApoB) / apolipoprotein A (ApoA)
Urinalysis Abnormalitites
Safety and tolerability will be described in terms of abnormal urine laboratory values
ECG Abnormalities
Safety and tolerability will be described in terms of abnormal electro cardio gram (ECG)
Physical Exam Abnormalitites
Safety and tolerability will be described in terms of abnormal physical examinations. Only parameters for which abnormalities were found are reported.
Abnormal Vital Signs
Safety and tolerability will be described in terms of abnormal vital signs

Full Information

First Posted
August 14, 2014
Last Updated
July 1, 2016
Sponsor
AstraZeneca
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1. Study Identification

Unique Protocol Identification Number
NCT02226198
Brief Title
A Study to Evaluate the Efficacy and Safety of Rosuvastatin in Children and Adolescents With Homozygous Familial Hypercholesterolemia
Acronym
HYDRA
Official Title
A Randomized, Double-blind, Placebo-controlled, Multi-center, Cross-over Study of Rosuvastatin in Children and Adolescents (Aged 6 to <18 Years) With Homozygous Familial Hypercholesterolemia (HoFH)
Study Type
Interventional

2. Study Status

Record Verification Date
July 2016
Overall Recruitment Status
Completed
Study Start Date
November 2014 (undefined)
Primary Completion Date
July 2015 (Actual)
Study Completion Date
July 2015 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
AstraZeneca

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The purpose of the study is to establish the efficacy, safety and tolerability of rosuvastatin in children and adolescents with homozygous familial hypercholesterolemia.
Detailed Description
This is a randomized, double-blind, placebo-controlled, multi-center, cross-over study of the efficacy, safety and tolerability rosuvastatin in children and adolescents (aged 6 to <18 years) with homozygous familial hypercholesterolemia (HoFH). The study is designed to assess the efficacy of rosuvastatin 20 mg compared to placebo on lipids, lipoproteins and apolipoproteins in pediatric patients with HoFH. The outcome measures to be assessed include low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), total cholesterol (TC), triglycerides, non-HDL-C, LDL-C/HDL-C, TC/HDL-C, non-HDL-C/HDL-C, apolipoprotein B (ApoB), apolipoprotein A 1 (ApoA-1) and ApoB/ApoA-1 following 6 weeks of treatment with rosuvastatin 20 mg or placebo. Pharmacokinetic data of the trough plasma exposure of rosuvastatin will also be assessed in these pediatric patients with HoFH.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Homozygous Familial Hypercholesterolemia (HoFH)
Keywords
LDL-C, HoFH, Hyperlipidemia

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Crossover Assignment
Masking
ParticipantCare ProviderInvestigator
Allocation
Randomized
Enrollment
20 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Rosuvastatin
Arm Type
Active Comparator
Arm Description
6-week treatment period, and after crossover finished a 12-week efficacy maintenance phase for all patients
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
6 weeks treatment during crossover
Intervention Type
Drug
Intervention Name(s)
Rosuvastatin 20mg
Intervention Description
Active drug will be taken taken orally, QD, either in the morning or in the evening
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Will be taken taken orally, QD, either in the morning or in the evening
Primary Outcome Measure Information:
Title
LDL-Cholesterol (mg/dL)
Description
Change in low density lipoprotein cholesterol (LDL C) following 6 weeks of rosuvastatin 20 mg compared to 6 weeks of placebo treatment
Time Frame
Samples taken on Day 42 (week 6) and on day 84 (week 12)
Title
LDL-Cholesterol (mmol/L)
Description
Change in low density lipoprotein cholesterol (LDL C) following 6 weeks of rosuvastatin 20 mg compared to 6 weeks of placebo treatment
Time Frame
Samples taken on Day 42 (week 6) and on day 84 (week 12)
Secondary Outcome Measure Information:
Title
TC (mg/dL)
Description
Efficacy in terms of total cholesterol (TC)
Time Frame
Samples taken at Day 42 (week 6) and Day 84 (week 12)
Title
TC (mmol/L)
Description
Efficacy in terms of total cholesterol (TC)
Time Frame
Samples taken at Day 42 (week 6) and Day 84 (week 12)
Title
Non-HDL C (mg/dL)
Description
Efficacy in terms of non-high density lipoprotein cholesterol (non-HDL C)
Time Frame
Samples taken at Day 42 (week 6) and Day 84 (week 12)
Title
Non-HDL C (mmol/L)
Description
Efficacy in terms of non-high density lipoprotein cholesterol (non-HDL C)
Time Frame
Samples taken at Day 42 (week 6) and Day 84 (week 12)
Title
ApoB (mg/dL)
Description
Efficacy in terms of apolipoprotein B (ApoB)
Time Frame
Samples taken at Day 42 (week 6) and Day 84 (week 12)
Title
ApoB (g/L)
Description
Efficacy in terms of apolipoprotein B (ApoB)
Time Frame
Samples taken at Day 42 (week 6) and Day 84 (week 12)
Title
HDL-C (mg/dL)
Description
Efficacy in terms of high density lipoprotein cholesterol (HDL C)
Time Frame
Samples taken at Day 42 (week 6) and Day 84 (week 12)
Title
HDL-C (mmol/L)
Description
Efficacy in terms of high density lipoprotein cholesterol (HDL C)
Time Frame
Samples taken at Day 42 (week 6) and Day 84 (week 12)
Title
LDL-C, Not on Apheresis (mg/dL)
Description
Efficacy in terms of low density lipoprotein cholesterol (LDL C) following 6 weeks rosuvastatin 20 mg or placebo treatment in patients not treated with Apheresis
Time Frame
Samples taken at Day 42 (week 6) and Day 84 (week 12)
Title
LDL-C, Not on Apheresis (mmol/L)
Description
Efficacy in terms of low density lipoprotein cholesterol (LDL C) following 6 weeks rosuvastatin 20 mg or placebo treatment in patients not treated with Apheresis
Time Frame
Samples taken at Day 42 (week 6) and Day 84 (week 12)
Title
LDL-C From End of Placebo (mg/dL)
Description
Change in low density lipoprotein cholesterol (LDL C) from end of placebo period to 6, 12, and 18 weeks of therapy with rosuvastatin 20 mg
Time Frame
Samples taken at Day 42 (week 6), Day 84 (week 12), Day 126 (week 18) and Day 168 (week 24)
Title
LDL-C From End of Placebo (mmol/L)
Description
Change in low density lipoprotein cholesterol (LDL C) from end of placebo period to 6, 12, and 18 weeks of therapy with rosuvastatin 20 mg
Time Frame
Samples taken at Day 42 (week 6), Day 84 (week 12), Day 126 (week 18) and Day 168 (week 24)
Title
Trough Concentrations
Description
Pharmacokinetic profile in terms of trough concentrations. Cross-over phase results based on measurements taken after 6 weeks active treatment (rosuvastatin) in the cross-over phase. Maintenance phase results based on measurements taken after 6 weeks active treatment (rosuvastatin) in the maintenance phase.
Time Frame
Samples taken 24 hours post-dose at Day 42 (week 6), Day 84 (week 12), Day 126 (week 18)
Title
Adverse Events
Description
Safety and tolerability will be described in terms of frequency and severity of adverse events
Time Frame
From screening (5-6weeks before dose) up to the last visit Day 168 (approximately 30 weeks after screening)
Title
AE's Leading to Discontinuation
Description
Safety and tolerability will be described in terms of rate of discontinuations due to adverse events
Time Frame
From screening (5-6weeks before dose) up to the last visit Day 168 (approximately 30 weeks after screening)
Title
Abnormal Serum Levels
Description
Safety and tolerability will be described in terms of abnormal serum laboratory values. The reported parameters are not the only ones measured, but rather those for which abnormailities were found
Time Frame
From screening (5-6weeks before dose) up to the last visit Day 168 (approximately 30 weeks after screening)
Title
Height
Description
Safety and tolerability will be described in terms of growth, including height (linear growth [cm and standard deviation (SD) score]), and weight.
Time Frame
Week 0 (start of cross-over), weeks 6, week 12 and week 18
Title
Height Z-score
Description
Safety and tolerability will be described in terms of growth, including height (linear growth [cm and standard deviation (SD) score]), and weight.
Time Frame
Week 0 (start of cross-over), weeks 6, week 12 and week 18
Title
Weight
Description
Safety and tolerability will be described in terms of growth, including height (linear growth [cm and standard deviation (SD) score]), and weight.
Time Frame
Week 0 (start of cross-over), weeks 6, week 12 and week 18
Title
Tanner Stage
Description
Stages for fem (Pubic hair, Breasts): (Preadol,Preadol) (Sparse, lightly pigmented, medial border of labia,Breast and papilla elevated as small mound; areolar diam incr) (Darker, beginning to curl, incr amount, Breast and areola enlarged, no contour separation) (Course, curly, abundant but less amount in adult,Areola and papilla form secondary mound) (Adult fem triangle, spread to medial surface of thighs,Mature, nipple projects, areola part of general breast contour) For males (Pubic hair, Penis, Testes) 1=(None,Preadol,Preadol) 2=(Scanty, long, light pigm,Slight enl,Enl scrotum, pink texture alt) 3=(Darker, starts to curl, small amount,Longer,Larger) 4=(Resembles adult type, but less in quant; course, curly,Larger; glans and breadth increased in size,Larger, scrotum dark) 5=(Adult distr, spread to medial thighs,Adult size,Adult size). Progr at a normal rate is preferred. Regr is not preferred.
Time Frame
Week 0 (start of cross-over)
Title
TG (mg/dL)
Description
Efficacy in terms of triglycerides (TG)
Time Frame
Samples taken at Day 42 (week 6) and Day 84 (week 12)
Title
TG (mmol/L)
Description
Efficacy in terms of triglycerides (TG)
Time Frame
Samples taken at Day 42 (week 6) and Day 84 (week 12)
Title
LDL C/HDL C
Description
Efficacy in terms of low density lipoprotein cholesterol (LDL C) / high density lipoprotein cholesterol (HDL C)
Time Frame
Samples taken at Day 42 (week 6) and Day 84 (week 12)
Title
TC/HDL C
Description
Efficacy in terms of total cholesterol (TC) / high density lipoprotein cholesterol (HDL C)
Time Frame
Samples taken at Day 42 (week 6) and Day 84 (week 12)
Title
Non-HDL C/HDL C
Description
Efficacy in terms of non-high density lipoprotein cholesterol (non-HDL C) / HDL C
Time Frame
Samples taken at Day 42 (week 6) and Day 84 (week 12)
Title
ApoB/ApoA
Description
Efficacy in terms of apolipoprotein B (ApoB) / apolipoprotein A (ApoA)
Time Frame
Samples taken at Day 42 (week 6) and Day 84 (week 12)
Title
Urinalysis Abnormalitites
Description
Safety and tolerability will be described in terms of abnormal urine laboratory values
Time Frame
Week 0, week 6, week 12 and week 18
Title
ECG Abnormalities
Description
Safety and tolerability will be described in terms of abnormal electro cardio gram (ECG)
Time Frame
Week 0
Title
Physical Exam Abnormalitites
Description
Safety and tolerability will be described in terms of abnormal physical examinations. Only parameters for which abnormalities were found are reported.
Time Frame
Screening, Week 0, week 6, week 12 and week 18, week 24
Title
Abnormal Vital Signs
Description
Safety and tolerability will be described in terms of abnormal vital signs
Time Frame
From screening (5-6weeks before dose) up to the last visit Day 168 (approximately 30 weeks after screening)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
6 Years
Maximum Age & Unit of Time
17 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Prior to any study related procedures being performed, provision of written informed consent from a parent/both parents or guardian and statement of assent from the child or adolescent (if required by Institutional Review Board [IRB] or Independent Ethics Committee [EC] according to local regulations and guidelines). Communication between the Investigator, patient/guardian and child/adolescent to confirm understanding and required compliance with the requirements of the study. Male and female children and adolescents (aged 6 to <18 years) with at least 1 of the following criteria: Documentation of genetic testing confirming 2 mutated alleles of the LDL receptor gene locus; and/or Documented untreated LDL C >500 mg/dL (12.9 mmol/L) and triglyceride (TG) <300 mg/dL (3.4 mmol/L) and at least 1 of the following criteria: Tendinous and/or cutaneous xanthoma prior to 10 years of age; or Documentation of HoFH in both parents by: genetic and/or clinical criteria Negative pregnancy test (b human chorionic gonadotropin analysis) prior to baseline in females of child bearing potential: Female patients of child bearing potential must adhere to a pregnancy prevention method (abstinence, chemical, or mechanical) during the study and 3 months following the last dose. Male patients should refrain from fathering a child (including sperm donation) during the study and up to 3 months following the last dose; and Willing to follow all study procedures including adherence to dietary guidelines, study visits, fasting blood draws, and compliance with study treatment regimens. Exclusion Criteria History of statin inducted myopathy or serious hypersensitivity reaction to other HMG CoA reductase inhibitors (statins), including rosuvastatin, at Visit 1. Fasting serum glucose of >9.99 mmol/L (180 mg/dL) or glycosylated hemoglobin >9% at Visit 1 or patients with a history of diabetic ketoacidosis within the past year. Uncontrolled hypothyroidism defined as thyroid stimulating hormone (TSH) >1.5 times the upper limit of normal (ULN) at Visit 1 or patients whose thyroid replacement therapy was initiated or modified within the last 3 months prior to Visit 2. Current active liver disease or hepatic dysfunction (except a confirmed diagnosis of Gilbert's disease) as defined as elevations of 1.5 times the upper limit of normal (ULN) for any age in any of the following liver function tests at Visit 1: Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), or bilirubin. Definite or suspected personal history or family history of clinically significant adverse drug reactions (ADRs), or hypersensitivity to drugs with a similar chemical structure to rosuvastatin as well as other statins.
Facility Information:
Facility Name
Research Site
City
Brussels (Woluwé-St-Lambert)
Country
Belgium
Facility Name
Research Site
City
Chicoutimi
State/Province
Quebec
Country
Canada
Facility Name
Research Site
City
København Ø
Country
Denmark
Facility Name
Research Site
City
Haifa
Country
Israel
Facility Name
Research Site
City
Kuala Lumpur
Country
Malaysia
Facility Name
Research Site
City
Kubang Kerian
Country
Malaysia
Facility Name
Research Site
City
Amsterdam
Country
Netherlands
Facility Name
Research Site
City
Goteborg
Country
Netherlands
Facility Name
Research Site
City
Taipei
Country
Taiwan

12. IPD Sharing Statement

Citations:
PubMed Identifier
28838366
Citation
Stein EA, Dann EJ, Wiegman A, Skovby F, Gaudet D, Sokal E, Charng MJ, Mohamed M, Luirink I, Raichlen JS, Sunden M, Carlsson SC, Raal FJ, Kastelein JJP. Efficacy of Rosuvastatin in Children With Homozygous Familial Hypercholesterolemia and Association With Underlying Genetic Mutations. J Am Coll Cardiol. 2017 Aug 29;70(9):1162-1170. doi: 10.1016/j.jacc.2017.06.058.
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A Study to Evaluate the Efficacy and Safety of Rosuvastatin in Children and Adolescents With Homozygous Familial Hypercholesterolemia

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