Combined Effects of Non-statin Treatments on Apolipoprotein A-I Up-Regulation (CENTAUR): A Feasibility Study
试验速览
- 阶段
- 2 期
- 状态
- 已完成
- 入组人数
- 25
- 试验地点
- 1
- 主要终点
- The Apolipoprotein A-I Fractional Catabolic Rate (FCR)
研究概览
简要总结
The investigators propose to investigate if using a combination of medications that may improve cholesterol give additional benefit to that gained from the statin medication, Lipitor. It is recommended that patients who meet certain criteria for risk of heart disease take a statin medication to improve cholesterol and hopefully reduce risk of heart disease. The combination therapy will include Lipitor, Niaspan, and investigational medication (known as ABT335) in a class of drugs called fibrates. We are looking to see if and how these three medications together might improve risk factors for atherosclerosis and influence HDL cholesterol. The study will also look at the safety and any side effects that might be associated with this combination of medications.
详细描述
Objectives Summary
* To investigate whether the progressive addition of a fibrate and niacin to baseline statin therapy will improve apolipoprotein A-I kinetics, postprandial lipidemia, and postabsorptive lipoproteins and metabolism in adult men and women with atherogenic dyslipidemia.
Major Efficacy Aims
- Objective 1 is to test the hypothesis that the fibrate ABT335 and extended release (ER) niacin progressively improve apolipoprotein A-I kinetics when added sequentially to baseline therapy with atorvastatin. The key outcomes include the apolipoprotein AI rate of catabolism and rate of production.
- Objective 2 is to test the hypothesis that the fibrate ABT335 and ER niacin progressively improve postprandial lipidemia by oral fat challenge when added sequentially to baseline therapy with atorvastatin. Key outcomes include the incremental area under the curve for triglycerides and high-density lipoprotein cholesterol.
- Objective 3 is to test the hypothesis that the fibrate ABT335 and ER niacin progressively improve markers of postabsorptive lipoproteins and metabolism when added sequentially to baseline therapy with atorvastatin. Key outcomes include a. fasting cholesterol efflux, b. HDL cholesterol, apolipoprotein A-I, and enzymes that remodel HDL, c. atherogenic lipoproteins, and d. markers of energy metabolism and e. markers of inflammation.
Additional Aims
研究设计
- 研究类型
- Interventional
- 分配方式
- Non Randomized
- 干预模型
- Single Group
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 80 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Men/women aged 18-80 years.
- •Low HDL-C, adjusted for baseline statin use
- •Not on statin: Men with HDL <= 40 or women with HDL <= 50 mg/dL
- •On statin: Men with HDL <= 42 or women with HDL <= 52 mg/dL
- •TG/HDL ratio >= 3.5
- •Able to understand and agree to informed consent
- •Women of child-bearing age must test negative on a urine pregnancy test and agree to use reliable birth control during the study and for 1 month after last dose of study drugs. Reliable methods include oral contraceptives, a barrier method, intrauterine device, partner with vasectomy, or abstinence.
- •Willing to be available for study duration and follow study procedures
排除标准
- •Subjects with following lipoprotein disorders:
- •Patients on high-potency lipid-lowering regimen, defined as two or more prescription lipid-altering medications (excluding fish oils) where one is a high-dose statin (40 mg/day of rosuvastatin, 80 mg/day of other approved statins). Those on combination therapy with a lower statin dose or those taking high-dose statin monotherapy (excluding fish oils) may participate. Patients will switch to atorvastatin 10 mg and/or wash off other lipid medications to participate
- •LDL > 190 mg/dL
- •TG > 750 mg/dL or pancreatitis from triglyceridemia, regardless of current TG levels
- •Dysbetalipoproteinemia (VLDL/TG > 0.3 -AND- TG > 200 mg/dL).
- •Use of non-statin lipid therapy prior to study initiation is exclusionary if (n.b. washout of non-statins is permitted):
- •Niacin > 250 mg/ day within 6 weeks: Advicor, Niaspan, Niacor, Simcor, Slo-Niacin, or supplemental niacin
- •Fibrates within 12 weeks: fenofibrate (Antara, Lofibra, Tricor, Triglide), gemfibrozil (Lopid), or clofibrate
- •Enterically active drugs within 4 weeks: colestipol, cholestyramine, colesevelam, ezetimibe, orlistat.
- •Red yeast rice during the treatment phase of the study (i.e. must be switched to study statin)
- •Fish oil > 2 g/day within 4 weeks: Lovaza (née Omacor), numerous supplements
- •Altered dose of a selective estrogen receptor modulator (SERM) within 4 weeks
- •Intolerance to statin, fibrate, aspirin, deuterated leucine, or niacin
- •Contraindications to medications, including chronic muscle disease, history of rhabdomyolysis, moderate-severe gout, severe peptic ulcer disease, bleeding disorders, and aspirin-sensitive asthma.
- •Diabetics, or fasting glucose > 110 mg/dL on two different days during screening, or use of anti-diabetic medications within 6 weeks of screening visit
- •Chronic renal insufficiency, nephrotic syndrome, or current serum creatinine > 2.5 mg/dL, or GFR < 60 mL/min/1.73m2 by the MDRD equation.
- •Aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), total bilirubin > 2 X the upper limit of normal (ULN), albumin of < 2.5 mg/dL, prothrombin time (PT) > 1.5 X ULN, partial thromboplastin time (PTT) > 1.5 X ULN, or current active hepatobiliary disease
- •Hemoglobin (Hgb) < 10 mg/dL
- •Weight < 110 lbs
- •Use of an investigational drug within 6 weeks prior to screening visit
- •Major surgery within the previous 6 weeks, or anticipated major surgery during course of study, or any history of organ transplant
- •Non-skin malignancy within previous 5 years
- •Drug abuse within past 3 years, or regular alcohol use >14 drinks/week
- •Women who are pregnant, plan to conceive, or breast-feed
- •Any serious or unstable medical or psychological conditions that, in investigator's opinion would compromise subject safety or successful participation.
- •Currently adhering to, planning to adhere to or used within 3 months prior to screening, supplements intended for weight loss or adopt diets with aggressive carbohydrate restrictions, such as but not limited to Atkins or South Beach diets.
- •Currently taking Vitamin A supplements (multivitamins allowed)(washout permitted)
- •Excluded concomitant medications
- •Immunosuppressants within 2 months prior to screening or are likely to require such treatment during the course of the study
- •Disinclination to dairy products (e.g. inviolable dietary restrictions or lactose intolerance to an 8oz glass of milk despite lactase supplementation) Lactase supplementation is allowed during the study.
- •Regular consumers of grapefruit juice, or currently taking medications metabolized by CYP 3A4 (cyclosporine, itraconazole, ketoconazole, erythromycin, clarithromycin, telithromycin, HIV protease inhibitors, and nefazodone)
- •History of pancreatitis or gallbladder disease
- •History of coronary heart disease
- •History of intolerance/adverse reaction to heparin or women who have dysfunctional uterine bleeding
- •Thrombocytopenia at screening
- •History of intracerebral or significant GI bleed
- •Subjects doing regular strenuous activity or have a CK > 3x ULN at screening
研究组 & 干预措施
Atorvastatin
atorvastatin 10 mg/day by mouth for a total duration of 4 weeks
干预措施: Atorvastatin (Drug)
ABT335
ABT335 135 mg/day by mouth added to atorvastatin for a total duration of at least 8
干预措施: Atorvastatin (Drug)
ABT335
ABT335 135 mg/day by mouth added to atorvastatin for a total duration of at least 8
干预措施: ABT335 (Drug)
ER niacin
ER niacin titrated up to 2 g/day with aspirin 325 mg/day by mouth added to atorvastatin and ABT335 for 10 weeks
干预措施: Atorvastatin (Drug)
ER niacin
ER niacin titrated up to 2 g/day with aspirin 325 mg/day by mouth added to atorvastatin and ABT335 for 10 weeks
干预措施: ABT335 (Drug)
ER niacin
ER niacin titrated up to 2 g/day with aspirin 325 mg/day by mouth added to atorvastatin and ABT335 for 10 weeks
干预措施: ER Niacin (Drug)
结局指标
主要结局
The Apolipoprotein A-I Fractional Catabolic Rate (FCR)
时间窗: 4 weeks, 12 weeks and 22 weeks
After receiving total daily caloric intake over 20 hrs as 20 identical small meals, starting at 0600 hrs, subjects took study medications at 0800 hrs. Five hours after the first meal, i.v. 5,5,5-2H3-L-leucine was administered, followed by a primed-constant infusion at 10 mol/kg body weight per hr for 15 hrs during which 14 blood samples were collected. Isotopic enrichment of leucine in apoA1 band excised from polyacrylamide gel was calculated. Assuming steady state apo A-I metabolism, we used a compartment model to fit data, consisting a precursor compartment (Compartment 1), the plasma leucine pool, an intracellular compartment accounting for apoA1 synthesis and lipoprotein assembly (Compartment 2), and compartments to account for dispositional kinetics of the subfractions including a plasma pool compartment (Compartment 3). The apoA1 FCR corresponds to the rate of irreversible loss of leucine pools from Compartment 3.
Apo-A1 Production Rate
时间窗: 4 weeks, 12 weeks and 22 weeks
The apolipoprotein A-I production rate using (5,5,5-2H3-L-leucine) was measured following each of the three study periods i.e following 4 weeks of atorvastatin 10 mg/day, following 8 further weeks of ABT335 135 mg/day added to atorvastatin and following 10 further weeks of ER niacin 2000 mg/day and aspirin 325 mg/day added to atorvastatin+ABT335.
Post-prandial Triglyceride Incremental Area Under the Curve (iAUC)
时间窗: 4 weeks, 12 weeks, 22 weeks
Triglyceride iAUC was measured during an oral fat tolerance test administered after 4 weeks of atorvastatin 10 mg/day , a further 8 weeks of atorvastatin 10mg /day+ABT335 135mg/day and then after a further 10 weeks of atorvastatin 10 mg/day+ABT335 135 mg/day+Niaspan 2000 mg/day. The standardized oral fat load was administered one hour post medication dosing and blood was collected prior to drug dosing, prior to the oral fat load and hourly thereafter for 10 hours (0,1,2,3,4,5,6,7,8,9,10,12 hrs post drug dosing)
次要结局
未报告次要终点
研究者
Richard Dunbar
Assistant Professor
University of Pennsylvania