A Prospective Randomized Placebo Controlled Study to Evaluate the Effect of Celecoxib on the Efficacy and Safety of Amlodipine on Renal and Vascular Function in Subjects With Existing Hypertension Requiring Antihypertensive Therapy
Overview
- Phase
- Phase 3
- Status
- Completed
- Sponsor
- Kitov Pharma Ltd
- Enrollment
- 105
- Locations
- 9
- Primary Endpoint
- Change in Average Daytime (9:00 to 21:00) Ambulatory Systolic Blood Pressure (SBPday)
Overview
Brief Summary
The purpose of this study was to evaluate the effect of celecoxib on the efficacy and safety of amlodipine besylate on renal and vascular function in subjects with existing hypertension requiring antihypertensive therapy.
Kitov Pharma Ltd. (Kitov) is developing KIT-302, an oral fixed combination drug product (FCDP) consisting of the calcium channel blocker amlodipine besylate and the nonsteroidal anti-inflammatory drug (NSAID) celecoxib, as a "convenience reformulation" FCDP to facilitate and improve patient compliance with the once a day (qd) administration of its individual components, amlodipine and celecoxib.
The formulation of KIT-302 consists of amlodipine besylate and celecoxib co-formulated in a single immediate release tablet. However, for this study (KIT-302-03-02), commercial celecoxib capsules (Celebrex®) and commercial amlodipine besylate tablets (Norvasc®) were separately over-encapsulated (OE) and matched placebos were used to allow for blinding.
Kitov completed a phase 3 pivotal trial in subjects with newly diagnosed hypertension (KIT-302-03-01) demonstrating that the amlodipine + celecoxib combination was statistically non-inferior to amlodipine monotherapy with regard to reduction of blood pressure. Further, trends towards superior blood pressure lowering effects and improved renal function were observed for the combination. This study (KIT-302-03-02) was conducted to quantify the beneficial renovascular effects noted in the prior study in subjects with existing hypertension requiring antihypertensive therapy.
On May 31, 2018, the United States (US) Food and Drug Administration (FDA) approved KIT-302, under the brand name Consensi® (amlodipine and celecoxib) tablets [New Drug Application (NDA) 210045] for the following indication: "patients for whom treatment with amlodipine for hypertension and celecoxib for osteoarthritis are appropriate. Lowering blood pressure reduces the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions."
Detailed Description
This was a multi-center, randomized, double blind, placebo controlled study to evaluate the effect of celecoxib on the efficacy, safety, and pharmacokinetics of amlodipine in subjects with existing hypertension requiring antihypertensive therapy. Approximately 105 eligible subjects were to be randomized 3:3:1 to one of three treatment arms.
Arm 1:OE 10 mg Norvasc tablet+OE 200 mg Celebrex capsule (amlodipine+celecoxib arm)
Arm 2:OE 10 mg Norvasc tablet+matched placebo for OE Celebrex capsule (amlodipine+placebo arm)
Arm 3:Matched placebo for OE Norvasc tablet+matched placebo for OE Celebrex capsule (placebo+placebo arm).
Following an up to 14-day screening phase, eligible subjects were randomized to one of the 3 treatment arms. All drugs were to be administered orally qd for 14 days for a total of 14 doses. Visits at the clinic took place at the start and at the end of the screening phase, at Study Day 0 (start of treatment), Day 6, Day 7, Day 13 (end of treatment), Day 14 and Day 28 (end of follow-up).
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Factorial
- Primary Purpose
- Treatment
- Masking
- Triple (Participant, Investigator, Outcomes Assessor)
Eligibility Criteria
- Ages
- 40 Years to 75 Years (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Adult 40 to 75 years of age
- •Existing hypertension that is being treated using pharmacological therapy with a single agent that is not a calcium channel blocker
- •SBPday \> 135 and ≤ 169 mmHg and average daytime (9:00 to 21:00) ambulatory diastolic blood pressure (DBPday) ≤ 110 mmHg at Day 0 (after the 10- to 14-day washout from prior blood pressure medication)
- •Body Mass Index of 18.5 to 34.9 kg/m2
- •Healthy (other than hypertension) as determined by the Investigator based on medical history, physical examination, vital signs, 12-lead electrocardiogram (ECG), and clinical laboratory tests
- •A negative pregnancy test at initial screening visit
- •If woman of childbearing potential, agree to use a highly effective form of birth control while on study (from Screening through final study visit)
- •Able to comprehend and sign an informed consent form.
Exclusion Criteria
- •Resting SBP \> 169 mmHg or a resting DBP \> 110 mmHg at initial screening visit while on their standard antihypertensive therapy (where resting is defined as supine for at least 10 minutes with minimal interaction)
- •Weight \< 55 kg
- •Fragile health
- •Evidence of clinically significant findings on screening evaluations (clinical, laboratory, and ECG) which, in the opinion of the Investigator would pose a safety risk or interfere with appropriate interpretation of safety data
- •Current or recent history (within four weeks prior to initial screening visit) of a clinically significant bacterial, fungal, or mycobacterial infection
- •Current clinically significant viral infection
- •History of malignancy, with the exception of cured basal cell or squamous cell carcinoma of the skin
- •Major surgery within four weeks prior to initial screening visit
- •Presence of a malabsorption syndrome possibly affecting drug absorption (e.g., Crohn's disease or chronic pancreatitis)
- •Active peptic ulceration or history of gastrointestinal bleeding
Arms & Interventions
Amlodipine+Celecoxib
OE 10 mg amlodipine besylate tablet + OE 200 mg celecoxib capsule qd for 14 days
Intervention: OE 10 mg amlodipine besylate tablet (Drug)
Amlodipine+Celecoxib
OE 10 mg amlodipine besylate tablet + OE 200 mg celecoxib capsule qd for 14 days
Intervention: OE 200 mg celecoxib capsule (Drug)
Amlodipine+Placebo
OE 10 mg amlodipine besylate tablet + matched placebo for OE celecoxib capsule qd for 14 days
Intervention: OE 10 mg amlodipine besylate tablet (Drug)
Amlodipine+Placebo
OE 10 mg amlodipine besylate tablet + matched placebo for OE celecoxib capsule qd for 14 days
Intervention: Matched placebo for OE celecoxib capsule (Drug)
Placebo+Placebo
Matched placebo for OE amlodipine besylate tablet + matched placebo for OE celecoxib capsule qd for 14 days
Intervention: Matched placebo for OE amlodipine besylate tablet (Drug)
Placebo+Placebo
Matched placebo for OE amlodipine besylate tablet + matched placebo for OE celecoxib capsule qd for 14 days
Intervention: Matched placebo for OE celecoxib capsule (Drug)
Outcomes
Primary Outcomes
Change in Average Daytime (9:00 to 21:00) Ambulatory Systolic Blood Pressure (SBPday)
Time Frame: Baseline and 14 days
An ambulatory blood pressure monitor (ABPM) fitted to upper arm was used for continuous recording of blood pressure over three 25-hour periods: Days -1 to 0 (Baseline), Days 6 to 7, \& Days 13 to 14. The ABPM recorded blood pressure every 20 minutes between 09:00 and 21:59 and every 30 minutes between 22:00 and 08:59. SBPday was calculated by averaging all of the systolic blood pressure measurements between the protocol-defined first \& last study measurements of the period that fell between 9:00 and 21:00; measurements during the first hour (white-coat window) were not included. Change in SBPday was calculated by subtracting the Baseline value from the end of study value (Day 13 to Day 14 period). If the Day 13 to Day 14 value was not available, the Day 6 to Day 7 value was used \[last observation carried forward (LOCF) method\]. A negative value for change in SBPday indicates a decrease in systolic blood pressure and a positive value indicates an increase.
Secondary Outcomes
- Non-transformed Plasma Concentration of Amlodipine(24 hours post-dose on Day 14)
- Change in Creatinine Clearance(Baseline and 14 days)
- Change in Average 24-hour Ambulatory Diastolic Blood Pressure (DBP24h)(Baseline and 14 days)
- Occurrence of Treatment Emergent Adverse Events(1 month)
- Change in Body Weight(Baseline and 14 days)
- Log-transformed Plasma Concentration of Amlodipine(24 hours post-dose on Day 14)
- Change in Average 24-hour Ambulatory Systolic Blood Pressure (SBP24h)(Baseline and 14 days)