Ezetimibe Reverse Cholesterol Transport (RCT) Pilot Study

• ClinicalTrials.gov Identifier: NCT00701727
• Recruitment Status: Completed
• First Posted: June 19, 2008
• Results First Posted: April 18, 2011
• Last Update Posted: April 18, 2011
• Sponsor: Radiant Research
• Information provided by: Radiant Research

Study Description

Brief Summary:

This is a prospective, placebo-controlled, cross-over trial comparing the the effects of approximately 7 weeks of placebo treatment to 7 weeks of ezetimibe (10mg/day) treatment on several parameters of reverse cholesterol transport (RCT) in men and post-menopausal women diagnosed with hypercholesterolemia. The primary hypothesis is that the ezetimibe treatment will increase the excretion of endogenous (plasma-derived) cholesterol as fecal sterols, with secondary hypotheses that there will be a significant increase in de novo cholesterol synthesis, treatment will increase cholesterol efflux from tissues into the bloodstream, and increase global RCT.

Condition or disease	Intervention/treatment	Phase
Hypercholesterolemia	Drug: ezetimibe; Drug: Placebo	Phase 4

Detailed Description:

The study will compare the effects of approximately 7 weeks of placebo treatment to 7 weeks of ezetimibe (10mg/day) on: 1) the efficiency of endogenous (plasma-derived) cholesterol excretion (%/day) 2) de novo cholesterol (DNC) synthesis ((%/day) 3) cholesterol efflux from tissues into blood (Ra), and 4) global RCT (efflux from tissues that is excreted as fecal sterols). Subjects will receive 7 weeks of either treatment or placebo, undergo RCT and DNC measurements, taking 10 days, then cross-over to the alternate placebo or treatment for an additional 7 weeks, followed by a second set of RCT and DNC measurements.

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 31 participants
• Allocation: Randomized
• Intervention Model: Crossover Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: Ezetimibe Reverse Cholesterol Transport (RCT) Pilot Study
• Study Start Date: June 2008
• Actual Primary Completion Date: March 2009
• Actual Study Completion Date: March 2009

Arms and Interventions

Arm	Intervention/treatment
Experimental: 1; ezetimibe (10mg/day)for 7 weeks	Drug: ezetimibe; 1 tablet,10mg, once a day, for 7 weeks
Placebo Comparator: 2; Placebo control	Drug: Placebo; 1 tablet, once a day, for 7 weeks

Outcome Measures

Primary Outcome Measures :

1. Fecal Excretion of Plasma-derived Cholesterol [ Time Frame: 7 weeks ]

   (Fecal excretion of plasma-derived cholesterol):The following measurements will be made following isotope infusion:

   1. The composition of fecal neutral and acidic sterols will be measured as % of total.
   2. The excretion rate of fecal neutral and acidic sterols will be measured as mg/day.
   3. The isotopic enrichment of both fecal neutral and acidic sterols will be measured as atomic percent excess (% APE).
   4. Fecal isotope excretion, or recovery, of plasma-derived cholesterol will be calculated as %/day.

Secondary Outcome Measures :

1. Change From Baseline in Total Cholesterol, From Fasting Plasma Samples [ Time Frame: 7 weeks ]
   plasma levels of total cholesterol
2. de Novo Cholesterol Synthesis (DNC) [ Time Frame: 7 weeks ]
   Plasma DNC will be measured following the isotope infusion of deuterated water, expressed as %.
3. Cholesterol Efflux Rate (Ra Cholesterol) [ Time Frame: 7 weeks ]
   The efflux, or mobilization, rate of cholesterol from peripheral tissues into the plasma will be measured as mg/kg/hr. An IV infusion of [13C2] cholesterol mixed in 10% Intralipid® and 10 % ethanol is given piggy-backed into normal saline over 20 hours (4pm - 12 noon). This is used to determine rate of appearance (Ra) cholesterol, which will be measured by dilution of infused [13C2] cholesterol during the plateau phase of plasma enrichment (approximately the last 4 hours of the infusion), as well as to provide the plasma cholesterol that will be traced into biliary sterols.
4. Triglycerides (TG) [ Time Frame: 7 weeks ]
   Change from baseline in plasma triglycerides, measured in fasting blood samples
5. Low-density Lipoprotein (LDL); [ Time Frame: 7 weeks ]
   Change from baseline in plasma low-density lipoprotein(LDL), measured in fasting blood samples
6. High-density Lipoprotein (HDL) [ Time Frame: 7 weeks ]
   Change from baseline in plasma HDL, measured in fasting blood samples

Eligibility Criteria

• Ages Eligible for Study: 21 Years to 75 Years (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: Yes

Criteria

Inclusion Criteria:

• male, non-smoker, 21-75 years of age
• female, non-smoker, 40-75 years of age
• post-menopausal women, as defined by lack of menses for at least 2 years and age >55, OR history of documented bilateral oophorectomy, confirmed with an elevated FSH at screening
• low-density lipoprotein (LDL) concentration between 130-200 mg/dL.
• triglyceride (TG) concentration <350 mg/dL, inclusive
• high-density lipoprotein (HDL) between 30-60 mg/dL for men and 40 -70 mg/dL for women
• ability to give informed consent

Exclusion Criteria:

• Subject has history of diabetes mellitus, active hepatitis, gall bladder disease, gastric or ileal bypass surgery, irritable bowel syndrome, and gastrointestinal disorder/condition associated with malabsorption, or clinically significant abnormalities on screening (prestudy) physical examination of laboratory tests.
• Screening laboratory tests with hematocrit <30%, aspartate aminotransferase/alanine aminotransferase (AST/ALT) >2*upper limit of normal, abnormal thyroid-stimulating hormone (TSH), fasting glucose >=126mg/dL
• renal impairment with creatinine clearance (CRCl)<80ml/min
• treatment within the last 2 months with drugs known to alter lipid metabolism including beta blockers, thiazide diuretics, bile acid resins, statins, ezetimibe, niacin, fibrates, plant stanol esters (eg Benecol,phyto sterols) and fishoils
• history of known coronary heart disease (CHD), stroke or prior revascularization procedure or peripheral vascular disease
• history of allergy to egg or soy products
• current or recent (past 12 months) of drug abuse or alcohol abuse. Alcohol use must be limited to no more than 2 drinks/day (1 drink=12 oz beer, 5 oz wine, or 1.5 oz hard liquor). Subject must be willing to avoid large day-to-day fluctuations in alcohol intake.
• participation in another clinical trial or exposure to any investigational agent within 30 days prior to Visit 1
• Individual has a condition the Principal Investigator believes would interfere with his/her ability to provide informed consent, comply with study instructions, or which might confound the interpretation of the study results, or put the subject at undue risk

Contacts and Locations

Locations

United States, Illinois

Radiant Research

Chicago, Illinois, United States, 60610

Sponsors and Collaborators

Radiant Research

Investigators

• Principal Investigator: Michael H Davidson, Md. FACC; Radiant Research

More Information

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Davidson MH, Voogt J, Luchoomun J, Decaris J, Killion S, Boban D, Glass A, Mohammad H, Lu Y, Villegas D, Neese R, Hellerstein M, Neff D, Musliner T, Tomassini JE, Turner S. Inhibition of intestinal cholesterol absorption with ezetimibe increases components of reverse cholesterol transport in humans. Atherosclerosis. 2013 Oct;230(2):322-9. doi: 10.1016/j.atherosclerosis.2013.08.006. Epub 2013 Aug 13.

• Responsible Party: Michael H. Davidson, MD, FACC, Radiant Research
• ClinicalTrials.gov Identifier: NCT00701727
• Other Study ID Numbers: Ezetimibe RCT-001
• First Posted: June 19, 2008
• Results First Posted: April 18, 2011
• Last Update Posted: April 18, 2011
• Last Verified: March 2011

Keywords provided by Radiant Research:

metabolic diseases; metabolic disorder; dyslipidemias; lipid metabolism disorders

Additional relevant MeSH terms:

Hypercholesterolemia; Hyperlipidemias; Dyslipidemias; Lipid Metabolism Disorders; Metabolic Diseases; Ezetimibe; Anticholesteremic Agents; Hypolipidemic Agents; Antimetabolites; Molecular Mechanisms of Pharmacological Action; Lipid Regulating Agents