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Pravastatin for Prevention of Preeclampsia

This study is currently recruiting participants.
Verified July 2017 by Maged Costantine, The University of Texas Medical Branch, Galveston
Sponsor:
ClinicalTrials.gov Identifier:
NCT01717586
First Posted: October 30, 2012
Last Update Posted: September 11, 2017
The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.
Collaborators:
University of Texas
University of Pittsburgh
Northwestern University
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
Information provided by (Responsible Party):
Maged Costantine, The University of Texas Medical Branch, Galveston
  Purpose
The primary purpose of this pilot study is to determine the pharmacokinetic (PK) parameters and collect preliminary safety data for pravastatin when used as a prophylactic daily treatment in pregnant women at high risk of preeclampsia.

Condition Intervention Phase
Preeclampsia Drug: Pravastatin Drug: Placebo Phase 1

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary Purpose: Prevention
Official Title: Pravastatin for the Prevention of Preeclampsia in High-Risk Women: A Phase I Pilot Study

Resource links provided by NLM:


Further study details as provided by Maged Costantine, The University of Texas Medical Branch, Galveston:

Primary Outcome Measures:
  • Number and type of maternal adverse events [ Time Frame: From the date of randomization until the date of delivery, assessed up to 210 days ]

    The presence of side effects and adverse events will be assessed at each study visit by:

    • a symptoms checklist
    • any other report of adverse events
    • at select visits: laboratory testing for liver function test(LFT) and creatine kinase(CK)

  • Number and type of fetal/neonatal adverse events [ Time Frame: From date of birth up to discharge or 120 days after birth. ]

    The presence of adverse events will be assessed by evaluating

    • Fetal and neonatal death
    • Birthweight (including rate of small for gestational age)
    • Apgar scores
    • Congenital malformations
    • Auditory brainstem response (ABR) evoked potential
    • Cord blood lipid profile, AST/ALT, and CK levels

  • Pharmacokinetic parameters of pravastatin sodium during pregnancy [ Time Frame: Between Pre-dose (0) and 24 hours post dose ]

    Timed blood and urine collection performed once between 18 wks 0 days GA and 23 wks 6 days GA and once between 30 wks 0 days GA and 33 wks 6 days GA.

    Timed blood collection intervals: pre-dose(0)and 0.5hr, 1hr, 1.5hr, 2hr, 3hr, 4hr, 6hr, 8hr post dose.

    Time urine collection intervals: pre-dose (0) and 0-4hr, 4-8hr hr post dose.

    Evaluation parameters:Maximum observed plasma concentration (Cmax) and peak time (Tmax), Steady-state area under the plasma concentration-time curve during the 24-h dosing interval (AUC0-24h), Steady-state apparent oral clearance (CL/F), Elimination half-life (t½), Renal clearance of pravastatin



Estimated Enrollment: 40
Study Start Date: August 2012
Estimated Study Completion Date: April 2019
Estimated Primary Completion Date: December 2018 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: Pravastatin Group
Pregnant women at high-risk for preeclampsia who are taking pravastatin during their pregnancy.
Drug: Pravastatin
Comparison of different drug dosages. Women will be instructed to take a pravastatin pill everyday starting the day of randomization and ending the day of delivery. The women will be divided into two cohorts. Each cohort will receive one of the following doses of pills: 10mg or 20mg.
Other Names:
  • pravastatin sodium
  • Brand name: Pravachol®
Placebo Comparator: Control Group
Pregnant women who are at high-risk for developing preeclampsia who are taking a placebo during their pregnancy.
Drug: Placebo
Women will be instructed to take a placebo pill daily beginning the day of randomization and ending the day of delivery.

Detailed Description:

Preeclampsia shares pathogenic similarities with adult cardiovascular diseases as well as many risk factors. Endothelial dysfunction and inflammation are fundamental for the initiation and progression of both. There is strong evidence that 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins) are beneficial in primary and secondary prevention of cardiovascular mortality and other cardiovascular events. Biological plausibility as well as animal data supports a similar role for statins in preeclampsia.

Currently, there are no clinically available agents to prevent preeclampsia. However because of the below properties of statins, this class of medications could substantially contribute to preeclampsia prevention.

  1. Statins pleiotropic actions on various mechanisms: reversing the angiogenic imbalance by upregulating vascular endothelial growth factor (VEGF) and placental growth factor (PlGF), and reducing the antiangiogenic factors such as soluble fms-like tyrosine kinase-1 (sFlt-1) and soluble endoglin (sEng).
  2. Statins up regulation of endothelial nitric oxide synthase, leading to improved nitric oxide production in the vasculature and to activate the heme oxygenase-1/carbon monoxide (HO-1/CO) pathway, protecting the endothelium and reducing the inflammatory and oxidative insults.

The purpose of this pilot study is to evaluate the maternal-fetal safety and pharmacokinetic (PK) profiles of pravastatin when used in pregnant women at high-risk of developing preeclampsia.

  Eligibility

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   Female
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Documented history (by chart review) of prior severe preeclampsia in either of the two pregnancies preceding the current one and requiring delivery at 34 completed weeks or less gestation.
  • 18 years or older with the ability to give informed consent
  • Singleton pregnancy
  • Normal serum transaminase (ALT and AST) concentrations in the last 6-months
  • Gestational age (GA) between 12 weeks 0 days to 16 weeks 6 days based on clinical information and confirmed by an ultrasound per study procedures

Exclusion Criteria:

  • Known chromosomal, genetic, or major fetal malformations, fetal demise, or planned termination
  • Patients with contraindications for statin therapy:

Hypersensitivity to pravastatin or any component of the product Active liver disease in the past 6 months (acute hepatitis, chronic active hepatitis, persistently abnormal liver enzymes (2 x normal of serum transaminases)

-History of myopathy or rhabdomyolysis

Patients with any of the following conditions:

  • HIV positive
  • Status post solid organ transplant
  • Chronic renal disease/insufficiency with baseline serum creatinine ≥1.5 mg/dL
  • Uterine malformations (didelphus, bicornuate, unicornate)
  • Cancer
  • Statin use in current pregnancy or in the last month prior to pregnancy
  • Current use of medications with potential drug interactions with statins, such as cyclosporine, fibrates, gemfibrozil, niacin, erythromycin, itraconazole, cholestyramine, digoxin, rifampin (patients will not be excluded if the drug has been discontinued, or is prescribed for a short duration of time)
  • Participating in another intervention study that influences the outcomes of this study
  • Plans to deliver in a non-network site
  Contacts and Locations
Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01717586


Contacts
Contact: Maged Costantine, MD 409-772-1571 mmcostan@utmb.edu
Contact: Holly West, DHEd, PA-C 409-747-8234 hawest@utmb.edu

Locations
United States, Illinois
Northwestern University Recruiting
Chicago, Illinois, United States, 60611
Contact: Katherine Wisner, MD    312-926-2323    Katherine.Wisner@northwestern.edu   
Contact: Kelly O'Shea       kelly.oshea@northwestern.edu   
United States, Pennsylvania
University of Pittsburgh Recruiting
Pittsburgh, Pennsylvania, United States, 15213
Contact: Steve Caritis, MD    412-641-4874    scaritis@mail.magee.edu   
Contact: Raman Venkataramanan, PhD    412-648-8547    rv@pitt.edu   
Principal Investigator: Steve Caritis, MD         
United States, Texas
University of Texas Medical Branch Recruiting
Galveston, Texas, United States, 77555
Contact: Maged Costantine, MD    409-772-1571    mmcostan@utmb.edu   
Contact: Gary D. Hankins, MD    409-772-1957    ghankins@utmb.edu   
Principal Investigator: Gary D. Hankins, MD         
Sponsors and Collaborators
The University of Texas Medical Branch, Galveston
University of Texas
University of Pittsburgh
Northwestern University
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
Investigators
Principal Investigator: Gary D. Hankins, MD University of Texas
  More Information

Publications:
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: Maged Costantine, Associate Professor, The University of Texas Medical Branch, Galveston
ClinicalTrials.gov Identifier: NCT01717586     History of Changes
Other Study ID Numbers: OPRU/OPRC Pravastatin
First Submitted: January 3, 2012
First Posted: October 30, 2012
Last Update Posted: September 11, 2017
Last Verified: July 2017

Keywords provided by Maged Costantine, The University of Texas Medical Branch, Galveston:
preeclampsia
pravastatin
Pravachol®
statin
high-risk pregnancy
safety
fetal morbidity and mortality
maternal morbidity and mortality
neonatal mortality
premature delivery
preemie

Additional relevant MeSH terms:
Pre-Eclampsia
Hypertension, Pregnancy-Induced
Pregnancy Complications
Pravastatin
Anticholesteremic Agents
Hypolipidemic Agents
Antimetabolites
Molecular Mechanisms of Pharmacological Action
Lipid Regulating Agents
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Enzyme Inhibitors