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Effects of the high-density lipoprotein mimetic agent CER-001 on coronary atherosclerosis in patients with acute coronary syndromes: a randomized trial†

Identifieur interne : 003996 ( Main/Exploration ); précédent : 003995; suivant : 003997

Effects of the high-density lipoprotein mimetic agent CER-001 on coronary atherosclerosis in patients with acute coronary syndromes: a randomized trial†

Auteurs : Jean-Claude Tardif ; Christie M. Ballantyne ; Philip Barter ; Jean-Louis Dasseux ; Zahi A. Fayad ; Marie-Claude Guertin ; John J. P. Kastelein ; Constance Keyserling ; Heather Klepp ; Wolfgang Koenig ; Philippe L. L'Allier ; Jacques Lespérance ; Thomas F. Lüscher ; John F. Paolini ; Ahmed Tawakol ; David D. Waters

Source :

RBID : PMC:4258222

Abstract

Aim

High-density lipoproteins (HDLs) have several potentially protective vascular effects. Most clinical studies of therapies targeting HDL have failed to show benefits vs. placebo.

Objective

To investigate the effects of an HDL-mimetic agent on atherosclerosis by intravascular ultrasonography (IVUS) and quantitative coronary angiography (QCA).

Design and setting

A prospective, double-blinded, randomized trial was conducted at 51 centres in the USA, the Netherlands, Canada, and France. Intravascular ultrasonography and QCA were performed to assess coronary atherosclerosis at baseline and 3 (2–5) weeks after the last study infusion.

Patients

Five hundred and seven patients were randomized; 417 and 461 had paired IVUS and QCA measurements, respectively.

Intervention

Patients were randomized to receive 6 weekly infusions of placebo, 3 mg/kg, 6 mg/kg, or 12 mg/kg CER-001.

Main outcome measures

The primary efficacy parameter was the nominal change in the total atheroma volume. Nominal changes in per cent atheroma volume on IVUS and coronary scores on QCA were also pre-specified endpoints.

Results

The nominal change in the total atheroma volume (adjusted means) was −2.71, −3.13, −1.50, and −3.05 mm3 with placebo, CER-001 3 mg/kg, 6 mg/kg, and 12 mg/kg, respectively (primary analysis of 12 mg/kg vs. placebo: P = 0.81). There was also no difference among groups for the nominal change in per cent atheroma volume (0.02, −0.02, 0.01, and 0.19%; nominal P = 0.53 for 12 mg/kg vs. placebo). Change in the coronary artery score was −0.022, −0.036, −0.022, and −0.015 mm (nominal P = 0.25, 0.99, 0.55), and change in the cumulative coronary stenosis score was −0.51, 2.65, 0.71, and −0.77% (compared with placebo, nominal P = 0.85 for 12 mg/kg and nominal P = 0.01 for 3 mg/kg). The number of patients with major cardiovascular events was 10 (8.3%), 16 (13.3%), 17 (13.7%), and 12 (9.8%) in the four groups.

Conclusion

CER-001 infusions did not reduce coronary atherosclerosis on IVUS and QCA when compared with placebo. Whether CER-001 administered in other regimens or to other populations could favourably affect atherosclerosis must await further study.

Name of the trial registry: Clinicaltrials.gov; Registry's URL: http://clinicaltrials.gov/ct2/show/NCT01201837?term=cer-001&rank=2; Trial registration number: NCT01201837.


Url:
DOI: 10.1093/eurheartj/ehu171
PubMed: 24780501
PubMed Central: 4258222


Affiliations:


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Le document en format XML

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<title xml:lang="en" level="a" type="main">Effects of the high-density lipoprotein mimetic agent CER-001 on coronary atherosclerosis in patients with acute coronary syndromes: a randomized trial
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<name sortKey="Tardif, Jean Claude" sort="Tardif, Jean Claude" uniqKey="Tardif J" first="Jean-Claude" last="Tardif">Jean-Claude Tardif</name>
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<name sortKey="Ballantyne, Christie M" sort="Ballantyne, Christie M" uniqKey="Ballantyne C" first="Christie M." last="Ballantyne">Christie M. Ballantyne</name>
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<name sortKey="Barter, Philip" sort="Barter, Philip" uniqKey="Barter P" first="Philip" last="Barter">Philip Barter</name>
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<name sortKey="Dasseux, Jean Louis" sort="Dasseux, Jean Louis" uniqKey="Dasseux J" first="Jean-Louis" last="Dasseux">Jean-Louis Dasseux</name>
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<name sortKey="Fayad, Zahi A" sort="Fayad, Zahi A" uniqKey="Fayad Z" first="Zahi A." last="Fayad">Zahi A. Fayad</name>
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<name sortKey="Guertin, Marie Claude" sort="Guertin, Marie Claude" uniqKey="Guertin M" first="Marie-Claude" last="Guertin">Marie-Claude Guertin</name>
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<name sortKey="Kastelein, John J P" sort="Kastelein, John J P" uniqKey="Kastelein J" first="John J. P." last="Kastelein">John J. P. Kastelein</name>
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<name sortKey="Klepp, Heather" sort="Klepp, Heather" uniqKey="Klepp H" first="Heather" last="Klepp">Heather Klepp</name>
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<name sortKey="Koenig, Wolfgang" sort="Koenig, Wolfgang" uniqKey="Koenig W" first="Wolfgang" last="Koenig">Wolfgang Koenig</name>
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<name sortKey="L Allier, Philippe L" sort="L Allier, Philippe L" uniqKey="L Allier P" first="Philippe L." last="L'Allier">Philippe L. L'Allier</name>
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<name sortKey="Lesperance, Jacques" sort="Lesperance, Jacques" uniqKey="Lesperance J" first="Jacques" last="Lespérance">Jacques Lespérance</name>
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<name sortKey="Luscher, Thomas F" sort="Luscher, Thomas F" uniqKey="Luscher T" first="Thomas F." last="Lüscher">Thomas F. Lüscher</name>
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<name sortKey="Paolini, John F" sort="Paolini, John F" uniqKey="Paolini J" first="John F." last="Paolini">John F. Paolini</name>
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<name sortKey="Tawakol, Ahmed" sort="Tawakol, Ahmed" uniqKey="Tawakol A" first="Ahmed" last="Tawakol">Ahmed Tawakol</name>
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<name sortKey="Waters, David D" sort="Waters, David D" uniqKey="Waters D" first="David D." last="Waters">David D. Waters</name>
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<idno type="ISSN">0195-668X</idno>
<idno type="eISSN">1522-9645</idno>
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<div type="abstract" xml:lang="en">
<sec>
<title>Aim</title>
<p>High-density lipoproteins (HDLs) have several potentially protective vascular effects. Most clinical studies of therapies targeting HDL have failed to show benefits vs. placebo.</p>
</sec>
<sec>
<title>Objective</title>
<p>To investigate the effects of an HDL-mimetic agent on atherosclerosis by intravascular ultrasonography (IVUS) and quantitative coronary angiography (QCA).</p>
</sec>
<sec>
<title>Design and setting</title>
<p>A prospective, double-blinded, randomized trial was conducted at 51 centres in the USA, the Netherlands, Canada, and France. Intravascular ultrasonography and QCA were performed to assess coronary atherosclerosis at baseline and 3 (2–5) weeks after the last study infusion.</p>
</sec>
<sec>
<title>Patients</title>
<p>Five hundred and seven patients were randomized; 417 and 461 had paired IVUS and QCA measurements, respectively.</p>
</sec>
<sec>
<title>Intervention</title>
<p>Patients were randomized to receive 6 weekly infusions of placebo, 3 mg/kg, 6 mg/kg, or 12 mg/kg CER-001.</p>
</sec>
<sec>
<title>Main outcome measures</title>
<p>The primary efficacy parameter was the nominal change in the total atheroma volume. Nominal changes in per cent atheroma volume on IVUS and coronary scores on QCA were also pre-specified endpoints.</p>
</sec>
<sec>
<title>Results</title>
<p>The nominal change in the total atheroma volume (adjusted means) was −2.71, −3.13, −1.50, and −3.05 mm
<sup>3</sup>
with placebo, CER-001 3 mg/kg, 6 mg/kg, and 12 mg/kg, respectively (primary analysis of 12 mg/kg vs. placebo:
<italic>P</italic>
= 0.81). There was also no difference among groups for the nominal change in per cent atheroma volume (0.02, −0.02, 0.01, and 0.19%; nominal
<italic>P</italic>
= 0.53 for 12 mg/kg vs. placebo). Change in the coronary artery score was −0.022, −0.036, −0.022, and −0.015 mm (nominal
<italic>P</italic>
= 0.25, 0.99, 0.55), and change in the cumulative coronary stenosis score was −0.51, 2.65, 0.71, and −0.77% (compared with placebo, nominal
<italic>P</italic>
= 0.85 for 12 mg/kg and nominal
<italic>P</italic>
= 0.01 for 3 mg/kg). The number of patients with major cardiovascular events was 10 (8.3%), 16 (13.3%), 17 (13.7%), and 12 (9.8%) in the four groups.</p>
</sec>
<sec>
<title>Conclusion</title>
<p>CER-001 infusions did not reduce coronary atherosclerosis on IVUS and QCA when compared with placebo. Whether CER-001 administered in other regimens or to other populations could favourably affect atherosclerosis must await further study.</p>
<p>Name of the trial registry: Clinicaltrials.gov; Registry's URL:
<uri xlink:type="simple" xlink:href="http://clinicaltrials.gov/ct2/show/NCT01201837?term=cer-001&rank=2">http://clinicaltrials.gov/ct2/show/NCT01201837?term=cer-001&rank=2</uri>
; Trial registration number: NCT01201837.</p>
</sec>
</div>
</front>
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<name sortKey="Kastelein, John J P" sort="Kastelein, John J P" uniqKey="Kastelein J" first="John J. P." last="Kastelein">John J. P. Kastelein</name>
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<name sortKey="L Allier, Philippe L" sort="L Allier, Philippe L" uniqKey="L Allier P" first="Philippe L." last="L'Allier">Philippe L. L'Allier</name>
<name sortKey="Lesperance, Jacques" sort="Lesperance, Jacques" uniqKey="Lesperance J" first="Jacques" last="Lespérance">Jacques Lespérance</name>
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