Heart Diseases Clinical Trial
Official title:
A Study to Assess Adding Ezetimibe 30 mg to Ongoing Treatment With Ezetimibe 10 mg in Patients With Homozygous Sitosterolemia
This study will test the safety and effectiveness of 40 mg of ezetimibe (Zetia ) daily in
lowering blood levels of cholesterol and of the plant sterols sitosterol and campesterol in
patients with homozygous sitosterolemia, an inherited disorder of sterol metabolism.
(Sterols are alcohol substances found in animal and plant fats.) In this disorder, an excess
of many plant sterols is absorbed and not enough excreted. Patients can develop
atherosclerosis and coronary heart disease as early as childhood, as well as other problems
including arthritis, arthralgia, and tendon xanthomas (lipid deposits). Current treatment
consists of ezetimibe 10 mg, dietary restriction of plant and shellfish sterols, and bile
salt binding resins. Ezetimibe is a cholesterol-lowering drug that inhibits intestinal
absorption of cholesterol and structurally related plant sterols across the intestinal wall.
Patients with homozygous sitosterolemia who are between 18 and 85 years of age have
completed NHLBI's 1-year study of ezetimibe at 10 mg a day may be eligible for this study.
All participants maintain their current stable diet and take a 10-mg pill of ezetimibe daily
for 26 weeks. They are also randomly selected to take either an additional 30-mg pill of
ezetimibe or a placebo (look-alike pill with no active ingredients). Patients fast for at
least 12 hours before each of 6 visits scheduled during the course of the study. At these
visits, patients undergo some or all of the following procedures for monitoring their health
and evaluating their response to treatment:
- Medical history and review of medications
- Physical examination
- Measurement of vital signs (pulse rate, blood pressure, breathing rate and temperature)
- Review of dietary maintenance
- Measurements of height, weight, and waist circumference
- Measurement (with ruler) and photographs of non-Achilles xanthoma
- X-ray of Achilles tendon
- Blood draw and urine collection
- Pregnancy test for women of childbearing potential
Homozygous Sitosterolemia is an inherited, autosomal recessive disorder of sterol
metabolism. Patients with homozygous sitosterolemia experience accelerated atherosclerosis
with initial coronary heart disease (CHD) events occurring in childhood. Plasma
concentrations of sitosterol and other dietary plant sterols are markedly elevated in
homozygous sitosterolemic patients, and are characteristic of this disorder. Sitosterolemic
individuals demonstrate a range of abnormalities in sterol absorption, metabolism, and
excretion. Recent reports have shown that sitosterolemia can result from mutations in 1 of 2
ATP-binding cassette half-transporters (ABCG5 or ABCG8), which are responsible for
regulation of non-cholesterol sterols in the body.
Current treatment of homozygous sitosterolemia consists of ezetimibe 10 mg, dietary
restriction of plant and shellfish sterols, as well as the use of bile salt binding resins.
Ezetimibe is the first member of a new class of cholesterol-lowering agents that inhibits
the intestinal absorption of cholesterol and structurally-related noncholesterol sterols
(plant sterols) across the intestinal wall. Importantly, ezetimibe is not an inhibitor or
inducer of CYP450, reducing the potential for drug-drug interactions which renders ezetimibe
a particularly appealing candidate with other drugs. Ezetimibe has proved to be generally
safe and well-tolerated as monotherapy or when coadministered with statins, with an overall
clinical adverse experience profile similar to placebo. In clinical studies with
hypercholesterolemic patients, ezetemibe doses ranging from 0.25 to 40 mg daily for periods
of 8 to 12 weeks were more effective than placebo in lowering plasma TC and LDL-C
concentrations. There were no dose-related increase in adverse experiences or laboratory
abnormalities in these studies. We will investigate whether a higher dose of ezetimibe is
safe and efficacious in lowering plant sterols in patients with sitosterolemia.
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Endpoint Classification: Efficacy Study, Primary Purpose: Treatment
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