A Phase 3 STudy of CaPRe In LOwering Very hiGh TriglYcerides (TRILOGY 1)

Hypertriglyceridemia Clinical Trial

— TRILOGY 1  

Official title:

A Phase 3, Multi-center, Placebo-controlled, Randomized, Double-blind 26-week Study to Assess the Safety and Efficacy of CaPre® in Patients With Severe Hypertriglyceridemia.

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03398005
• Other study ID #: ACA-CAP-001
• Status: Completed
• Phase: Phase 3
• Start date: January 23, 2018
• Est. completion date: November 20, 2019

Study information

• Verified date: January 2020
• Source: Acasti Pharma Inc.
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The primary objective of this study is to determine the efficacy of CaPre 4 g daily, compared to placebo, in lowering fasting triglyceride (TG) levels in patients with fasting TG levels ≥500 mg/dL and ≤1500 mg/dL (≥5.7 mmol/L and ≤17.0 mmol/L) after 12 weeks of treatment.

Approximately 615 subjects will be screened to obtain 245 randomized subjects following a 2.5:1 treatment allocation ratio (CaPre: placebo).

Recruitment information / eligibility

• Status: Completed
• Enrollment: 256
• Est. completion date: November 20, 2019
• Est. primary completion date: July 21, 2019
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

1. Subjects =18 years of age.

2. Isolated hypertriglyceridemia, with triglycerides =500 mg/dL and <1500 mg/dL (=5.7 mmol/L and <17.0 mmol/L) OR Mixed hyperlipidemia, with serum triglycerides =500 and <1500 mg/dL treated with a statin, CAI or PCSK9I inhibitor, alone or in combination, that has been stable for 6 weeks prior to randomization. If the subject is not being treated and not contraindicated, a statin and/or CAI treatment may be initiated at the discretion of the Investigator at time of screening.

3. Willingness to maintain current physical activity level and follow the NCEP-TLC diet throughout the study.

4. Be informed of the nature of the study and give written consent prior to any study procedure.

Exclusion Criteria:

1. Allergy or intolerance to OM3 fatty acids, OM3-acid ethyl esters, OM3 phospholipids, fish, shell fish, or any component of the study medication.

2. Known lipoprotein lipase impairment or deficiency, or apo CII deficiency.

3. Subjects with lysosomal acid lipase deficiency.

4. Body mass index greater than 45 kg/m2.

5. Subjects who are pregnant, lactating, and subjects of childbearing potential who are either planning to become pregnant or who are not using acceptable birth control methods during study participation. Subjects of childbearing potential are subjects who have experienced menarche and do not otherwise meet the criteria for subjects not of childbearing potential, defined as:

• Subjects who have had surgical sterilization (hysterectomy or bilateral oophorectomy or tubal ligation); or

• Subjects who are postmenopausal, i.e., who have had a cessation of menses for at least 12 months without an alternative medical cause. A follicle stimulating hormone (FSH) test =40 mIU/mL may be used to confirm the post-menopausal state in women not using hormonal contraception or hormonal replacement therapy.

Subjects of childbearing potential must test negative for pregnancy at the time of enrollment and agree to use an acceptable contraceptive method or remain abstinent during the study or for at least 8 weeks following the last dose of study medication, whichever is longer.

6. Subjects taking tamoxifen, estrogens, or progestins, or other medications or nutritional supplements with mechanisms modifying estrogen or progestogen pathways, who have had dosage changes within 4 weeks prior to Visit 1.

7. Use of oral or injected corticosteroids or anabolic steroids within 6 weeks prior to randomization.

8. History of pancreatitis within the last 6 months prior to Visit 1.

9. History of symptomatic gallstone disease within the last 5 years, unless treated with cholecystectomy.

10. Diabetics requiring changes in medical therapy (other than short acting insulin dosage adjustments) within 6 weeks prior to Visit 1 or who have HbA1c greater than 9.5% at Visit 1.

11. Clinical or biochemical evidence of hyperthyroidism not stable with medication for at least 6 weeks prior to Visit 1.

12. Uncontrolled hypothyroidism or thyroid stimulating hormone (TSH) level more than 1.5 × upper limit of normal (ULN).

13. Thyroid hormone replacement therapy that has not been stable for more than 6 weeks prior to Visit 1.

14. History of cancer (other than basal cell carcinoma) within 2 years prior to Visit 1.

15. Cardiovascular event (i.e., myocardial infarction, acute coronary syndrome, new onset angina, stroke, transient ischemic attack, exacerbation of congestive heart failure requiring hospitalization or a change in treatment), life threatening arrhythmia, or revascularization procedure within 6 months prior to Visit 1.

16. Use of other prohibited drugs: weight loss prescription medications; human immunodeficiency virus (HIV) protease inhibitors; cyclophosphamide; isotretinoin; routine or anticipated use of systemic corticosteroids (local, topical, inhalation, or nasal corticosteroids are permitted); or anabolic steroids.

17. Use of any lipid-altering drug therapy, other than statins, CAI (such as ezetimibe) or PCSK9I inhibitors, alone or in combination, including niacin at a dose greater than 200 mg/day, fibrates, bile acid sequestrants, OM3 drugs (e.g., Lovaza or its generics,Vascepa, Epanova, Omtryg), OM3 supplements (e.g., fish oil, krill oil products), or any other herbal products or dietary supplements with potential lipid-altering effects. These products must be discontinued at least 6 weeks prior to randomization.

18. Resection of an aortic aneurysm or endovascular aortic repair within 6 months prior to Visit 1.

19. Recent history (within 6 months prior to Visit 1) or current significant nephrotic syndrome or =3 gram proteinuria daily, pulmonary, gastrointestinal, or immunologic disease.

20. Poorly controlled hypertension (systolic blood pressure =170 mmHg and/or diastolic blood pressure =100 mmHg). Subjects with hypertension adequately controlled with medication are eligible provided that their antihypertensive therapy has been stable for at least 4 weeks prior to Visit 1.

21. Recent history (past 12 months) of drug abuse or alcohol abuse, or alcohol use greater than 2 units per day (a unit of alcohol is defined as a 12-ounce (350 mL) beer, 5 ounce (150 mL) wine, or 1.5-ounce (45 mL) of 80-proof alcohol for drinks).

22. Hepatobiliary disease or serum alanine aminotransferase (ALT) or aspartate aminotransferase (AST) >5× ULN; if ALT/AST is >3× ULN, the levels must have been stable for 3 months prior to Visit 1.

23. Severe renal disease as defined by less than 30 mL/min serum creatinine clearance calculated using the Cockcroft-Gault formula.

24. Significant coagulopathy as defined by a known hereditary deficiency of coagulation factors or platelet function or an unexplained elevation of the prothrombin time (PT) international normalized ratio (INR) of =1.5. Subjects using warfarin [Coumadin®] or heparin are allowed. Subjects receiving other anticoagulants dabigatran, rivaroxaban, or apixaban are allowed. Subjects receiving acetylsalicylic acid (ASA) alone or in combination with other anti platelet agents (e.g., clopidogrel, prasugrel, ticagrelor) are also allowed.

25. Unexplained creatine kinase concentration 3 × ULN.

26. Creatine kinase elevation owing to known hereditary or acquired muscle disease.

27. Exposure to any investigational product, within 4 weeks prior to Visit 1.

28. Presence of any other condition the Investigator believes would interfere with the subject's 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.

29. Any life-threatening disease expected to result in death within 2 years, require frequent hospitalizations, extensive surgery or changes in medications or diet.

Related Conditions & MeSH terms

• Hypertriglyceridemia

Intervention

Drug:
• CaPre
4 x 1 g capsules administered orally once a day for 26 weeks
• Placebo
4 x 1 g capsules administered orally once a day for 26 weeks

Locations

Country	Name	City	State
United States	Research site	Anderson	Indiana
United States	Research site	Arlington	Texas
United States	Research site	Atlanta	Georgia
United States	Research site	Beaver	Pennsylvania
United States	Research site	Bellevue	Washington
United States	Research site	Birmingham	Alabama
United States	Research site	Boca Raton	Florida
United States	Research site	Cadillac	Michigan
United States	Research site	Canton	Ohio
United States	Research site	Chattanooga	Tennessee
United States	Research site	Clearwater	Florida
United States	Research site	Conway	Arkansas
United States	Research site	Danville	Virginia
United States	Research site	El Cajon	California
United States	Research site	Eunice	Louisiana
United States	Research site	Fort Myers	Florida
United States	Research site	Fresno	California
United States	Research site	Gainesville	Georgia
United States	Research site	Garden Grove	California
United States	Research site	Greensboro	North Carolina
United States	Research site	Gurnee	Illinois
United States	Research site	Hialeah	Florida
United States	Research site	Homestead	Florida
United States	Research site	Houston	Texas
United States	Research site	Houston	Texas
United States	Research site	Jackson	Mississippi
United States	Research site	Jacksonville	Florida
United States	Research site	Kendall	Florida
United States	Research site	Kenosha	Wisconsin
United States	Research site	Lake Worth	Florida
United States	Research site	Lampasas	Texas
United States	Research site	Lomita	California
United States	Research site	Louisville	Kentucky
United States	Research site	Marion	Ohio
United States	Research site	Maumee	Ohio
United States	Research site	Memphis	Tennessee
United States	Research site	Meridian	Idaho
United States	Research site	Meridian	Idaho
United States	Research site	Miami	Florida
United States	Research site	Miami	Florida
United States	Research site	Miami	Florida
United States	Research site	Miami	Florida
United States	Research site	Miami	Florida
United States	Research site	Miami	Florida
United States	Research site	Miami	Florida
United States	Research site	Miami Springs	Florida
United States	Research site	Mooresville	North Carolina
United States	Research site	Newport Beach	California
United States	Research site	Norman	Oklahoma
United States	Research site	North Miami Beach	Florida
United States	Research site	Olive Branch	Mississippi
United States	Research site	Omaha	Nebraska
United States	Research site	Orlando	Florida
United States	Research site	Pembroke Pines	Florida
United States	Research site	Saint Louis	Missouri
United States	Research site	Salt Lake City	Utah
United States	Research site	San Antonio	Texas
United States	Research site	Savannah	Georgia
United States	Research site	Snellville	Georgia
United States	Research site	Spartanburg	South Carolina
United States	Research site	Sugar Hill	Georgia
United States	Research site	Tamarac	Florida
United States	Research site	Tampa	Florida
United States	Research site	Tucson	Arizona
United States	Research site	Tustin	California
United States	Research site	Wellington	Florida
United States	Research site	West Jordan	Utah
United States	Research site	West Palm Beach	Florida
United States	Research site	West Palm Beach	Florida

Sponsors (1)

Lead Sponsor	Collaborator
Acasti Pharma Inc.

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Percent change from baseline (average of Week -2, -1, and 0) to all measured visits other than Week 12 (Week 4, Week 18 and Week 26) in TG (persistence of the effect of CaPre on TG).		Week 4; Week 18; Week 24
Other	Proportion of subjects with a fasting TG level below 500 mg/dL (<5.7 mmol/L) at Week 12 and at Week 26.		Week 12; Week 26
Other	Percent change from baseline (average of Week -2, -1, and 0) to Week 12 (average of Week 11 and Week 12) and Week 26 in TC.		Week 12; Week 26
Other	Percent change from baseline (average of Week -1 and 0) to Week 12 (average of Week 11 and 12) and to Week 26 in RLP-C.		Week 12; Week 26
Other	Percent change from baseline (average of Week -1 and 0) to Week 26 in LDL-C (ß-quantification) and VLDL-C (ß-quantification).		Week 26
Other	Percent change from baseline (average of Week -2, -1, and 0) to Week 26 in non-HDL-C and HDL-C.		Week 26
Other	Percent change from baseline (Week 0) to Week 12 and to Week 26 in apo B, apo A1, apo B/apo A1 ratio, apo CIII and apo A5.		Week 12; Week 26
Other	Percent change from baseline (Week 0) to Week 12 and to Week 26 in lipoprotein particles concentration and size (LDL, non-HDL, HDL, IDL and VLDL).		Week 12; Week 26
Other	Percent change from baseline (Week 0) to Week 12 and to Week 26 in oxidized LDL.		Week 12; Week 26
Other	Percent change from baseline (Week 0) to Week 12 and to Week 26 in fasting serum glucose, insulin and HbA1c.		Week 12; Week 26
Other	Percent change from baseline (Week 0) to Week 12 and to Week 26 in HOMA-IR and HOMA-ß.		Week 12; Week 26
Other	Percent change from baseline (Week 0) to Week 12 and to Week 26 in hs-CRP and Lp-PLA2.		Week 12; Week 26
Other	Change from baseline (Week 0) to Week 4, Week 12, Week 18 and to Week 26 in Total plasma EPA concentration and Total plasma DHA concentration.		Week 4; Week 12; Week 18; Week 26
Other	Percent change from baseline (Week 0) to Week 4, Week 12, Week 18 and to Week 26 in Total plasma EPA concentration and Total plasma DHA concentration.		Week 4; Week 12; Week 18; Week 26
Other	Change from baseline (Week 0) to Week 12 and to Week 26 in OM3 Index.		Week 12; Week 26
Other	Percent change from baseline (Week 0) to Week 12 and to Week 26 in OM3 Index.		Week 12; Week 26
Other	Change from baseline (Week 0) to Week 12 and to Week 26 in AA.		Week 12; Week 26
Other	Percent change from baseline (Week 0) to Week 12 and to Week 26 in AA.		Week 12; Week 26
Other	Change from baseline (Week 0) to Week 12 and to Week 26 in omega-6/omega-3 ratio.		Week 12; Week 26
Other	Percent change from baseline (Week 0) to Week 12 and to Week 26 in omega-6/omega-3 ratio.		Week 12; Week 26
Other	Change from baseline (Week 0) to Week 12 and to Week 26 in EPA/AA ratio.		Week 12; Week 26
Other	Percent change from baseline (Week 0) to Week 12 and to Week 26 in EPA/AA ratio.		Week 12; Week 26
Primary	Percent change in fasting TG levels from baseline (average of Week -2, -1, and 0) to Week 12 (average of Week 11 and 12) in patients with fasting TG levels =500 mg/dL and =1500 mg/dL (=5.7 mmol/L and =17.0 mmol/L).		Week 12
Secondary	Percent change from baseline (average of Week -2, -1, and 0) to Week 12 (average of Week 11 and 12) in non-HDL-C.		Week 12
Secondary	Percent change from baseline (Week -1 and 0) to Week 12 (average of Week 11 and 12) in VLDL-C (ß-quantification).		Week 12
Secondary	Percent change from baseline (average of Week -2, -1, and 0) to Week 12 (average of Week 11 and 12) in HDL-C.		Week 12
Secondary	Percent change from baseline (average of Week -1 and 0) to Week 12 (average of Week 11 and 12) in LDL-C (ß-quantification).		Week 12