INvestigating the Lowest Threshold of Vascular bENefits From LDL Lowering With a PCSK9 InhibiTor in healthY Volunteers

NCT ID: NCT03273972

Last Updated: 2023-07-27

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

30 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-09-07

Study Completion Date

2018-10-10

Brief Summary

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The INTENSITY-LOW study aims to answer if there are any limits to LDL reduction in relation to benefitting vascular health from a mechanistic viewpoint, and therefore potentially limitations to primary prevention in healthy volunteers by lowering LDL cholesterol using PCSK9 therapies. This research is being carried out because it is unclear what the lowest threshold of LDL cholesterol should be to attain significant reductions in CV risk in healthy individuals. It is also unknown whether there is a true limit of LDL cholesterol below which there is no further improvement in endothelial function in healthy people, and, whether this is associated with a reduction in markers of both systemic and vascular inflammation. This study will hope to provide evidence that the so-called pleiotropic effects of statins are actually mediated by a mechanism of LDL-cholesterol lowering per se and not necessarily a special therapeutic effect of statins.

Defining this may help identify individuals from the general population who may benefit from more aggressive lipid-lowering treatment than standard statin treatment in terms of CV morbidity and mortality.

This study will be conducted in healthy volunteers only, where participants will be randomized to either the Alirocumab arm (which is a therapy designed to lower cholesterol) or comparator arm. Both Alirocumab and comparator arms will be combined with Atorvastatin (another therapy designed to lower cholesterol) at the second dosing visit.

In total, thirty healthy individuals will be recruited to this single centre, randomized, single blind, parallel group, mechanistic physiological study which will be conducted at Cambridge University Hospitals NHS Foundation Trust/University of Cambridge. This study will be open to recruitment for one year and the total study duration for each participant will be approximately 10 weeks. There will be 4 study visits in total with a telephone follow up at the end of the study. Of these visits, two will be dosing visits and the total duration of treatment is approx. 4 weeks.

A series of non-invasive haemodynamic assessments and minimally invasive procedures including blood tests and forearm blood flow measurements will be conducted prior, during and post dosing to determine if there is an improvement of endothelia vascular function (as measured by nitric oxide bioavailability) and reduced systemic inflammation. This study is funded by JP Moulton Charitable Foundation.

Detailed Description

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Conditions

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Atherosclerosis Cardiovascular Diseases

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Randomisation to be performed to a 1:1 ratio.

Alirocumab treatment arm:

* V2: Alirocumab (150mg)
* V3: Alirocumab (150mg) \& Atorvastatin (20mg)

Comparator treatment arm

* V2: Placebo
* V3: Placebo \& Atorvastatin (20mg)
Primary Study Purpose

BASIC_SCIENCE

Blinding Strategy

DOUBLE

Participants Investigators
Independent CRF research nurse to perform the drug administration. CRF nurse will be unblinded whilst the rest of the study team (including the CI/PI) are blinded. This will involve the ACRC nurse bringing the injection in a sealed box to the room, preparing a shield (so the volunteer is blinded), administering the injection (via alirocumab pen or placebo - saline in insulin syringe) and then putting the syringe back in the sealed box and removing the screen. They have to ensure none of the study team are aware of the Rx as well as the patient.

CRF nurses will also have to collect and store medication in their building. Statin can be stored in a locked cupboard (open label).

Study Groups

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Alirocumab Treatment Arm

V2: Day 1 - Alirocumab 150mg (subcutaneous injection) V3: Day 15 +/- 3 days - Alirocumab 150mg (subcutaneous injection) plus Atorvastatin 20mg (oral) approx. 14 days prescription.

Group Type EXPERIMENTAL

Written Informed Consent

Intervention Type OTHER

To be completed prior to conducting any study related procedures

Inclusion/Exclusion check

Intervention Type OTHER

Eligibility check

Full Clinical Chemistry and Haematology Bloods

Intervention Type OTHER

Participant required to fast for at least 6-8 hoursprior to visit. (Clear, non-caffeinated fluids are allowed)

Serum sample for systemic markers and lipid sub-fractions

Intervention Type OTHER

Serum samples may be stored for later analysis.

Pregnancy Test

Intervention Type OTHER

If applicable for women of child bearing potential

12 Lead ECG

Intervention Type OTHER

participant resting supine

Blood Pressure and Heart Rate

Intervention Type OTHER

Measured in the seated position after 5 minutes rest

Arterial Stiffness

Intervention Type OTHER

Measure of functional and structural changes which accompanies cardiovascular disease

Central Haemodynamics

Intervention Type OTHER

Measure of functional and structural changes which accompanies cardiovascular disease

Carotid Intima Media Thickness

Intervention Type OTHER

Measurements will be repeated three times, and the average of the median values will be recorded

Forearm blood flow studies

Intervention Type OTHER

Assess and determine vascular function, which can interrogate endothelium dependent and independent mechanisms of nitric oxide bioavailability

Concomitant medication check

Intervention Type OTHER

Review of medication taken by the participant

Medication compliance check (Pill count)

Intervention Type OTHER

Ensure prescribed statin has been taken

Physical examination

Intervention Type OTHER

Check overall health

Medical history

Intervention Type OTHER

Review of volunteers medial history

AE/SAE review & reporting

Intervention Type OTHER

Monitor safety from the point of consent

Dosing

Intervention Type DRUG

To be performed at the end of the visit following completion all other study visits

Comparator Treatment Arm

V2: Day 1 - Placebo (subcutaneous injection) V3: Day 15 +/- 3 days - Placebo (subcutaneous injection) plus Atorvastatin 20mg (oral) approx. 14 days prescription.

Group Type OTHER

Written Informed Consent

Intervention Type OTHER

To be completed prior to conducting any study related procedures

Inclusion/Exclusion check

Intervention Type OTHER

Eligibility check

Full Clinical Chemistry and Haematology Bloods

Intervention Type OTHER

Participant required to fast for at least 6-8 hoursprior to visit. (Clear, non-caffeinated fluids are allowed)

Serum sample for systemic markers and lipid sub-fractions

Intervention Type OTHER

Serum samples may be stored for later analysis.

Pregnancy Test

Intervention Type OTHER

If applicable for women of child bearing potential

12 Lead ECG

Intervention Type OTHER

participant resting supine

Blood Pressure and Heart Rate

Intervention Type OTHER

Measured in the seated position after 5 minutes rest

Arterial Stiffness

Intervention Type OTHER

Measure of functional and structural changes which accompanies cardiovascular disease

Central Haemodynamics

Intervention Type OTHER

Measure of functional and structural changes which accompanies cardiovascular disease

Carotid Intima Media Thickness

Intervention Type OTHER

Measurements will be repeated three times, and the average of the median values will be recorded

Forearm blood flow studies

Intervention Type OTHER

Assess and determine vascular function, which can interrogate endothelium dependent and independent mechanisms of nitric oxide bioavailability

Concomitant medication check

Intervention Type OTHER

Review of medication taken by the participant

Medication compliance check (Pill count)

Intervention Type OTHER

Ensure prescribed statin has been taken

Physical examination

Intervention Type OTHER

Check overall health

Medical history

Intervention Type OTHER

Review of volunteers medial history

AE/SAE review & reporting

Intervention Type OTHER

Monitor safety from the point of consent

Dosing

Intervention Type DRUG

To be performed at the end of the visit following completion all other study visits

Interventions

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Written Informed Consent

To be completed prior to conducting any study related procedures

Intervention Type OTHER

Inclusion/Exclusion check

Eligibility check

Intervention Type OTHER

Full Clinical Chemistry and Haematology Bloods

Participant required to fast for at least 6-8 hoursprior to visit. (Clear, non-caffeinated fluids are allowed)

Intervention Type OTHER

Serum sample for systemic markers and lipid sub-fractions

Serum samples may be stored for later analysis.

Intervention Type OTHER

Pregnancy Test

If applicable for women of child bearing potential

Intervention Type OTHER

12 Lead ECG

participant resting supine

Intervention Type OTHER

Blood Pressure and Heart Rate

Measured in the seated position after 5 minutes rest

Intervention Type OTHER

Arterial Stiffness

Measure of functional and structural changes which accompanies cardiovascular disease

Intervention Type OTHER

Central Haemodynamics

Measure of functional and structural changes which accompanies cardiovascular disease

Intervention Type OTHER

Carotid Intima Media Thickness

Measurements will be repeated three times, and the average of the median values will be recorded

Intervention Type OTHER

Forearm blood flow studies

Assess and determine vascular function, which can interrogate endothelium dependent and independent mechanisms of nitric oxide bioavailability

Intervention Type OTHER

Concomitant medication check

Review of medication taken by the participant

Intervention Type OTHER

Medication compliance check (Pill count)

Ensure prescribed statin has been taken

Intervention Type OTHER

Physical examination

Check overall health

Intervention Type OTHER

Medical history

Review of volunteers medial history

Intervention Type OTHER

AE/SAE review & reporting

Monitor safety from the point of consent

Intervention Type OTHER

Dosing

To be performed at the end of the visit following completion all other study visits

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Apparently healthy male or female individuals
* Age 18-45 years old inclusive at screening
* Body weight ≥ 45kg and BMI 18 -29.9 kg/m2
* Fasting LDL-C \< 4.1 mmol/l, TG \<1.7 mmol/l and HDL-C ≥ 1.0 mmol for men and ≥1.3 mmol for women
* Palpable brachial arterial pulse, as per study team assessment
* Not currently eligible for statin therapy according to current treatment criteria

Exclusion Criteria

* History of established CV disease (Coronary Heart Disease, Cerebrovascular Disease, Peripheral Vascular Disease or Abdominal Aortic Aneurysm)
* Lipid lowering treatment at screening or within 6 weeks before screening
* Pregnancy at any study visit
* Ongoing anticoagulation therapy with warfarin or any of the DOAC/NOAC's
* History of hypersensitivity to any of the study drugs/any known sensitivity to alirocumab or monoclonal antibodies
* History of alcohol or drug abuse or dependence within 6 months of the study at screening
* Current or previous history of regular smoking (defined as 1 pack-year) within the last 10 years.
* History of hypertension or sustained BP ≥140/90 mmHg on repeated measurements at screening
* History of type 1 or 2 diabetes or HbA1c ≥ 48 mmol/mol (6.5%) at screening
* Chronic kidney disease defined as eGFR \<60ml/min/1.73m2 at screening
* Biological first-degree relatives who have experienced stroke, TIA, myocardial infarction or peripheral vascular disease (incident event at an age younger than: 55 for male and 65 for female relatives)
* History of autoimmune inflammatory conditions
* Lack of ability to provide informed consent
* TSH \>5.0 mu/l at screening
* Clinically significant liver disease on the basis of screening bloods or history
* History of myositis/rhabdomyolysis
* Any concomitant condition that, at the discretion of the investigator, may affect the participants' ability to complete the study or the study results
Minimum Eligible Age

18 Years

Maximum Eligible Age

45 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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University of Cambridge

OTHER

Sponsor Role collaborator

Cambridge University Hospitals NHS Foundation Trust

OTHER

Sponsor Role lead

Responsible Party

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Joseph Cheriyan, MD

Consultant Physician & Clinical Pharmacologist/Associate Lecturer

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Joseph Cheriyan, MBChB, FRCP, MA

Role: PRINCIPAL_INVESTIGATOR

Cambridge University Hospitals NHS Trust

Michalis Kostapanos, MD, PhD, FRSPH

Role: PRINCIPAL_INVESTIGATOR

Cambridge University Hospitals NHS Trust

Locations

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Addenbrooke's Hospital

Cambridge, Cambridgeshire, United Kingdom

Site Status

Countries

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United Kingdom

Other Identifiers

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INTENSITY-LOW

Identifier Type: -

Identifier Source: org_study_id

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