Atorvastatin on Biomarkers of Inflammation, Coagulopathy, Angiogenesis & T-cells

NCT01351025 | Completed Phase 2 Results DMC

• 2 other identifiers: ACTG A52751U01AI068636
• Study Type: interventional
• Target: 98
• Locations: 2 countries
• Sites: 31

Brief Summary

ACTG A5275 was a prospective, double-blind, randomized, placebo-controlled cross-over design pilot study evaluating the effect of atorvastatin on biomarkers of inflammation, coagulopathy, angiogenesis, and T-lymphocyte activation in HIV-1 infected individuals with suppressed HIV-1 RNA on stable protease inhibitor based antiretroviral therapy with fasting LDL cholesterol \< 130 mg/dL. Atorvastatin is a drug approved by the Food and Drug Administration (FDA) for treating high cholesterol. Atorvastatin has also been able to lower the level of inflammation blood tests in certain other diseases but has not been studied for this purpose in people who have HIV. The main goal of this experimental study is to see how taking atorvastatin affects inflammation blood tests in people infected with HIV who do not need to take medicine for high cholesterol. In addition to observing the effects of atorvastatin on the level of inflammation measured in the blood, this study evaluated if atorvastatin is safe for people with HIV who are also taking medication for HIV.

Conditions

HIV-1 Infection

Outcome Measures

Primary Outcomes (4)

• Difference Between [Change From Week 24 to Week 44] and [Change From Baseline to Week 20] in log10 IL-6

  IL-6 (Interleukin 6) in log10 pg/mL: Difference between \[change from week 24 to week 44\] and \[change from baseline to week 20\] (i.e. \[week 44 - week 24\] - \[week 20 - baseline\])

  baseline, week 20, week 24, and week 44

• Difference Between [Change From Week 24 to Week 44] and [Change From Baseline to Week 20] in CD4+ T-cell Activation Percent

  CD4+ T-cell activation percent (% CD38+/DR+ of CD4+): Difference between \[change from week 24 to week 44\] and \[change from baseline to week 20\] (i.e. \[week 44 - week 24\] - \[week 20 - baseline\])

  baseline, week 20, week 24, and week 44

• Difference Between [Change From Week 24 to Week 44] and [Change From Baseline to Week 20] in log10 D-dimer

  D-dimer in log10 ng/mL: Difference between \[change from week 24 to week 44\] and \[change from baseline to week 20\] (i.e. \[week 44 - week 24\] - \[week 20 - baseline\])

  baseline, week 20, week 24, and week 44

• Difference Between [Change From Week 24 to Week 44] and [Change From Baseline to Week 20] in CD8+ T-cell Activation Percent

  CD8+ T-cell activation percent (% CD38+/DR+ of CD8+): Difference between \[change from week 24 to week 44\] and \[change from baseline to week 20\] (i.e. \[week 44 - week 24\] - \[week 20 - baseline\])

  baseline, week 20, week 24, and week 44

Secondary Outcomes (8)

• Difference Between [Change From Week 24 to Week 44] and Change From [Baseline to Week 20] in MCP-1 (log10 Transformed)

  baseline, week 20, week 24, and week 44

• Difference Between [Change From Week 24 to Week 44] and Change From [Baseline to Week 20] in IP-10 (log10 Transformed)

  baseline, week 20, week 24, and week 44

• Difference Between [Change From Week 24 to Week 44] and Change From [Baseline to Week 20] in CD40L (log10 Transformed)

  baseline, week 20, week 24, and week 44

• Difference Between [Change From Week 24 to Week 44] and Change From [Baseline to Week 20] in sCD14 (log10 Transformed)

  baseline, week 20, week 24, and week 44

• Difference Between [Change From Week 24 to Week 44] and Change From [Baseline to Week 20] in P-selectin (log10 Transformed)

  baseline, week 20, week 24, and week 44

Study Arms (2)

Arm A: atorvastatin / placebo

EXPERIMENTAL

At study entry (week 0), participants continued the entry boosted PI-based antiretroviral regimen (not provided by the study) and initiated atorvastatin at a daily dose of 10 mg for 4 weeks. If no symptoms or lab findings suggestive of atorvastatin toxicity were found, the dose of atorvastatin was increased to 20 mg daily at the week 4 visit. At week 20, atorvastatin was stopped for a 4-week washout period. At week 24, placebo was started for 4 weeks. If no symptoms or lab findings suggestive of toxicity were found, the placebo dose was doubled at week 28. At week 44, the placebo was stopped to allow for another 4-week washout period.

Drug: atorvastatin; Drug: placebo for atorvastin

Arm B: placebo / atorvastatin

EXPERIMENTAL

At study entry (week 0), participants continued the entry boosted PI-based antiretroviral regimen (not provided by the study) and initiated placebo for 4 weeks. If no symptoms or lab findings suggestive of toxicity were found, the dose of placebo was doubled at the week 4 visit. At week 20, the placebo was stopped for a 4-week washout period. At week 24, atorvastatin was started at a daily dose of 10 mg for 4 weeks. If no symptoms or lab findings suggestive of atorvastatin toxicity were found, the dose of atorvastatin was increased to 20 mg daily at week 28. At week 44, atorvastatin was stopped to allow for another 4-week washout period.

Drug: atorvastatin; Drug: placebo for atorvastin

Interventions

atorvastatin DRUG

10 mg daily for 4 weeks, if no symptoms or lab findings suggestive of atorvastatin toxicity, dose increase to 20 mg daily from week 4- week 20

Also known as: Lipitor

Arm A: atorvastatin / placebo

placebo for atorvastin DRUG

One tablet once daily for 4 weeks. If no symptoms or lab findings suggestive of toxicity were found, then increase the dose to two tablets once daily.

Also known as: placebo

Arm A: atorvastatin / placebo; Arm B: placebo / atorvastatin

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• HIV-1 infected
• Combination ART that includes any boosted PI regimen for at least 6 months prior to study entry
• No plans to change the antiretroviral regimen in the next year
• Must have been on the same HAART regimen for at least 12 weeks with no change prior to study entry. More information on this criterion can be found in the study protocol.
• If on vitamin D replacement therapy, must have been on stable regimen for ≥ 1 mo. prior to study entry.
• CD4+ T-cell count obtained within 45 days prior to study entry at any laboratory that has a Clinical Laboratory Improvement Amendments (CLIA) certification or its equivalent.
• Screening HIV-1 RNA \< 40 copies/mL by Abbott RealTime PCR at a laboratory certified by the DAIDS Virology Quality Assurance (VQA) program within 45 days prior to study entry.
• All known HIV-1 RNA levels obtained within 180 days prior to study entry are below the limits of quantification on all tests, with documentation of at least 1 test by any FDA-approved assay at a CLIA-certified laboratory obtained between 90 to 180 days prior to study entry. A single RNA "blip" of \< 500 copies/mL during this time period was permissible if RNA levels immediately before and after were below the limits of quantification for the assay.
• Laboratory values obtained within 45 days prior to study entry- Absolute neutrophil count (ANC) 750/mm3, Hemoglobin ≥ 9.0 g/dL for female subjects,10.0 g/dL for male subjects, Platelet count ≥ 100,000/mm3, Calculated creatinine clearance (CrCl) 30 mL/min, as estimated by the Cockcroft-Gault equation, Creatine kinase (CK) \< 3 x ULN, AST ≤ 2.0 x ULN, ALT ≤ 2.0 x ULN, Total bilirubin ≤ 2.5 x ULN. If the subject was taking an indinavir- or atazanavir-containing regimen at the time of screening, a total bilirubin of ≤ 5 x ULN is acceptable, Fasting LDL cholesterol ≥ 70 mg/dL and \< 130 mg/dL, Fasting triglycerides \< 400 mg/dL, Fasting glucose \< 110 mg/dL
• Screening plasma D-dimer \> 0.34 μg/mL from a sample obtained within 45 days prior to study entry was the original D-dimer criterion. It was revised to ≥ 0.25 ug/mL four months after the first enrollment, and subsequently the D-dimer eligibility criterion was completely cut off a year later.
• For females of reproductive potential (women who had not been post-menopausal for at least 24 consecutive months, i.e., who had menses within 24 months prior to study entry), or women who had not undergone surgical sterilization, specifically hysterectomy or bilateral oophorectomy or tubal ligation) required a negative serum or urine pregnancy test within 48 hours prior to entry. More information on this criterion can be found in the study protocol.
• Must agree not to participate in the conception process (e.g., active attempt to become pregnant or to impregnate, sperm donation, in vitro fertilization), and if participating in sexual activity that could lead to pregnancy, the subject/partner must use at least 2 reliable methods of contraception, (condoms, without a spermicidal agent; a diaphragm or cervical cap without spermicide; an IUD; or hormone-based contraceptive), for 2 weeks before study treatment, while receiving study treatment, and for 6 weeks after receiving study treatment. As hormone-based contraceptives (oral, transdermal, or subdermal) can affect coagulopathy biomarkers, subjects who plan on using such a contraceptive during the study must be taking the same product for ≥ 4 weeks prior to screening and be encouraged to continue throughout the duration of the study if medically feasible.
• Karnofsky performance score ≥ 70 on at least one occasion within 45 days prior to study entry
• Confirmation of the availability of the stored pre-entry fasting plasma, serum, and cell samples. The site had to confirm that these samples had entered into the Laboratory Data Management System (LDMS).

You may not qualify if:

• Current or past malignancy (except non-melanoma cancer of the skin)
• Coronary artery disease (CAD) or CAD equivalent including diabetes mellitus or National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) calculated 10-year coronary heart disease (CHD) risk of \> 20%.
• Known cirrhosis.
• Known chronic active hepatitis B or C.
• Thyroid-stimulating hormone (TSH) \< 1.0 x lower limit of normal or \> 1.0 x ULN.
• Known inflammatory conditions, such as, but not limited to, rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), sarcoidosis, inflammatory bowel disease (IBD), chronic pancreatitis, autoimmune hepatitis, myositis, or myopathy.
• Pregnant or breast-feeding.
• Previous intolerance to any statin or any of its components.
• Use of any lipid-lowering therapies including all statin drugs, Omega 3 fatty acids/fish oil, red yeast rice, and niacin products ≥ 1 g/day (e.g., niacin, nicotinic acid, vitamin B3) taken within 45 days prior to study entry. More information on this criterion can be found in the study protocol.
• Immunosuppressant use, such as, but not limited to, systemic or potentially systemic glucocorticoids (including nasal or inhaled steroids), azathioprine, tacrolimus, mycophenolate, sirolimus, rapamycin, or cyclosporine within 45 days prior to study entry.
• Use of any systemic antineoplastic or immunomodulatory treatment, investigational vaccines, interleukins, interferons, growth factors, or intravenous immunoglobulin (IVIG) within 45 days prior to study entry. More information on this criterion can be found in the study protocol.
• Concurrent use of prohibited medications. More information on this criterion can be found in the study protocol.
• Heavy alcohol use as defined by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) (http://pubs.niaaa.nih.gov/publications/Practitioner/pocketguide/pocket\_guide3.htm) and alcohol or drug use or dependence that, in the opinion of the site investigator, would interfere with adherence to study requirements.
• Current use of anticoagulation therapy other than ≤ 325 mg of daily aspirin.
• Known coagulopathy, deep venous thrombosis, pulmonary embolism within 6 months prior to study entry.

Sponsors & Collaborators

• Advancing Clinical Therapeutics Globally for HIV/AIDS and Other Infections: lead
• National Institute of Allergy and Infectious Diseases (NIAID): collaborator
• Pfizer: collaborator

Study Sites (31)

31788 Alabama CRS

Birmingham, Alabama, 35294, United States

Location

UCLA CARE Center CRS (601)

Los Angeles, California, 90095, United States

Location

Ucsd, Avrc Crs (701)

San Diego, California, 92103, United States

Location

Harbor-UCLA Med. Ctr. CRS (603)

Torrance, California, 90502, United States

Location

University of Colorado Hospital CRS (6101)

Aurora, Colorado, 80045, United States

Location

Georgetown University CRS (GU CRS) (1008)

Washington D.C., District of Columbia, 20007, United States

Location

Northwestern University CRS (2701)

Chicago, Illinois, 60611, United States

Location

Massachusetts General Hospital ACTG CRS (101)

Boston, Massachusetts, 02114, United States

Location

Brigham and Women's Hosp. ACTG CRS (107)

Boston, Massachusetts, 02115, United States

Location

Beth Israel Deaconess Med. Ctr., ACTG CRS (103)

Boston, Massachusetts, 02215, United States

Location

Wayne State Univ. CRS (31478)

Detroit, Michigan, 48201, United States

Location

Henry Ford Hosp. CRS (31472)

Detroit, Michigan, 48202, United States

Location

Washington U CRS (2101)

St Louis, Missouri, 63110, United States

Location

Cooper Univ. Hosp. CRS (31476)

Camden, New Jersey, 08103, United States

Location

New Jersey Medical School-Adult Clinical Research Ctr. CRS (31486)

Newark, New Jersey, 07103, United States

Location

Cornell CRS (7804)

New York, New York, 10011, United States

Location

NY Univ. HIV/AIDS CRS (401)

New York, New York, 10016, United States

Location

AIDS Care CRS (1101)

Rochester, New York, 14642, United States

Location

University of Rochester Adult HIV Therapeutic Strategies Network CRS (31787)

Rochester, New York, 14642, United States

Location

Unc Aids Crs (3201)

Chapel Hill, North Carolina, 27516, United States

Location

Duke Univ. Med. Ctr. Adult CRS (1601)

Durham, North Carolina, 27710, United States

Location

Univ. of Cincinnati CRS (2401)

Cincinnati, Ohio, 45267, United States

Location

Case CRS (2501)

Cleveland, Ohio, 44106, United States

Location

Metro Health CRS (2503)

Cleveland, Ohio, 44109, United States

Location

The Ohio State Univ. AIDS CRS (2301)

Columbus, Ohio, 43210, United States

Location

Hosp. of the Univ. of Pennsylvania CRS (6201)

Philadelphia, Pennsylvania, 19104, United States

Location

Pitt CRS (1001)

Pittsburgh, Pennsylvania, 15213, United States

Location

Houston AIDS Research Team CRS (31473)

Houston, Texas, 77030, United States

Location

Virginia Commonwealth Univ. Medical Ctr. CRS (31475)

Richmond, Virginia, 23219, United States

Location

University of Washington AIDS CRS (1401)

Seattle, Washington, 98104, United States

Location

Puerto Rico-AIDS CRS (5401)

San Juan, 00935, Puerto Rico

Location

Related Publications (1)

• Rahman F, Brates I, Aweeka F, Bosch RJ, Deitchman A, Nixon D, Aberg JA. Evaluating the effect of atorvastatin exposure and vitamin D levels on lipid outcomes in people with HIV-1 with suppressed HIV-1 RNA and LDL cholesterol <130 mg/dL. HIV Med. 2023 Jun;24(6):749-753. doi: 10.1111/hiv.13453. Epub 2022 Dec 22.

  PMID: 36549898 DERIVED

MeSH Terms

Interventions

Atorvastatin

Intervention Hierarchy (Ancestors)

Pyrroles; Azoles; Heterocyclic Compounds, 1-Ring; Heterocyclic Compounds; Heptanoic Acids; Fatty Acids; Lipids

Results Point of Contact

• Title: ACTG Clinicaltrials.gov Coordinator
• Organization: ACTG Network Coordinating Center, Social and Scientific Systems, Inc.

ACTGCT.Gov@s-3.com

301-628-3313

Study Officials

• Judith A. Aberg, M.D.

  NYU/Bellevue/HIV/AIDS CTU

  STUDY CHAIR

• Daniel E Nixon, D.O., Ph.D.

  Virginia Commonwealth University Medical Center

  STUDY CHAIR

Publication Agreements

• PI is Sponsor Employee: No
• Restriction Type: OTHER
• Restrictive Agreement: Yes

Study Design

• Study Type: interventional
• Phase: phase 2
• Allocation: RANDOMIZED
• Masking: TRIPLE
• Who Masked: PARTICIPANT, CARE PROVIDER, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: CROSSOVER
• Sponsor Type: NETWORK
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: November 8, 2010
• First Posted: May 10, 2011
• Study Start: April 14, 2011
• Primary Completion: May 1, 2014
• Study Completion: May 1, 2014
• Last Updated: August 3, 2021
• Results First Posted: August 4, 2015

Record last verified: 2021-07

Locations

PR (1); US (30)