MUscle Side-Effects of Atorvastatin in Coronary Patients

NCT03874156 | Completed Phase 4

• 1 other identifier: REK 2018/2302
• Study Type: interventional
• Target: 77
• Locations: 1 country
• Sites: 2

Brief Summary

The study aims to estimate the effect of atorvastatin on muscular symptom intensity in coronary patients with subjective statin-associated muscle symptoms (SAMS) and to determine the association with blood levels of atorvastatin and its metabolites, to obtain an objective marker for true SAMS. A randomized study will include 80 coronary patients with SAMS during ongoing atorvastatin therapy or previous muscle symptoms that led to discontinuation of atorvastatin. Patients will be randomized to 7-weeks treatment with atorvastatin 40 mg/day in the first period and matched placebo in the second 7-weeks period, or placebo in the first period and atorvastatin in the second period. A control group (n=40) without muscle symptoms will have 7 weeks open treatment with atorvastatin 40 mg/day. Blood samples will be collected at baseline and after each treatment period, and muscular symptom intensities will be rated by the patients weekly. The primary outcome is the difference in aggregated mean Visual Analogue Scale (VAS) scores between the last three weeks of atorvastatin treatment and of placebo treatment. The main purpose is to develop an objective marker for true SAMS, by comparing SAMS associated with blinded atorvastatin treatment with blood concentrations of atorvastatin and its metabolites. Diagnostic and discrimination performance will be determined. The study provides new clinical knowledge on SAMS in coronary patients and may contribute to more personalized statin treatment and monitoring, fewer side-effects and consequently improved adherence and lipid management in future practice.

Conditions

Statin Adverse Reaction

Outcome Measures

Primary Outcomes (1)

• Individual mean difference in muscular symptom intensity measured with a 0 (no symptoms) to 10 (worst imaginable symptoms) Visual Analogue Scale (VAS) score between treatment periods with statin and placebo

  Individual mean difference in muscular symptom (i.e. pain, aching, tenderness, stiffness, cramp and/or weakness) intensity between treatment periods with statin and placebo, reported by the patients over the last three weeks (i.e. week 4-7) measured with a 0 (no symptoms) to 10 (worst imaginable symptoms) Visual Analogue Scale (VAS) score with aggregated data from each subscale

  16 weeks following randomization

Secondary Outcomes (9)

• The proportion of patients who report muscle symptoms on atorvastatin treatment and not on placebo (dichotomous Statin Associated Muscle Symptom classification)

  16 weeks following randomization

• The correlation between individual muscular symptom intensity between treatment periods with statin and placebo over the last three weeks measured with 0 to 10 VAS score aggregated from each subscale, and levels of atorvastatin and metabolites

  16 weeks following randomization

• Sensitivity, specificity, and area under the curve of blood concentrations of parent drug and the active metabolites of atorvastatin for the classification of true Statin Associated Muscle Symptoms (SAMS)

  16 weeks following randomization

• Individual mean difference in likelihood of statin discontinuation between treatment periods with statin and placebo over the last three weeks (i.e. week 4-7) measured with 0 to 10 VAS score with aggregated data from each subscale.

  16 weeks following randomization

• Statin adherence measured weekly with self-reported questionnaire methods during the study periods

  16 weeks following randomization

Study Arms (2)

Intervention group

ACTIVE COMPARATOR

Atorvastatin 40 mg once daily

Drug: Atorvastatin 40mg

Placebo group

PLACEBO COMPARATOR

Matched placebo tablet once daily

Drug: Placebo Oral Tablet

Interventions

Atorvastatin 40mg DRUG

Oral tablet fabricated and labelled at Krageroe Tablettproduksjon AS

Intervention group

Placebo Oral Tablet DRUG

Oral tablet fabricated and labelled at KrageroeTablettproduksjon AS

Placebo group

Eligibility Criteria

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

You may qualify if:

• years or older
• First or recurrent diagnosis (myocardial infarction) or treatments (Percutaneous Coronary Intervention \[PCI\] or Coronary Artery Bypass Graft operation \[CABG\]) for a coronary heart disease (CHD) event at least 6 months prior to study start and prescribed atorvastatin (irrespective of dose)
• Reporting muscle complaints (i.e. pain, weakness, tenderness, stiffness or cramp) that they attribute to atorvastatin therapy or atorvastatin discontinuation due to muscle complains
• Signed informed consent and expected cooperation of the patient according to International Council for Harmonisation/Good Clinical Practice and national/local regulations

You may not qualify if:

• First or recurrent diagnosis (myocardial infarction) or treatments (PCI or CABG) for a CHD event the a) past 12 months prior to study start in high risk patients (i.e. at least one of following comorbid conditions: systolic heart failure, \>1 previous myocardial infarction, kidney failure, diabetes, and smokers) and b) the past 6 months prior to study start in low risk patients without any of the co-morbid conditions mentioned above and in patients who are not taking a statin at all
• Patients with symptomatic peripheral artery disease and patients with familial hypercholesterolemia
• Patient has any contraindications for atorvastatin listed in the Summary of Product Characteristics (i.e. known hypersensitivity to the ingredients, acute liver failure/ Alanine Aminotransferase \> 3 times upper limit of the normal range in blood at study start, pregnancy and breastfeeding)
• History of previous rhabdomyolysis, myopathy or liver failure due to statin treatment with Creatine Kinase \> 10 times upper limit of the normal range or Alanine Aminotransferase \> 3 times upper limit of the normal range.
• Any condition (e.g. psychiatric illness, dementia) or situation, that in the investigator's opinion could put the subject at significant risk, confound the study results, interfere significantly with the subject participation in the study, or rendering informed consent unfeasible
• Short life expectancy (\<12 months) due to other medical conditions
• Not being able to understand Norwegian.
• Women of childbearing potential defined as all premenopausal female.
• Participation in another randomized clinical trial

Sponsors & Collaborators

• Vestre Viken Hospital Trust: lead
• The Hospital of Vestfold: collaborator
• Oslo University Hospital: collaborator
• University of Oslo: collaborator

Study Sites (2)

Vestre Viken Trust, Drammen Hospital

Drammen, Buskerud, 3004, Norway

Location

Hospital of Vestfold Trust

Tønsberg, Vestfold, 3103, Norway

Location

Related Publications (1)

• Sverre E, Munkhaugen J, Kristiansen O, Weedon-Fekjaer H, Peersen K, Gjertsen E, Gullestad L, Bergan S, Husebye E, Vethe NT. Plasma concentration of atorvastatin metabolites correlates with low-density lipoprotein cholesterol reduction in patients with coronary heart disease. Pharmacol Res Perspect. 2023 Jun;11(3):e01089. doi: 10.1002/prp2.1089.

  PMID: 37186070 DERIVED

MeSH Terms

Interventions

Atorvastatin

Intervention Hierarchy (Ancestors)

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

Study Officials

• john munkhaugen, MD, PhD

  Vestre Viken Trust

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: phase 4
• Allocation: RANDOMIZED
• Masking: QUADRUPLE
• Who Masked: PARTICIPANT, CARE PROVIDER, INVESTIGATOR, OUTCOMES ASSESSOR
• Purpose: DIAGNOSTIC
• Intervention Model: CROSSOVER
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: Prospective, randomized double-blinded placebo controlled cross-over phase 4 study.

Study Record Dates

• First Submitted: March 5, 2019
• First Posted: March 14, 2019
• Study Start: March 5, 2019
• Primary Completion: December 12, 2019
• Study Completion: December 12, 2019
• Last Updated: January 3, 2020

Record last verified: 2020-01

Data Sharing

• IPD Sharing: Will share
• Time Frame: Data will be available within 5 years of study completion

Locations

NO (2)