Study to Evaluate the Effect of Celecoxib on the Efficacy and Safety of Amlodipine in Subjects With Hypertension Requiring Antihypertensive Therapy

A Prospective Randomized Placebo Controlled Study to Evaluate the Effect of Celecoxib on the Efficacy and Safety of Amlodipine in Subjects With Hypertension Requiring Antihypertensive Therapy

The purpose of this study was to evaluate the effect of celecoxib on the efficacy and safety of amlodipine besylate in subjects with newly diagnosed hypertension requiring antihypertensive therapy.

This study was conducted to support a future marketing application for KIT-302. Kitov Pharma Ltd. (Kitov) is developing KIT-302, an oral fixed combination drug product (FCDP) consisting of the calcium channel blocker amlodipine besylate and the nonsteroidal anti-inflammatory drug (NSAID) celecoxib, as a "convenience reformulation" FCDP to facilitate and improve patient compliance with the once a day (qd) administration of its individual components, amlodipine and celecoxib.

The formulation of KIT-302 consists of amlodipine besylate and celecoxib co-formulated in a single immediate release tablet. However, for this study, two separate capsules were utilized: one containing a commercial celecoxib capsule (Celebrex®) or matched placebo capsule and one containing a commercial amlodipine besylate tablet (Norvasc®) or matched placebo tablet.

The study hypothesis was that treatment with the amlodipine besylate containing capsule plus the celecoxib containing capsule would reduce blood pressure (BP) in subjects with hypertension with an efficacy that is not substantially inferior to the effect of amlodipine besylate alone (i.e., the amlodipine containing capsule plus the matched placebo for the celecoxib capsule).

The United States (US) Food and Drug Administration (FDA) recently approved KIT-302, under the brand name Consensi® (amlodipine and celecoxib) tablets [New Drug Application (NDA) 210045] for the following indication: "patients for whom treatment with amlodipine for hypertension and celecoxib for osteoarthritis are appropriate. Lowering blood pressure reduces the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions."

Study Overview

• Status: Completed
• Conditions: Hypertension
• Intervention / Treatment: Drug: Over-encapsulated 10 mg amlodipine besylate tablet; Drug: Over-encapsulated 200 mg celecoxib capsule; Drug: Matched placebo capsule for over-encapsulated celecoxib capsule; Drug: Matched placebo capsule for over-encapsulated amlodipine besylate tablet

• Study Type: Interventional
• Enrollment (Actual): 152
• Phase: Phase 3

Contacts and Locations

Study Locations

• United Kingdom
  • Birmingham, United Kingdom, B15 2SQ
    • Synexus Midlands Clinical Research Centre
  • Glasgow, United Kingdom, G20 0SP
    • Synexus Scotland Clinical Research Centre
  • London, United Kingdom, EC1M 6BQ
    • Barts Health NHS Trust, William Harvey Heart Centre, Barts & The London, Queen Mary School of Medicine and Dentistry, Queen Mary, University of London
  • Reading, United Kingdom, RG6 6BZ
    • Reading Clinical Research Aspect
  • Antrim
    • Belfast, Antrim, United Kingdom, BT9 6AD
      • Celerion
  • Greater Manchester
    • Manchester, Greater Manchester, United Kingdom, M23 9QZ
      • The Medicines Evaluation Unit Ltd.
  • Herefordshire
    • Ledbury, Herefordshire, United Kingdom, HR8 2AA
      • Reading Clinical Research Aspect
  • Merseyside
    • Liverpool, Merseyside, United Kingdom, L22 0LG
      • Synexus Merseyside Clinical Research Centre
  • North East Somerset
    • Bath, North East Somerset, United Kingdom, BA2 3HT
      • Oldfield Surgery
  • Wiltshire
    • Chippenham, Wiltshire, United Kingdom, SN15 2SB
      • Rowden Surgery

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 40 years to 75 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Adult 40 to 75 years of age

2. Newly diagnosed hypertension that requires chronic pharmacological therapy. Specifically, the subject must meet both of the following criteria:

   1. Resting systolic BP ≥140 mmHg and ≤179 mmHg (where resting is defined as supine for at least 10 minutes with minimal interaction) at Initial Screening Visit
   2. SBPday >135 mmHg at Baseline Visit (Day 0)
3. Body Mass Index of 18.5 to 34.9 kg/m2
4. Healthy (other than hypertension) as determined by the Investigator based on medical history, physical examination, vital signs, 12-lead electrocardiogram (ECG), and clinical laboratory tests
5. A negative pregnancy test at Screening
6. Both males and women of child bearing potential agree to use adequate contraceptive methods while on study (from Screening through final study visit)
7. Able to comprehend and sign an informed consent form

Exclusion Criteria:

1. Resting systolic BP >179 mmHg or a resting diastolic BP >110 mmHg at Screening (where resting is defined as supine for at least 10 minutes with minimal interaction) or SBP24h >169 mmHg or DBP24h >110 mmHg at randomization
2. SBPday ≤135 mmHg at baseline (Day 0)
3. Weight <55 kg
4. Fragile health
5. Evidence of clinically significant findings on screening evaluations (clinical, laboratory, and ECG) which, in the opinion of the Investigator would pose a safety risk or interfere with appropriate interpretation of safety data
6. Current or recent history (within 4 weeks prior to Screening) of a clinically significant bacterial, fungal, or mycobacterial infection
7. Current clinically significant viral infection
8. History of malignancy, with the exception of cured basal cell or squamous cell carcinoma of the skin
9. Major surgery within 4 weeks prior to Screening
10. Presence of a malabsorption syndrome possibly affecting drug absorption (e.g., Crohn's disease or chronic pancreatitis)
11. Active peptic ulceration or history of gastrointestinal bleeding
12. History of myocardial infarction, congestive heart failure, or stroke
13. Any current cardiovascular disease
14. History of psychotic disorder
15. History of alcoholism or drug addiction or current alcohol or drug use that, in the opinion of the Investigator, will interfere with the subject's ability to comply with the dosing schedule and study evaluations
16. History of any illicit drug use within one year prior to Screening
17. Positive drug screen at Screening. A positive drug screen for opiates only (with all other drug tests negative) will not be a basis for exclusion if the subject took over-the-counter narcotics as indicated on the product label within 24 hours prior to the drug screen
18. Current treatment or treatment within 30 days prior to first dose of study drugs with another investigational drug or current enrollment in another clinical trial
19. Current treatment or treatment within 30 days prior to first dose of study drugs with an NSAID or systemic corticosteroid
20. Known history of human immunodeficiency virus, hepatitis B, or hepatitis C
21. Known hypersensitivity to amlodipine or celecoxib
22. Known hypersensitivity to the inactive ingredients in the over-encapsulated study drugs
23. Asthma, acute rhinitis, nasal polyps, angioneurotic oedema, urticaria or other allergic type reactions after taking acetylsalicylic acid or NSAIDs including cyclooxygenase-2 inhibitors
24. Subjects who, in the opinion of the Investigator, are unable or unlikely to comply with the dosing schedule and study evaluations
25. Pregnant or lactating
26. Unable to correctly use ambulatory blood pressure monitor after instruction on its use
27. Subjects with Child-Pugh Class B or C cirrhosis;
28. Subjects currently taking a calcium channel blocker for any reason including angina. Subjects will not be withdrawn from these drugs to be enrolled in the trial
29. Creatinine clearance <50 ml/min as estimated by the Cockroft-Gault equation
30. Known cytochrome P450 2C9 poor metabolizer
31. Subjects with allergy or hypersensitivity to sulfonamides

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Amlodipine+Celecoxib; Over-encapsulated 10 mg amlodipine besylate tablet + over-encapsulated 200 mg celecoxib capsule once a day for two weeks	Drug: Over-encapsulated 10 mg amlodipine besylate tablet; Over-encapsulated 10 mg amlodipine besylate tablet once a day for two weeks; Other Names: Norvasc; Drug: Over-encapsulated 200 mg celecoxib capsule; Over-encapsulated 200 mg celecoxib capsule once a day for two weeks; Other Names: Celebrex
Active Comparator: Amlodipine+Placebo; Over-encapsulated 10 mg amlodipine besylate tablet + matched placebo capsule for over-encapsulated celecoxib capsule once a day for two weeks	Drug: Over-encapsulated 10 mg amlodipine besylate tablet; Over-encapsulated 10 mg amlodipine besylate tablet once a day for two weeks; Other Names: Norvasc; Drug: Matched placebo capsule for over-encapsulated celecoxib capsule; Matched placebo capsule for over-encapsulated celecoxib capsule once a day for two weeks; Other Names: Placebo
Placebo Comparator: Placebo+Celecoxib; Matched placebo capsule for over-encapsulated amlodipine besylate tablet + over-encapsulated 200 mg celecoxib capsule once a day for two weeks	Drug: Over-encapsulated 200 mg celecoxib capsule; Over-encapsulated 200 mg celecoxib capsule once a day for two weeks; Other Names: Celebrex; Drug: Matched placebo capsule for over-encapsulated amlodipine besylate tablet; Matched placebo capsule for over-encapsulated amlodipine besylate tablet once a day for two weeks; Other Names: Placebo
Sham Comparator: Placebo+Placebo; Matched placebo capsule for over-encapsulated amlodipine besylate tablet + matched placebo capsule for over-encapsulated celecoxib capsule once a day for two weeks	Drug: Matched placebo capsule for over-encapsulated celecoxib capsule; Matched placebo capsule for over-encapsulated celecoxib capsule once a day for two weeks; Other Names: Placebo; Drug: Matched placebo capsule for over-encapsulated amlodipine besylate tablet; Matched placebo capsule for over-encapsulated amlodipine besylate tablet once a day for two weeks; Other Names: Placebo

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mean Change in Average Daytime (9:00 to 21:00) Ambulatory Systolic Blood Pressure (SBPday) - Primary Endpoint		Baseline and 2 weeks
Frequency of Adverse Events (Number of Participants Affected/Number of Participants at Risk)	Including any untoward medical occurrence in a participant administered study drug, which do not necessarily have a causal relationship with the study drug [i.e., any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease temporally associated with the use of the study drug, whether or not related to the study drug].	1 month

Secondary Outcome Measures

Outcome Measure	Time Frame
Mean Change in Average 24-hour Ambulatory Systolic Blood Pressure (SBP24h)	Baseline and 2 weeks
Mean Change in Average Night-time (01:00 to 06:00) Ambulatory Systolic Blood Pressure (SBPnight)	Baseline and 2 weeks
Mean Change in Average 24-hour Ambulatory Diastolic Blood Pressure (DBP24h)	Baseline and 2 weeks
Mean Change in Average Daytime (9:00 to 21:00) Ambulatory Diastolic Blood Pressure (DBPday)	Baseline and 2 weeks
Mean Change in Average Night-time (01:00 to 06:00) Ambulatory Diastolic Blood Pressure (DBPnight)	Baseline and 2 weeks
Mean Non-transformed Amlodipine Plasma Concentration	24 hours post-dose on Day 14
Mean Non-transformed Celecoxib Plasma Concentration	24 hours post-dose on Day 14
Mean Log-transformed Amlodipine Plasma Concentration	24 hours post-dose on Day 14
Mean Log-transformed Celecoxib Plasma Concentration	24 hours post-dose on Day 14
Mean Change in Average Daytime (9:00 to 21:00) Ambulatory Systolic Blood Pressure (SBPday) - Secondary Endpoint	Baseline and 2 weeks

Collaborators and Investigators

• Sponsor: Kitov Pharmaceuticals, Ltd.
• Investigators: Study Director: J. Paul Waymack, MD, ScD, Kitov Pharma Ltd; Principal Investigator: Brendan Colgan, MD, Celerion; Principal Investigator: Claire Kightley, MB, Reading Clinical Research Aspect; Principal Investigator: David Collier, MBBS, PhD, BSc, Barts Health NHS Trust, William Harvey Heart Centre, Barts & The London, Queen Mary School of Medicine and Dentistry, Queen Mary, University of London; Principal Investigator: Paul Ivan, MBBS, Synexus Merseyside Clinical Research Centre; Principal Investigator: Veronika Horvathova, MD, Synexus Scotland Clinical Research Centre; Principal Investigator: Amit Mathew, MS, MBBS, Synexus Midlands Clinical Research Centre; Principal Investigator: Alexander Thompson, MB, BS, DRCOG, Reading Clinical Research Aspect; Principal Investigator: Mohamed Okily, MB, Synexus Manchester Clinical Research Centre; Principal Investigator: Richard Gaunt, MB, ChB, MRCGP, DRCOG, Rowden Surgery; Principal Investigator: Patrick Eavis, MBBS, DRCOG, DFFP, MRCGP, Oldfield Surgery; Principal Investigator: Arjun Ravi, MBBS, MRCP, The Medicines Evaluation Unit Ltd.

Study record dates

Study Major Dates

• Study Start (Actual): June 26, 2014
• Primary Completion (Actual): November 19, 2015
• Study Completion (Actual): November 19, 2015

Study Registration Dates

• First Submitted: June 20, 2014
• First Submitted That Met QC Criteria: June 23, 2014
• First Posted (Estimate): June 24, 2014

Study Record Updates

• Last Update Posted (Actual): October 10, 2018
• Last Update Submitted That Met QC Criteria: September 11, 2018
• Last Verified: September 1, 2018

More Information

Terms related to this study

• Keywords: Systolic blood pressure; Antihypertensive; High blood pressure; Diastolic blood pressure
• Additional Relevant MeSH Terms: Cardiovascular Diseases; Vascular Diseases; Hypertension; Physiological Effects of Drugs; Molecular Mechanisms of Pharmacological Action; Antihypertensive Agents; Vasodilator Agents; Peripheral Nervous System Agents; Enzyme Inhibitors; Analgesics; Sensory System Agents; Anti-Inflammatory Agents, Non-Steroidal; Analgesics, Non-Narcotic; Anti-Inflammatory Agents; Antirheumatic Agents; Cyclooxygenase Inhibitors; Membrane Transport Modulators; Calcium-Regulating Hormones and Agents; Cyclooxygenase 2 Inhibitors; Calcium Channel Blockers; Celecoxib; Amlodipine
• Other Study ID Numbers: KIT-302-03-01; 2013-005381-19 (EudraCT Number)