评估血脂异常疗法在墨西哥人群中疗效的临床试验
Estudio clínico Fase III Para Evaluar la Eficacia terapéutica en Pacientes Mexicanos Con Dislipidemia Mediante el Uso vía Oral de L-Carnitina + Atorvastatina Comparado Con 阿托伐他汀
临床试验 III 期、实验性、简单盲法、随机分为两个治疗组、多中心、纵向,以评估墨西哥成年人群血脂异常的治疗效果。 该试验包括可以根据疾病状况、生物学特征和社会人口统计学特征进行比较的同质人群。
2 治疗组: 实验组:口服左旋肉碱(1g)+口服阿托伐他汀(20mg),每24小时一次,连续6个月。
活性对照组:口服阿托伐他汀 20mg,每 24 小时一次,持续 6 个月。
样本量:120 名受试者,年龄在 35 至 75 岁之间的女性或男性。 实验室检查:血液生物测定、quimical 血液成分、心电图和妊娠尿液检查。
研究概览
详细说明
总体目标:
在治疗六个月后,通过与使用阿托伐他汀进行比较,通过口服途径使用左旋肉碱 + 阿托伐他汀来评估患有血脂异常的墨西哥成人的治疗效果。
评估研究中药物的安全性。
假设:
L-肉碱+阿托伐他汀的组合使用相对于使用阿托伐他汀作为降低血脂异常患者C-LDL百分比的治疗提供治疗优势。
在血脂异常患者的治疗中,与使用阿托伐他汀作为单一疗法相比,左旋肉碱 + 阿托伐他汀的组合在存在可归因于药物的不良事件时显示出较少的发生率。
设计:
III 期临床试验,实验随机采用两种治疗方法,多中心,纵向,以评估墨西哥成人血脂异常的治疗效果。
材料与方法:
样本量 120 个受试者将被包括在内。 纳入标准 35 至 75 岁的墨西哥人。 男女不分。 血脂异常的患者被认为是通过实验室参数获得的 C-LDL 血清水平为 100mg/dl 或更高。
没有接受药物治疗来处理他们的血脂异常或接受暂停他们目前的治疗并在从初始评估之日开始的接下来的 3 周内评估他们是否被纳入。
处于生育期的女性采用安全、无激素的计划生育方法。 安全的计划方法包括女性手术方法、不释放孕激素的宫内节育器以及在所有性关系中使用防腐剂。
在参与研究期间不想怀孕的处于生育期的女性。
绝经后妇女或有子宫切除史。 拥有固定电话和/或移动电话,并接受接收来自研究过程站点的电话。
给予他们适当的知情同意。 排除标准受试者缺乏理解暗示他们参与研究的过程的心智能力,因此不能以自愿的方式同意他们的参与。
对正在研究的药物过敏史。 每天至少摄入240毫升葡萄汁或偶尔摄入1升。 没有安全计划生育方法且希望在研究期间怀孕的潜在生育妇女已经怀孕或处于哺乳期。
对墨西哥人具有 Globorisk 量表,或作为相关的风险因素,心血管风险的高分层。
根据国际单位,ALT 高于正常上限 1.5 倍的基础实验室值。
CPK 升高的基础实验室值不能归因于身体活动。
接受抗凝治疗、患有凝血障碍或任何禁忌采血情况的受试者。
急性心肌梗死、不稳定型心绞痛病史,部分确诊冠状动脉病、心律失常、充血性心力衰竭或脑血管疾病。
患者或一级亲属的遗传类型肌肉病史或横纹肌溶解症。
先天性肝病、肝炎病毒慢性感染、脂肪肝肝炎、酒精性肝炎、原发性胆汁性肝硬化、原发性硬化症、胆管炎或肝功能衰竭的病史或诊断。
先天性肾病、慢性肾功能衰竭、急性肾损伤或肾病综合征的病史或诊断。
人类免疫缺陷病毒感染史。 急性或慢性胰腺炎病史。 以下内分泌疾病史:未控制的糖尿病、脂肪代谢障碍、甲状腺疾病、库欣综合征和/或多囊卵巢综合征。
损害免疫力的疾病,例如系统性红斑狼疮、类风湿性关节炎、抗磷脂抗体综合征或牛皮癣。
由沉积物引起的疾病,例如戈谢病、由糖原沉积物引起的疾病、Tay-Sachs juvenile disease 或 Niemann Pick Disease。
川崎病、维尔纳综合征、间歇性急性卟啉症、特发性高钾血症或克氏综合征的诊断。
患有特发性高钾血症、克兰费尔特综合征、沃纳综合征、川崎病或卟啉症。
癫痫病史。 酗酒史或诊断。 每天摄入超过20克酒精。 大麻使用者。 非法药物使用者。
摄入具有药理学相互作用的药物,可增加或降低左旋肉碱和/或阿托伐他汀的功效或改变血脂,例如:
大环内酯类抗生素:红霉素、泰利霉素和克拉霉素。 唑类抗真菌药:酮康唑、伊曲康唑、氟康唑和奈法唑酮。 槲皮素、胺碘酮、阿瑞匹坦、西咪替丁、环丙沙星、环孢素、地尔硫卓、伊马替尼、紫锥菊、依诺沙星、麦角胺、甲硝唑、米非司酮、托非索泮、孕二烯酮、维拉帕米、米贝拉地尔、氟西汀、苯巴比妥、卡马西平、苯妥英钠、利福平、莫达非尼、糖皮质激素罗格列酮、灰黄霉素、吡格列酮、吉非贝齐、氯贝特、非诺贝特、烟酸、奈法唑酮、考来烯胺、秋水仙碱、考来替泊、扑米酮、托吡酯、曲格列酮、利福布汀、地高辛、噻嗪类、合成代谢类固醇、孕激素、雌激素、达那唑、胺碘酮、贝酸、二十二碳六烯酸,异维A酸,免疫抑制剂,HIV或丙型肝炎病毒的蛋白酶抑制剂,钠-葡萄糖共转运抑制剂,他莫昔芬,雷洛昔芬,非选择性β受体阻滞剂,胆汁酸螯合剂,天冬酰胺酶,西罗莫司和干扰素。
被诊断患有绝症的患者。 最近诊断出癌症或正在接受任何类型的癌症治疗的患者。 患有非黑色素瘤类型皮肤癌且已治愈且在开始参与研究前至少 1 年未接受治疗的患者可以参加。
正在接受降脂治疗的患者,以及由于其临床状况不适合灌洗或排毒期的患者;或拒绝相同。
在开始参与本研究之前的 30 天内,一直在参与另一项临床试验或已经结束参与。
根据研究者的标准,任何其他会危及参与者安全和/或干扰研究结果的。
左旋肉碱、阿托伐他汀剂量 左旋肉碱 1 克 + 阿托伐他汀 20 毫克每天 6 个月和阿托伐他汀 20 毫克每天 6 个月
疗效标准:
通过评估研究开始和结束时生化参数的变异性,将比较联合治疗与阿托伐他汀单一治疗血脂异常的疗效。
研究类型
注册 (实际的)
阶段
- 第三阶段
联系人和位置
学习地点
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Mexico City、墨西哥、04040
- Laboratorios Grossman Sa
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参与标准
资格标准
适合学习的年龄
接受健康志愿者
有资格学习的性别
描述
纳入标准:
- 年龄在 35 至 75 岁之间的墨西哥人。
- 男女不分。
- 血脂异常的患者被认为是血清胆固醇低密度脂蛋白水平为 100 毫克/分升或更高,通过实验室参数获得。
- 未接受药物治疗以控制其血脂异常或接受暂停当前治疗并在从初始评估之日起的接下来的 3 周内评估是否纳入。
- 处于生育期的女性采用安全、无激素的计划生育方法。 安全的计划方法包括女性手术方法、不释放孕激素的宫内节育器以及在所有性关系中使用防腐剂。
- 在参与研究期间不想怀孕的处于生育期的女性。
- 绝经后妇女或有子宫切除史。
- 拥有固定电话和/或移动电话,并接受接收来自研究过程站点的电话。
- 给予他们适当的知情同意。
排除标准:
- 受试者缺乏理解暗示他们参与研究的过程的心智能力,因此不能以自愿的方式同意他们的参与
- 对正在研究的药物过敏史。
- 每天至少摄入 240 毫升葡萄汁或偶尔摄入 1 升。
- 没有安全计划生育方法且希望在研究期间怀孕的潜在生育妇女已经怀孕或处于哺乳期。
- 对墨西哥人具有 Globorisk 量表,或作为相关的风险因素,心血管风险的高分层。
- 根据国际单位,ALT 高于正常上限 1.5 倍的基础实验室值。
CPK 升高的基础实验室值不能归因于身体活动。
- 接受抗凝治疗、患有凝血障碍或任何禁忌采血的情况的受试者。
- 急性心肌梗死、不稳定型心绞痛病史,部分确诊冠状动脉病、心律失常、充血性心力衰竭或脑血管疾病。
- 患者或一级亲属的遗传类型肌肉病史或横纹肌溶解症。
- 先天性肝病、肝炎病毒慢性感染、脂肪肝肝炎、酒精性肝炎、原发性胆汁性肝硬化、原发性硬化症、胆管炎或肝功能衰竭的病史或诊断。
- 先天性肾病、慢性肾功能衰竭、急性肾损伤或肾病综合征的病史或诊断。
- 人类免疫缺陷病毒感染史。
- 急性或慢性胰腺炎病史。
- 以下内分泌疾病史:非控制性糖尿病、脂肪代谢障碍、甲状腺疾病、库欣综合征和/或多囊卵巢综合征。
- 损害免疫力的疾病,例如系统性红斑狼疮、类风湿性关节炎、抗磷脂抗体综合征或牛皮癣。
由沉积引起的疾病,例如戈谢病、由糖原沉积引起的疾病、泰萨克斯幼年病或尼曼匹克病。
- 川崎病、维尔纳综合征、间歇性急性卟啉症、特发性高钾血症或克氏综合征的诊断
- 患有特发性高钾血症、克兰费尔特综合征、沃纳综合征、川崎病或卟啉症。
- 癫痫病史。
- 酗酒史或诊断。
- 每天摄入超过20克酒精。
- 大麻使用者。
- 非法药物使用者。
- 摄入具有药理相互作用的药物,可增加或降低左旋肉碱和/或阿托伐他汀的功效或改变血脂,如红霉素、泰利霉素和克拉霉素。 唑类抗真菌剂如酮康唑、伊曲康唑、氟康唑和奈法唑酮。 槲皮素、胺碘酮、阿瑞匹坦、西咪替丁、环丙沙星、环孢菌素、地尔硫卓、伊马替尼、紫锥菊、依诺沙星、麦角胺、甲硝唑、米非司酮、托非索泮、孕二烯酮、维拉帕米、米贝拉地尔、氟西汀、苯巴比妥、卡马西平、苯妥英钠、利福平、莫达非尼、糖皮质激素罗格列酮、灰黄霉素、吡格列酮、吉非贝齐、氯贝特、非诺贝特、烟酸、奈法唑酮、考来烯胺、秋水仙碱、考来替泊、扑米酮、托吡酯、曲格列酮、利福布汀、地高辛、噻嗪类、合成代谢类固醇、孕激素、雌激素、达那唑、胺碘酮、贝酸、二十二碳六烯酸,异维A酸,免疫抑制剂,HIV或丙型肝炎病毒的蛋白酶抑制剂,葡萄糖钠共转运抑制剂,他莫昔芬,雷洛昔芬,非选择性β受体阻滞剂,胆汁酸螯合剂,天冬酰胺酶,西罗莫司和干扰素。
- 被诊断患有绝症的患者。
- 最近诊断出癌症或正在接受任何类型的癌症治疗的患者。
- 患有非黑色素瘤类型皮肤癌且已治愈且在开始参与研究前至少 1 年未接受治疗的患者可以参加。
- 正在接受降脂治疗的患者,以及由于其临床状况不适合灌洗或排毒期的患者;或者拒绝它。
- 正在参与另一项临床试验或在开始参与本研究前的 30 天内结束参与。
- 根据研究者的标准,任何其他会危及参与者安全和/或干扰研究结果的。
学习计划
研究是如何设计的?
设计细节
- 主要用途:治疗
- 分配:随机化
- 介入模型:并行分配
- 屏蔽:单身的
武器和干预
参与者组/臂 |
干预/治疗 |
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实验性的:实验组
2 片:左旋肉碱 500 毫克口服片剂 + 阿托伐他汀 10 毫克
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每 24 小时口服 2 片阿托伐他汀 10 毫克(每片),持续 6 个月。
其他名称:
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有源比较器:控制组
2 片:阿托伐他汀 10 毫克
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每 24 小时口服 2 片阿托伐他汀 10 毫克(每片),持续 6 个月。
其他名称:
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研究衡量的是什么?
主要结果指标
结果测量 |
措施说明 |
大体时间 |
---|---|---|
胆固醇低密度脂蛋白变化的实验治疗效果
大体时间:6个月
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通过改变 mg/dl 的 C-LDL,评估阿托伐他汀 + 左旋肉碱与单独阿托伐他汀治疗血脂异常的变化
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6个月
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次要结果测量
结果测量 |
措施说明 |
大体时间 |
---|---|---|
胆固醇 no-HDL 变化的实验治疗效果
大体时间:6个月
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在治疗六个月后,通过使用口服途径左旋肉碱 + 阿托伐他汀与使用阿托伐他汀相比,评估患有血脂异常的墨西哥成年人的胆固醇非 HDL 的变化。
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6个月
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总血清胆固醇变化的实验治疗效果
大体时间:6个月
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在治疗六个月后,通过使用口服途径左旋肉碱 + 阿托伐他汀与使用阿托伐他汀相比,评估患有血脂异常的墨西哥成人血清胆固醇水平的变化(mg / dl)。
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6个月
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甘油三酯变化的实验治疗效果
大体时间:6个月
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治疗六个月后,与使用阿托伐他汀相比,通过使用口服途径左旋肉碱 + 阿托伐他汀评估患有血脂异常的墨西哥成人血清甘油三酯水平的降低(以 mg/dl 为单位)
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6个月
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胆固醇高密度脂蛋白变化的实验治疗效果
大体时间:6个月
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在治疗六个月后,通过使用口服途径左旋肉碱 + 阿托伐他汀与使用阿托伐他汀相比,评估患有血脂异常的墨西哥成人血清胆固醇 HDL 水平的变化(mg / dl)
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6个月
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治疗紧急不良事件的发生率(安全性和耐受性)
大体时间:6个月
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评估参与研究的受试者在治疗六个月后与使用阿托伐他汀相比,通过口服途径给予左旋肉碱 + 阿托伐他汀相关的严重和非严重不良事件的发生率
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6个月
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合作者和调查者
调查人员
- 首席研究员:Aurelio Cruz Valdez, PhD、Instituto Nacional de Salud Publica
- 首席研究员:José Flores Figueroa, PhD、JM Research, SC
出版物和有用的链接
一般刊物
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- National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002 Dec 17;106(25):3143-421. No abstract available.
- Piaggio G, Elbourne DR, Pocock SJ, Evans SJ, Altman DG; CONSORT Group. Reporting of noninferiority and equivalence randomized trials: extension of the CONSORT 2010 statement. JAMA. 2012 Dec 26;308(24):2594-604. doi: 10.1001/jama.2012.87802.
- Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, Goldberg AC, Gordon D, Levy D, Lloyd-Jones DM, McBride P, Schwartz JS, Shero ST, Smith SC Jr, Watson K, Wilson PW; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014 Jul 1;63(25 Pt B):2889-934. doi: 10.1016/j.jacc.2013.11.002. Epub 2013 Nov 12. No abstract available. Erratum In: J Am Coll Cardiol. 2014 Jul 1;63(25 Pt B):3024-3025. J Am Coll Cardiol. 2015 Dec 22;66(24):2812.
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有用的网址
- World Health Organization: Global Status report on non-communicable diseases 2014.
- Protocolo clínico para el diagnóstico y tratamiento de las Dislipidemias. CENAPRECE, Secretaría e Salud, D.F. México.
- Treatment of lipids (including hypercholesterolemia) in secondary prevention.
- Detección y Estratificación de Factores de Riesgo Cardiovascular. México, 2010.
- Organization for Economic Cooperation and Development.
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