Cardiovascular Diseases, Obesity
Conditions
Keywords
Drug therapy
Brief summary
The purpose of this study is to evaluate cardiovascular (CV) safety of naltrexone hydrochloride (HCl) and bupropion HCl extended release combination (NB) compared with placebo and rule out excess risk of major adverse cardiovascular events (MACE) when given in combination with standard of care in overweight and obese participants with documented history of CV disease.
Detailed description
The drug being evaluated in this study is naltrexone hydrochloride (HCl) and bupropion HCl extended release combination (NB). NB is being evaluated in this study to rule out excess cardiovascular risk. This study will evaluate the occurrence of major adverse CV events in participants who take NB compared with placebo given in combination with standard of care in overweight and obese participants with documented history of CV disease. The study will enroll approximately 8800 patients. After a 2-week lead-in period evaluating tolerance to NB (participants were randomly assigned in a 1:1 ratio to 1 week of NB \[1 tablet per day\] followed by 1 week of placebo \[1 tablet per day\] or 1 week of placebo followed by 1 week of NB), participants will be randomly assigned to one of two treatment groups in a 1:1 ratio, which will remain undisclosed to the patient, study site personnel, and investigator/study physician during the study (unless there is an urgent medical need): * Naltrexone HCl 8 mg/bupropion 90 mg extended release combination tablets * Placebo (dummy inactive pill) - this is a tablet that looks like the study drug but has no active ingredient All participants will be asked to take tablet(s) in the AM and PM at the same time each day throughout the study. This multi-center trial will be conducted in the United States. The overall time to participate in this study is up to 6 years. Participants will make multiple visits to the clinic, and will be contacted by telephone 30 days after last dose of study drug for a follow-up assessment.
Interventions
DRUGNaltrexone HCl/Bupropion HCl ER
Naltrexone HCl 8 mg/bupropion HCl 90 mg ER combination tablets
DRUGPlacebo
Naltrexone HCl/bupropion HCl placebo-matching tablets
Sponsors
Orexigen Therapeutics, Inc
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1\. In the opinion of the investigator, the participant is capable of understanding and complying with protocol requirements. 2\. Participant signs and dates a written, informed consent form and any required privacy authorization prior to the initiation of any study procedures. 3\. Has body mass index (BMI) ≥27.0 kg/m\^2 at Screening. 4. Is male or female and aged ≥18 years at Screening. 5. A female participant of childbearing potential who is sexually active with a nonsterilized male partner agrees to use routinely adequate contraception from signing of informed consent through 12 weeks after the last dose of study medication. 6\. Participant meets at least 1 the following categories of cardiovascular (CV) disease (a-c): 1. Documented coronary artery disease (at least 1 of the following 2 criteria must be satisfied): 1. A documented history of myocardial infarction (MI) occurring greater than 3 months prior to Screening. 2. History of coronary revascularization with at least 1 of the following: 1. Coronary artery bypass graft surgery occurring greater than 3 months prior to Screening. 2. Percutaneous coronary intervention (PCI) occurring greater than 3 months prior to Screening. 2. Documented peripheral arterial disease (at least 1 of the following 3 criteria must be satisfied): 1. Current intermittent claudication or verified ischemic ulcer(s) together with documented ankle-brachial index ≤0.85. 2. History of previous vascular intervention for intermittent claudication or resting limb ischemia greater than 3 months prior to Screening (example: amputation for arterial disease, peripheral bypass, or history of angioplasty/stenting). 3. History of symptomatic carotid artery disease (requiring revascularization with carotid endarterectomy or stenting) greater than 3 months prior to Screening or ≥50% stenosis on at least one carotid artery documented by duplex ultrasonography, magnetic resonance angiography, computed tomographic angiography, or catheter-based contrast angiography. 3. Documented cerebrovascular disease (at least 1 of the following 2 criteria must be satisfied): 1. A history of transient ischemic attack confirmed by a neurologist greater than 3 months prior to Screening and clinically and neurologically stable at Screening. 2. A history of ischemic stroke (with a Modified Rankin Scale Score ≤3) greater than 3 months prior to Screening and clinically and neurologically stable at Screening.
Exclusion criteria
1. Has received any investigational compound or investigational device within 3 months prior to Screening. 2. Is an immediate family member, study site employee, or is in a dependent relationship with a study site employee who is involved in conduct of this study (eg, spouse, parent, child, sibling) or may consent under duress. 3. Has had an MI or unstable angina within 3 months of Screening. 4. Has planned bariatric surgery, cardiac surgery, coronary revascularization, or peripheral artery revascularization. 5. Has history of bariatric surgery (eg, Roux-en-Y gastric bypass, duodenal switch, or sleeve gastrectomy). 6. Has had a procedure for weight loss other than bariatric surgery (eg, gastric banding or any other devices that maybe used in obesity treatment) within past 12 months prior to Screening. 7. Has a history of hypersensitivity or allergies to any component of naltrexone hydrochloride (HCl) and bupropion HCl extended release combination (NB) or excipients. 8. Has a history of cancer that has been in remission for \<5 years prior to Screening. A history of basal cell carcinoma or Stage 1 squamous cell carcinoma of the skin is allowed. 9. Is hemodynamically unstable, including severe heart failure (New York Heart Association Class IV) at Screening. 10. Has a history of drug abuse (defined as any illicit drug use) or a history of alcohol abuse within 2 years prior to Screening. 11. Has been randomized into a previous NB (Contrave) study or has been exposed to commercially available NB (Contrave) for any period of time prior to Screening. 12. Is taking excluded medications within 28 days of Screening. 13. Has uncontrolled hypertension defined by systolic blood pressure (SBP) ≥160 mm Hg and/or ≥100 mm Hg diastolic blood pressure (DBP) on the average of two seated blood pressure measurements after being at rest at least 5 minutes, confirmed on 2 separate days during the Screening Period. 14. Has severe renal impairment defined by estimated glomerular filtration rate (eGFR) \<30 ml/min/1.73 m\^2 based on the Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI) at Screening. 15. Has a clinical history of liver failure. 16. Has a known infection with human immunodeficiency virus that is being treated with ritonavir, lopinavir or efavirenz. 17. Has known acute hepatitis at Screening. 18. Has chronic use of opioids, defined as longer than 3 months prior to Screening. 19. Has a positive drug screen for cocaine, methamphetamine, methadone, opiates, oxycodone, phencyclidine, and propoxyphene at Screening. A positive screen for amphetamines, barbiturates, benzodiazepines, and cannabinoids is exclusionary if abuse or dependence is suspected. 20. Has a history of seizures (including febrile seizures), cranial trauma, or other conditions that predispose the participant to seizures. 21. Has a history of mania, history of or current diagnosis of bipolar disorder or current diagnosis of active psychosis, active bulimia or anorexia nervosa (binge eating disorder is not exclusionary). 22. Is at risk for suicide attempts based on the judgment of the investigator. 23. If female, the participant is pregnant (confirmed by laboratory testing at screening) or lactating or intending to become pregnant from signing the informed consent through 12 weeks after last dose of study medication; or intending to donate ova during such time period. 24. Has a history of severe ischemic stroke (with a Modified Rankin Scale Score ≥4). 25. Has any major illness or condition that, in the investigator's opinion, prohibits the participant from participating in the study or meeting the planned visit schedule. 26. Is unable to understand verbal or written English or any other language, for which a certified translation of the approved informed consent is available. Additional
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Time From Treatment Period Randomization to the First Confirmed Occurrence of Major Adverse Cardiovascular Events (MACE) | Day 1 to first confirmed occurrence of MACE (up to 6 years) | MACE are defined as cardiovascular death, nonfatal myocardial infarction and nonfatal stroke. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time From Treatment Period Randomization to the First Confirmed Occurrence of Extended Major Adverse Cardiovascular Events (MACE) | Day 1 to first confirmed occurrence of extended MACE (up to 6 years) | Extended MACE defined as cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, and unstable angina requiring hospitalization. |
| Time From Treatment Period Randomization to the Occurrence of All-Cause Death | Day 1 to the occurrence of all-cause death (up to 6 years) | — |
| Time From Treatment Period Randomization to the Occurrence of Cardiovascular Death | Day 1 to the occurrence of cardiovascular death (up to 6 years) | — |
Countries
United States
Participant flow
Pre-assignment details
Sixty-seven (67) participants randomized into the double-blind lead-in period (Enrolled Set), while 58 participants were randomized into the double-blind treatment period (Full Analysis Set).
Participants by arm
| Arm | Count |
|---|---|
| Naltrexone/Bupropion Naltrexone HCl 8 mg/bupropion HCl 90 mg ER combination tablets, orally, one tablet, in the morning (AM), daily, for 1 week, followed by naltrexone HCl 8 mg/bupropion HCl 90 mg ER combination tablets, orally, one tablet in the AM and one in the evening (PM), daily, for 1 week, followed by naltrexone HCl 8 mg/bupropion HCl 90 mg ER combination tablets, orally, two tablets in the AM and one in the PM, daily, for 1 week, followed by naltrexone HCl 8 mg/bupropion HCl 90 mg ER combination tablets, orally, two tablets in the AM and two in the PM, daily, for up to 6 years.
Naltrexone HCl/Bupropion HCl ER: Naltrexone HCl 8 mg/bupropion HCl 90 mg ER combination tablets | 28 |
| Placebo Naltrexone/bupropion placebo-matching tablets, orally, one tablet in the AM, daily, for 1 week, followed by naltrexone/bupropion placebo-matching tablets, orally, one tablet in the AM and one in the PM, daily, for 1 week, followed by naltrexone/bupropion placebo-matching tablets, orally, two tablets in the AM and one in the PM, daily, for 1 week, followed by naltrexone/bupropion placebo-matching tablets, orally, two tablets in the AM and two in the PM, daily, for up to 6 years.
Placebo: Naltrexone HCl/bupropion HCl placebo-matching tablets | 30 |
| Total | 58 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Study terminated | 28 | 30 |
Baseline characteristics
| Characteristic | Naltrexone/Bupropion | Placebo | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 9 Participants | 16 Participants | 25 Participants |
| Age, Categorical Between 18 and 65 years | 19 Participants | 14 Participants | 33 Participants |
| Age, Continuous | 61.3 years STANDARD_DEVIATION 9.29 | 65.5 years STANDARD_DEVIATION 7.04 | 63.5 years STANDARD_DEVIATION 8.4 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 2 Participants | 2 Participants | 4 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 26 Participants | 28 Participants | 54 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 1 Participants | 0 Participants | 1 Participants |
| Race (NIH/OMB) Black or African American | 7 Participants | 7 Participants | 14 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 1 Participants | 0 Participants | 1 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 19 Participants | 23 Participants | 42 Participants |
| Sex: Female, Male Female | 6 Participants | 9 Participants | 15 Participants |
| Sex: Female, Male Male | 22 Participants | 21 Participants | 43 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 1 / 28 | 2 / 30 |
| serious Total, serious adverse events | 2 / 28 | 2 / 30 |
Outcome results
Primary
Time From Treatment Period Randomization to the First Confirmed Occurrence of Major Adverse Cardiovascular Events (MACE)
MACE are defined as cardiovascular death, nonfatal myocardial infarction and nonfatal stroke.
Time frame: Day 1 to first confirmed occurrence of MACE (up to 6 years)
Population: The trial was prematurely terminated. Due to the short trial duration and as a result of very limited participant follow-up, insufficient data was collected (or did not exist) to allow for a statistical analysis as described in the protocol. The necessary and sufficient data to conduct the primary and secondary analyses was not available.
Secondary
Time From Treatment Period Randomization to the First Confirmed Occurrence of Extended Major Adverse Cardiovascular Events (MACE)
Extended MACE defined as cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, and unstable angina requiring hospitalization.
Time frame: Day 1 to first confirmed occurrence of extended MACE (up to 6 years)
Population: The trial was prematurely terminated. Due to the short trial duration and as a result of very limited participant follow-up, insufficient data was collected (or did not exist) to allow for a statistical analysis as described in the protocol. The necessary and sufficient data to conduct the primary and secondary analyses was not available.
Secondary
Time From Treatment Period Randomization to the Occurrence of All-Cause Death
Time frame: Day 1 to the occurrence of all-cause death (up to 6 years)
Population: The trial was prematurely terminated. Due to the short trial duration and as a result of very limited participant follow-up, insufficient data was collected (or did not exist) to allow for a statistical analysis as described in the protocol. The necessary and sufficient data to conduct the primary and secondary analyses was not available.
Secondary
Time From Treatment Period Randomization to the Occurrence of Cardiovascular Death
Time frame: Day 1 to the occurrence of cardiovascular death (up to 6 years)
Population: The trial was prematurely terminated. Due to the short trial duration and as a result of very limited participant follow-up, insufficient data was collected (or did not exist) to allow for a statistical analysis as described in the protocol. The necessary and sufficient data to conduct the primary and secondary analyses was not available.