Effects of laropiprant on nicotinic acid-induced flushing in patients with dyslipidemia

Merck Research Laboratories, Rahway, NJ, USA.
The American Journal of Cardiology (Impact Factor: 3.43). 04/2008; 101(5):625-30. DOI: 10.1016/j.amjcard.2007.10.023
Source: PubMed

ABSTRACT Niacin (nicotinic acid) is not optimally used mainly because of flushing, a process mediated primarily by prostaglandin D(2), which leads to poor patient compliance and suboptimal dosing. This phase II dose-ranging study was designed to assess whether the prostaglandin D(2) receptor 1 antagonist laropiprant (LRPT; MK-0524) would (1) reduce extended-release niacin (ERN)-induced flushing in dyslipidemic patients and (2) support a novel accelerated ERN dosing paradigm: initiating ERN at 1 g and advancing rapidly to 2 g. In part A of the study, 154 dyslipidemic patients were randomized to LRPT 150 mg/day or placebo in a 9-week, 2-period crossover study. Patients who completed part A (n = 122) entered part B (after a 2-week washout), together with additional patients who entered part B directly (n = 290). Part B patients were randomized to placebo, ERN 1 g (Niaspan, no previous titration), or ERN 1 g coadministered with LRPT 18.75, 37.5, 75, or 150 mg for 4 weeks, with doubling of the respective doses for the remaining 4 weeks. Patients treated with LRPT plus ERN experienced significantly less ERN-induced flushing than those treated with ERN alone during the initiation of treatment (ERN 1 g, week 1) and the maintenance treatment (ERN 1 to 2 g, weeks 2 to 8). All doses of LRPT were maximally effective in inhibiting niacin-induced flushing. LRPT did not alter the beneficial lipid effects of ERN. LRPT plus ERN was well tolerated. In conclusion, the significant reduction in ERN-induced flushing provided by LRPT plus ERN supports an accelerated ERN dose-advancement paradigm to achieve rapidly a 2-g dose in dyslipidemic patients.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Complex formation of divalent transition metal ions (copper(II), cobalt(II) and nickel(II)), vitamin B3 (nicotinic acid) and glycine oligopeptides (glycine, glycylglycine, glycyl-l-phenylalanine, and glycylglycylglycine) were studied at 298 K in aqueous solutions using the pH-potentiometric technique. The copper Cu(II), cobalt Co(II), and nickel Ni(II) complexing capacity of vitamin B3 in the absence and in the presence of glycine peptides and their overall stability constants in aqueous solutions were obtained and explained by the HYPERQUAD 2008 program using the potentiometric data. From the protonation and complex formation constants, representative complex species distribution diagrams were obtained using HYSS 2009 software. The UV–Vis spectroscopic, cyclic voltammeteric and conductometric titration measurements were carried out to give qualitative information about the conformation of the complexes formed in these solutions and their stoichiometric ratios. The Gibbs energies and the molecular structures of the complexes were evaluated and predicted using Gaussian 09 software molecular modeling and density functional theory calculations.
    Journal of Solution Chemistry 11/2013; 42(12):2409-2442. DOI:10.1007/s10953-013-0116-5 · 1.08 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Several studies have shown an inverse relationship between HDL cholesterol (HDL-C) levels and the risk of cardiovascular disease. Low HDL-C levels are commonly present in subjects with diabetes, metabolic syndrome, or obesity. These observations have suggested that increasing HDL concentrations might help in decreasing the cardiovascular disease risk. However, despite initial positive results, some recent data from clinical trials with HDL-raising therapies failed to confirm this hypothesis; in addition, data from Mendelian randomization analyses showed that nucleotide polymorphisms associated with increased HDL-C levels did not decrease the risk of myocardial infarction, further challenging the concept that higher HDL-C levels will automatically translate into lower cardiovascular disease risk. Differences in the quality and distribution of HDL particles might partly explain these findings, and in agreement with this hypothesis, some observations have suggested that HDL subpopulation levels may be better predictors of cardiovascular disease than simple HDL-C levels. Thus, it is expected that increased HDL-C levels may be beneficial when associated with an improvement in HDL function, suggesting that pharmacological approaches able to correct or increase HDL functions might produce more reliable clinical benefits.
    Current Atherosclerosis Reports 08/2014; 16(8):429. DOI:10.1007/s11883-014-0429-x · 3.06 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The degree of glycemic control in patients with type 2 diabetes mellitus (T2DM) may alter lipid levels and may alter the efficacy of lipid-modifying agents. Evaluate the lipid-modifying efficacy of extended-release niacin/laropiprant (ERN/LRPT) in subgroups of patients with T2DM with better or poorer glycemic control. Post hoc analysis of clinical trial data from patients with T2DM who were randomized 4:3 to double-blind ERN/LRPT or placebo (n=796), examining the lipid-modifying effects of ERN/LRPT in patients with glycosylated hemoglobin or fasting plasma glucose levels above and below median baseline levels. At Week 12 of treatment, ERN/LRPT significantly improved low-density lipoprotein cholesterol, high-density lipoprotein cholesterol (HDL-C), non-high-density lipoprotein cholesterol, triglycerides, and lipoprotein (a), compared with placebo, with equal efficacy in patients above or below median baseline glycemic control. Compared with placebo, over 36 weeks of treatment more patients treated with ERN/LRPT had worsening of their diabetes and required intensification of antihyperglycemic medication, irrespective of baseline glycemic control. Incidences of other adverse experiences were generally low in all treatment groups. The lipid-modifying effects of ERN/LRPT are independent of the degree of baseline glycemic control in patients with T2DM (NCT00485758).
    Journal of Clinical Lipidology 05/2012; 6(3):270-271. DOI:10.1016/j.jacl.2012.04.041 · 3.59 Impact Factor