Effect of celiprolol on prevention of cardiovascular events in vascular Ehlers-Danlos syndrome: a prospective randomised, open, blinded-endpoints trial
| Autor: | Jérôme Perdu, Kim-Thanh Ong, Anne De Paepe, G. Georgesco, Pierre Boutouyrie, Jean-Sébastien Hulot, Anne-Laure Fauret, Patrick Collignon, Joseph Emmerich, Jean Noel Fiessinger, Henri Plauchu, Erwan Bozec, Dominique P. Germain, Julie De Backer, Stéphane Laurent, Xavier Jeunemaitre |
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| Rok vydání: | 2010 |
| Předmět: |
Adult
Male medicine.medical_specialty Randomization Adolescent Adrenergic beta-Antagonists Aneurysm Ruptured law.invention Young Adult Randomized controlled trial law Internal medicine Humans Medicine Vascular Diseases Young adult Adverse effect Celiprolol business.industry Hazard ratio General Medicine Adrenergic beta-Agonists Middle Aged medicine.disease Surgery Clinical trial Aortic Dissection Collagen Type III Ehlers–Danlos syndrome Mutation Ehlers-Danlos Syndrome Female business medicine.drug |
| Zdroj: | The Lancet. 376:1476-1484 |
| ISSN: | 0140-6736 0019-0411 |
| DOI: | 10.1016/s0140-6736(10)60960-9 |
| Popis: | Summary Background Vascular Ehlers-Danlos syndrome is a rare severe disease that causes arterial dissections and ruptures that can lead to early death. No preventive treatment has yet been validated. Our aim was to assess the ability of celiprolol, a β 1 -adrenoceptor antagonist with a β 2 -adrenoceptor agonist action, to prevent arterial dissections and ruptures in vascular Ehlers-Danlos syndrome. Methods Our study was a multicentre, randomised, open trial with blinded assessment of clinical events in eight centres in France and one in Belgium. Patients with clinical vascular Ehlers-Danlos syndrome were randomly assigned to 5 years of treatment with celiprolol or to no treatment. Randomisation was done from a centralised, previously established list of sealed envelopes with stratification by patients' age (≤32 years or >32 years). 33 patients were positive for mutation of collagen 3A1 ( COL3A1 ). Celiprolol was administered twice daily and uptitrated every 6 months by steps of 100 mg to a maximum of 400 mg per day. The primary endpoints were arterial events (rupture or dissection, fatal or not). This study is registered with ClinicalTrials.gov, number NCT00190411. Findings 53 patients were randomly assigned to celiprolol (25 patients) or control groups (28). Mean duration of follow-up was 47 (SD 5) months, with the trial stopped early for treatment benefit. The primary endpoints were reached by five (20%) in the celiprolol group and by 14 (50%) controls (hazard ratio [HR] 0·36; 95% CI 0·15–0·88; p=0·040). Adverse events were severe fatigue in one patient after starting 100 mg celiprolol and mild fatigue in two patients related to dose uptitration. Interpretation We suggest that celiprolol might be the treatment of choice for physicians aiming to prevent major complications in patients with vascular Ehlers-Danlos syndrome. Whether patients with similar clinical presentations and no mutation are also protected remains to be established. Funding French Ministry of Health, Programme Hospitalier de Recherche Clinique 2001. |
| Databáze: | OpenAIRE |
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