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Trial registered on ANZCTR
Registration number
ACTRN12616001168448
Ethics application status
Approved
Date submitted
19/08/2016
Date registered
26/08/2016
Date last updated
10/07/2018
Type of registration
Prospectively registered
Titles & IDs
Public title
A study to determine whether myalgia is due to statin use
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Scientific title
Protocol for a N-of-1 (Single-Patient) trial service to determine whether myalgia is due to statin use in a sample of patients with a history of statin-induced myalgia
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Secondary ID [1]
289307
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Nil known
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Statin-induced myalgia
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Condition category
Condition code
Cardiovascular
298978
298978
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0
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Other cardiovascular diseases
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Musculoskeletal
299900
299900
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0
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Other muscular and skeletal disorders
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Rosuvastatin 5mg once daily for 3 weeks followed by a “wash-out period” with a matching placebo for 3 weeks, and followed by matching placebo 3 weeks. Oral capsules
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Intervention code [1]
295664
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Treatment: Drugs
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Comparator / control treatment
matching placebo capsule
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Control group
Placebo
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Outcomes
Primary outcome [1]
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To evaluate the value of N-of-1 trials in determining statin induced myalgia by comparing measures of myalgia (through the Myalgia Score questionnaire, and CK levels in serum assay) in treatment versus control periods.
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Assessment method [1]
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Timepoint [1]
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3, 6, 9, 12, 15, 18, 21, 24 and 27 weeks post randomisation
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Secondary outcome [1]
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To record the number of eligible patients screened and number of those consent to participate
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Assessment method [1]
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Timepoint [1]
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27 weeks post randomisation
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Secondary outcome [2]
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To evaluate the trial drop out rate and reasons for drop out
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Assessment method [2]
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Timepoint [2]
326887
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27 weeks post randomisation
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Secondary outcome [3]
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To evaluate resume rate to statin therapy after completion of N-of-1 trials
the number of participants that will continue statin therapy after completion of the study
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Assessment method [3]
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Timepoint [3]
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6 months post randomisation
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Secondary outcome [4]
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The percentage of participants that are given a final diagnosis of statin-related myalgia at the conclusion of their participation in the N-of-1 service
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Assessment method [4]
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Timepoint [4]
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27 weeks post randomisation
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Eligibility
Key inclusion criteria
Has indication for statin therapy;
History of intolerance of both atorvastatin 10 mg AND rosuvastatin 5 mg monotherapy;
History of statin-related myalgia occuring within three weeks of starting statin therapy and consequently discontinued statin use;
Without clinically significant CK elevations, <3x the upper limit of normal or <3x times the baseline value
Willing to restart statin therapy.
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Minimum age
18
Years
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Maximum age
80
Years
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
Pregnancy;
History of alcohol and/or drug abuse;
Hypothyroidism;
Renal function impairment;
Liver obstructions, patients with elevated liver enzymes (up to 3 times)
History of rhabdomyolysis;
History of metabolic or inflammatory myopathy;
History of neuropathy;
Unlikely to comply with the demands of N-of-1 trial.
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Allocation involved contacting the holder of the allocation schedule who was "off-site" or at central administration site.
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Simple randomisation using a randomisation table created by computer software (i.e. computerised sequence generation)
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people receiving the treatment/s
The people administering the treatment/s
The people assessing the outcomes
The people analysing the results/data
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Intervention assignment
Other
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Other design features
N-of-1 single patient design
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Phase
Phase 4
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Type of endpoint/s
Safety
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Statistical methods / analysis
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Recruitment
Recruitment status
Active, not recruiting
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Date of first participant enrolment
Anticipated
1/10/2016
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Actual
3/04/2017
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Date of last participant enrolment
Anticipated
5/02/2018
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Actual
5/02/2018
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Date of last data collection
Anticipated
31/08/2018
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Actual
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Sample size
Target
15
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Accrual to date
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Final
5
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Recruitment in Australia
Recruitment state(s)
NSW
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Recruitment hospital [1]
6505
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Royal Prince Alfred Hospital - Camperdown
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Recruitment postcode(s) [1]
14069
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2050 - Camperdown
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Funding & Sponsors
Funding source category [1]
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Charities/Societies/Foundations
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Name [1]
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National Heart Foundation Vanguard Grant
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Address [1]
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Level 3, 80 William Street, EAST SYDNEY New South Wales 2010
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Country [1]
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Australia
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Primary sponsor type
Other
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Name
The George Institue for Global Health
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Address
Level 10, King George V Building Missenden Rd, Camperdown NSW 2050
Postal Address: PO Box: M201 Missenden Rd, NSW 2050
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Country
Australia
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Secondary sponsor category [1]
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Hospital
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Name [1]
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Royal Prince Alfred Hospital
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Address [1]
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Level 11 KGV Building, Missenden Rd
Camperdown
2050 NSW
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Country [1]
293180
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Australia
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
295759
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Sydney Local Health District
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Ethics committee address [1]
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c/- Research Ethics and Governance Office (REGO) Royal Prince Alfred Hospital Missenden Road CAMPERDOWN NSW 2050
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Ethics committee country [1]
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Australia
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Date submitted for ethics approval [1]
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09/12/2015
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Approval date [1]
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18/07/2016
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Ethics approval number [1]
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X15-0411
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Summary
Brief summary
National Heart Foundation guidelines recommend long-term statin therapy in several major patient groups, but adherence rates are low, even following life-threatening events such as acute coronary syndrome. Muscle-related symptoms are the most commonly reported reason for statin discontinuation and about 1 in 5 patients taking statins report some degree of muscular pain. Placebo-controlled trials indicate overall in a treated population most symptoms are not due to the statin, but for an individual patient it is typically impossible to be certain. N-of-1 (single-patient multiple crossover) trials offer a simple, intuitive way to resolve this uncertainty. While N-of-1 trials have been used for more than 20 years, to date, few clinical services in Australia are conducting N-of-1 trials on a regular basis to improve the management of individual patient. Fewer studies have looked at the potential of using N-of-1 trials to determine statin tolerability. A recently published study suggested that N-of-1 trials can improve the assessment of statin-related myalgia in selected patients from endocrinology clinics in Canada. However, the results were limited by its small sample size and the potential for expanded use of N-of-1 trials to improve the compliance of statin therapy among statin intolerant patients remains unclear. The study will include up to 15 N-of-1 trial participants. Patients with prior history of intolerance of both atorvastatin 10 mg AND rosuvastatin 5 mg monotherapy, had statin-related myalgia occurring within three weeks of starting statin therapy and consequently discontinued statin use will be invited to participate. Each person will go through 3 double-blind, crossover comparisons of statin versus matching placebo. Each treatment and control period will last for 3-weeks and there will be a 3-week placebo wash out period after each of the active statin treatment. The total trial period for each participant will be 27 weeks. Myalgia scores will be recorded on a weekly basis during the study period. Brief Pain Inventory Questionnaire will be completed and blood sample collection will be done at baseline and at the end of each active treatment and control period to measure serum CK, ALT, AST, FGF21 and creatinine levels. To avoid unblinding of treatment allocation during the trial period, additional blood samples will be stored to measure lipids’ levels upon study completion. Genotype analysis will also be done at the end of the study to determine if genotype is associated with statin-induced myalgia.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Dr Nicole Li
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Address
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The George Institute for Global Health
Level 10 KGV Building
Missenden rd
Camperdown
NSW 2050
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Country
66202
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Australia
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Phone
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+61 2 8052 4507
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Fax
66202
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+61 2 8052 4502
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Email
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[email protected]
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Contact person for public queries
Name
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Nicole Li
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Address
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The George Institute for Global Health
Level 10 KGV Building
Missenden rd
Camperdown
NSW 2050
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Country
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Australia
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Phone
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+61280524507
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Fax
66203
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+61 2 8052 4502
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Email
66203
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[email protected]
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Contact person for scientific queries
Name
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Nicole Li
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Address
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The George Institute for Global Health
Level 10 KGV Building
Missenden rd
Camperdown
NSW 2050
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Country
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Australia
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Phone
66204
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+61280524507
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Fax
66204
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+61 2 8052 4502
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Email
66204
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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