Colesevelam
Tóm tắt
▲ Colesevelam, a bile acid sequestrant used in the treatment of patients with hypercholesterolemia, is a lipid-lowering polymer that has high affinity for bile acids. In animals colesevelam was not systemically absorbed after oral administration and was rapidly eliminated via the gastrointestinal tract. Colesevelam did not alter the serum concentrations or pharmacokinetic properties of drugs from several different classes in healthy volunteers. ▲ Colesevelam administered orally in patients with primary hypercholesterolemia significantly reduced serum levels of low density lipoprotein (LDL)-cholesterol and total cholesterol. This lipid-lowering activity was sustained during short (6 weeks) and longer term (24 weeks) treatment. ▲ Combination therapy with colesevelam plus hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (lovastatin, simvastatin or atorvastatin) was associated with additive reductions in serum levels of LDL-cholesterol and total cholesterol, relative to either agent alone. ▲ Colesevelam treatment was well tolerated and lacked severe gastrointestinal adverse events typical of other bile acid sequestrants (bloating, flatulence, heartburn and nausea). The most frequently reported adverse events were constipation and dyspepsia. In humans colesevelam did not induce clinically significant changes in serum levels of vitamins, coagulation parameters or liver enzymes.
Tài liệu tham khảo
Insull W, Toth P, Mullican W, et al. Cholestagel, a novel, highly potent, polymeric bile acid sequestrant significantly lowers LDL cholesterol [abstract]. J Am Coll Cardiol 2000 Feb; 35(2) Suppl. A: 258
Davidson MH, Dicklin MR, Maki KC, et al. Colesevelam hydrochloride: a non-absorbed, polymeric cholesterol-lowering agent. Expert Opin Invest Drug 2000; 9(11): 2663–71
Sankyo Pharma. Colesevelam hydrochloride Clinical Executive Summary. Sankyo Pharma, Rockville (MD): 2000 Pata on file]
Davidson MH, Toth P, Weiss S, et al. A randomized, double-blind, placebo-controlled trial of colesevelam hydrochloride and lovastatin alone and in combination in subjects with primary hypercholesterolemia. Clin Cardiol. In press
Knapp HH, Schrott H, Ma P, et al. A randomized, double-blind, placebo controlled trial of colesevelam and simvastatin alone and in combination in patients with primary hypercholesterolemia. Am J Med 2001 Apr; 110(5): 351–9
Martin MJ, Hulley SB, Browner WS, et al. Serum cholesterol, blood pressure, and mortality: implications from a cohort of 361 662 men. Lancet 1986 Oct 26; 2(8513): 933–6
Anderson KM, Castelli WP, Levy D. Cholesterol and mortality. JAMA 1987; 257(16): 2176–80
Farnier M, Davignon J. Current and future treatment of hyperlipidemia: the role of statins. Am J Cardiol 1998 Aug 27; 82(4B): 3J–10J
Archbold RA, Timmis AD. Cholesterol lowering and coronary artery disease: mechanisms of risk reduction. Heart 1998 Dec; 80(8): 543–7
Mandeville WH, Arbeeny C. Bile acid sequestrants: their use in combination with other lipid- lowering agents. Drugs 1999; 2(3): 237–42
Lee TH, Cleeman JI, Grundy SM, et al. Clinical goals and performance measures for cholesterol management in secondary prevention of coronary heart disease. JAMA 2000 Jan 5; 283: 94–8
Ansell BJ, Watson KE, Fogelman AM. An evidence-based assessment of the NCEP Adult Treatment Panel II guidelines. JAMA 1999 Dec 1; 282: 2051–7
Lipid Research Clinics Program. The lipid research clinics coronary primary prevention trial results. JAMA 1984; 251(3): 351–64
Lipid Research Clinics Program. The lipid research clinics coronary primary prevention trial results. JAMA 1984; 251(3): 365–74
Pedersen TR, Olsson AG, Faergeman O, et al. Lipoprotein changes and reduction in the incidence of major coronary heart disease events in the Scandinavian Simvastatin Survival study. Circulation 1998; 97: 1453–60
Hodis HN, Mack WJ. Triglyceride-rich lipoproteins and progression of atherosclerosis. Eur Heart J 1998; 19 Suppl. A: A40–4
Anderson LO. Pharmacology of apolipoprotein A-1. Curr Opin Lipidol 1997; 8(4): 225–8
Andrade SE, Walker AM, Gottlieb LK, et al. Discontinuation of anti-hyperlipidemic drugs: do rates reported in clinical trials relect rates in primary care settings? N Engl J Med 1995 Apr 27; 332(17): 1125–31
Dorr AE, Gundersen K, Schneider JC, et al. Colestipol hydrochloride in hypercholesterolemic patients: effect on serum cholesterol and mortality. J Chronic Dis 1978; 31: 5–14
The Lovastatin Study Group III. A multicenter comparison of lovastatin and cholestyramine therapy for severe primary hypercholesterolemia. JAMA 1988 Jul 15; 260(3): 359–66
Safeer RS, Lacivita CL. Choosing drug therapy for patients with hyperlipidemia. Am Fam Physician 2000 Jun 1; 61(11): 3371–82
Davidson MH, Dillon MA, Gordon B, et al. Colesevelam hydrochloride (cholestagel): a new, potent bile acid sequestrant associated with a low incidence of gastrointestinal side effects. Arch Intern Med 1999 Sep 13; 159: 1893–900
Braulin W, Zhorov E, Smisek D, et al. In vitro comparison of bile acid binding to colesevelam and other bile acid sequestrants. Polymer Preprints 2000; 41(1): 708–9
Holmes-Farley SR, Mandeville WH, Miller K, et al. CholestaGel: design and testing of a potent bile acid sequestrant [abstract]. 13th International Symposium on Drugs Affecting Lipid Metabolism; 1998 May 30, 40; Florence
Ose L, MacMahon M, Theisen K, et al. Once per day and split dosing of colesevelam in patients with type IIa hypercholesterolemia. 5th International Symposium on Multiple Risk Factors in Cardiovascular Disease: Global Assessment and Intervention; 1999 Oct 28–31; Venice
Hunninghake D, Insull W, Toth P, et al. Simultaneous administration of colesevelam hydrochloride with atorvastatin additively lowers LDL cholesterol. Atherosclerosis. In press
Rosenbaum DP, Petersen JS, Ducharme S, et al. Absorption, distribution and excretion of GT31-104, a novel bile acid sequestrant, in rats and dogs after acute and subchronic administration. J Pharm Sci 1997; 86(5): 591–5
Shepherd J, Packard CJ, Bicker S, et al. Cholestyramine promotes receptor-mediated low-density-lipoprotein catabolism. N Engl J Med 1980 May 29; 302(22): 1219–22
Einarsson K, Ericsson S, Ewerth S, et al. Bile acid sequestrants: mechanisms of action on bile acid and cholesterol metabolism. Eur J Clin Pharmacol 1991; 40 Suppl. 1: S53–8
Geltex Pharmaceuticals I. NDAs 21–141/21–176 Welchol Tablets Package Insert. Available from: URL: http://www.fda.gov/cderapproval/index [Accessed 2001 May 9]
Grundy SM, Ahrens EH, Salen G. Interruption of the enterohepatic circulation of bile acids in man: comparative effects of cholestyramine and ileal exclusion on cholesterol metabolism. J Lab Clin Med 1971; 78(1): 94–121
Cooper AD. Role of the enterohepatic circulation of bile salts in lipoprotein metabolism. Gastroenterol Clin North Am 1999 Mar; 28(1): 211–29
Donovan JM, Stypinski D, Stiles MR, et al. Drug interactions of colesevelam HCL, a novel potent bile acid binding polymer. Cardiovasc Drugs Therapeutics 2001; 14(6): 681–90
Mesner CH, Burke SK, Olson T. Effect of CholestaGel (Rm) and lovastatin alone and in combination for the treatment of hypercholesterolemia [abstract]. 13th International Symposium on Drugs Affecting Lipid Metabolism; 1998 May 30, 60; Florence