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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Circulation
2016 ; 134
(2
): 114-25
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Clinical Trial of the Protein Farnesylation Inhibitors Lonafarnib, Pravastatin,
and Zoledronic Acid in Children With Hutchinson-Gilford Progeria Syndrome
#MMPMID27400896
Gordon LB
; Kleinman ME
; Massaro J
; D'Agostino RB Sr
; Shappell H
; Gerhard-Herman M
; Smoot LB
; Gordon CM
; Cleveland RH
; Nazarian A
; Snyder BD
; Ullrich NJ
; Silvera VM
; Liang MG
; Quinn N
; Miller DT
; Huh SY
; Dowton AA
; Littlefield K
; Greer MM
; Kieran MW
Circulation
2016[Jul]; 134
(2
): 114-25
PMID27400896
show ga
BACKGROUND: Hutchinson-Gilford progeria syndrome is an extremely rare, fatal,
segmental premature aging syndrome caused by a mutation in LMNA yielding the
farnesylated aberrant protein progerin. Without progerin-specific treatment,
death occurs at an average age of 14.6 years from an accelerated atherosclerosis.
A previous single-arm clinical trial demonstrated that the protein
farnesyltransferase inhibitor lonafarnib ameliorates some aspects of
cardiovascular and bone disease. This present trial sought to further improve
disease by additionally inhibiting progerin prenylation. METHODS: Thirty-seven
participants with Hutchinson-Gilford progeria syndrome received pravastatin,
zoledronic acid, and lonafarnib. This combination therapy was evaluated, in
addition to descriptive comparisons with the prior lonafarnib monotherapy trial.
RESULTS: No participants withdrew because of side effects. Primary outcome
success was predefined by improved per-patient rate of weight gain or carotid
artery echodensity; 71.0% of participants succeeded (P<0.0001). Key
cardiovascular and skeletal secondary variables were predefined. Secondary
improvements included increased areal (P=0.001) and volumetric (P<0.001-0.006)
bone mineral density and 1.5- to 1.8-fold increases in radial bone structure
(P<0.001). Median carotid artery wall echodensity and carotid-femoral pulse wave
velocity demonstrated no significant changes. Percentages of participants with
carotid (5% to 50%; P=0.001) and femoral (0% to 12%; P=0.13) artery plaques and
extraskeletal calcifications (34.4% to 65.6%; P=0.006) increased. Other than
increased bone mineral density, no improvement rates exceeded those of the prior
lonafarnib monotherapy treatment trial. CONCLUSIONS: Comparisons with lonafarnib
monotherapy treatment reveal additional bone mineral density benefit but likely
no added cardiovascular benefit with the addition of pravastatin and zoledronic
acid. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique
identifiers: NCT00879034 and NCT00916747.
|Bone and Bones/diagnostic imaging
[MESH]
|Carotid Arteries/diagnostic imaging
[MESH]
|Child, Preschool
[MESH]
|Diphosphonates/adverse effects/*therapeutic use
[MESH]
|Drug Therapy, Combination
[MESH]
|Female
[MESH]
|Humans
[MESH]
|Imidazoles/adverse effects/*therapeutic use
[MESH]
|Infant
[MESH]
|Male
[MESH]
|Piperidines/adverse effects/pharmacokinetics/*therapeutic use
[MESH]
|Pravastatin/adverse effects/*therapeutic use
[MESH]
|Progeria/*drug therapy
[MESH]
|Prospective Studies
[MESH]
|Protein Prenylation/drug effects
[MESH]
|Pyridines/adverse effects/pharmacokinetics/*therapeutic use
[MESH]