Parenteral therapy with lipo-ecraprost, a lipid-based formulation of a PGE1 analog, does not alter six-month outcomes in patients with critical leg ischemia.
OBJECTIVE
Eicosanoids with vasodilating and angiogenic properties have been postulated to be effective therapies for critical leg ischemia (CLI) secondary to atherosclerotic peripheral arterial disease. The ability to deliver active drug to the site of action at adequate doses for sufficient duration has been a major limitation in the clinical development of such therapies. Lipo-ecraprost is a lipid-encapsulated prostaglandin E1 prodrug with the potential to deliver active prostaglandin to the site of critical arterial ischemia. The current trial was designed to test the hypothesis that lipo-ecraprost would improve amputation-free survival in patients with CLI who had no revascularization options.


METHODS
The study was randomized, multicenter, double blind, and placebo controlled. Patients who met clinical and hemodynamic criteria were randomized to receive placebo or lipo-ecraprost (60 microg) administered intravenously on each of 5 days per week, for a total of 8 weeks. The study's primary endpoint was the rate of a composite end point of death or amputation above the level of the ankle at 180 days (6 months).


RESULTS
The study was terminated on a recommendation from the Data and Safety Monitoring Board after the completion of a protocol-specified interim analysis for futility. At the time of termination, 383 of the planned 560 patients had been randomized, of which 379 received at least one dose of study medication and thus were included in the intention-to-treat population. Twenty-three patients were lost to follow-up and were not available for 6-month assessments. At 6 months of follow-up, there were 23 amputations in the 177 patients who received placebo, and 29 amputations in the 179 patients randomized to lipo-ecraprost. At 6 months, 10 deaths had occurred in the placebo group and 18 deaths had occurred in the lipo-ecraprost arm. Changes in lower-extremity hemodynamics over the 6-month study period did not differ between the placebo and lipo-ecraprost treatment arms.


CONCLUSIONS
Intensive treatment with lipo-ecraprost failed to modify the 6-month amputation rate in patients with CLI who were not candidates for revascularization.
Brass
Eric P
EP
Harbor-UCLA Medical Center for Clinical Pharmacology, Torrance, California 90502, USA. ebrass@ucla.edu
Anthony
Richard
R
Dormandy
John
J
Hiatt
William R
WR
Jiao
Jenny
J
Nakanishi
Atsushi
A
McNamara
Thomas
T
Nehler
Mark
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000527:Alprostadil / Q000031:analogs & derivatives*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004337:Drug Carriers; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016285:Iloprost / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D007383:Intermittent Claudication / Q000000981:diagnostic imaging / Q000188:drug therapy; D007511:Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy*; D007866:Leg / Q000098:blood supply*; D023821:Limb Salvage / Q000379:methods; D008055:Lipids; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D016491:Peripheral Vascular Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy; D012016:Reference Values; D018570:Risk Assessment; D016896:Treatment Outcome; D014463:Ultrasonography
D004337:Drug Carriers; D008055:Lipids; D000527:Alprostadil; D016285:Iloprost