title: Safety, tolerance, and efficacy of extended-release niacin monotherapy for treating dyslipidemia risks in persons with chronic tetraplegia: a randomized multicenter controlled trial.
abstract: OBJECTIVE
  To test the safety, tolerance, and efficacy of extended-release niacin monotherapy on dyslipidemia in persons with chronic tetraplegia.
  
  
  METHODS
  Placebo-controlled, blinded, multicenter, randomized controlled trial.
  
  
  METHODS
  Three spinal cord injury research/rehabilitation centers.
  
  
  METHODS
  Persons with chronic tetraplegia (N=54) and low plasma high-density lipoprotein cholesterol (HDL-C) levels.
  
  
  METHODS
  Extended-release niacin monotherapy (48 weeks; n=31) on a dose-titration schedule versus matched placebo (n=23).
  
  
  METHODS
  Safety was assessed by using percentages of treatment-emergent adverse events and increased levels of hepatic transaminases, uric acid, glycosylated hemoglobin, and fasting glucose. Tolerance was assessed by using participant reports for frequency and intensity of adverse effects of extended-release niacin. Primary effectiveness outcomes were fasting HDL-C level and plasma total cholesterol (TC)/HDL-C ratio. Secondary outcomes included plasma low-density lipoprotein cholesterol (LDL-C) and TC levels and LDL-C/HDL-C ratio.
  
  
  RESULTS
  Significant increases in fasting HDL-C levels (24.5%) were accompanied by decreases in TC/HDL-C and LDL-C/HDL-C ratios, LDL-C levels, and TC levels (all P<.05). No evidence of sustained hepatotoxicity or hyperglycemia was observed. Treatment-emergent withdrawals (12.9%) accompanied flushing (n=1), hypotension/presyncope (n=1), and diarrhea (n=2). One subject experienced transient hyperuricemia. Other drug-reported symptoms did not differ from those for placebo.
  
  
  CONCLUSIONS
  Extended-release niacin monotherapy is safe, tolerated, and effective for most persons with chronic tetraplegia. Special precautions for changes in bowel habits and postadministration hypotension should be observed.
authors.affiliation: Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, FL, USA. mnash@med.miami.edu
authors.forename: Mark S
authors.initials: MS
authors.lastname: Nash
authors.forename: John E
authors.initials: JE
authors.lastname: Lewis
authors.forename: Trevor A
authors.initials: TA
authors.lastname: Dyson-Hudson
authors.forename: Yaga
authors.initials: Y
authors.lastname: Szlachcic
authors.forename: Florence
authors.initials: F
authors.lastname: Yee
authors.forename: Armando J
authors.initials: AJ
authors.lastname: Mendez
authors.forename: Ann M
authors.initials: AM
authors.lastname: Spungen
authors.forename: William A
authors.initials: WA
authors.lastname: Bauman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002784:Cholesterol / Q000097:blood; D002908:Chronic Disease; D003692:Delayed-Action Preparations; D004311:Double-Blind Method; D050171:Dyslipidemias / Q000150:complications* / Q000188:drug therapy*; D005260:Female; D006801:Humans; D000960:Hypolipidemic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009525:Niacin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D011782:Quadriplegia / Q000150:complications*; D014280:Triglycerides / Q000097:blood; D055815:Young Adult
chemical_list: D003692:Delayed-Action Preparations; D000960:Hypolipidemic Agents; D014280:Triglycerides; D009525:Niacin; D002784:Cholesterol