title: Safety and efficacy of dalcetrapib on atherosclerotic disease using novel non-invasive multimodality imaging (dal-PLAQUE): a randomised clinical trial.
abstract: BACKGROUND
  Dalcetrapib modulates cholesteryl ester transfer protein (CETP) activity to raise high-density lipoprotein cholesterol (HDL-C). After the failure of torcetrapib it was unknown if HDL produced by interaction with CETP had pro-atherogenic or pro-inflammatory properties. dal-PLAQUE is the first multicentre study using novel non-invasive multimodality imaging to assess structural and inflammatory indices of atherosclerosis as primary endpoints.
  
  
  METHODS
  In this phase 2b, double-blind, multicentre trial, patients (aged 18-75 years) with, or with high risk of, coronary heart disease were randomly assigned (1:1) to dalcetrapib 600 mg/day or placebo for 24 months. Randomisation was done with a computer-generated randomisation code and was stratified by centre. Patients and investigators were masked to treatment. Coprimary endpoints were MRI-assessed indices (total vessel area, wall area, wall thickness, and normalised wall index [average carotid]) after 24 months and (18)F-fluorodeoxyglucose ((18)F-FDG) PET/CT assessment of arterial inflammation within an index vessel (right carotid, left carotid, or ascending thoracic aorta) after 6 months, with no-harm boundaries established before unblinding of the trial. Analysis was by intention to treat. This trial is registered at ClinicalTrials.gov, NCT00655473.
  
  
  RESULTS
  189 patients were screened and 130 randomly assigned to placebo (66 patients) or dalcetrapib (64 patients). For the coprimary MRI and PET/CT endpoints, CIs were below the no-harm boundary or the adverse change was numerically lower in the dalcetrapib group than in the placebo group. MRI-derived change in total vessel area was reduced in patients given dalcetrapib compared with those given placebo after 24 months; absolute change from baseline relative to placebo was -4·01 mm(2) (90% CI -7·23 to -0·80; nominal p=0·04). The PET/CT measure of index vessel most-diseased-segment target-to-background ratio (TBR) was not different between groups, but carotid artery analysis showed a 7% reduction in most-diseased-segment TBR in the dalcetrapib group compared with the placebo group (-7·3 [90% CI -13·5 to -0·8]; nominal p=0·07). Dalcetrapib did not increase office blood pressure and the frequency of adverse events was similar between groups.
  
  
  CONCLUSIONS
  Dalcetrapib showed no evidence of a pathological effect related to the arterial wall over 24 months. Moreover, this trial suggests possible beneficial vascular effects of dalcetrapib, including the reduction in total vessel enlargement over 24 months, but long-term safety and clinical outcomes efficacy of dalcetrapib need to be analysed.
  
  
  BACKGROUND
  F Hoffmann-La Roche Ltd.
authors: Translational and Molecular Imaging Institute and Department of Radiology, Mount Sinai School of Medicine, New York, NY 10029, USA. zahi.fayad@mssm.edu
authors: Zahi A
authors: ZA
authors: Fayad
authors: Venkatesh
authors: V
authors: Mani
authors: Mark
authors: M
authors: Woodward
authors: David
authors: D
authors: Kallend
authors: Markus
authors: M
authors: Abt
authors: Tracy
authors: T
authors: Burgess
authors: Valentin
authors: V
authors: Fuster
authors: Christie M
authors: CM
authors: Ballantyne
authors: Evan A
authors: EA
authors: Stein
authors: Jean-Claude
authors: JC
authors: Tardif
authors: James H F
authors: JH
authors: Rudd
authors: Michael E
authors: ME
authors: Farkouh
authors: Ahmed
authors: A
authors: Tawakol
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000577:Amides; D000924:Anticholesteremic Agents / Q000008:administration & dosage*; D016001:Confidence Intervals; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000517:prevention & control*; D023921:Coronary Stenosis / Q000175:diagnosis / Q000517:prevention & control*; D003952:Diagnostic Imaging / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D064420:Drug-Related Side Effects and Adverse Reactions; D004952:Esters; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006937:Hypercholesterolemia / Q000175:diagnosis / Q000188:drug therapy*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods; D012016:Reference Values; D018570:Risk Assessment; D013438:Sulfhydryl Compounds / Q000008:administration & dosage*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000577:Amides; D000924:Anticholesteremic Agents; D004952:Esters; D013438:Sulfhydryl Compounds; C411602:dalcetrapib