This study aims to verify the hypothesis that patients with Vascular Ehlers Danlos syndrome (vEDS) should benefit of the blockade of angiotensin (Ang) II noxious effects on their vasculature affected by a defect in type III collagen in addition to the effects celiprolol. This randomized, double blind, placebo controlled trial compares the administration of the Ang II type I receptor blocker (ARB) - irbesartan- to placebo over a 2-year period in vEDS patients with the main objective to reduce the incidence of both symptomatic and asymptomatic vascular events.
vEDS is a rare life-threatening inherited condition due to mutations at the COL3A1 gene encoding the pro-alpha 1 chain of type III procollagen (OMIM #130050) with unpredictable and recurring arterial dissections/aneurysms starting in the early adulthood. The investigators have previously shown that a treatment with 200-400 mg per day of celiprolol, reduces both fatal and non-fatal vascular events in patients with vEDS. If tolerated, the treatment is now the standard treatment for vEDS. However, despite celiprolol , symptomatic and asymptomatic arterial events continue to occur in vEDS patients. Recent findings suggest a possible deleterious effect of endogenous Angiotensin II on medium size arteries in vEDS patients. The hypothesis of this study is that the blockade of endogenous Ang II will provide supplemental vascular protection and thus reduce recurrence of arterial events in vEDS patients. The primary objective of this study is to determine in patients with molecularly proven vEDS, whether an Ang II receptor blocker, prescribed at an optimally tolerated dose combined with the reference celiprolol treatment, decreases the 24 months rate of both asymptomatic and symptomatic cardiovascular (CV) events when compared to placebo. Methodology: Multicenter, double-blind, randomized (1:1), placebo-controlled, parallel group, study with blind endpoint evaluation in adult vEDS patients. Main criteria for inclusion: Patients of both sexes aged 18 to 70 years with molecularly proven vEDS, not in an acute phase of the disease, with no contra-indication for taking an Ang II blocker.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
61
Irbesartan: 150 or 300 mg o.d. The up-titration of irbesartan from 150 mg to 300 mg o.d. occur during the first 8 weeks following randomization
Placebo o.d. to match 150mg or 300mg irbesartan tablets
CHU DE BORDEAUX - Hopital Saint Andre
Bordeaux, France
CHU DE LYON - Hopital Femme Mere Enfant
Bron, France
CHU DE CAEN - Hopital Cote de Nacre
Caen, France
CHU DE TOURS - Hopital Trousseau
Chambray-lès-Tours, France
CHU DE GRENOBLE - Hopital Albert Michallon
Grenoble, France
CHU DE GRENOBLE - Hopital Couple Enfant
Grenoble, France
CHRU DE LILLE - Hopital Claude Huriez
Lille, France
CHU DE LYON - Hopital Edouard Herriot
Lyon, France
AP-HM - Hopital de la Timone
Marseille, France
CHU DE MONTPELLIER - Hopital Saint Eloi
Montpellier, France
...and 5 more locations
Cardiovascular morbidity and mortality
Total number of any non-fatal and fatal cardiovascular events or events related to vEDS
Time frame: 2 years
Arterial lesions
number and severity of arterial lesions detected by CTA
Time frame: 2 years
Rate of any symptomatic cardiovascular event
CV death; any morbid and fatal events related to vEDS; Any non fatal CV event; Non-fatal stroke
Time frame: 2 years
Occurrence of new asymptomatic arterial lesions (aneurysm, dissection), detected by a systematic CTA
Arterial dissection/rupture/aneurysm in any vascular bed
Time frame: 2 years
Time to first symptomatic clinical morbid and fatal events
Time frame: 2 years
Number of unplanned hospitalization for any vEDS related event
Time frame: 2 years
Total number of arterial lesions detected by vascular DUS
Echo duplex ultrasound made at inclusion, 6, 12, 18 and 24 months
Time frame: 2 years
Total number of arterial lesions worsened during follow-up
Time frame: 2 years
Changes in PWV (Pulse Wave Velocity)
Applanation tonometry made at randomization visit, 6, 12, 18 and 24 months
Time frame: 2 years
Changes in large arteries properties (diameter, wall stress, stiffness)
Echotracking made at randomization visit, 6, 12, 18 and 24 months
Time frame: 2 years
Decrease in office systolic/diastolic BP
Vital signs (BP and HR) measured by automatic device at each visit
Time frame: 2 years
Change in estimated glomerular filtration rate (MDRD)
eGFR evaluated at each visit
Time frame: 2 years
Tolerability and safety of the irbesartan assessed by orthostatic hypotension, plasma creatinine, plasma K+ evaluated at each visit
Time frame: 2 years
Compliance to treatment
Spot urine for drug determination (celiprolol and irbesartan urinary detection) made at randomization visit and 3, 12 and 24 months
Time frame: 2 years
Quality of life
SF36 and HADS questionnaires submitted to participants at randomization visit, 6, 12 and 24 months
Time frame: 2 years
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