Journal Article

Effect of celiprolol on prevention of cardiovascular events in vascular Ehlers-Danlos syndrome: a prospective randomised, open, blinded-endpoints trial

Germain, Dominique P, Bozec, Erwan, Georgesco, Gabriella, Hulot, Jean-Sebastien, De Paepe, Anne, Jeunemaitre, Xavier, Fauret, Anne-Laure, Collignon, Patrick, Plauchu, Henri, Emmerich, Joseph, Ong, Kim-Thanh, Fiessinger, Jean-Noël, De Backer, Julie, Perdu, Jérôme, Laurent, Stéphane, Boutouyrie, Pierre

2010

Overview

Vascular Ehlers-Danlos syndrome is a rare severe disease that causes arterial dissections and ruptures that can lead to early death. No preventive treatment has yet been validated. Our aim was to assess the ability of celiprolol, a β1-adrenoceptor antagonist with a β2-adrenoceptor agonist action, to prevent arterial dissections and ruptures in vascular Ehlers-Danlos syndrome. Our study was a multicentre, randomised, open trial with blinded assessment of clinical events in eight centres in France and one in Belgium. Patients with clinical vascular Ehlers-Danlos syndrome were randomly assigned to 5 years of treatment with celiprolol or to no treatment. Randomisation was done from a centralised, previously established list of sealed envelopes with stratification by patients' age (≤32 years or >32 years). 33 patients were positive for mutation of collagen 3A1 (COL3A1). Celiprolol was administered twice daily and uptitrated every 6 months by steps of 100 mg to a maximum of 400 mg per day. The primary endpoints were arterial events (rupture or dissection, fatal or not). This study is registered with ClinicalTrials.gov, number NCT00190411. 53 patients were randomly assigned to celiprolol (25 patients) or control groups (28). Mean duration of follow-up was 47 (SD 5) months, with the trial stopped early for treatment benefit. The primary endpoints were reached by five (20%) in the celiprolol group and by 14 (50%) controls (hazard ratio [HR] 0·36; 95% CI 0·15–0·88; p=0·040). Adverse events were severe fatigue in one patient after starting 100 mg celiprolol and mild fatigue in two patients related to dose uptitration. We suggest that celiprolol might be the treatment of choice for physicians aiming to prevent major complications in patients with vascular Ehlers-Danlos syndrome. Whether patients with similar clinical presentations and no mutation are also protected remains to be established. French Ministry of Health, Programme Hospitalier de Recherche Clinique 2001.

• Publisher: Elsevier Ltd,Elsevier,Elsevier Limited
• Subject: Adolescent / Adrenergic beta-Agonists - therapeutic use / Adrenergic beta-Antagonists - therapeutic use / Adult / Aneurysm, Dissecting - etiology / Aneurysm, Dissecting - prevention & control / Aneurysm, Ruptured - etiology / Aneurysm, Ruptured - prevention & control / Biological and medical sciences / Blood pressure / Celiprolol - therapeutic use / Collagen / Collagen Type III - genetics / Deoxyribonucleic acid / Dissection / DNA / Ehlers-Danlos Syndrome - complications / Ehlers-Danlos Syndrome - diagnosis / Ehlers-Danlos Syndrome - genetics / Fatigue / Female / General aspects / Genetic testing / Humans / Internal Medicine / Male / Medical sciences / Middle Aged / Mutation / Prevention and actions / Public health. Hygiene / Public health. Hygiene-occupational medicine / Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis / Vascular Diseases - etiology / Vascular Diseases - prevention & control / Young Adult