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Cozaar

Clinical Pharmacology
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Clinical Pharmacology

The mean baseline blood pressures were 152/82 mmHg for COZAAR plus conventional antihypertensive therapy and 153/82 mmHg for placebo plus conventional antihypertensive therapy. At the end of the study, the mean blood pressures were 143/76 mmHg for the group treated with COZAAR and 146/77 mmHg for the group treated with placebo.


Kaplan-Meier curve for the primary composite endpoint of doubling of serum creatinine, end stage renal disease (need for dialysis or transplantation) or death - illustration

Figure 4. Kaplan-Meier curve for the primary composite endpoint of doubling of serum creatinine, end stage renal disease (need for dialysis or transplantation) or death.

Table 3 Incidence of Primary Endpoint Events


  Incidence Risk Reduction 95% C.I. p-Value
Losartan Placebo        
Primary Composite Endpoint 43.5% 47.1% 16.1% 2.3 to 27.9% 0.022
Doubling of Serum Creatinine, ESRD and Death Occurring as a First Event
  Doubling of Serum Creatinine 21.6% 26.0%      
  ESRD 8.5% 8.5%      
  Death 13.4% 12.6%      
Overall Incidence of Doubling of Serum Creatinine, ESRD and Death
Doubling of Serum Creatinine 21.6% 26.0% 25.3% 7.8% to 39.4% 0.006
ESRD 19.6% 25.5% 28.6% 11.5% to 42.4% 0.002
Death 21.0% 20.3% -1.7% -26.9% to 18.6% 0.884

The secondary endpoints of the study were change in proteinuria, change in the rate of progression of renal disease, and the composite of morbidity and mortality from cardiovascular causes (hospitalization for heart failure, myocardial infarction, revascularization, stroke, hospitalization for unstable angina, or cardiovascular death). Compared with placebo, COZAAR significantly reduced proteinuria by an average of 34%, an effect that was evident within 3 months of starting therapy, and significantly reduced the rate of decline in glomerular filtration rate during the study by 13%, as measured by the reciprocal of the serum creatinine concentration. There was no significant difference in the incidence of the composite endpoint of cardiovascular morbidity and mortality.

The favorable effects of COZAAR were seen in patients also taking other anti-hypertensive medications (angiotensin II receptor antagonists and angiotensin converting enzyme inhibitors were not allowed), oral hypoglycemic agents and lipid-lowering agents.

For the primary endpoint and ESRD, the effects of COZAAR in patient subgroups defined by age, gender and race are shown in Table 4 below. Subgroup analyses can be difficult to interpret and it is not known whether these represent true differences or chance effects.

Table 4 Efficacy Outcomes within Demographic Subgroups


    Primary Composite End point ESRD
  No. of Patients COZAAR Event Rate
%
Placebo Event Rate
%
Hazard Ratio
(95% CI)
COZAAR Event Rate
%
Placebo Event Rate
%
Hazard Ratio
(95% CI)
Overall Results 1513 43.5 47.1 0.839 (0.721, 0.977) 19.6 25.5 0.714 (0.576, 0.885)
Age
   < 65 years 1005 44.1 49.0 0.784 (0.653, 0.941) 21.1 28.5 0.670 (0.521, 0.863)
    ≥ 65 years 508 42.3 43.5 0.978 (0.749, 1.277) 16.5 19.6 0.847 (0.560, 1.281)
Gender
   Female 557 47.8 54.1 0.762 (0.603, 0.962) 22.8 32.8 0.601 (0.436, 0.828)
   Male 956 40.9 43.3 0.892 (0.733, 1.085) 17.5 21.5 0.809 (0.605, 1.081)
Race
   Asian 252 41.9 54.8 0.655 (0.453, 0.947) 18.8 27.4 0.625 (0.367, 1.066)
   Black 230 40.0 39.0 0.983 (0.647, 1.495) 17.6 21.0 0.831 (0.456, 1.516)
   Hispanic 277 55.0 54.0 1.003 (0.728, 1.380) 30.0 28.5 1.024 (0.661, 1.586)
   White 735 40.5 43.2 0.809 (0.645, 1.013) 16.2 23.9 0.596 (0.427, 0.831)
Brand Name: Cozaar
Generic Name: Losartan Potassium
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