Disposition of HMG-CoA reductase inhibitors, including rosuvastatin, involves OATP1B1 and other transporter proteins. Higher plasma concentrations of rosuvastatin have been reported in very small groups of patients (n=3 to 5) who have two reduced function alleles of the gene that encodes OATP1B1 (SLCO1B1 521T > C). The frequency of this genotype (i.e., SLCO1B1 521 C/C) is generally lower than 5% in most racial/ethnic groups. The impact of this polymorphism on efficacy and/or safety of rosuvastatin has not been clearly established.
In a 104-week carcinogenicity study in rats at dose levels of 2, 20, 60, or 80 mg/kg/day by oral gavage, the incidence of uterine stromal polyps was significantly increased in females at 80 mg/kg/day at systemic exposure 20 times the human exposure at 40 mg/day based on AUC. Increased incidence of polyps was not seen at lower doses.
In a 107-week carcinogenicity study in mice given 10, 60 or 200 mg/kg/day by oral gavage, an increased incidence of hepatocellular adenoma/carcinoma was observed at 200 mg/kg/day at systemic exposures 20 times the human exposure at 40 mg/day based on AUC. An increased incidence of hepatocellular tumors was not seen at lower doses.
Rosuvastatin was not mutagenic or clastogenic with or without metabolic activation in the Ames test with Salmonella typhimurium and Escherichia coli , the mouse lymphoma assay, and the chromosomal aberration assay in Chinese hamster lung cells. Rosuvastatin was negative in the in vivo mouse micronucleus test.
In rat fertility studies with oral gavage doses of 5, 15, 50 mg/kg/day, males were treated for 9 weeks prior to and throughout mating and females were treated 2 weeks prior to mating and throughout mating until gestation day 7. No adverse effect on fertility was observed at 50 mg/kg/day (systemic exposures up to 10 times the human exposure at 40 mg/day based on AUC). In testicles of dogs treated with rosuvastatin at 30 mg/kg/day for one month, spermatidic giant cells were seen. Spermatidic giant cells were observed in monkeys after 6-month treatment at 30 mg/kg/day in addition to vacuolation of seminiferous tubular epithelium. Exposures in the dog were 20 times and in the monkey 10 times the human exposure at 40 mg/day based on body surface area. Similar findings have been seen with other drugs in this class.
Central Nervous System Toxicity
CNS vascular lesions, characterized by perivascular hemorrhages, edema, and mononuclear cell infiltration of perivascular spaces, have been observed in dogs treated with several other members of this drug class. A chemically similar drug in this class produced dose-dependent optic nerve degeneration (Wallerian degeneration of retinogeniculate fibers) in dogs, at a dose that produced plasma drug levels about 30 times higher than the mean drug level in humans taking the highest recommended dose. Edema, hemorrhage, and partial necrosis in the interstitium of the choroid plexus was observed in a female dog sacrificed moribund at day 24 at 90 mg/kg/day by oral gavage (systemic exposures 100 times the human exposure at 40 mg/day based on AUC). Corneal opacity was seen in dogs treated for 52 weeks at 6 mg/kg/day by oral gavage (systemic exposures 20 times the human exposure at 40 mg/day based on AUC). Cataracts were seen in dogs treated for 12 weeks by oral gavage at 30 mg/kg/day (systemic exposures 60 times the human exposure at 40 mg/day based on AUC). Retinal dysplasia and retinal loss were seen in dogs treated for 4 weeks by oral gavage at 90 mg/kg/day (systemic exposures 100 times the human exposure at 40 mg/day based on AUC). Doses ≤30 mg/kg/day (systemic exposures ≤ 60 times the human exposure at 40 mg/day based on AUC) did not reveal retinal findings during treatment for up to one year.
Juvenile Toxicology Study
In a juvenile study, rats were dosed by oral gavage with 10 or 50 mg/kg/day from weaning for 9 weeks prior to pairing, throughout pairing and up to the day before necropsy for males or up to gestation day 7 for females. No effects on sexual development, testicular and epididymal appearance or fertility were observed at either dose level.
Pediatric information is approved for AstraZeneca’s CRESTOR (rosuvastatin calcium) tablets. However, due to AstraZeneca’s marketing exclusivity rights, this drug product is not labeled with that pediatric information.
Dose-Response Study: In a double-blind, placebo-controlled dose-response study in patients with baseline TG levels from 273 to 817 mg/dL, rosuvastatin given as a single daily dose (5 mg to 40 mg) over 6 weeks significantly reduced serum TG levels (Table 9).
|Dose||Placebo (n=26)||Rosuvastatin 5 mg (n=25)||Rosuvastatin 10 mg (n=23)||Rosuvastatin 20 mg (n=27)||Rosuvastatin 40 mg (n=25)|
|Triglycerides||1 (-40, 72)||-21 (-58, 38)||-37 (-65, 5)||-37 (-72, 11)||-43 (-80, -7)|
|nonHDL-C||2 (-13, 19)||-29 (-43, -8)||-49 (-59, -20)||-43 (-74, 12)||-51 (-62, -6)|
|VLDL-C||2 (-36, 53)||-25 (-62, 49)||-48 (-72, 14)||-49 (-83, 20)||-56 (-83, 10)|
|Total-C||1 (-13, 17)||-24 (-40, -4)||-40 (-51, -14)||-34 (-61, -11)||-40 (-51, -4)|
|LDL-C||5 (-30, 52)||-28 (-71, 2)||-45 (-59, 7)||-31 (-66, 34)||-43 (-61, -3)|
|HDL-C||-3 (-25, 18)||3 (-38, 33)||8 (-8, 24)||22 (-5, 50)||17 (-14, 63)|
In a randomized, multicenter, double-blind crossover study, 32 patients (27 with є2/є2 and 4 with apo E mutation [Arg145Cys] with primary dysbetalipoproteinemia (Type III Hyperlipoproteinemia) entered a 6-week dietary lead-in period on the NCEP Therapeutic Lifestyle Change (TLC) diet. Following dietary lead-in, patients were randomized to a sequence of treatments in conjunction with the TLC diet for 6 weeks each: rosuvastatin 10 mg followed by rosuvastatin 20 mg or rosuvastatin 20 mg followed by rosuvastatin 10 mg. Rosuvastatin reduced non HDL-C (primary end point) and circulating remnant lipoprotein levels. Results are shown in the table below.
|Median at Baseline (mg/dL)||Median percent change from baseline (95% CI) Rosuvastatin 10 mg||Median percent change from baseline (95% CI) Rosuvastatin 20 mg|
|Total-C||342.5||-43.3 (-46.9, -37.5)||-47.6 (-51.6,-42.8)|
|Triglycerides||503.5||-40.1 (-44.9, -33.6)||-43 (-52.5, -33.1)|
|NonHDL-C||294.5||-48.2 (-56.7, -45.6)||-56.4 (-61.4, -48.5)|
|VLDL-C + IDL-C||209.5||-46.8 (-53.7, -39.4)||-56.2 (-67.7, -43.7)|
|LDL-C||112.5||-54.4 (-59.1, -47.3)||-57.3 (-59.4, -52.1)|
|HDL-C||35.5||10.2 (1.9, 12.3)||11.2 (8.3, 20.5)|
|RLP-C||82||-56.4 (-67.1, -49)||-64.9 (-74, -56.6)|
|Apo-E||16||-42.9 (-46.3, -33.3)||-42.5 (-47.1, -35.6)|
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