NCT01984424

Goal Achievement After Utilizing an Anti-PCSK9 Antibody in Statin Intolerant Subjects-3

A Double-blind, Randomized, Multicenter Study to Evaluate the Safety and Efficacy of Evolocumab, Compared With Ezetimibe, in Hypercholesterolemic Subjects Unable to Tolerate an Effective Dose of a HMG-CoA Reductase Inhibitor Due to Muscle Related Side Effects

• Status: Completed
• Phase: Phase 3
• Study type: Interventional
• Enrollment: 511 (actual)
• Sponsor: Amgen · Industry
• Sex: All
• Age: 18 Years – 80 Years
• Healthy volunteers: Not accepted

Summary

The primary objective of this study was to evaluate the effect of 24 weeks of evolocumab administered subcutaneously (SC) every month, compared with ezetimibe, on low-density lipoprotein cholesterol (LDL-C) levels in adults with high cholesterol who are unable to tolerate an effective dose of a statin due to muscle-related side effects (MRSE).

Detailed description

The study is divided into 3 parts (A, B, C). After an initial 4-week washout period in which any statins, ezetimibe, or other lipid-lowering agents were discontinued, participants were enrolled in phase A, a double-blind, placebo-controlled crossover procedure to rechallenge patients with atorvastatin. Patients were randomly assigned in a 1:1 ratio to receive either atorvastatin (20 mg daily) or matching placebo for the first 10 weeks (period 1), then underwent a 2-week washout period, followed by crossover to the alternate therapy for a second 10-week period (period 2). Patients who experienced intolerable muscle symptoms during the first period did not complete the full 10 weeks of exposure but entered a 2-week washout period before proceeding to period 2. Participants who did not develop muscle-related side effects were removed from the study, as were patients who reported muscle-related side effects during a placebo period. After completion of phase A, patients who experienced muscle-related adverse effects while taking atorvastatin but not placebo were eligible for phase B, a 24-week, double-blind randomization to ezetimibe or evolocumab using a double-dummy design in which patients received either injectable placebo and oral ezetimibe or injectable evolocumab and oral placebo. A patient could proceed directly to phase B if they had a documented history of creatine kinase (CK) elevation more than 10 times the upper limit of normal accompanied by muscle symptoms while taking statin therapy, with documented resolution of both CK elevation and symptoms upon discontinuation of statin therapy. These study procedures were designed to ensure that only patients with reproducible statin-associated muscle symptoms entered phase B of the study. For phase B, participants were randomized 2:1 to receive subcutaneously administered evolocumab (420 mg monthly) or oral ezetimibe (10 mg daily). Randomization in part B was stratified by screening LDL-C level (\< 180 mg/dL \[4.66 mmol/L\] vs. ≥ 180 mg/dL) at study baseline. Participants who completed phase B and did not discontinue SC investigational product for any reason, including an adverse event, were eligible to proceed to the 2-year open-label extension phase C to evaluate the long-term safety and efficacy of evolocumab in statin-intolerant patients. Participants in phase C were allowed to choose quarterly between evolocumab 420 mg SC QM or evolocumab 140 mg SC every 2 weeks (Q2W).

Conditions

• Hyperlipidemia

Interventions

Type	Name	Description
DRUG	Atorvastatin	Atorvastatin was supplied as over-encapsulated 20 mg tablets
DRUG	Placebo to Atorvastatin	Placebo matching to atorvastatin supplied as over-encapsulated tablets
OTHER	Placebo to Ezetimibe	Placebo matching to Ezetimibe supplied as over-encapsulated tablets.
DRUG	Ezetimibe	Ezetimibe was supplied as 10 mg tablets, over-encapsulated for blinding.
OTHER	Placebo to Evolocumab	Placebo matching to evolocumab supplied as single-use prefilled autoinjector/pen(s)
DRUG	Evolocumab	Evolocumab supplied as single-use prefilled autoinjector/pen(s)

Timeline

• Start date: 2013-12-10
• Primary completion: 2015-11-10
• Completion: 2017-11-21
• First posted: 2013-11-14
• Last updated: 2018-11-29
• Results posted: 2018-03-13

Locations

58 sites across 13 countries: United States, Australia, Canada, Czechia, Denmark, France, Germany, Italy, Netherlands, New Zealand, Norway, South Africa, United Kingdom