Hyperlipidemia
Conditions
Keywords
Hypercholesterolemia, Proprotein convertase subtilisin/kexin type 9 (PCSK9)
Brief summary
To evaluate the effect of 12 weeks of subcutaneous (SC) evolocumab (AMG 145) administered every 2 weeks (Q2W) or every 4 weeks (Q4W), compared with placebo, on percent change from baseline in LDL-C when used in addition to a statin in adults with hypercholesterolemia.
Interventions
Administered by subcutaneous injection
Administered by subcutaneous injection
Sponsors
Study design
Eligibility
Inclusion criteria
* Male or female ≥ 18 to ≤ 80 years of age * On an approved statin, with or without ezetimibe, with stable dose(s) for at least 4 weeks * Fasting LDL-C ≥ 85 mg/dL * Fasting triglycerides ≤ 400 mg/dL
Exclusion criteria
* Myocardial infarction, unstable angina, percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG) or stroke within 3 months prior to randomization * Type 1 diabetes; newly diagnosed or poorly controlled type 2 diabetes (Glycosyated Hemoglobin (HbA1c) \> 8.5%) * Uncontrolled hypertension * New York Heart Association (NYHA) III or IV heart failure, or known left ventricular ejection fraction \< 30% * Uncontrolled cardiac arrhythmia
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percent Change From Baseline in Low-Density Lipoprotein Cholesterol (LDL-C) at Week 12 | Baseline and Week 12 | LDL-C was measured using ultracentrifugation. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change From Baseline in LDL-C at Week 12 | Baseline and Week 12 | LDL-C was measured using ultracentrifugation. |
| Percent Change From Baseline in Non-High Density Lipoprotein Cholesterol (Non-HDL-C) at Week 12 | Baseline and Week 12 | — |
| Percent Change From Baseline in Apolipoprotein B at Week 12 | Baseline and Week 12 | — |
| Percent Change From Baseline in Total Cholesterol/HDL-C Ratio at Week 12 | Baseline and Week 12 | — |
| Percent Change From Baseline in Apolipoprotein B/Apolipoprotein A-1 Ratio at Week 12 | Baseline and Week 12 | — |
Countries
Canada, Czechia, Denmark, Hungary, United States
Participant flow
Recruitment details
This study enrolled adults aged 18 - 80 years who were on a statin, with or without ezetimibe, with stable dose(s) for at least 4 weeks, and fasting low-density lipoprotein cholesterol (LDL-C) ≥ 85 mg/dL. The first patient enrolled on 18 July 2011 and the last patient enrolled on 22 December 2011.
Pre-assignment details
Eligible participants were randomized equally into 1 of 8 treatment groups. Randomization was stratified by screening LDL-C level (\< 130 mg/dL or ≥ 130 mg/dL) and ezetimibe use at baseline (yes or no).
Participants by arm
| Arm | Count |
|---|---|
| Placebo Q2W Participants received placebo subcutaneous injection once every 2 weeks (Q2W) for 12 weeks. | 78 |
| Placebo Q4W Participants received placebo subcutaneous injection once every 4 weeks (Q4W) for 12 weeks. | 77 |
| Evolocumab 70 mg Q2W Participants received 70 mg evolocumab by subcutaneous injection once every 2 weeks for 12 weeks. | 79 |
| Evolocumab 105 mg Q2W Participants received 105 mg evolocumab by subcutaneous injection once every 2 weeks for 12 weeks. | 79 |
| Evolocumab 140 mg Q2W Participants received 140 mg evolocumab by subcutaneous injection once every 2 weeks for 12 weeks. | 78 |
| Evolocumab 280 mg Q4W Participants received 280 mg evolocumab by subcutaneous injection once every 4 weeks for 12 weeks. | 79 |
| Evolocumab 350 mg Q4W Participants received 350 mg evolocumab by subcutaneous injection once every 4 weeks for 12 weeks. | 79 |
| Evolocumab 420 mg Q4W Participants received 420 mg evolocumab by subcutaneous injection once every 4 weeks for 12 weeks. | 80 |
| Total | 629 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 | FG003 | FG004 | FG005 | FG006 | FG007 |
|---|---|---|---|---|---|---|---|---|---|
| Overall Study | Death | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 0 |
Baseline characteristics
| Characteristic | Placebo Q4W | Placebo Q2W | Total | Evolocumab 420 mg Q4W | Evolocumab 350 mg Q4W | Evolocumab 280 mg Q4W | Evolocumab 140 mg Q2W | Evolocumab 105 mg Q2W | Evolocumab 70 mg Q2W |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | 60.1 years STANDARD_DEVIATION 9.6 | 60.2 years STANDARD_DEVIATION 8.8 | 60.5 years STANDARD_DEVIATION 9.5 | 60.9 years STANDARD_DEVIATION 10.3 | 61.9 years STANDARD_DEVIATION 8.8 | 60.3 years STANDARD_DEVIATION 8.4 | 62.4 years STANDARD_DEVIATION 10.2 | 58.8 years STANDARD_DEVIATION 9.7 | 59.4 years STANDARD_DEVIATION 9.9 |
| Apolipoprotein B/Apolipoprotein A-1 Ratio | 0.676 ratio STANDARD_DEVIATION 0.194 | 0.660 ratio STANDARD_DEVIATION 0.155 | 0.670 ratio STANDARD_DEVIATION 0.184 | 0.653 ratio STANDARD_DEVIATION 0.177 | 0.687 ratio STANDARD_DEVIATION 0.175 | 0.662 ratio STANDARD_DEVIATION 0.199 | 0.649 ratio STANDARD_DEVIATION 0.155 | 0.695 ratio STANDARD_DEVIATION 0.219 | 0.675 ratio STANDARD_DEVIATION 0.191 |
| Apolipoprotein B Concentration | 101.6 mg/dL STANDARD_DEVIATION 20 | 99.9 mg/dL STANDARD_DEVIATION 17 | 100.9 mg/dL STANDARD_DEVIATION 19 | 99.9 mg/dL STANDARD_DEVIATION 18.6 | 102.6 mg/dL STANDARD_DEVIATION 18.9 | 101.3 mg/dL STANDARD_DEVIATION 21.2 | 98.8 mg/dL STANDARD_DEVIATION 16.6 | 103.6 mg/dL STANDARD_DEVIATION 22.3 | 99.9 mg/dL STANDARD_DEVIATION 16.8 |
| LDL-C Concentration | 124.9 mg/dL STANDARD_DEVIATION 30.6 | 122.2 mg/dL STANDARD_DEVIATION 27.1 | 122.8 mg/dL STANDARD_DEVIATION 27.7 | 120.8 mg/dL STANDARD_DEVIATION 26.5 | 123.2 mg/dL STANDARD_DEVIATION 27.1 | 122.0 mg/dL STANDARD_DEVIATION 28.8 | 120.9 mg/dL STANDARD_DEVIATION 25.1 | 127.4 mg/dL STANDARD_DEVIATION 32.1 | 121.4 mg/dL STANDARD_DEVIATION 24.4 |
| Non-High-Density Lipoprotein Cholesterol (non-HDL-C) Concentration | 150.2 mg/dL STANDARD_DEVIATION 36.5 | 146.9 mg/dL STANDARD_DEVIATION 29.9 | 147.4 mg/dL STANDARD_DEVIATION 31.8 | 144.4 mg/dL STANDARD_DEVIATION 31.2 | 150.0 mg/dL STANDARD_DEVIATION 29.1 | 146.3 mg/dL STANDARD_DEVIATION 33.3 | 145.3 mg/dL STANDARD_DEVIATION 26.2 | 151.2 mg/dL STANDARD_DEVIATION 37.2 | 145.3 mg/dL STANDARD_DEVIATION 29.9 |
| Race/Ethnicity, Customized American Indian or Alaska Native | 1 participants | 0 participants | 3 participants | 0 participants | 0 participants | 1 participants | 1 participants | 0 participants | 0 participants |
| Race/Ethnicity, Customized Asian | 2 participants | 0 participants | 12 participants | 1 participants | 2 participants | 2 participants | 1 participants | 3 participants | 1 participants |
| Race/Ethnicity, Customized Black or African American | 0 participants | 6 participants | 50 participants | 9 participants | 4 participants | 8 participants | 9 participants | 8 participants | 6 participants |
| Race/Ethnicity, Customized Hispanic or Latino | 6 participants | 1 participants | 21 participants | 2 participants | 0 participants | 1 participants | 6 participants | 0 participants | 5 participants |
| Race/Ethnicity, Customized Native Hawaiian or Other Pacific Islander | 0 participants | 0 participants | 3 participants | 0 participants | 0 participants | 2 participants | 0 participants | 1 participants | 0 participants |
| Race/Ethnicity, Customized Not Hispanic or Latino | 71 participants | 77 participants | 608 participants | 78 participants | 79 participants | 78 participants | 72 participants | 79 participants | 74 participants |
| Race/Ethnicity, Customized Other | 0 participants | 0 participants | 3 participants | 0 participants | 1 participants | 2 participants | 0 participants | 0 participants | 0 participants |
| Race/Ethnicity, Customized White | 74 participants | 72 participants | 558 participants | 70 participants | 72 participants | 64 participants | 67 participants | 67 participants | 72 participants |
| Sex: Female, Male Female | 41 Participants | 42 Participants | 319 Participants | 44 Participants | 38 Participants | 40 Participants | 45 Participants | 25 Participants | 44 Participants |
| Sex: Female, Male Male | 36 Participants | 36 Participants | 310 Participants | 36 Participants | 41 Participants | 39 Participants | 33 Participants | 54 Participants | 35 Participants |
| Stratification Factor: Baseline Ezetimibe Use No | 69 participants | 71 participants | 572 participants | 73 participants | 72 participants | 72 participants | 71 participants | 72 participants | 72 participants |
| Stratification Factor: Baseline Ezetimibe Use Yes | 8 participants | 7 participants | 57 participants | 7 participants | 7 participants | 7 participants | 7 participants | 7 participants | 7 participants |
| Stratification Factor: LDL-C Level < 130 mg/dL | 51 participants | 51 participants | 412 participants | 53 participants | 52 participants | 51 participants | 52 participants | 51 participants | 51 participants |
| Stratification Factor: LDL-C Level ≥ 130 mg/dL | 26 participants | 27 participants | 217 participants | 27 participants | 27 participants | 28 participants | 26 participants | 28 participants | 28 participants |
| Total Cholesterol/HDL-C ratio | 4.057 ratio STANDARD_DEVIATION 1.303 | 3.940 ratio STANDARD_DEVIATION 1.016 | 4.008 ratio STANDARD_DEVIATION 1.184 | 3.885 ratio STANDARD_DEVIATION 1.09 | 4.118 ratio STANDARD_DEVIATION 0.963 | 4.007 ratio STANDARD_DEVIATION 1.3 | 3.932 ratio STANDARD_DEVIATION 1.022 | 4.128 ratio STANDARD_DEVIATION 1.473 | 4.002 ratio STANDARD_DEVIATION 1.243 |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk | EG004 affected / at risk | EG005 affected / at risk | EG006 affected / at risk | EG007 affected / at risk |
|---|---|---|---|---|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — | — / — | — / — | — / — | — / — | — / — |
| other Total, other adverse events | 15 / 78 | 17 / 77 | 20 / 79 | 28 / 79 | 27 / 78 | 21 / 79 | 23 / 79 | 30 / 80 |
| serious Total, serious adverse events | 4 / 78 | 0 / 77 | 0 / 79 | 1 / 79 | 4 / 78 | 2 / 79 | 2 / 79 | 2 / 80 |
Outcome results
Percent Change From Baseline in Low-Density Lipoprotein Cholesterol (LDL-C) at Week 12
LDL-C was measured using ultracentrifugation.
Time frame: Baseline and Week 12
Population: Full analysis set; missing ultracentrifugation LDL-C at Week 12 was imputed using last observation carried forward (LOCF) and calculated LDL-C.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Placebo Q2W | Percent Change From Baseline in Low-Density Lipoprotein Cholesterol (LDL-C) at Week 12 | 2.76 percent change | Standard Error 2.39 |
| Placebo Q4W | Percent Change From Baseline in Low-Density Lipoprotein Cholesterol (LDL-C) at Week 12 | -0.98 percent change | Standard Error 2.51 |
| Evolocumab 70 mg Q2W | Percent Change From Baseline in Low-Density Lipoprotein Cholesterol (LDL-C) at Week 12 | -39.06 percent change | Standard Error 2.39 |
| Evolocumab 105 mg Q2W | Percent Change From Baseline in Low-Density Lipoprotein Cholesterol (LDL-C) at Week 12 | -57.48 percent change | Standard Error 2.39 |
| Evolocumab 140 mg Q2W | Percent Change From Baseline in Low-Density Lipoprotein Cholesterol (LDL-C) at Week 12 | -63.34 percent change | Standard Error 2.4 |
| Evolocumab 280 mg Q4W | Percent Change From Baseline in Low-Density Lipoprotein Cholesterol (LDL-C) at Week 12 | -42.82 percent change | Standard Error 2.52 |
| Evolocumab 350 mg Q4W | Percent Change From Baseline in Low-Density Lipoprotein Cholesterol (LDL-C) at Week 12 | -50.98 percent change | Standard Error 2.51 |
| Evolocumab 420 mg Q4W | Percent Change From Baseline in Low-Density Lipoprotein Cholesterol (LDL-C) at Week 12 | -51.31 percent change | Standard Error 2.53 |
Change From Baseline in LDL-C at Week 12
LDL-C was measured using ultracentrifugation.
Time frame: Baseline and Week 12
Population: Full analysis set; missing data at Week 12 were imputed using LOCF.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Placebo Q2W | Change From Baseline in LDL-C at Week 12 | -0.2 mg/dL | Standard Error 3.4 |
| Placebo Q4W | Change From Baseline in LDL-C at Week 12 | -3.2 mg/dL | Standard Error 3.3 |
| Evolocumab 70 mg Q2W | Change From Baseline in LDL-C at Week 12 | -50.9 mg/dL | Standard Error 3.4 |
| Evolocumab 105 mg Q2W | Change From Baseline in LDL-C at Week 12 | -77.6 mg/dL | Standard Error 3.5 |
| Evolocumab 140 mg Q2W | Change From Baseline in LDL-C at Week 12 | -79.5 mg/dL | Standard Error 3.4 |
| Evolocumab 280 mg Q4W | Change From Baseline in LDL-C at Week 12 | -53.7 mg/dL | Standard Error 3.3 |
| Evolocumab 350 mg Q4W | Change From Baseline in LDL-C at Week 12 | -64.3 mg/dL | Standard Error 3.3 |
| Evolocumab 420 mg Q4W | Change From Baseline in LDL-C at Week 12 | -64.3 mg/dL | Standard Error 3.3 |
Percent Change From Baseline in Apolipoprotein B/Apolipoprotein A-1 Ratio at Week 12
Time frame: Baseline and Week 12
Population: Full analysis set; missing data at Week 12 were imputed using LOCF.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Placebo Q2W | Percent Change From Baseline in Apolipoprotein B/Apolipoprotein A-1 Ratio at Week 12 | -0.30 percent change | Standard Error 2.13 |
| Placebo Q4W | Percent Change From Baseline in Apolipoprotein B/Apolipoprotein A-1 Ratio at Week 12 | -0.35 percent change | Standard Error 2.38 |
| Evolocumab 70 mg Q2W | Percent Change From Baseline in Apolipoprotein B/Apolipoprotein A-1 Ratio at Week 12 | -35.04 percent change | Standard Error 2.13 |
| Evolocumab 105 mg Q2W | Percent Change From Baseline in Apolipoprotein B/Apolipoprotein A-1 Ratio at Week 12 | -47.60 percent change | Standard Error 2.12 |
| Evolocumab 140 mg Q2W | Percent Change From Baseline in Apolipoprotein B/Apolipoprotein A-1 Ratio at Week 12 | -53.73 percent change | Standard Error 2.14 |
| Evolocumab 280 mg Q4W | Percent Change From Baseline in Apolipoprotein B/Apolipoprotein A-1 Ratio at Week 12 | -34.11 percent change | Standard Error 2.4 |
| Evolocumab 350 mg Q4W | Percent Change From Baseline in Apolipoprotein B/Apolipoprotein A-1 Ratio at Week 12 | -42.74 percent change | Standard Error 2.39 |
| Evolocumab 420 mg Q4W | Percent Change From Baseline in Apolipoprotein B/Apolipoprotein A-1 Ratio at Week 12 | -43.28 percent change | Standard Error 2.4 |
Percent Change From Baseline in Apolipoprotein B at Week 12
Time frame: Baseline and Week 12
Population: Full analysis set; missing data at Week 12 were imputed using LOCF.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Placebo Q2W | Percent Change From Baseline in Apolipoprotein B at Week 12 | 5.86 percent change | Standard Error 2.15 |
| Placebo Q4W | Percent Change From Baseline in Apolipoprotein B at Week 12 | 3.22 percent change | Standard Error 2.25 |
| Evolocumab 70 mg Q2W | Percent Change From Baseline in Apolipoprotein B at Week 12 | -28.88 percent change | Standard Error 2.15 |
| Evolocumab 105 mg Q2W | Percent Change From Baseline in Apolipoprotein B at Week 12 | -44.29 percent change | Standard Error 2.14 |
| Evolocumab 140 mg Q2W | Percent Change From Baseline in Apolipoprotein B at Week 12 | -50.59 percent change | Standard Error 2.15 |
| Evolocumab 280 mg Q4W | Percent Change From Baseline in Apolipoprotein B at Week 12 | -31.16 percent change | Standard Error 2.26 |
| Evolocumab 350 mg Q4W | Percent Change From Baseline in Apolipoprotein B at Week 12 | -37.55 percent change | Standard Error 2.26 |
| Evolocumab 420 mg Q4W | Percent Change From Baseline in Apolipoprotein B at Week 12 | -38.81 percent change | Standard Error 2.27 |
Percent Change From Baseline in Non-High Density Lipoprotein Cholesterol (Non-HDL-C) at Week 12
Time frame: Baseline and Week 12
Population: Full analysis set; missing data at Week 12 were imputed using LOCF.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Placebo Q2W | Percent Change From Baseline in Non-High Density Lipoprotein Cholesterol (Non-HDL-C) at Week 12 | 2.21 percent change | Standard Error 2.2 |
| Placebo Q4W | Percent Change From Baseline in Non-High Density Lipoprotein Cholesterol (Non-HDL-C) at Week 12 | -1.26 percent change | Standard Error 2.26 |
| Evolocumab 70 mg Q2W | Percent Change From Baseline in Non-High Density Lipoprotein Cholesterol (Non-HDL-C) at Week 12 | -36.23 percent change | Standard Error 2.2 |
| Evolocumab 105 mg Q2W | Percent Change From Baseline in Non-High Density Lipoprotein Cholesterol (Non-HDL-C) at Week 12 | -53.21 percent change | Standard Error 2.2 |
| Evolocumab 140 mg Q2W | Percent Change From Baseline in Non-High Density Lipoprotein Cholesterol (Non-HDL-C) at Week 12 | -59.19 percent change | Standard Error 2.21 |
| Evolocumab 280 mg Q4W | Percent Change From Baseline in Non-High Density Lipoprotein Cholesterol (Non-HDL-C) at Week 12 | -39.05 percent change | Standard Error 2.27 |
| Evolocumab 350 mg Q4W | Percent Change From Baseline in Non-High Density Lipoprotein Cholesterol (Non-HDL-C) at Week 12 | -47.05 percent change | Standard Error 2.26 |
| Evolocumab 420 mg Q4W | Percent Change From Baseline in Non-High Density Lipoprotein Cholesterol (Non-HDL-C) at Week 12 | -48.83 percent change | Standard Error 2.27 |
Percent Change From Baseline in Total Cholesterol/HDL-C Ratio at Week 12
Time frame: Baseline and Week 12
Population: Full analysis set; missing data at Week 12 were imputed using LOCF.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Placebo Q2W | Percent Change From Baseline in Total Cholesterol/HDL-C Ratio at Week 12 | 2.64 percent change | Standard Error 1.97 |
| Placebo Q4W | Percent Change From Baseline in Total Cholesterol/HDL-C Ratio at Week 12 | -2.00 percent change | Standard Error 1.9 |
| Evolocumab 70 mg Q2W | Percent Change From Baseline in Total Cholesterol/HDL-C Ratio at Week 12 | -28.76 percent change | Standard Error 1.97 |
| Evolocumab 105 mg Q2W | Percent Change From Baseline in Total Cholesterol/HDL-C Ratio at Week 12 | -40.73 percent change | Standard Error 1.97 |
| Evolocumab 140 mg Q2W | Percent Change From Baseline in Total Cholesterol/HDL-C Ratio at Week 12 | -45.09 percent change | Standard Error 1.98 |
| Evolocumab 280 mg Q4W | Percent Change From Baseline in Total Cholesterol/HDL-C Ratio at Week 12 | -29.73 percent change | Standard Error 1.91 |
| Evolocumab 350 mg Q4W | Percent Change From Baseline in Total Cholesterol/HDL-C Ratio at Week 12 | -37.97 percent change | Standard Error 1.91 |
| Evolocumab 420 mg Q4W | Percent Change From Baseline in Total Cholesterol/HDL-C Ratio at Week 12 | -37.66 percent change | Standard Error 1.92 |