Dyslipidemia
Conditions
Keywords
High cholesterol, Treatment for high cholesterol, Lowering cholesterol, Lowering high cholesterol, Hypercholesterolemia
Brief summary
This study evaluated change over time in neurocognitive testing in patients receiving statin therapy in combination with evolocumab (AMG 145), compared with patients receiving statin therapy in combination with placebo.
Detailed description
Participants who were enrolled in study 20110118 (FOURIER; NCT01764633) at select sites in select countries (selected based on study start-up timelines) were invited to participate in this cognitive function study, 20130385. There was no separate randomization for Study 20130385; data were analyzed according to Study 20110118 randomized treatment arm.
Interventions
Administered subcutaneously using a spring-based prefilled 1.0 mL autoinjector/pen.
Administered subcutaneously using a spring-based prefilled 1.0 mL autoinjector/pen.
Participants were required to be on a stable, high- to moderate-intensity statin background therapy consisting of an effective statin dose, ie, at least atorvastatin 20 mg daily or equivalent, and where locally approved, highly effective statin therapy (defined as at least atorvastatin 40 mg daily or equivalent) was recommended.
Sponsors
Study design
Eligibility
Inclusion criteria
* Randomized into Study 20110118 (FOURIER; NCT01764633)
Exclusion criteria
* Current or known past diagnosis of dementia or mild cognitive impairment (MCI)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Mean Change From Baseline in Spatial Working Memory Strategy Index of Executive Function (6-8 Boxes) Z Score | Assessments were conducted at Baseline and at weeks 24, 48, 96, 144 and end of study visit (median time on study was 19.4 months). | Assessments were performed with the Cambridge Neuropsychological Test Automated Battery (CANTAB), a language-independent battery of computerized tests that is used to assess cognitive function. The Spatial Working Memory (SWM) test assesses the cognitive domain of executive function (high-level thinking and decision making). Patients search for colored tokens hidden inside boxes on the screen by touching them. The critical instruction is that once a token has been found inside a box, there will never be a token hidden inside that box again, so patients must not return to a box where a token has been found. The SWM strategy index of executive function represented the number of times a subject began a search with a different box. The Z score represents the standardized measure of how far an individual subject deviates from the study cohort average at baseline. A higher Z score reflects better performance. The mean change from baseline averaged across all the visits is reported. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Mean Change From Baseline in Spatial Working Memory (SWM) Between-errors Z Score | Assessments were conducted at Baseline and at weeks 24, 48, 96, 144 and end of study visit (median time on study was 19.4 months). | Assessments were performed with the CANTAB, a language-independent battery of computerized tests that is used to assess cognitive function. The Spatial Working Memory (SWM) between-errors test assesses the cognitive domain of working memory (holding material in mind while that material is being actively processed). Patients search for colored tokens hidden inside boxes on the screen by touching them. The critical instruction is that once a token has been found inside a box, there will never be a token hidden inside that box again, so patients must not return to a box where a token has been found. The SWM between-errors score is the number of times that a patient revisited a box in which a token had previously been found. The Z score represents the standardized measure of how far an individual participant deviates from the study cohort average at baseline. A higher Z score reflects better performance. The mean change from baseline averaged across all the visits is reported. |
| Mean Change From Baseline in Paired Associated Learning (PAL) Total Errors Adjusted Z Score | Assessments were conducted at Baseline and at weeks 24, 48, 96, 144 and end of study visit (median time on study was 19.4 months). | The CANTAB PAL test assesses visuospatial episodic memory (storing/retrieving information by associating an event with a time and place). Boxes on the screen opened up one at a time to reveal a number of patterns. Participants were asked to remember the location of each pattern. After all the boxes had been opened, each pattern was then shown in the center of the screen in a randomized order, and the patient should touch the box where they think each pattern was hidden. The PAL total errors adjusted comprised the number of errors committed by a patient plus an adjustment for the estimated number of errors the patient would have made on any stages that were not reached. Z score represents the standardized measure of how far an individual patient deviates from the study cohort average at baseline. A higher Z score indicated better performance. The mean change from baseline averaged across all the visits is reported. |
| Mean Change From Baseline in Reaction Time (RTI) Median 5-choice Reaction Time Z Score | Assessments were conducted at Baseline and at weeks 24, 48, 96, 144 and end of study visit (median time on study was 19.4 months). | Assessments were performed with the CANTAB, a language-independent battery of computerized tests that is used to assess cognitive function. The Reaction Time (RTI) test assessed the cognitive domain of psychomotor speed (detecting and responding to a stimulus). Participants held down a button until a spot appeared in 1 of 5 circles on the screen. As soon as possible after the spot flashed up, the patient lifted their finger from the button and touched the circle in which the spot appeared. The RTI median 5-choice reaction time was the median duration between the onset of the stimulus and the release of the button. Z score represents the standardized measure of how far an individual participant deviates from the study cohort average at baseline. A higher Z score reflects better performance. The mean change from baseline averaged across all the visits is reported. |
Countries
Australia, Belgium, Canada, Czechia, Denmark, Estonia, Finland, France, Germany, Greece, Hong Kong, Hungary, Italy, Japan, Latvia, Lithuania, Malaysia, Netherlands, New Zealand, Norway, Poland, Portugal, Russia, Slovakia, South Africa, Spain, Sweden, Turkey (Türkiye), United Kingdom, United States
Participant flow
Recruitment details
Participants enrolled in Study 20110118 (FOURIER; NCT01764633) at select sites in select countries (based on study start-up timelines) were invited to participate in this cognitive function study. Participants were enrolled at 340 centers in 29 countries in Europe, North America, and Asia Pacific from September 2014 to July 2015.
Pre-assignment details
There was no separate randomization in this study; each participant received their assigned treatment per Protocol 20110118. Data were analyzed according to Study 20110118 randomized treatment arm.
Participants by arm
| Arm | Count |
|---|---|
| Placebo Participants received placebo subcutaneous injections either once every 2 weeks (Q2W) or once a month (QM) according to their own preference. Participants continued with their background statin therapy during the course of the study. | 990 |
| Evolocumab Participants received evolocumab 140 mg Q2W or 420 mg QM subcutaneous injections according to their own preference. Participants continued with their background statin therapy during the course of the study. | 984 |
| Total | 1,974 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Lost to Follow-up | 1 | 0 |
| Overall Study | Withdrawal by Subject | 21 | 31 |
Baseline characteristics
| Characteristic | Evolocumab | Total | Placebo |
|---|---|---|---|
| Age, Continuous | 62.9 years STANDARD_DEVIATION 8.7 | 62.8 years STANDARD_DEVIATION 8.7 | 62.7 years STANDARD_DEVIATION 8.7 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 9 Participants | 23 Participants | 14 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 975 Participants | 1951 Participants | 976 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Paired Associates Learning (PAL) Total Errors Adjusted Raw Score | 26.5 units on a scale STANDARD_DEVIATION 19.3 | 25.8 units on a scale STANDARD_DEVIATION 18.9 | 25.2 units on a scale STANDARD_DEVIATION 18.4 |
| Paired Associates Learning Total Errors Adjusted Z Score | -0.0272 Z score STANDARD_DEVIATION 1.0294 | 0.0095 Z score STANDARD_DEVIATION 1.0063 | 0.0442 Z score STANDARD_DEVIATION 0.9834 |
| Race/Ethnicity, Customized American Indian or Alaska Native | 1 Participants | 3 Participants | 2 Participants |
| Race/Ethnicity, Customized Asian | 31 Participants | 59 Participants | 28 Participants |
| Race/Ethnicity, Customized Black or African American | 28 Participants | 60 Participants | 32 Participants |
| Race/Ethnicity, Customized Multiple | 1 Participants | 2 Participants | 1 Participants |
| Race/Ethnicity, Customized Native Hawaiian or Other Pacific Islander | 3 Participants | 3 Participants | 0 Participants |
| Race/Ethnicity, Customized Other | 12 Participants | 29 Participants | 17 Participants |
| Race/Ethnicity, Customized White | 908 Participants | 1818 Participants | 910 Participants |
| Reaction Time Median 5-Choice Reaction Time Raw Score | 356.74 msec STANDARD_DEVIATION 65.01 | 355.90 msec STANDARD_DEVIATION 71.71 | 355.10 msec STANDARD_DEVIATION 77.6 |
| Reaction Time Median 5-Choice Reaction Time Z Score | -0.0500 Z-score STANDARD_DEVIATION 0.9072 | -0.0383 Z-score STANDARD_DEVIATION 1.0007 | -0.0271 Z-score STANDARD_DEVIATION 1.0829 |
| Sex: Female, Male Female | 269 Participants | 543 Participants | 274 Participants |
| Sex: Female, Male Male | 715 Participants | 1431 Participants | 716 Participants |
| Spatial Working Memory Between Errors Raw Score | 20.9 units on a scale STANDARD_DEVIATION 10.2 | 21.0 units on a scale STANDARD_DEVIATION 10.4 | 21.0 units on a scale STANDARD_DEVIATION 10.6 |
| Spatial Working Memory Between Errors Z Score | 0.0024 Z score STANDARD_DEVIATION 0.9675 | -0.0055 Z score STANDARD_DEVIATION 0.9879 | -0.0130 Z score STANDARD_DEVIATION 1.0075 |
| Spatial Working Memory (SWM) Strategy Index of Executive Function Raw Score | 17.8 units on a scale STANDARD_DEVIATION 3.5 | 17.8 units on a scale STANDARD_DEVIATION 3.4 | 17.8 units on a scale STANDARD_DEVIATION 3.4 |
| Spatial Working Memory (SWM) Strategy Index of Executive Function Z Score | 0.0166 Z score STANDARD_DEVIATION 1.0066 | 0.0026 Z score STANDARD_DEVIATION 0.9983 | -0.0106 Z score STANDARD_DEVIATION 0.991 |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 257 / 990 | 272 / 983 |
| serious Total, serious adverse events | 204 / 990 | 212 / 983 |
Outcome results
Mean Change From Baseline in Spatial Working Memory Strategy Index of Executive Function (6-8 Boxes) Z Score
Assessments were performed with the Cambridge Neuropsychological Test Automated Battery (CANTAB), a language-independent battery of computerized tests that is used to assess cognitive function. The Spatial Working Memory (SWM) test assesses the cognitive domain of executive function (high-level thinking and decision making). Patients search for colored tokens hidden inside boxes on the screen by touching them. The critical instruction is that once a token has been found inside a box, there will never be a token hidden inside that box again, so patients must not return to a box where a token has been found. The SWM strategy index of executive function represented the number of times a subject began a search with a different box. The Z score represents the standardized measure of how far an individual subject deviates from the study cohort average at baseline. A higher Z score reflects better performance. The mean change from baseline averaged across all the visits is reported.
Time frame: Assessments were conducted at Baseline and at weeks 24, 48, 96, 144 and end of study visit (median time on study was 19.4 months).
Population: All enrolled and dosed participants who completed a baseline cognitive functional assessment prior to or on the first date of administration of study drug and who have at least one post-baseline cognitive measure.~Cognitive function assessments after an on-study stroke event were excluded from the analysis.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) |
|---|---|---|
| Placebo | Mean Change From Baseline in Spatial Working Memory Strategy Index of Executive Function (6-8 Boxes) Z Score | 0.1206 Z score |
| Evolocumab | Mean Change From Baseline in Spatial Working Memory Strategy Index of Executive Function (6-8 Boxes) Z Score | 0.1134 Z score |
Mean Change From Baseline in Paired Associated Learning (PAL) Total Errors Adjusted Z Score
The CANTAB PAL test assesses visuospatial episodic memory (storing/retrieving information by associating an event with a time and place). Boxes on the screen opened up one at a time to reveal a number of patterns. Participants were asked to remember the location of each pattern. After all the boxes had been opened, each pattern was then shown in the center of the screen in a randomized order, and the patient should touch the box where they think each pattern was hidden. The PAL total errors adjusted comprised the number of errors committed by a patient plus an adjustment for the estimated number of errors the patient would have made on any stages that were not reached. Z score represents the standardized measure of how far an individual patient deviates from the study cohort average at baseline. A higher Z score indicated better performance. The mean change from baseline averaged across all the visits is reported.
Time frame: Assessments were conducted at Baseline and at weeks 24, 48, 96, 144 and end of study visit (median time on study was 19.4 months).
Population: All enrolled and dosed participants who completed a baseline cognitive functional assessment prior to or on the first date of administration of study drug and who have at least one post-baseline cognitive measure.~Cognitive function assessments after an on-study stroke event were excluded from the analysis.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) |
|---|---|---|
| Placebo | Mean Change From Baseline in Paired Associated Learning (PAL) Total Errors Adjusted Z Score | 0.1098 Z score |
| Evolocumab | Mean Change From Baseline in Paired Associated Learning (PAL) Total Errors Adjusted Z Score | 0.0873 Z score |
Mean Change From Baseline in Reaction Time (RTI) Median 5-choice Reaction Time Z Score
Assessments were performed with the CANTAB, a language-independent battery of computerized tests that is used to assess cognitive function. The Reaction Time (RTI) test assessed the cognitive domain of psychomotor speed (detecting and responding to a stimulus). Participants held down a button until a spot appeared in 1 of 5 circles on the screen. As soon as possible after the spot flashed up, the patient lifted their finger from the button and touched the circle in which the spot appeared. The RTI median 5-choice reaction time was the median duration between the onset of the stimulus and the release of the button. Z score represents the standardized measure of how far an individual participant deviates from the study cohort average at baseline. A higher Z score reflects better performance. The mean change from baseline averaged across all the visits is reported.
Time frame: Assessments were conducted at Baseline and at weeks 24, 48, 96, 144 and end of study visit (median time on study was 19.4 months).
Population: All enrolled and dosed participants who completed a baseline cognitive functional assessment prior to or on the first date of administration of study drug and who have at least one post-baseline cognitive measure.~Cognitive function assessments after an on-study stroke event were excluded from the analysis.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) |
|---|---|---|
| Placebo | Mean Change From Baseline in Reaction Time (RTI) Median 5-choice Reaction Time Z Score | 0.0153 Z score |
| Evolocumab | Mean Change From Baseline in Reaction Time (RTI) Median 5-choice Reaction Time Z Score | -0.0575 Z score |
Mean Change From Baseline in Spatial Working Memory (SWM) Between-errors Z Score
Assessments were performed with the CANTAB, a language-independent battery of computerized tests that is used to assess cognitive function. The Spatial Working Memory (SWM) between-errors test assesses the cognitive domain of working memory (holding material in mind while that material is being actively processed). Patients search for colored tokens hidden inside boxes on the screen by touching them. The critical instruction is that once a token has been found inside a box, there will never be a token hidden inside that box again, so patients must not return to a box where a token has been found. The SWM between-errors score is the number of times that a patient revisited a box in which a token had previously been found. The Z score represents the standardized measure of how far an individual participant deviates from the study cohort average at baseline. A higher Z score reflects better performance. The mean change from baseline averaged across all the visits is reported.
Time frame: Assessments were conducted at Baseline and at weeks 24, 48, 96, 144 and end of study visit (median time on study was 19.4 months).
Population: All enrolled and dosed participants who completed a baseline cognitive functional assessment prior to or on the first date of administration of study drug and who have at least one post-baseline cognitive measure.~Cognitive function assessments after an on-study stroke event were excluded from the analysis.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) |
|---|---|---|
| Placebo | Mean Change From Baseline in Spatial Working Memory (SWM) Between-errors Z Score | 0.1024 Z score |
| Evolocumab | Mean Change From Baseline in Spatial Working Memory (SWM) Between-errors Z Score | 0.0691 Z score |