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Evaluating PCSK9 Binding antiBody Influence oN coGnitive HeAlth in High cardiovascUlar Risk Subjects

A Double-Blind, Placebo Controlled, Multicenter Study to Assess the Effect of Evolocumab on Cognitive Function in Patients With Clinically Evident Cardiovascular Disease and Receiving Statin Background Lipid Lowering Therapy: A Study for Subjects Enrolled in the FOURIER (Study 20110118) Trial

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT02207634
Acronym
EBBINGHAUS
Enrollment
1974
Registered
2014-08-04
Start date
2014-09-10
Completion date
2016-11-11
Last updated
2018-01-16

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Dyslipidemia

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

BIOLOGICALEvolocumab

Administered subcutaneously using a spring-based prefilled 1.0 mL autoinjector/pen.

DRUGPlacebo

Administered subcutaneously using a spring-based prefilled 1.0 mL autoinjector/pen.

DRUGBackground Statin Therapy

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

Amgen
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)

Eligibility

Sex/Gender
ALL
Age
40 Years to 85 Years
Healthy volunteers
No

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

MeasureTime frameDescription
Mean Change From Baseline in Spatial Working Memory Strategy Index of Executive Function (6-8 Boxes) Z ScoreAssessments 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

MeasureTime frameDescription
Mean Change From Baseline in Spatial Working Memory (SWM) Between-errors Z ScoreAssessments 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 ScoreAssessments 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 ScoreAssessments 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

ArmCount
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
Total1,974

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyLost to Follow-up10
Overall StudyWithdrawal by Subject2131

Baseline characteristics

CharacteristicEvolocumabTotalPlacebo
Age, Continuous62.9 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 Participants23 Participants14 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
975 Participants1951 Participants976 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
0 Participants0 Participants0 Participants
Paired Associates Learning (PAL) Total Errors Adjusted Raw Score26.5 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 Participants3 Participants2 Participants
Race/Ethnicity, Customized
Asian
31 Participants59 Participants28 Participants
Race/Ethnicity, Customized
Black or African American
28 Participants60 Participants32 Participants
Race/Ethnicity, Customized
Multiple
1 Participants2 Participants1 Participants
Race/Ethnicity, Customized
Native Hawaiian or Other Pacific Islander
3 Participants3 Participants0 Participants
Race/Ethnicity, Customized
Other
12 Participants29 Participants17 Participants
Race/Ethnicity, Customized
White
908 Participants1818 Participants910 Participants
Reaction Time Median 5-Choice Reaction Time Raw Score356.74 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 Participants543 Participants274 Participants
Sex: Female, Male
Male
715 Participants1431 Participants716 Participants
Spatial Working Memory Between Errors Raw Score20.9 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 Score0.0024 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 Score17.8 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 Score0.0166 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 typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
— / —— / —
other
Total, other adverse events
257 / 990272 / 983
serious
Total, serious adverse events
204 / 990212 / 983

Outcome results

Primary

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.

ArmMeasureValue (LEAST_SQUARES_MEAN)
PlaceboMean Change From Baseline in Spatial Working Memory Strategy Index of Executive Function (6-8 Boxes) Z Score0.1206 Z score
EvolocumabMean Change From Baseline in Spatial Working Memory Strategy Index of Executive Function (6-8 Boxes) Z Score0.1134 Z score
Comparison: A repeated measures mixed-effect linear model was used to estimate treatment difference (placebo - evolocumab) in change from baseline and associated 95% confidence intervals (CI). The model included stratification factors for Study 20110118 (final screening low-density lipoprotein cholesterol \[LDL-C\] and geographical region), age, education level, baseline SWM strategy index Z score, treatment group, visit, and treatment by visit interaction.95% CI: [-0.0664, 0.0808]
Secondary

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.

ArmMeasureValue (LEAST_SQUARES_MEAN)
PlaceboMean Change From Baseline in Paired Associated Learning (PAL) Total Errors Adjusted Z Score0.1098 Z score
EvolocumabMean Change From Baseline in Paired Associated Learning (PAL) Total Errors Adjusted Z Score0.0873 Z score
Comparison: A repeated measures mixed-effect linear model was used to estimate treatment difference (placebo - evolocumab) in change from baseline and associated 95% confidence intervals (CI). The model included stratification factors for Study 20110118 (final screening LDL-C and geographical region), age, education level, baseline PAL total errors adjusted Z score, treatment group, visit, and treatment by visit interaction.95% CI: [-0.0422, 0.0873]
Secondary

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.

ArmMeasureValue (LEAST_SQUARES_MEAN)
PlaceboMean Change From Baseline in Reaction Time (RTI) Median 5-choice Reaction Time Z Score0.0153 Z score
EvolocumabMean Change From Baseline in Reaction Time (RTI) Median 5-choice Reaction Time Z Score-0.0575 Z score
Comparison: A repeated measures mixed-effect linear model was used to estimate treatment difference ( placebo - evolocumab) in change from baseline and associated 95% confidence intervals (CI). The model included stratification factors for Study 20110118 (final screening LDL-C and geographical region), age, education level, baseline RTI median 5-choice reaction time Z score, treatment group, visit, and treatment by visit interaction.95% CI: [-0.0022, 0.1477]
Secondary

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.

ArmMeasureValue (LEAST_SQUARES_MEAN)
PlaceboMean Change From Baseline in Spatial Working Memory (SWM) Between-errors Z Score0.1024 Z score
EvolocumabMean Change From Baseline in Spatial Working Memory (SWM) Between-errors Z Score0.0691 Z score
Comparison: A repeated measures mixed-effect linear model was used to estimate treatment difference (placebo - evolocumab) in change from baseline and associated 95% confidence intervals (CI). The model included stratification factors for Study 20110118 (final screening LDL-C and geographical region), age, education level, baseline SWM between-errors Z score, treatment group, visit, and treatment by visit interaction.95% CI: [-0.0378, 0.1045]

Source: ClinicalTrials.gov · Data processed: Feb 26, 2026