Hyperlipidemias
Conditions
Keywords
hyperlipidemia, heterozygous familial hypercholesterolemia, atherosclerotic cardiovascular disease, high cholesterol, ASCVD, HeFH, LDL
Brief summary
The purpose of this study is to determine if Bempedoic Acid (BA) + Ezetimibe (EZE) in a fixed-dose combination (FDC) is effective and safe versus its individual components and placebo in patients with elevated LDL cholesterol treated with maximally tolerated statin therapy.
Interventions
bempedoic acid + ezetimibe FDC 180 mg/10 mg tablet
bempedoic acid 180 mg tablet
ezetimibe 10 mg overencapsulated tablet
placebo tablet or capsule to match bempedoic acid + ezetimibe fixed-dose combination (FDC) 180 mg/10 mg tablet, or bempedoic acid 180 mg tablet, or ezetimibe 10 mg capsule
Sponsors
Study design
Eligibility
Inclusion criteria
* Require lipid-modifying therapy for primary or secondary prevention of cardiovascular disease * Fasting LDL-C ≥ 130 mg/dL for primary prevention or LDL-C ≥ 100 mg/dL for secondary prevention (history of HeFH and/or ASCVD) * Treated with maximally tolerated statin therapy at stable dose for at least 4 weeks prior to screening
Exclusion criteria
* Total Fasting Triglyceride ≥ 400 mg/dL * Renal Dysfunction or nephrotic syndrome or history of nephritis * Significant cardiovascular disease or cardiovascular event within the past 3 months
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percent Change From Baseline to Week 12 in Low-density Lipoprotein Cholesterol (LDL-C) | Baseline; Week 12 | Blood samples were drawn after a minimum 10-hour fast (water was allowed) at pre-specified intervals. Samples were collected and analyzed for LDL-C. Baseline was defined as the mean of the LDL-C values from Week -2 and predose Day 1/Week 0. Percent change from baseline in LDL-C was analyzed using analysis of covariance (ANCOVA) with treatment group and randomization stratification as a factors and baseline LDL-C as a covariate. Percent change from baseline was calculated as: (\[LDL-C value at Week 12 minus Baseline value\] divided by \[Baseline Value\]) multiplied by 100. For LDL-C, if measured LDL-C value was available, measured LDL-C was used. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percent Change From Baseline to Week 12 in Non-high-density Lipoprotein Cholesterol (Non-HDL-C) | Baseline; Week 12 | Blood samples were drawn after a minimum 10-hour fast (water was allowed) at pre-specified intervals. Samples were collected and analyzed for non-HDL-C. Baseline was defined as the mean of the non-HDL-C values from Week -2 and predose Day 1/Week 0. Percent change from baseline in non-HDL-C was analyzed using ANCOVA with treatment group and randomization stratification as a factors and baseline non-HDL-C as a covariate. Percent change from baseline was calculated as: (\[non-HDL-C value at Week 12 minus Baseline value\] divided by \[Baseline Value\]) multiplied by 100. |
| Percent Change From Baseline to Week 12 in Total Cholesterol (TC) | Baseline; Week 12 | Blood samples were drawn after a minimum 10-hour fast (water was allowed) at pre-specified intervals. Samples were collected and analyzed for TC. Baseline was defined as the mean of the TC values from Week -2 and predose Day 1/Week 0. Percent change from baseline in TC was analyzed using ANCOVA with treatment group and randomization stratification as a factors and baseline TC as a covariate. Percent change from baseline was calculated as: (\[TC value at Week 12 minus Baseline value\] divided by \[Baseline Value\]) multiplied by 100. |
| Percent Change From Baseline to Week 12 in High-sensitivity C-reactive Protein (hsCRP) | Baseline; Week 12 | Blood samples were drawn after a minimum 10-hour fast (water was allowed) at pre-specified intervals. Samples were collected and analyzed for hsCRP. Baseline was defined as the predose Day 1/Week 0 value. Percent change from baseline in hsCRP was analyzed using a non-parametric analysis. Percent change from baseline was calculated as: (\[hsCRP value at Week 12 minus Baseline value\] divided by \[Baseline Value\]) multiplied by 100. |
| Percent Change From Baseline to Week 12 in High-density Lipoprotein Cholesterol (HDL-C) | Baseline; Week 12 | Blood samples were drawn after a minimum 10-hour fast (water was allowed) at pre-specified intervals. Samples were collected and analyzed for HDL-C. Baseline was defined as the mean of the HDL-C values from Week -2 and predose Day 1/Week 0. Percent change from baseline was calculated as: (\[HDL-C value at Week 12 minus Baseline value\] divided by \[Baseline Value\]) multiplied by 100. |
| Percent Change From Baseline to Week 12 in Triglycerides (TGs) | Baseline; Week 12 | Blood samples were drawn after a minimum 10-hour fast (water was allowed) at pre-specified intervals. Samples were collected and analyzed for TGs. Baseline was defined as the mean of the TGs values from Week -2 and predose Day 1/Week 0. Percent change from baseline was calculated as: (\[TGs value at Week 12 minus Baseline value\] divided by \[Baseline Value\]) multiplied by 100. |
| Percent Change From Baseline to Week 12 in Apolipoprotein B (Apo B) | Baseline; Week 12 | Blood samples were drawn after a minimum 10-hour fast (water was allowed) at pre-specified intervals. Samples were collected and analyzed for apo B. Baseline was defined as the predose Day 1/Week 0 value. Percent change from baseline in apo B was analyzed using ANCOVA with treatment group and randomization stratification as a factors and baseline apo B as a covariate. Percent change from baseline was calculated as: (\[apo B value at Week 12 minus Baseline value\] divided by \[Baseline Value\]) multiplied by 100. |
Countries
United States
Participant flow
Pre-assignment details
Data are presented for the Full Analysis Set, comprised of all randomized participants. One participant was randomized but was not treated.
Participants by arm
| Arm | Count |
|---|---|
| Bempedoic Acid 180 mg + Ezetimibe 10 mg FDC Participants received bempedoic acid + ezetimibe fixed-dose combination (FDC) 180 milligrams (mg)/10 mg tablets orally once daily for 12 weeks. | 108 |
| Bempedoic Acid 180 mg Participants received bempedoic acid 180 mg tablets taken orally once daily for 12 weeks. | 110 |
| Ezetimibe 10 mg Participants received ezetimibe 10 mg overencapsulated tablets orally once daily for 12 weeks. | 109 |
| Placebo Participants received placebo to match the bempedoic acid + ezetimibe FDC 180 mg/10 mg tablet, the bempedoic acid 180 mg tablet, or the ezetimibe 10 mg capsule, taken orally, once daily for 12 weeks. | 55 |
| Total | 382 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 | FG003 |
|---|---|---|---|---|---|
| Overall Study | Adverse Event | 2 | 3 | 3 | 1 |
| Overall Study | Lost to Follow-up | 1 | 2 | 0 | 0 |
| Overall Study | Protocol Violation | 0 | 1 | 0 | 0 |
| Overall Study | Withdrawal by Subject | 2 | 1 | 2 | 1 |
Baseline characteristics
| Characteristic | Bempedoic Acid 180 mg + Ezetimibe 10 mg FDC | Bempedoic Acid 180 mg | Ezetimibe 10 mg | Placebo | Total |
|---|---|---|---|---|---|
| Age, Continuous | 63.0 Years STANDARD_DEVIATION 9.97 | 65.2 Years STANDARD_DEVIATION 9.54 | 64.4 Years STANDARD_DEVIATION 8.91 | 65.6 Years STANDARD_DEVIATION 10.74 | 64.4 Years STANDARD_DEVIATION 9.68 |
| Apolipoprotein B (apo B) | 121.1 mg/dL STANDARD_DEVIATION 30.85 | 113.4 mg/dL STANDARD_DEVIATION 26.43 | 115.5 mg/dL STANDARD_DEVIATION 31.3 | 115.1 mg/dL STANDARD_DEVIATION 32.52 | 116.4 mg/dL STANDARD_DEVIATION 29.98 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 32 Participants | 33 Participants | 32 Participants | 20 Participants | 117 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 76 Participants | 77 Participants | 77 Participants | 35 Participants | 265 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| High-density lipoprotein cholesterol (HDL-C) | 49.19 mg/dL STANDARD_DEVIATION 14.566 | 49.89 mg/dL STANDARD_DEVIATION 12.383 | 51.23 mg/dL STANDARD_DEVIATION 15.902 | 50.40 mg/dL STANDARD_DEVIATION 14.067 | 50.14 mg/dL STANDARD_DEVIATION 14.256 |
| High-sensitivity C-reactive protein (hsCRP) | 3.08 milligrams per liter (mg/L) | 2.91 milligrams per liter (mg/L) | 2.78 milligrams per liter (mg/L) | 3.01 milligrams per liter (mg/L) | 2.96 milligrams per liter (mg/L) |
| Low-density lipoprotein cholesterol (LDL-C) | 153.80 milligrams per deciliter (mg/dL) STANDARD_DEVIATION 40.526 | 145.13 milligrams per deciliter (mg/dL) STANDARD_DEVIATION 38.456 | 148.80 milligrams per deciliter (mg/dL) STANDARD_DEVIATION 41.839 | 152.80 milligrams per deciliter (mg/dL) STANDARD_DEVIATION 46.773 | 149.70 milligrams per deciliter (mg/dL) STANDARD_DEVIATION 41.162 |
| Non-high-density lipoprotein cholesterol (non-HDL-C) | 188.22 mg/dL STANDARD_DEVIATION 46.657 | 175.67 mg/dL STANDARD_DEVIATION 40.474 | 180.18 mg/dL STANDARD_DEVIATION 47.308 | 180.91 mg/dL STANDARD_DEVIATION 49.72 | 181.26 mg/dL STANDARD_DEVIATION 45.595 |
| Race (NIH/OMB) American Indian or Alaska Native | 1 Participants | 0 Participants | 0 Participants | 0 Participants | 1 Participants |
| Race (NIH/OMB) Asian | 2 Participants | 1 Participants | 1 Participants | 0 Participants | 4 Participants |
| Race (NIH/OMB) Black or African American | 20 Participants | 19 Participants | 16 Participants | 7 Participants | 62 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 1 Participants | 0 Participants | 1 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 85 Participants | 90 Participants | 91 Participants | 48 Participants | 314 Participants |
| Sex: Female, Male Female | 58 Participants | 65 Participants | 57 Participants | 22 Participants | 202 Participants |
| Sex: Female, Male Male | 50 Participants | 45 Participants | 52 Participants | 33 Participants | 180 Participants |
| Total cholesterol (TC) | 237.32 mg/dL STANDARD_DEVIATION 48.694 | 225.55 mg/dL STANDARD_DEVIATION 43.165 | 231.41 mg/dL STANDARD_DEVIATION 50.478 | 231.27 mg/dL STANDARD_DEVIATION 50.21 | 231.36 mg/dL STANDARD_DEVIATION 47.857 |
| Triglycerides (TGs) | 177.19 mg/dL STANDARD_DEVIATION 94.904 | 156.65 mg/dL STANDARD_DEVIATION 71.985 | 161.73 mg/dL STANDARD_DEVIATION 79.924 | 144.59 mg/dL STANDARD_DEVIATION 55.814 | 162.33 mg/dL STANDARD_DEVIATION 79.973 |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 107 | 0 / 110 | 0 / 109 | 0 / 55 |
| other Total, other adverse events | 26 / 107 | 27 / 110 | 26 / 109 | 12 / 55 |
| serious Total, serious adverse events | 8 / 107 | 7 / 110 | 10 / 109 | 1 / 55 |
Outcome results
Percent Change From Baseline to Week 12 in Low-density Lipoprotein Cholesterol (LDL-C)
Blood samples were drawn after a minimum 10-hour fast (water was allowed) at pre-specified intervals. Samples were collected and analyzed for LDL-C. Baseline was defined as the mean of the LDL-C values from Week -2 and predose Day 1/Week 0. Percent change from baseline in LDL-C was analyzed using analysis of covariance (ANCOVA) with treatment group and randomization stratification as a factors and baseline LDL-C as a covariate. Percent change from baseline was calculated as: (\[LDL-C value at Week 12 minus Baseline value\] divided by \[Baseline Value\]) multiplied by 100. For LDL-C, if measured LDL-C value was available, measured LDL-C was used.
Time frame: Baseline; Week 12
Population: Full Analysis Set (FAS), also known as the intention-to-treat set, was defined as all randomized participants. After a Root Cause Analysis, three sites were found not to have followed Good Clinical Practice; therefore, analysis was completed with all efficacy data from these sites removed.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Bempedoic Acid 180 mg + Ezetimibe 10 mg FDC | Percent Change From Baseline to Week 12 in Low-density Lipoprotein Cholesterol (LDL-C) | -36.2 Percent Change | Standard Error 2.56 |
| Bempedoic Acid 180 mg | Percent Change From Baseline to Week 12 in Low-density Lipoprotein Cholesterol (LDL-C) | -17.2 Percent Change | Standard Error 2.52 |
| Ezetimibe 10 mg | Percent Change From Baseline to Week 12 in Low-density Lipoprotein Cholesterol (LDL-C) | -23.2 Percent Change | Standard Error 2.18 |
| Placebo | Percent Change From Baseline to Week 12 in Low-density Lipoprotein Cholesterol (LDL-C) | 1.8 Percent Change | Standard Error 3.49 |
Percent Change From Baseline to Week 12 in Apolipoprotein B (Apo B)
Blood samples were drawn after a minimum 10-hour fast (water was allowed) at pre-specified intervals. Samples were collected and analyzed for apo B. Baseline was defined as the predose Day 1/Week 0 value. Percent change from baseline in apo B was analyzed using ANCOVA with treatment group and randomization stratification as a factors and baseline apo B as a covariate. Percent change from baseline was calculated as: (\[apo B value at Week 12 minus Baseline value\] divided by \[Baseline Value\]) multiplied by 100.
Time frame: Baseline; Week 12
Population: FAS. After a Root Cause Analysis, three sites were found not to have followed Good Clinical Practice; therefore, analysis was completed with all efficacy data from these sites removed. Only participants with available data were analyzed.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Bempedoic Acid 180 mg + Ezetimibe 10 mg FDC | Percent Change From Baseline to Week 12 in Apolipoprotein B (Apo B) | -24.6 Percent change | Standard Error 2.38 |
| Bempedoic Acid 180 mg | Percent Change From Baseline to Week 12 in Apolipoprotein B (Apo B) | -11.8 Percent change | Standard Error 2.18 |
| Ezetimibe 10 mg | Percent Change From Baseline to Week 12 in Apolipoprotein B (Apo B) | -15.3 Percent change | Standard Error 1.97 |
| Placebo | Percent Change From Baseline to Week 12 in Apolipoprotein B (Apo B) | 5.5 Percent change | Standard Error 2.97 |
Percent Change From Baseline to Week 12 in High-density Lipoprotein Cholesterol (HDL-C)
Blood samples were drawn after a minimum 10-hour fast (water was allowed) at pre-specified intervals. Samples were collected and analyzed for HDL-C. Baseline was defined as the mean of the HDL-C values from Week -2 and predose Day 1/Week 0. Percent change from baseline was calculated as: (\[HDL-C value at Week 12 minus Baseline value\] divided by \[Baseline Value\]) multiplied by 100.
Time frame: Baseline; Week 12
Population: FAS. Only participants with available data were analyzed. After a Root Cause Analysis, three sites were found not to have followed Good Clinical Practice; therefore, analysis was completed with all efficacy data from these sites removed.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Bempedoic Acid 180 mg + Ezetimibe 10 mg FDC | Percent Change From Baseline to Week 12 in High-density Lipoprotein Cholesterol (HDL-C) | -5.59 Percent change | Standard Deviation 12.269 |
| Bempedoic Acid 180 mg | Percent Change From Baseline to Week 12 in High-density Lipoprotein Cholesterol (HDL-C) | -5.40 Percent change | Standard Deviation 14.688 |
| Ezetimibe 10 mg | Percent Change From Baseline to Week 12 in High-density Lipoprotein Cholesterol (HDL-C) | -2.11 Percent change | Standard Deviation 11.59 |
| Placebo | Percent Change From Baseline to Week 12 in High-density Lipoprotein Cholesterol (HDL-C) | -0.54 Percent change | Standard Deviation 12.799 |
Percent Change From Baseline to Week 12 in High-sensitivity C-reactive Protein (hsCRP)
Blood samples were drawn after a minimum 10-hour fast (water was allowed) at pre-specified intervals. Samples were collected and analyzed for hsCRP. Baseline was defined as the predose Day 1/Week 0 value. Percent change from baseline in hsCRP was analyzed using a non-parametric analysis. Percent change from baseline was calculated as: (\[hsCRP value at Week 12 minus Baseline value\] divided by \[Baseline Value\]) multiplied by 100.
Time frame: Baseline; Week 12
Population: FAS. Only participants with available data were analyzed. After a Root Cause Analysis, three sites were found not to have followed Good Clinical Practice;therefore, analysis was completed with all efficacy data from these sites removed.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Bempedoic Acid 180 mg + Ezetimibe 10 mg FDC | Percent Change From Baseline to Week 12 in High-sensitivity C-reactive Protein (hsCRP) | -35.1 Percent Change |
| Bempedoic Acid 180 mg | Percent Change From Baseline to Week 12 in High-sensitivity C-reactive Protein (hsCRP) | -31.9 Percent Change |
| Ezetimibe 10 mg | Percent Change From Baseline to Week 12 in High-sensitivity C-reactive Protein (hsCRP) | -8.2 Percent Change |
| Placebo | Percent Change From Baseline to Week 12 in High-sensitivity C-reactive Protein (hsCRP) | 21.6 Percent Change |
Percent Change From Baseline to Week 12 in Non-high-density Lipoprotein Cholesterol (Non-HDL-C)
Blood samples were drawn after a minimum 10-hour fast (water was allowed) at pre-specified intervals. Samples were collected and analyzed for non-HDL-C. Baseline was defined as the mean of the non-HDL-C values from Week -2 and predose Day 1/Week 0. Percent change from baseline in non-HDL-C was analyzed using ANCOVA with treatment group and randomization stratification as a factors and baseline non-HDL-C as a covariate. Percent change from baseline was calculated as: (\[non-HDL-C value at Week 12 minus Baseline value\] divided by \[Baseline Value\]) multiplied by 100.
Time frame: Baseline; Week 12
Population: FAS. After a Root Cause Analysis, three sites were found not to have followed Good Clinical Practice; therefore, analysis was completed with all efficacy data from these sites removed.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Bempedoic Acid 180 mg + Ezetimibe 10 mg FDC | Percent Change From Baseline to Week 12 in Non-high-density Lipoprotein Cholesterol (Non-HDL-C) | -31.9 Percent change | Standard Error 2.23 |
| Bempedoic Acid 180 mg | Percent Change From Baseline to Week 12 in Non-high-density Lipoprotein Cholesterol (Non-HDL-C) | -14.1 Percent change | Standard Error 2.17 |
| Ezetimibe 10 mg | Percent Change From Baseline to Week 12 in Non-high-density Lipoprotein Cholesterol (Non-HDL-C) | -19.9 Percent change | Standard Error 2.05 |
| Placebo | Percent Change From Baseline to Week 12 in Non-high-density Lipoprotein Cholesterol (Non-HDL-C) | 1.8 Percent change | Standard Error 3.28 |
Percent Change From Baseline to Week 12 in Total Cholesterol (TC)
Blood samples were drawn after a minimum 10-hour fast (water was allowed) at pre-specified intervals. Samples were collected and analyzed for TC. Baseline was defined as the mean of the TC values from Week -2 and predose Day 1/Week 0. Percent change from baseline in TC was analyzed using ANCOVA with treatment group and randomization stratification as a factors and baseline TC as a covariate. Percent change from baseline was calculated as: (\[TC value at Week 12 minus Baseline value\] divided by \[Baseline Value\]) multiplied by 100.
Time frame: Baseline; Week 12
Population: FAS. Only participants with available data were analyzed. After a Root Cause Analysis, three sites were found not to have followed Good Clinical Practice; therefore, analysis was completed with all efficacy data from these sites removed.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Bempedoic Acid 180 mg + Ezetimibe 10 mg FDC | Percent Change From Baseline to Week 12 in Total Cholesterol (TC) | -26.4 Percent change | Standard Error 1.9 |
| Bempedoic Acid 180 mg | Percent Change From Baseline to Week 12 in Total Cholesterol (TC) | -12.1 Percent change | Standard Error 1.83 |
| Ezetimibe 10 mg | Percent Change From Baseline to Week 12 in Total Cholesterol (TC) | -16.0 Percent change | Standard Error 1.59 |
| Placebo | Percent Change From Baseline to Week 12 in Total Cholesterol (TC) | 0.7 Percent change | Standard Error 2.46 |
Percent Change From Baseline to Week 12 in Triglycerides (TGs)
Blood samples were drawn after a minimum 10-hour fast (water was allowed) at pre-specified intervals. Samples were collected and analyzed for TGs. Baseline was defined as the mean of the TGs values from Week -2 and predose Day 1/Week 0. Percent change from baseline was calculated as: (\[TGs value at Week 12 minus Baseline value\] divided by \[Baseline Value\]) multiplied by 100.
Time frame: Baseline; Week 12
Population: FAS. Only participants with available data were analyzed. After a Root Cause Analysis, three sites were found not to have followed Good Clinical Practice; therefore, analysis was completed with all efficacy data from these sites removed.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Bempedoic Acid 180 mg + Ezetimibe 10 mg FDC | Percent Change From Baseline to Week 12 in Triglycerides (TGs) | -7.90 Percent change | Standard Deviation 25.633 |
| Bempedoic Acid 180 mg | Percent Change From Baseline to Week 12 in Triglycerides (TGs) | 7.94 Percent change | Standard Deviation 42.312 |
| Ezetimibe 10 mg | Percent Change From Baseline to Week 12 in Triglycerides (TGs) | -2.46 Percent change | Standard Deviation 33.402 |
| Placebo | Percent Change From Baseline to Week 12 in Triglycerides (TGs) | 5.47 Percent change | Standard Deviation 31.992 |