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DECLARATION OF INTEREST
NO INTEREST
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Mipomersen
(previously ISIS 301012, trade name Kynamro)
Is a cholesterol-reducing drug
It is an antisense oligonucleotide inhibitor of apoB100
36%
PCSK-9 inhibitors
(proprotein convertase subtilin/kexin 9)
Effect of a monoclonal antibody to PCSK-9, REGN727/SAR236553, to reduce low-density lipoprotein cholesterol in patients with heterozygous familial hypercholesterolaemia on stable statin dose with or without ezetimibe therapy: a phase 2 randomised controlled trial
Prof, Dr Evan A Stein, MD, et al
Multicentre, randomised, placebo-controlled phase 2 trial done at 16 lipid clinics in the USA and Canada (Jan 18, 2011& Nov 7, 2011) Adults with heterozygous familial hypercholesterolaemia and LDL-C concentrations of 26 mmol/L or higher on stable diet and statin dose, with or without ezetimibe Pts were randomly assigned to receive REGN727 150 mg, 200 mg, or 300 mg / 4 weeks, or 150 mg/ 2 weeks, or placebo / 2 weeks (ratio 1:1:1:1:1) Randomisation was stratified by concomitant use of ezetimibe at baseline Blinding was maintained by administration of placebo alternating with REGN727 for the groups of 4 week dosing The primary endpoint was mean % in LDL-C from baseline at week 12 Was analysed in the modified intention-to-treat population with an analysis of covariance (ANCOVA) model with treatment group
Mean % change in baseline LDL-C (A) & ApoB (B) vs week during treatment & follow-up period. Data are mean % LDL-C & ApoB
MTP inhibitors
Phase 3 study of lomitapide (AEGR-733) to lower LDL-c for the treatment of pts with (HoFH )
November 16, 2009 Aegerion Pharmaceuticals
22 pts enrolled in the ongoing Phase 3 trial 14 of the pts for a min of 26 & 7 pts for 56 weeks Pts are titrated >to a max tolerated dose of lomitapide (up to 60 mg/day) The 14 pts treated with lomitapide for 26 weeks experienced a mean reduction in LDL-C of 49% on top of maximum tolerated background therapy. Average baseline LDL-C levels in this trial were 351 mg/dl &6 of the 14 patients achieved an LDL-C level below 100 mg/dl At 26 weeks, pts experienced a modest in hepatic fat from 1.0% to 7.8% All pts that have reached 56 weeks have seen their hepatic fat levels 7% at 56 weeks Mild -moderate gastrointestinal adverse events have been the most commonly reported side effect 2 of the 14 pts experienced transaminase which required a dose None of the ps required drug discontinuation due to liver function test elevations
25,673 high-risk pts with occlusive arterial disease from China, Scandinavia and UK
Randomized comparison: ER niacin/laropiprant (ERN/LRPT) 2g daily versus placebo
Primary end point: Major vascular events after median follow-up of 4 years
Pre-specified safety analyses: Median follow-up of 3.4 years (to January 2012) Background LDL-lowering therapy with: Simvastatin 40mg (+/- ezetimibe 10mg)/daily
China
Europe All
10932
14741 25673
1.51 (0.41)
1.74 (0.43) 1.64 (0.44) 1.06 (0.24)
-0.32
-0.36 -0.34 +0.15
-20%
+0.20 +0.18
+17%
HPS2-THRIVE
LIPOTEST
(75 g 25 g 10 g ) 4
Meta-analysis of 13 statin trials (n=91,140), 9% increase in incident DM during 4 yrs follow-up in pts receiving a statin versus placebo or standard care. In absolute terms, this equates to one additional case of
However, clinicians need to bear in mind that this absolute risk is low when compared with the reduction in coronary events achieved with statin therapy. Moreover, a definitive mechanism of action has not yet been elucidated
Naveed A Sattar, Institute of Cardiovascular& Medical Sciences, University of Glasgow, UK Atheroscler Suppl 2012
12 513 pts
6244 randomly assigned to 1gr of -3 fatty acids 6269 patients randomized to placebo
The primary end point of the trial was initially a
composite that included death, nonfatal MI, and nonfatal stroke Was revised to death from CVD causes / hospital admissions for CVD causes.
After a median follow-up of five years
May 9, 2013 New England Journal of Medicine
3 n=6239 (%)
1,0 0,8
0,8 0,6
0,22 0,36
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