Erik Stroes1, David Colquhoun2, David Sullivan3, Fernando Civeira4, Robert S Rosenson5, Gerald F Watts6, Eric Bruckert7, Leslie Cho8, Ricardo Dent9, Beat Knusel9, Allen Xue9, Rob Scott9, Scott M Wasserman9, Michael Rocco10. 1. Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands. Electronic address: e.s.stroes@amc.uva.nl. 2. Wesley Medical Centre, Auchenflower, Australia. 3. Department of Clinical Biochemistry, Royal Prince Alfred Hospital, Camperdown, Australia. 4. Hospital Universitario Miguel Servet, Zaragoza, Spain. 5. Cardiometabolic Disorders Department, Icahn School of Medicine at Mount Sinai, New York, New York. 6. Lipid Disorders Clinic, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia, Perth, Australia. 7. Hopital Pitie-Salpetriere, Paris, France. 8. Preventive Cardiology and Rehabilitation, Cleveland Clinic, Cleveland, Ohio. 9. Amgen, Thousand Oaks, California. 10. Cardiovascular Medicine Department, Cleveland Clinic, Cleveland, Ohio.
Abstract
OBJECTIVES: This study sought to evaluate the efficacy and safety of subcutaneous evolocumab compared with oral ezetimibe in hypercholesterolemic patients who are unable to tolerate effective statin doses. BACKGROUND: Statin intolerance, which is predominantly due to muscle-related side effects, is reported in up to 10% to 20% of patients. Evolocumab, a fully human monoclonal antibody to proprotein convertase subtilisin/kexin type 9 (PCSK9), demonstrated marked reductions in plasma low-density lipoprotein cholesterol (LDL-C) in a phase 2 study in statin-intolerant patients. METHODS: The GAUSS-2 (Goal Achievement after Utilizing an Anti-PCSK9 Antibody in Statin Intolerant Subjects) trial was a 12-week, double-blind study of randomized patients (2:2:1:1) to evolocumab 140 mg every two weeks (Q2W) or evolocumab 420 mg once monthly (QM) both with daily oral placebo or subcutaneous placebo Q2W or QM both with daily oral ezetimibe 10 mg. Co-primary endpoints were percent change from baseline in LDL-C at the mean of weeks 10 and 12, and at week 12. RESULTS:Three hundred seven patients (age 62 ± 10 years; LDL-C 193 ± 59 mg/dl) were randomized. Evolocumab reduced LDL-C from baseline by 53% to 56%, corresponding to treatment differences versus ezetimibe of 37% to 39% (p <0.001). Muscle adverse events occurred in 12% of evolocumab-treated patients and 23% of ezetimibe-treated patients. Treatment-emergent adverse events and laboratory abnormalities were comparable across treatment groups. CONCLUSIONS: Robust efficacy combined with favorable tolerability makes evolocumab a promising therapy for addressing the largely unmet clinical need in high-risk patients with elevated cholesterol who are statin intolerant. (Goal Achievement After Utilizing an Anti-PCSK9 Antibody in Statin Intolerant Subjects-2; NCT01763905).
RCT Entities:
OBJECTIVES: This study sought to evaluate the efficacy and safety of subcutaneous evolocumab compared with oral ezetimibe in hypercholesterolemicpatients who are unable to tolerate effective statin doses. BACKGROUND: Statin intolerance, which is predominantly due to muscle-related side effects, is reported in up to 10% to 20% of patients. Evolocumab, a fully human monoclonal antibody to proprotein convertase subtilisin/kexin type 9 (PCSK9), demonstrated marked reductions in plasma low-density lipoprotein cholesterol (LDL-C) in a phase 2 study in statin-intolerant patients. METHODS: The GAUSS-2 (Goal Achievement after Utilizing an Anti-PCSK9 Antibody in Statin Intolerant Subjects) trial was a 12-week, double-blind study of randomized patients (2:2:1:1) to evolocumab 140 mg every two weeks (Q2W) or evolocumab 420 mg once monthly (QM) both with daily oral placebo or subcutaneous placebo Q2W or QM both with daily oral ezetimibe 10 mg. Co-primary endpoints were percent change from baseline in LDL-C at the mean of weeks 10 and 12, and at week 12. RESULTS: Three hundred seven patients (age 62 ± 10 years; LDL-C 193 ± 59 mg/dl) were randomized. Evolocumab reduced LDL-C from baseline by 53% to 56%, corresponding to treatment differences versus ezetimibe of 37% to 39% (p <0.001). Muscle adverse events occurred in 12% of evolocumab-treated patients and 23% of ezetimibe-treated patients. Treatment-emergent adverse events and laboratory abnormalities were comparable across treatment groups. CONCLUSIONS: Robust efficacy combined with favorable tolerability makes evolocumab a promising therapy for addressing the largely unmet clinical need in high-risk patients with elevated cholesterol who are statin intolerant. (Goal Achievement After Utilizing an Anti-PCSK9 Antibody in Statin Intolerant Subjects-2; NCT01763905).
Authors: Lotte C A Stiekema; Erik S G Stroes; Simone L Verweij; Helina Kassahun; Lisa Chen; Scott M Wasserman; Marc S Sabatine; Venkatesh Mani; Zahi A Fayad Journal: Eur Heart J Date: 2019-09-01 Impact factor: 29.983
Authors: Frederick J Raal; Robert P Giugliano; Marc S Sabatine; Michael J Koren; Dirk Blom; Nabil G Seidah; Narimon Honarpour; Armando Lira; Allen Xue; Padmaja Chiruvolu; Simon Jackson; Mei Di; Matthew Peach; Ransi Somaratne; Scott M Wasserman; Rob Scott; Evan A Stein Journal: J Lipid Res Date: 2016-04-21 Impact factor: 5.922