Physicians' Academy for Cardiovascular Education

PCSK9 inhibition results in consistent LDL-c lowering benefit in various patient subgroups

Consistent LDL-C response with evolocumab among patient subgroups in PROFICIO: a pooled analysis of 3146 patients from phase 3 studies

Literature - Stroes E, Robinson JG, Raal FJ et al. - Clin Cardiol 2018; published online ahead of print

Introduction and methods

The Program to Reduce low density lipoprotein cholesterol (LDL-c) and Cardiovascular Outcomes Following Inhibition of proprotein convertase subtilisin/kexin type 9 (PCSK9) In Different Populations (PROFICIO) trial tested efficacy and safety of evolocumab in different patient populations with hypercholesterolemia, including those with familial hypercholesterolemia or statin intolerance. Within each of the studies in the PROFICIO program, evolocumab therapy substantially and consistently decreased LDL-c [1-5].

This analysis pooling data from four randomized studies further investigated the LDL-c reduction associated with evolocumab therapy in different patient subsets based on demographic and disease characteristics.

This pooled analysis included four placebo- or ezetimibe-controlled, phase 3 trials and evaluated the difference in percent change from baseline in LDL-c between each evolocumab dosing regimen and control therapy, using the mean of week 10 and 12 LDL-c values. Background lipid therapies included statin monotherapy or statin combined with ezetimibe. The evolocumab dosing regimens were 140 mg subcutaneously every two weeks (Q2W) or 420 mg monthly (QM).

In total, 3,146 patients with primary hypercholesterolemia and cardiovascular (CV) risk of various levels, familial hypercholesterolemia, and prior intolerance to ≥2 statins were randomized and received at least one dose of evolocumab or control therapy.

Main results

In the pooled population, the mean age of participants was 57.8 years, 49.4% of patients were women, 91.5% were white, and 54.1% were receiving statins.

In the pooled analysis, the mean percent treatment differences from baseline in LDL-c were:

LDL-c changes were similar in the following subgroups (consistent after adjusting for age, body mass index, baseline LDL-c, baseline PCSK9, and baseline statin treatment):

Overall, adverse events foreseen with the evolocumab 140 mg Q2W and 420 mg QM dosing regimens were similar to those seen in the control arms.

Conclusion

In a pooled analysis of four phase 3 trials, evolocumab 140 mg Q2W and 420 mg QM resulted in significantly greater reductions in LDL-c vs placebo or ezetimibe, on top of background statin therapy for all demographic and disease status subgroups analyzed, with similar adverse effects compared to controls.

References

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