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Effect of a monoclonal antibody to PCSK9, 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
The Lancet, 07/10/2012
Clinical Article
Stein EA et al. – REGN727 was well tolerated and achieved substantial further low–density lipoprotein cholesterol (LDL–C) reduction in patients with heterozygous familial hypercholesterolaemia and elevated LDL–C treated with high–dose statins, with or without ezetimibe. REGN727 has the potential to provide optimum control of LDL–C in patients with this disorder.
Methods- This multicentre, randomised, placebo–controlled phase 2 trial was done at 16 lipid clinics in the USA and Canada.
- Between Jan 18, 2011, and Nov 7, 2011, the authors enrolled adults with heterozygous familial hypercholesterolaemia and LDL–C concentrations of 2.6 mmol/L or higher on stable diet and statin dose, with or without ezetimibe.
- Patients were randomly assigned to receive REGN727 150 mg, 200 mg, or 300 mg every 4 weeks, or 150 mg every 2 weeks, or placebo every 2 weeks (ratio 1:1:1:1:1).
- Randomisation was stratified by concomitant use of ezetimibe at baseline.
- Investigators, study staff, and patients were masked to treatment group.
- Blinding was maintained by administration of placebo alternating with REGN727 for the groups of 4 week dosing.
- The primary endpoint was mean percent reduction in LDL–C from baseline at week 12 and was analysed in the modified intention–to–treat population with an analysis of covariance (ANCOVA) model with treatment group.
- 77 patients were randomly assigned to study groups (15—16 patients per group) and all were analysed.
- Least–squares (LS) mean LDL–C reduction from baseline to week 12 was 28.9% (SE 5.08) for 150 mg every 4 weeks (p=0.0113), 31.54% (4.91) for 200 mg every 4 weeks (p=0.0035), 42.53% (5.09) for 300 mg every 4 weeks (p<0.0001), and 67.90% (4.85) for 150 mg every 2 weeks (p<0.0001), compared with 10.65% (5.04) with placebo.
- One serious adverse event was reported with placebo and none with REGN727.
- No increases of more than three times the upper limit of normal were reported for hepatic transaminases or creatinine kinase.
- The most common adverse event was injection–site reaction with one patient in the group of 300 mg REGN727 terminating treatment.