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Bhatt D, Brinton E, Miller M, Steg P, Jacobson T, Ketchum S, Juliano R, Jiao L, Doyle R, Granowitz C, Busch R, Tardif J, Ballantyne C. SUBSTANTIAL CARDIOVASCULAR RISK REDUCTION WITH ICOSAPENT ETHYL REGARDLESS OF DIABETES STATUS OR BMI: REDUCE-IT BMI. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2021.07.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Bhatt D, Miller M, Steg P, Brinton E, Jacobson T, Ketchum S, Doyle R, Juliano R, Jiao L, Granowitz C, Tardif JC, Ballantyne C. REDUCE-IT: outcomes by baseline statin type. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
REDUCE-IT (Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial) randomized 8,179 statin-treated patients with elevated triglycerides and increased cardiovascular (CV) risk to either icosapent ethyl (IPE), a pure, stable prescription form of eicosapentaenoic acid, 4g/day or placebo. IPE significantly reduced time to first occurrence of the primary composite endpoint of major adverse CV events (CV death, nonfatal myocardial infarction [MI], nonfatal stroke, coronary revascularization, or hospitalization for unstable angina) (HR 0.75, CI 0.68–0.83) and key secondary endpoint events (composite of CV death, nonfatal MI, or nonfatal stroke) (HR 0.74, CI 0.65–0.83) versus placebo (all p<0.0001). A modest reduction in placebo-corrected LDL-C was observed (−6.6%; p<0.0001). The mechanisms for the CV benefit of icosapent ethyl are not fully understood.
Purpose
Explore the impact of statin type and lipophilic/lipophobic category on outcomes, and on LDL-C, to further consider the possible relevance of LDL-C pathways to the observed CV benefit of icosapent ethyl.
Methods
Primary and key secondary endpoint analyses and LDL-C changes from baseline were explored by individual statin type (atorvastatin, simvastatin, rosuvastatin, or pravastatin) at baseline, and then by categorizing these statins into lipophilic (i.e., hydrophobic: atorvastatin, simvastatin) and lipophobic (i.e., hydrophilic: rosuvastatin, pravastatin) statin groups; 96.1% of patients fell within these individual statin groups.
Results
CV outcomes were similar across statin types (interaction p=0.61) and lipophilic/lipophobic categories (interaction p=0.51) (Figure). Statin type and category had a similar lack of meaningful impact on the modest placebo-corrected median LDL-C changes from baseline to one year, which ranged from −5.8 to −8.4% (all p≤0.0003).
Conclusion
No meaningful treatment differences in the primary or key secondary endpoints across statin type or lipophilic/lipophobic category were observed. A similar lack of treatment difference was observed in LDL-C changes from baseline to one year. Therefore, the LDL-C changes and CV risk reduction in REDUCE-IT appear independent of the type of concomitant statin therapy. These data provide clinicians with additional insight regarding concomitant statin therapy considerations when prescribing icosapent ethyl and suggest there are important mechanisms of action for the substantial CV risk reduction observed with icosapent ethyl that are distinct from the LDL receptor pathway.
Funding Acknowledgement
Type of funding source: Other. Main funding source(s): The study was funded by Amarin Pharma, Inc.
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Affiliation(s)
- D Bhatt
- Brigham and Women's Hospital, Boston, United States of America
| | - M Miller
- University of Maryland, Department of Medicine, University of Maryland School of Medicine, Baltimore, United States of America
| | - P.G Steg
- University of Paris, INSERM Unité 1148; FACT Hopital Bichat, Paris, France
| | - E.A Brinton
- Utah Lipid Center, Salt Lake City, United States of America
| | - T.A Jacobson
- Emory University School of Medicine, Lipid Clinic and Cardiovascular Risk Reduction Program, Department of Medicine, Atlanta, United States of America
| | - S.B Ketchum
- Amarin Pharma, Inc., Bridgewater, United States of America
| | - R.T Doyle
- Amarin Pharma, Inc., Bridgewater, United States of America
| | - R.A Juliano
- Amarin Pharma, Inc., Bridgewater, United States of America
| | - L Jiao
- Amarin Pharma, Inc., Bridgewater, United States of America
| | - C Granowitz
- Amarin Pharma, Inc., Bridgewater, United States of America
| | - J.-C Tardif
- University of Montreal, Montreal Heart Institute, Montreal, Canada
| | - C.M Ballantyne
- Baylor College of Medicine, Department of Medicine, Houston, United States of America
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Olshansky B, Bhatt D, Miller M, Steg P, Brinton E, Jacobson T, Ketchum S, Doyle R, Juliano R, Jiao L, Granowitz C, Tardif JC, Mehta C, Ballantyne C, Chung M. REDUCE-IT: accumulation of data across prespecified interim analyses to final results. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
REDUCE-IT (Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial), an event-driven trial, randomized 8,179 statin-treated patients with elevated triglycerides (TGs) and increased cardiovascular (CV) risk to icosapent ethyl (IPE); pure, stable prescription eicosapentaenoic acid, 4g/day or placebo. 1,612 primary endpoint events (CV death, nonfatal myocardial infarction [MI], nonfatal stroke, coronary revascularization, or hospitalization for unstable angina) projected 90% power to detect 15% relative risk reduction (5% 2-sided alpha). The key secondary composite endpoint was CV death, nonfatal MI, or nonfatal stroke. An independent data and safety monitoring committee (DMC) performed prespecified interim analyses (IAs) at ∼60% (IA1 31 May 2016 data cutoff; 2.9 y median primary endpoint follow-up) and ∼80% (IA2 01 May 2017; 3.7 y) of events; final analysis included 1,606 events (06 Sep 2018; 4.9 y median study follow-up).
Purpose
Explore REDUCE-IT efficacy and safety across prespecified IAs for insight into progression of robustness and consistency of conclusions.
Methods
The interim statistical analysis plan guided study continuation decisions by a prespecified decision-making process, including assessment of safety, treatment arm performance, primary composite endpoint formal analyses, and informal robustness analyses, with no futility or efficacy stopping requirements. Prior to DMC IA study continuation decisions, the need for a mature dataset to support the robustness of final efficacy and safety findings was discussed. Sponsor, Steering Committee, and Clinical Endpoint Committee were blinded throughout.
Results
Primary and key secondary endpoints achieved statistical significance at IA1 and IA2 that persisted at final analyses (p-value below final adjusted 2-sided alpha of 0.0437); hazard ratios also remained consistent and similar robustness was observed across individual endpoint components; clarity of findings across endpoints and subgroups improved with more events. Stopping for overwhelming efficacy was discussed at each IA; prior to IA study continuation recommendations, the DMC considered historical examples of failed CV outcome studies for TG-lowering and mixed omega-3 therapies, reflected on the potential for overestimating final demonstrated benefit using incomplete data, and weighed societal impacts of fuller datasets relative to patient therapy access.
Conclusions
Consistent, potent efficacy emerged early and persisted across the two prespecified interim and final analyses. The mature dataset demonstrated highly statistically significant reductions in the primary (25%; p=0.00000001) and key secondary (26%; p=0.0000006) endpoints and allowed robust analyses to support overall efficacy and safety conclusions. Allowing the REDUCE-IT dataset to fully mature provided clinicians with robust, consistent, and reliable data upon which to base clinical decisions for IPE in CV risk reduction.
Funding Acknowledgement
Type of funding source: Other. Main funding source(s): The study was funded by Amarin Pharma, Inc.
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Affiliation(s)
- B Olshansky
- University of Iowa College of Medicine, Iowa city, United States of America
| | - D Bhatt
- Brigham and Women's Hospital, Boston, United States of America
| | - M Miller
- University of Maryland, Department of Medicine, University of Maryland School of Medicine, Baltimore, United States of America
| | - P.G Steg
- University of Paris, INSERM Unité 1148; FACT Hopital Bichat, Paris, France
| | - E.A Brinton
- Utah Lipid Center, Salt Lake City, United States of America
| | - T.A Jacobson
- Emory University School of Medicine, Lipid Clinic and Cardiovascular Risk Reduction Program, Department of Medicine, Atlanta, United States of America
| | - S.B Ketchum
- Amarin Pharma, Inc., Bridgewater, United States of America
| | - R.T Doyle
- Amarin Pharma, Inc., Bridgewater, United States of America
| | - R.A Juliano
- Amarin Pharma, Inc., Bridgewater, United States of America
| | - L Jiao
- Amarin Pharma, Inc., Bridgewater, United States of America
| | - C Granowitz
- Amarin Pharma, Inc., Bridgewater, United States of America
| | - J.-C Tardif
- University of Montreal, Montreal Heart Institute, Montreal, Canada
| | - C Mehta
- Cytel Inc., Waltham, United States of America
| | - C.M Ballantyne
- Baylor College of Medicine, Houston, United States of America
| | - M.K Chung
- Cleveland Clinic, Cleveland, United States of America
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Bhatt D, Miller M, Steg P, Brinton E, Jacobson T, Ketchum S, Doyle R, Juliano R, Jiao L, Granowitz C, Gregson J, Pocock S, Tardif JC, Ballantyne C. REDUCE-IT: total ischemic events reduced across the full range of baseline LDL cholesterol and other key subgroups. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
REDUCE-IT (Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial), a study of 8,179 randomized statin-treated patients with elevated triglycerides (TG) and increased cardiovascular (CV) risk followed for a median of 4.9 years, demonstrated robust results. Icosapent ethyl (IPE), a pure and stable prescription form of eicosapentaenoic acid, 4g/day reduced both time-to-first and total primary endpoint ischemic events (CV death, nonfatal myocardial infarction [MI], nonfatal stroke, coronary revascularization, or hospitalization for unstable angina) by 25% (HR 0.75; 95% CI 0.68–0.83; p<0.0001) and 30% (rate ratio 0.70; 95% CI 0.62–0.78; p<0.0001), respectively. Similar substantial reductions in first and total key secondary endpoint ischemic events (composite of CV death, nonfatal MI, or nonfatal stroke) were also observed. Demographic and baseline disease characteristics were generally balanced across treatment groups. Time-to-first event analyses showed robust and generally consistent benefit across subgroups. Previous total event analyses by baseline TG demonstrated large, consistent, statistically significant reductions across tertiles, suggesting the CV benefit of IPE is tied primarily to non-TG factors.
Purpose
Further explore the extent to which IPE reduced total primary and key secondary events across prespecified baseline demographic, disease, treatment, and lipid/lipoprotein/inflammatory biomarker subgroups.
Methods
Total events across subgroups were assessed with the prespecified negative binomial regression method. Main outcomes were total (first and subsequent) primary and key secondary composite endpoint events.
Results
Median baseline LDL-C levels in ascending tertiles were 58, 76, and 96 mg/dL; there were large, significant relative reductions in total primary endpoint events with IPE across tertiles (35%, 28%, and 27%, respectively; interaction p=0.62), with parallel substantial absolute risk reductions. Similar, significant relative reductions of 33%, 28%, and 24% in total key secondary endpoint events were observed, along with substantial absolute risk reductions. Total events analyses of prespecified subgroups also demonstrated robust and generally consistent findings for the primary and key secondary composite endpoints.
Conclusion
REDUCE-IT demonstrated substantial reductions in first and total primary and key secondary endpoint ischemic events, with robust and generally consistent results across baseline TG and LDL-C levels, as well as other prespecified baseline biomarker, demographic, disease, and treatment subgroups. These analyses provide useful insights for clinicians considering the range of patients who may benefit from IPE therapy and suggest that mechanisms beyond the lipid/lipoprotein/inflammatory pathways tested, including mechanisms beyond the LDL receptor pathways, may contribute to the observed substantial reductions in total ischemic burden with IPE therapy.
Funding Acknowledgement
Type of funding source: Other. Main funding source(s): The study was funded by Amarin Pharma, Inc.
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Affiliation(s)
- D Bhatt
- Brigham and Women's Hospital, Boston, United States of America
| | - M Miller
- University of Maryland, Department of Medicine, University of Maryland School of Medicine, Baltimore, United States of America
| | - P.G Steg
- University of Paris, INSERM Unité 1148; FACT Hopital Bichat, Paris, France
| | - E.A Brinton
- Utah Lipid Center, Utah, United States of America
| | - T.A Jacobson
- Emory University School of Medicine, Lipid Clinic and Cardiovascular Risk Reduction Program, Department of Medicine, Atlanta, United States of America
| | - S.B Ketchum
- Amarin Pharma, Inc., Bridgewater, United States of America
| | - R.T Doyle
- Amarin Pharma, Inc., Bridgewater, United States of America
| | - R.A Juliano
- Amarin Pharma, Inc., Bridgewater, United States of America
| | - L Jiao
- Amarin Pharma, Inc., Bridgewater, United States of America
| | - C Granowitz
- Amarin Pharma, Inc., Bridgewater, United States of America
| | - J Gregson
- London School of Hygiene and Tropical Medicine, Department of Medical Statistics, London, United Kingdom
| | - S.J Pocock
- London School of Hygiene and Tropical Medicine, Department of Medical Statistics, London, United Kingdom
| | - J.-C Tardif
- University of Montreal, Montreal Heart Institute, Montreal, Canada
| | - C.M Ballantyne
- Baylor College of Medicine, Houston, United States of America
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Bhatt D, Steg P, Miller M, Brinton E, Jacobson T, Ketchum S, Juliano R, Jiao L, Doyle R, Granowitz C, Tardif J, Verma S, Ballantyne C. SIGNIFICANT CARDIOVASCULAR BENEFITS OF ICOSAPENT ETHYL FROM REDUCE-IT. Can J Cardiol 2020. [DOI: 10.1016/j.cjca.2020.07.218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Lichtenstein A, Brinton E, Rimm E. Abstract: 598 DIETARY RECOMMENDATIONS TO REDUCE CARDIOVASCULAR DISEASE RISK– HISTORICAL PERSPECTIVE. ATHEROSCLEROSIS SUPP 2009. [DOI: 10.1016/s1567-5688(09)71601-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Cannon C, Dansky H, Davidson M, Gotto A, Brinton E, Gould A, Stepanavage M, Liu S, Shah S, Rubino J, Gibbons P, Hermanowski-Vosatka A, Binkowitz B, Mitchel Y, Barter P. Abstract: P1390 DESIGN OF THE DEFINE TRIAL: DETERMINING THE EFFICACY AND TOLERABILITY OF CETP INHIBITION WITH ANACETRAPIB. ATHEROSCLEROSIS SUPP 2009. [DOI: 10.1016/s1567-5688(09)71398-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Marin V, Brinton E, Huntley M. Depth relationships of Euphausia superba eggs, larvae and adults near the Antarctic Peninsula, 1986–87. ACTA ACUST UNITED AC 1991. [DOI: 10.1016/0198-0149(91)90104-n] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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