1
|
Rosenson RS, Rader DJ, Ali S, Banerjee P, McGinniss J, Pordy R. Evinacumab Reduces Triglyceride-Rich Lipoproteins in Patients with Hyperlipidemia: A Post-Hoc Analysis of Three Randomized Clinical Trials. Cardiovasc Drugs Ther 2024:10.1007/s10557-024-07567-z. [PMID: 38446275 DOI: 10.1007/s10557-024-07567-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/24/2024] [Indexed: 03/07/2024]
Abstract
PURPOSE Natural selection (Mendelian randomization) studies support a causal relationship between elevated triglyceride-rich lipoproteins (TRLs) and atherosclerotic cardiovascular disease (ASCVD). This post-hoc analysis assessed the efficacy of evinacumab in reducing TRLs in patient cohorts from three separate clinical trials with evinacumab. METHODS Patients with homozygous familial hypercholesterolemia (HoFH) and low-density lipoprotein cholesterol (LDL-C) ≥ 70 mg/dL were enrolled in a phase III trial (R1500-CL-1629; NCT03399786). Patients diagnosed with refractory hypercholesterolemia, with LDL-C ≥ 70 mg/dL or ≥ 100 mg/dL for those with or without ASCVD, respectively, were enrolled in a phase II trial (R1500-CL-1643; NCT03175367). Patients with severe hypertriglyceridemia (fasting TGs ≥ 500 mg/dL) were enrolled in a phase II trial (R1500-HTG-1522; NCT03452228). Patients received evinacumab intravenously (5 or 15 mg/kg) every 4 weeks, or subcutaneously (300 or 450 mg) every week or every 2 weeks. Efficacy outcomes included change in TRLs (calculated as total cholesterol minus high-density lipoprotein cholesterol minus LDL-C) and other lipid parameters from baseline to 12, 16, or 24 weeks for trial 1522, 1643, and 1629, respectively. RESULTS At baseline, TRL levels were higher for patients with severe hypertriglyceridemia entering the 1522 trial vs. other cohorts. Reductions in TRLs were observed across all studies with evinacumab, with > 50% reduction from baseline observed at the highest doses evaluated in patients with HoFH or refractory hypercholesterolemia. Within all three trials, evinacumab was generally well tolerated. CONCLUSIONS Despite limitations in direct comparisons between study groups, these data indicate that TRL levels could be a future target for lipid-lowering therapies.
Collapse
Affiliation(s)
- Robert S Rosenson
- Metabolism and Lipids Unit, Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY, 10029, USA.
| | - Daniel J Rader
- Department of Genetics and Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Shazia Ali
- Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, New York, NY, 10591, USA
| | - Poulabi Banerjee
- Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, New York, NY, 10591, USA
| | - Jennifer McGinniss
- Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, New York, NY, 10591, USA
| | - Robert Pordy
- Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, New York, NY, 10591, USA
| |
Collapse
|
2
|
Rosenson RS, Burgess LJ, Ebenbichler CF, Baum SJ, Stroes ESG, Ali S, Khilla N, McGinniss J, Gaudet D, Pordy R. Longer-Term Efficacy and Safety of Evinacumab in Patients With Refractory Hypercholesterolemia. JAMA Cardiol 2023; 8:1070-1076. [PMID: 37703006 PMCID: PMC10500429 DOI: 10.1001/jamacardio.2023.2921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 07/20/2023] [Indexed: 09/14/2023]
Abstract
Importance Patients with refractory hypercholesterolemia who do not achieve their guideline-defined low-density lipoprotein cholesterol (LDL-C) thresholds despite treatment with maximally tolerated combinations of lipid-lowering therapies (LLTs) have an increased risk of atherosclerotic cardiovascular disease (ASCVD). Objective To evaluate longer-term efficacy and safety of evinacumab in patients with refractory hypercholesterolemia. Design, Setting, and Participants This randomized clinical trial included a 2-week screening period followed by a 16-week double-blind treatment period (DBTP) for subcutaneous regimens (evinacumab, 450 mg, once weekly [QW]; evinacumab, 300 mg, QW; evinacumab, 300 mg, every 2 weeks; or placebo QW) or a 24-week DBTP for intravenous regimens (evinacumab, 15 mg/kg, every 4 weeks [Q4W]; evinacumab, 5 mg/kg, Q4W; or placebo Q4W); a 48-week open-label treatment period (OLTP) for intravenous treatment only; and a 24-week follow-up period. Patients from 85 sites across 20 countries were recruited for the study; patients with primary hypercholesterolemia (defined as heterozygous familial hypercholesterolemia or established clinical ASCVD without familial hypercholesterolemia) who entered the 48-week OLTP were included. In addition, the patients' hypercholesterolemia was refractory to maximally tolerated LLTs. Interventions All patients entering the OLTP received evinacumab, 15 mg/kg, intravenously Q4W. Main Outcomes and Measures Efficacy outcomes included change in LDL-C level and other lipid/lipoprotein parameters from baseline to week 72 (end of the OLTP). Safety outcomes included assessment of treatment-emergent adverse events (TEAEs). Results A total of 96 patients (mean [SD] age, 54.4 [11.3] years; 52 female [54.2%]) entered the OLTP, of whom 88 (91.7%) completed the OLTP. Mean (SD) baseline LDL-C level was 145.9 (55.2) mg/dL. At week 72, evinacumab, 15 mg/kg, reduced mean (SD) LDL-C level from baseline by 45.5% (28.7%) in the overall cohort. Evinacumab, 15 mg/kg, reduced mean (SD) apolipoprotein B (38.0% [22.1%]), non-high density lipoprotein cholesterol (48.4% [23.2%]), total cholesterol (42.6% [17.5%]), and median (IQR) fasting triglyceride (57.2% [65.4%-44.4%]) levels at week 72 from baseline in the overall cohort. TEAEs occurred in 78 of 96 patients (81.3%). Serious TEAEs occurred in 9 of 96 patients (9.4%); all were considered unrelated to study treatment. Conclusions and Relevance In patients with refractory hypercholesterolemia, evinacumab provided sustained reductions in LDL-C level and was generally well tolerated. Trial Registration ClinicalTrials.gov Identifier: NCT03175367.
Collapse
Affiliation(s)
- Robert S. Rosenson
- Metabolism and Lipids Unit, Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lesley J. Burgess
- TREAD Research Centre, Cardiology Unit, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Parow, South Africa
| | | | - Seth J. Baum
- Excel Medical Clinical Trials and Department of Integrated Medical Sciences, Charles E Schmidt College of Medicine, Florida Atlantic University, Boca Raton
| | - Erik S. G. Stroes
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Shazia Ali
- Regeneron Pharmaceuticals Inc, Tarrytown, New York
| | - Nagwa Khilla
- Regeneron Pharmaceuticals Inc, Tarrytown, New York
| | | | - Daniel Gaudet
- Clinical Lipidology and Rare Lipid Disorders Unit, Department of Medicine, Université de Montréal Community Gene Medicine Center, and ECOGENE-21 Clinical and Translational Research Center, Chicoutimi, Québec, Canada
| | - Robert Pordy
- Regeneron Pharmaceuticals Inc, Tarrytown, New York
| |
Collapse
|
3
|
Rosenson RS, Gaudet D, Ballantyne CM, Baum SJ, Bergeron J, Kershaw EE, Moriarty PM, Rubba P, Whitcomb DC, Banerjee P, Gewitz A, Gonzaga-Jauregui C, McGinniss J, Ponda MP, Pordy R, Zhao J, Rader DJ. Evinacumab in severe hypertriglyceridemia with or without lipoprotein lipase pathway mutations: a phase 2 randomized trial. Nat Med 2023; 29:729-737. [PMID: 36879129 PMCID: PMC10033404 DOI: 10.1038/s41591-023-02222-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/19/2023] [Indexed: 03/08/2023]
Abstract
Severe hypertriglyceridemia (sHTG) is an established risk factor for acute pancreatitis. Current therapeutic approaches for sHTG are often insufficient to reduce triglycerides and prevent acute pancreatitis. This phase 2 trial ( NCT03452228 ) evaluated evinacumab (angiopoietin-like 3 inhibitor) in three cohorts of patients with sHTG: cohort 1, familial chylomicronemia syndrome with bi-allelic loss-of-function lipoprotein lipase (LPL) pathway mutations (n = 17); cohort 2, multifactorial chylomicronemia syndrome with heterozygous loss-of-function LPL pathway mutations (n = 15); and cohort 3, multifactorial chylomicronemia syndrome without LPL pathway mutations (n = 19). Fifty-one patients (males, n = 27; females, n = 24) with a history of hospitalization for acute pancreatitis were randomized 2:1 to intravenous evinacumab 15 mg kg-1 or placebo every 4 weeks over a 12-week double-blind treatment period, followed by a 12-week single-blind treatment period. The primary end point was the mean percent reduction in triglycerides from baseline after 12 weeks of evinacumab exposure in cohort 3. Evinacumab reduced triglycerides in cohort 3 by a mean (s.e.m.) of -27.1% (37.4) (95% confidence interval -71.2 to 84.6), but the prespecified primary end point was not met. No notable differences in adverse events between evinacumab and placebo treatment groups were seen during the double-blind treatment period. Although the primary end point of a reduction in triglycerides did not meet the prespecified significance level, the observed safety and changes in lipid and lipoprotein levels support the further evaluation of evinacumab in larger trials of patients with sHTG. Trial registration number: ClinicalTrials.gov NCT03452228 .
Collapse
Affiliation(s)
- Robert S Rosenson
- Metabolism and Lipids Unit, Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Daniel Gaudet
- Clinical Lipidology and Rare Lipid Disorders Unit, Department of Medicine, Université de Montréal Community Gene Medicine Center, and ECOGENE-21 Clinical and Translational Research Center, Chicoutimi, Quebec, Canada
| | | | - Seth J Baum
- Excel Medical Clinical Trials and Department of Integrated Medical Sciences, Charles E Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Jean Bergeron
- Departments of Laboratory Medicine and of Medicine, Centre Hospitalier Universitaire de Québec-Université Laval, Québec, Québec, Canada
| | - Erin E Kershaw
- Division of Endocrinology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Patrick M Moriarty
- Division of Clinical Pharmacology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Paolo Rubba
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - David C Whitcomb
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
| | | | | | | | | | | | | | - Jian Zhao
- Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | - Daniel J Rader
- Department of Genetics and Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
4
|
Hagström E, Steg PG, Szarek M, Bhatt DL, Bittner VA, Danchin N, Diaz R, Goodman SG, Harrington RA, Jukema JW, Liberopoulos E, Marx N, McGinniss J, Manvelian G, Pordy R, Scemama M, White HD, Zeiher AM, Schwartz GG. Apolipoprotein B, Residual Cardiovascular Risk After Acute Coronary Syndrome, and Effects of Alirocumab. Circulation 2022; 146:657-672. [PMID: 35770629 PMCID: PMC9422774 DOI: 10.1161/circulationaha.121.057807] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Apolipoprotein B (apoB) provides an integrated measure of atherogenic risk. Whether apoB levels and apoB lowering hold incremental predictive information on residual risk after acute coronary syndrome beyond that provided by low-density lipoprotein cholesterol is uncertain. METHODS The ODYSSEY OUTCOMES trial (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) compared the proprotein convertase subtilisin/kexin type 9 inhibitor alirocumab with placebo in 18 924 patients with recent acute coronary syndrome and elevated atherogenic lipoproteins despite optimized statin therapy. Primary outcome was major adverse cardiovascular events (MACE; coronary heart disease death, nonfatal myocardial infarction, fatal/nonfatal ischemic stroke, hospitalization for unstable angina). Associations between baseline apoB or apoB at 4 months and MACE were assessed in adjusted Cox proportional hazards and propensity score-matched models. RESULTS Median follow-up was 2.8 years. In proportional hazards analysis in the placebo group, MACE incidence increased across increasing baseline apoB strata (3.2 [95% CI, 2.9-3.6], 4.0 [95% CI, 3.6-4.5], and 5.5 [95% CI, 5.0-6.1] events per 100 patient-years in strata <75, 75-<90, ≥90 mg/dL, respectively; Ptrend<0.0001) and after adjustment for low-density lipoprotein cholesterol (Ptrend=0.035). Higher baseline apoB stratum was associated with greater relative (Ptrend<0.0001) and absolute reduction in MACE with alirocumab versus placebo. In the alirocumab group, the incidence of MACE after month 4 decreased monotonically across decreasing achieved apoB strata (4.26 [95% CI, 3.78-4.79], 3.09 [95% CI, 2.69-3.54], and 2.41 [95% CI, 2.11-2.76] events per 100 patient-years in strata ≥50, >35-<50, and ≤35 mg/dL, respectively). Compared with propensity score-matched patients from the placebo group, treatment hazard ratios for alirocumab also decreased monotonically across achieved apoB strata. Achieved apoB was predictive of MACE after adjustment for achieved low-density lipoprotein cholesterol or non-high-density lipoprotein cholesterol but not vice versa. CONCLUSIONS In patients with recent acute coronary syndrome and elevated atherogenic lipoproteins, MACE increased across baseline apoB strata. Alirocumab reduced MACE across all strata of baseline apoB, with larger absolute reductions in patients with higher baseline levels. Lower achieved apoB was associated with lower risk of MACE, even after accounting for achieved low-density lipoprotein cholesterol or non-high-density lipoprotein cholesterol, indicating that apoB provides incremental information. Achievement of apoB levels as low as ≤35 mg/dL may reduce lipoprotein-attributable residual risk after acute coronary syndrome. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT01663402.
Collapse
Affiliation(s)
- Emil Hagström
- Uppsala University, Department of Medical Sciences, and Uppsala Clinical Research Center, Sweden (E.H.)
| | - P. Gabriel Steg
- Department of Cardiology, Université de Paris, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, FACT (French Alliance for Cardiovascular Trials), and INSERM U1148, France (P.G.S.).,Imperial College, Royal Brompton Hospital, London, UK (P.G.S.)
| | - Michael Szarek
- CPC Clinical Research (M. Szarek), University of Colorado School of Medicine, Aurora.,Division of Cardiology (M. Szarek, G.G.S.), University of Colorado School of Medicine, Aurora.,State University of New York, Downstate Health Sciences University, Brooklyn (M. Szarek)
| | - Deepak L. Bhatt
- Department of Medicine, Brigham and Women’s Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.)
| | - Vera A. Bittner
- Division of Cardiovascular Disease, University of Alabama at Birmingham (V.A.B.)
| | - Nicolas Danchin
- Department of Cardiology, Hôpital Européen Georges Pompidou, AP-HP, Paris, France (N.D.).,Université Paris Descartes, France (N.D.)
| | - Rafael Diaz
- Estudios Cardiológicos Latino América, Instituto Cardiovascular de Rosario, Argentina (R.D.)
| | - Shaun G. Goodman
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada (S.G.G.).,St. Michael’s Hospital, University of Toronto, Ontario, Canada (S.G.G.)
| | - Robert A. Harrington
- Stanford Center for Clinical Research, Department of Medicine, Stanford University, CA (R.A.H.)
| | - J. Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, the Netherlands (J.W.J.).,Netherlands Heart Institute, Utrecht (J.W.J.)
| | | | - Nikolaus Marx
- University Hospital, RWTH Aachen University, Germany (N.M.)
| | | | - Garen Manvelian
- Regeneron Pharmaceuticals Inc, Tarrytown, NY (J.M., G.M., R.P.)
| | - Robert Pordy
- Regeneron Pharmaceuticals Inc, Tarrytown, NY (J.M., G.M., R.P.)
| | | | - Harvey D. White
- Green Lane Cardiovascular Services, Auckland City Hospital and Auckland University, New Zealand (H.D.W.)
| | - Andreas M. Zeiher
- Department of Medicine III, Goethe University, Frankfurt am Main, Germany (A.M.Z.)
| | - Gregory G. Schwartz
- Division of Cardiology (M. Szarek, G.G.S.), University of Colorado School of Medicine, Aurora
| | | |
Collapse
|
5
|
Moriarty PM, Steg PG, McGinniss J, Zeiher AM, White HD, Manvelian G, Pordy R, Loy M, Jukema JW, Harrington RA, Gray JV, Gorby LK, Goodman SG, Diaz R, Bittner VA, Bhatt DL, Szarek M, Schwartz GG. Relation of red blood cell distribution width to risk of major adverse cardiovascular events, death, and effect of alirocumab after acute coronary syndromes. J Clin Lipidol 2022; 16:747-756. [DOI: 10.1016/j.jacl.2022.08.004] [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] [Received: 05/26/2022] [Revised: 08/04/2022] [Accepted: 08/15/2022] [Indexed: 10/15/2022]
|
6
|
Landmesser U, McGinniss J, Steg PG, Bhatt DL, Bittner VA, Diaz R, Dilic M, Goodman SG, Jukema JW, Loy M, Pećin I, Pordy R, Poulsen SH, Szarek M, White HD, Schwartz GG. Achievement of ESC/EAS LDL-C treatment goals after an acute coronary syndrome with statin and alirocumab. Eur J Prev Cardiol 2022; 29:1842-1851. [PMID: 35708715 DOI: 10.1093/eurjpc/zwac107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/18/2022] [Accepted: 05/20/2022] [Indexed: 11/12/2022]
Abstract
AIMS European guidelines set low-density lipoprotein cholesterol (LDL-C) treatment goals <1.4 mmol/L after acute coronary syndrome (ACS), and <1.0 mmol/L for patients with recurrent cardiovascular events ≤2 years. Many ACS patients do not achieve these goals on statin alone. We examined actual goal achievement with alirocumab and projected achievement with ezetimibe, either added to optimized statin therapy. METHODS AND RESULTS The ODYSSEY OUTCOMES trial (NCT01663402) compared alirocumab with placebo in 18,924 patients with recent ACS and hyperlipidaemia despite high-intensity or maximum-tolerated statin therapy. This subanalysis comprised 17,589 patients with LDL-C ≥1.4 mmol/L at baseline who did not receive ezetimibe treatment. High-intensity statin treatment was used in 88.8%. Median (interquartile range) baseline LDL-C was 2.3 (1.9-2.7) mmol/L. With alirocumab, 94.6% of patients achieved LDL-C <1.4 mmol/L at ≥1 post-baseline measurement vs. 17.3% with placebo. Among 2236 patients with a previous cardiovascular event within 2 years (before the qualifying ACS), 85.2% vs. 3.5%, respectively, achieved LDL-C <1.0 mmol/L. Among patients not treated with ezetimibe, we projected that its use would have achieved LDL-C <1.4 and <1.0 mmol/L in 10.6% and 0%, respectively at baseline (assuming 18 ± 3% reduction of LDL-C). CONCLUSION Among patients with recent ACS and LDL-C ≥1.4 mmol/L despite optimized statin therapy, addition of alirocumab allowed 94.6% to achieve the 2019 European guideline LDL-C goal <1.4 mmol/L, and 85.2% of those with recurrent cardiovascular events to achieve <1.0 mmol/L. In contrast, addition of ezetimibe to optimized statin therapy was projected to achieve LDL-C <1.4 mmol/L in only 10.6% of patients at baseline.
Collapse
Affiliation(s)
- Ulf Landmesser
- Department of Cardiology, Charite Universitätsmedizin Berlin, Berlin, Germany
| | | | - Ph Gabriel Steg
- Université de Paris, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, FACT (French Alliance for Cardiovascular Trials), INSERM U1148, Paris, France.,National Heart and Lung Institute, Imperial College, Royal Brompton Hospital, London, UK
| | - Deepak L Bhatt
- Department of Medicine, Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Vera A Bittner
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rafael Diaz
- Estudios Clínicos Latino América, Instituto Cardiovascular de Rosario, Rosario, Argentina
| | - Mirza Dilic
- University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Shaun G Goodman
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.,St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - J Wouter Jukema
- Leiden University Medical Center, Leiden, the Netherlands.,Netherlands Heart Institute, Utrecht, the Netherlands
| | | | - Ivan Pećin
- University of Zagreb, Zagreb School of Medicine, University Hospital Center Zagreb, Zagreb, Croatia
| | | | | | - Michael Szarek
- State University of New York, Downstate School of Public Health, Brooklyn, NY, USA.,CPC Clinical Research and Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Harvey D White
- Green Lane Cardiovascular Services Auckland City Hospital, Auckland, New Zealand
| | | | | |
Collapse
|
7
|
Özgüroğlu M, Sezer A, Kilickap S, Gümüş M, Bondarenko I, Gogishvili M, He X, McGinniss J, Gullo G, Rietschel P, Quek RGW. CLO22-074: Patient-Reported Outcomes (PROs) in Patients (pts) With Advanced Non-Small Cell Lung Cancer (aNSCLC) With Programmed Cell Death-Ligand 1 (PD-L1) ≥50% Receiving Cemiplimab (CEMI) Monotherapy Versus Platinum-Doublet Chemotherapy (CHEMO): A Focus on the EMPOWER-Lung 1 Brain Metastases Subpopulation. J Natl Compr Canc Netw 2022. [DOI: 10.6004/jnccn.2021.7246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Mustafa Özgüroğlu
- 1 Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | | | | | - Mahmut Gümüş
- 4 School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | | | - Miranda Gogishvili
- 6 High Technology Medical Centre, University Clinic Ltd, Tbilisi, Georgia
| | - Xuanyao He
- 7 Regeneron Pharmaceuticals, Inc., Tarrytown, NY
| | | | | | | | | |
Collapse
|
8
|
Stein D, Oviedo-Orta E, Kampman WA, McGinniss J, Betts G, McDermott M, Holly B, Lancaster JM, Braunstein N, Yancopoulos GD, Weinreich DM. Compassionate Use of REGEN-COV ® in Patients with COVID-19 and Immunodeficiency-Associated Antibody Disorders. Clin Infect Dis 2021; 75:e509-e515. [PMID: 34971385 PMCID: PMC8755381 DOI: 10.1093/cid/ciab1059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Indexed: 12/15/2022] Open
Abstract
Background Patients with immunodeficiency-associated antibody disorders are at a higher risk of prolonged/persistent COVID-19 infection, having no viable treatment options. Methods A retrospective analysis of patients with primary and/or secondary immunodeficiency-associated antibody disorders who received casirivimab and imdevimab (REGEN-COV®) under emergency compassionate use. Objective were to describe safety and response to REGEN-COV, focusing on the subset of patients who had COVID-19 duration ≥21 days before treatment. Results Quantitative (change in oxygenation status and/or viral load) and/or qualitative (physician-reported clinical status) outcomes data are reported from 64 patients. Improvement in ≥1 outcome was observed in 90.6% of the overall patient group. Thirty-seven of these had COVID-19 duration ≥21 days before treatment; median time from diagnosis to REGEN-COV treatment was 60.5 days. Of the 29 patients with COVID-19 duration ≥21 days before treatment and available outcome data, 96.6% showed improvement in ≥1 outcome. In the 14 patients with post-treatment reverse transcription–polymerase chain reaction (RT-PCR) results available, 11 (78.6%) reported a negative RT-PCR following treatment, with 5 (45.5%) and 8 (72.7%) patients reporting a negative RT-PCR within 5 days and 21 days of treatment, respectively. Ten of 85 patients (11.8%) experienced serious adverse events; only one was an infusion-related reaction, possibly related to REGEN-COV. Two deaths were reported; neither were attributed to REGEN-COV. Conclusions In this retrospective analysis of immunodeficient patients granted REGEN-COV under emergency compassionate use, REGEN-COV treatment was associated with rapid viral clearance and clinical improvement in patients with longstanding COVID-19. Adverse events were consistent with COVID-19 and its associated complications, and due to patients’ concurrent medical conditions.
Collapse
Affiliation(s)
- David Stein
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY
| | | | | | | | | | | | - Beth Holly
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY
| | | | | | | | | |
Collapse
|
9
|
Raal FJ, Rosenson R, Reeskamp L, Hovingh GK, Kastelein J, Rubba P, Ali S, Banerjee P, Chan KC, Khilla N, McGinniss J, Pordy R, Zhang Y, Gaudet D. The effect of evinacumab on LDL-C goal attainment in patients with homozygous familial hypercholesterolemia. J Clin Lipidol 2021. [DOI: 10.1016/j.jacl.2021.08.019] [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: 11/26/2022]
|
10
|
Ozguroglu M, Sezer A, Kilickap S, Gumus M, Bondarenko I, Gogishvili M, Turk HM, Cicin I, Bentsion D, Gladkov O, Clingan PR, Sriuranpong V, Rizvi NA, McGinniss J, Pouliot JF, Lee S, Seebach FA, Lowy I, Gullo G, Rietschel P. Cemiplimab monotherapy as first-line (1L) treatment of patients with brain metastases from advanced non-small cell lung cancer (NSCLC) with programmed cell death-ligand 1 (PD-L1) ≥ 50%: EMPOWER-Lung 1 subgroup analysis. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.9085] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9085 Background: In the Phase 3, EMPOWER-Lung 1 study, cemiplimab monotherapy provided significant survival benefit and an acceptable safety profile vs chemotherapy in patients with advanced NSCLC and PD-L1 ≥50%. EMPOWER-Lung 1 included patients with brain metastases at baseline who are typically underrepresented in clinical trials. Other published exploratory analyses in single-cohort studies suggest benefit from immunotherapy in this patient population. Here, we present subgroup analysis of patients with brain metastasis from EMPOWER-Lung 1. Methods: Patients were randomized 1:1 to cemiplimab 350 mg IV every 3 weeks or investigator’s choice of chemotherapy (NCT03088540). Patients with treated, clinically stable brain metastases (radiological stability not required) were eligible to enroll and are the focus of this subgroup analysis from the PD-L1 ≥50% population (n=563) of the EMPOWER-Lung 1 study. Results: A total of 68 of 563 (12.1%) cases had treated stable brain metastases at time of randomization. Patients were evenly distributed between cemiplimab (n=34) and chemotherapy (n=34), with similar median duration of follow-up (Table). Baseline characteristics were generally similar; median (range) age: 60.0 (45–76 ) vs 62.0 (48–77); male: 97.1% vs 85.3%; and non-squamous histology: 85.3% vs 76.5%; between cemiplimab vs chemotherapy, respectively. Per independent review committee, median overall survival (OS, 18.7 vs 11.7 months), median progression-free survival (PFS, 10.4 vs 5.3 months), and objective response rate (ORR, 41.2% vs 8.8%) were superior with cemiplimab vs chemotherapy (Table). After baseline, central nervous system (CNS) disease progression occurred in 2 (5.9%) patients with cemiplimab vs 4 (11.8%) patients with chemotherapy; extra-CNS disease progression occurred in 9 (26.5%) patients with cemiplimab vs 15 (44.1%) patients with chemotherapy. Conclusions: 1L cemiplimab monotherapy improved OS, PFS, and ORR vs chemotherapy, in patients with advanced NSCLC with PD-L1 ≥50%, and clinically stable brain metastases at baseline. Cemiplimab monotherapy represents a suitable option for this subgroup of patients. Clinical trial information: NCT03088540. [Table: see text]
Collapse
Affiliation(s)
- Mustafa Ozguroglu
- Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Ahmet Sezer
- Department of Medical Oncology, Başkent University, Adana, Turkey
| | - Saadettin Kilickap
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Mahmut Gumus
- Department of Medical Oncology, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Igor Bondarenko
- Department of Oncology and Medical Radiology; Dnipropetrovsk Medical Academy, Dnipro, Ukraine
| | | | - Haci M. Turk
- Department of Medical Oncology, Bezmialem Vakif University, Medical Faculty, Istanbul, Turkey
| | - Irfan Cicin
- Department of Medical Oncology, Trakya University, Edirne, Turkey
| | - Dmitry Bentsion
- Radiotherapy Department, Sverdlovsk Regional Oncology Centre, Sverdlovsk, Russian Federation
| | | | - Philip R. Clingan
- Southern Medical Day Care Centre and Illawarra Health and Medical Research Institute, University of Wollongong/Illawarra Cancer Centre, Wollongong Hospital, Wollongong, NSW, Australia
| | - Virote Sriuranpong
- Division of Medical Oncology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and the King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Naiyer A. Rizvi
- Division of Hematology/Oncology, Columbia University Medical Center, New York, NY
| | | | | | - Sue Lee
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY
| | | | - Israel Lowy
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY
| | | | | |
Collapse
|
11
|
Rabinowits G, Park SJ, Ellison DM, Worden FP, Gentry RW, Strasswimmer J, Venna SS, Migden MR, Chandra S, Ruiz ES, Mehta N, Zhang HR, McGinniss J, Desai J. Checkpoint inhibition in immunosuppressed or immunocompromised patients with advanced cutaneous squamous cell carcinoma (CSCC): Data from prospective CemiplimAb-rwlc Survivorship and Epidemiology (C.A.S.E.) study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.9547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9547 Background: Immunosuppressed and/or immunocompromised patients are at increased risk for solid tumors and cutaneous malignancies. Limited data exist on the safety and effectiveness of immune checkpoint inhibitors (ICIs) in these patients because they are frequently excluded from clinical trials. Here, we describe the safety and effectiveness results from the initial cohort of immunosuppressed and/or immunocompromised patients with advanced CSCC enrolled in the C.A.S.E. study (NCT03836105). Methods: C.A.S.E. is a prospective, real-world, multi-center, longitudinal study evaluating the effectiveness, safety, quality of life, and survivorship in patients with advanced CSCC treated with cemiplimab. Patients received cemiplimab 350 mg intravenously every 3 weeks per routine standard of care. Patient demographics, disease characteristics, immunosuppression, and relevant medical history were collected. Immunosuppressive regimens varied amongst patients. Investigator assessment of objective response rate (ORR), safety, and tolerability was conducted. Data from 26 immunosuppressed and/or immunocompromised patients with advanced CSCC treated with cemiplimab are presented. Recruitment is ongoing. Results: As of November 17, 2020, 121 patients were enrolled in the C.A.S.E. study, of which 26 patients (median age: 74 years [IQR: 71-84]; 85% male; 89% Caucasian) were designated as immunocompromised or immunosuppressed due to a history of solid organ transplant (n = 6), autoimmune disorder (n = 11), or hematologic malignancy (n = 9). Median duration of cemiplimab exposure was 14 months (IQR: 9.1–42, range: 0, 67). Among 19 immunocompromised or immunosuppressed patients who enrolled in C.A.S.E. prior to their third dose of cemiplimab, ORR per investigator assessment was 47% (95% CI: 24–71); 1 (5%) patient had complete response; 8 (42%) had partial response. One patient had a treatment-related serious adverse reaction of organ transplant rejection. One (3.8%) patient discontinued treatment due to increased alanine aminotransferase (not treatment-related). Immune-related AEs (irAEs) occurred in 23% of patients. No treatment-related AEs led to death. Conclusions: The safety, tolerability, and effectiveness of cemiplimab in this initial cohort of immunosuppressed and/or immunocompromised patients with advanced CSCC appear to be consistent with those observed in clinical trials that excluded these patients. Further follow-up and additional data would add to our general understanding of safety and effectiveness of anti-PD1 therapy in immunocompromised and/or immunosuppressed patient populations overall. Clinical trial information: NCT03836105.
Collapse
Affiliation(s)
- Guilherme Rabinowits
- Department of Hematology/Oncology, Miami Cancer Institute/Baptist Health South Florida, Miami, FL
| | - Soo J Park
- Division of Hematology and Oncology, University of California San Diego, San Diego, CA
| | | | | | | | - John Strasswimmer
- College of Medicine (Dermatology) and College of Sciences (Biochemistry), Florida Atlantic University, Boca Raton, FL
| | - Suraj S. Venna
- Inova Schar Cancer Institute Melanoma Center, Fairfax, VA
| | - Michael Robert Migden
- Departments of Dermatology and Head and Neck Surgery, University of Texas, MD Anderson Cancer Center, Houston, TX
| | - Sunandana Chandra
- Division of Hematology Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | | | | | | | - Jigar Desai
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY
| |
Collapse
|
12
|
Rabinowits G, Homsi J, Nikanjam M, Gentry R, Strasswimmer J, Venna S, Migden M, Chandra S, Ruiz E, Zhang H, McGinniss J, Seluzhytsky A, Desai J. Demographics, Prior Therapies, and Reasons for Cemiplimab Treatment: Prospective CemiplimAb-rwlc Survivorship and Epidemiology (C.A.S.E.) Study in Patients with Advanced Cutaneous Squamous Cell Carcinoma. ACTA ACUST UNITED AC 2020. [DOI: 10.25251/skin.4.supp.125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Abstract not available.
Collapse
|
13
|
Rabinowits G, Homsi J, Nikanjam M, Gentry R, Strasswimmer J, Venna S, Migden M, Chandra S, Ruiz E, Zhang H, McGinniss J, Seluzhytsky A, Desai J. 1094P Demographics, prior therapies and reasons for cemiplimab treatment: Prospective cemiplimAb-rwlc survivorship and epidemiology (C.A.S.E.) study in patients with advanced cutaneous squamous cell carcinoma (CSCC). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1218] [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: 10/23/2022] Open
|
14
|
Bittner V, McGinniss J, Schwartz GG, Bhatt D, Chua T, de Silva HA, Diaz R, Dorobantu M, Goodman S, Harrington RA, Jukema JW, Kim YU, Pordy R, Roe M, Szarek M, White H, Zeiher AM, Steg PG. ALIROCUMAB AND CARDIOVASCULAR OUTCOMES IN WOMEN AFTER AN ACUTE CORONARY SYNDROME: AN ODYSSEY OUTCOMES TRIAL ANALYSIS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32481-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
15
|
Landmesser U, McGinniss J, Steg PG, Bhatt D, Bittner V, Diaz R, Goodman S, Harrington RA, Jukema JW, Laucevicius A, Pecin I, Pordy R, Poulsen S, Roe M, Sourdille T, Szarek M, White H, Zeiher A, Schwartz GG. ACHIEVEMENT OF NEW EUROPEAN DYSLIPIDEMIA-GUIDELINE LOW-DENSITY LIPOPROTEIN CHOLESTEROL TREATMENT GOALS AFTER ACUTE CORONARY SYNDROME: INSIGHTS FROM ODYSSEY OUTCOMES. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32605-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
16
|
Brown D, Nakagome K, Cordes J, Brenner R, Gründer G, Keefe RSE, Riesenberg R, Walling DP, Daniels K, Wang L, McGinniss J, Sand M. Evaluation of the Efficacy, Safety, and Tolerability of BI 409306, a Novel Phosphodiesterase 9 Inhibitor, in Cognitive Impairment in Schizophrenia: A Randomized, Double-Blind, Placebo-Controlled, Phase II Trial. Schizophr Bull 2019; 45:350-359. [PMID: 29718385 PMCID: PMC6403090 DOI: 10.1093/schbul/sby049] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Patients with cognitive impairment associated with schizophrenia may benefit from treatments targeting dysfunctional glutamatergic neurotransmission. BI 409306, a potent and selective phosphodiesterase 9 inhibitor, was assessed in patients with schizophrenia using a learn-and-confirm adaptive trial design. METHODS This double-blind, parallel-group trial randomized patients 2:1:1:1:1 to once-daily placebo or BI 409306 (10, 25, 50, or 100 mg) for 12 weeks. Stage 1 (learn) assessed change from baseline in Cambridge Neuropsychological Test Automated Battery (CANTAB) scores (week 12) to identify ≥1 meaningful endpoints for stage 2 (confirm). If no domains showed efficacy, change from baseline in Measurements and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery (MCCB) composite scores (week 12) was the primary endpoint. The key secondary endpoint was change from baseline in Schizophrenia Cognition Rating Scale (SCoRS) total score. Safety was monitored. RESULTS Five hundred eighteen patients were randomized. In stage 1, CANTAB did not differentiate between BI 409306 and placebo (n = 120), so the primary endpoint of change from baseline in MCCB composite score was analyzed in 450 patients in stage 2. There was no significant difference between BI 409306 (1.2-2.8) and placebo (2.5) in MCCB composite score change. BI 409306 did not significantly improve change from baseline in SCoRS total score (-3.1 to -2.0) vs placebo (-2.5). Adverse events were dose-dependent, increasing from 33.3% (10 mg) to 53.5% (100 mg), vs 36.4% for placebo. CONCLUSION The primary endpoint of cognitive function improvement was not met. BI 409306 was well-tolerated, with an acceptable safety profile.
Collapse
Affiliation(s)
- David Brown
- Community Clinical Research, Inc, Austin, TX
| | - Kazuyuki Nakagome
- Department of Forensic Psychiatry, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Joachim Cordes
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | | | - Gerhard Gründer
- Department of Molecular Neuroimaging, Central Institute of Mental Health, Clinical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Richard S E Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC
| | | | | | | | - Lara Wang
- Boehringer Ingelheim Taiwan Limited, Taipei, Taiwan
| | | | - Michael Sand
- Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, CT
| |
Collapse
|
17
|
Abstract
Missing values present challenges in the analysis of data across many areas of research. Handling incomplete data incorrectly can lead to bias, over-confident intervals, and inaccurate inferences. One principled method of handling incomplete data is multiple imputation. This article considers incomplete data in which values are missing for three or more qualitatively different reasons and applies a modified multiple imputation framework in the analysis of that data. Included are a proof of the methodology used for three-stage multiple imputation with its limiting distribution, an extension to more than three types of missing values, an extension to the ignorability assumption with proof, and simulations demonstrating that the estimator is unbiased and efficient under the ignorability assumption.
Collapse
Affiliation(s)
- J McGinniss
- Boehringer Ingelheim Pharmaceuticals, Ridgefield, Connecticut, U.S.A
| | - O Harel
- Department of Statistics, University of Connecticut, Storrs, Connecticut, U.S.A
| |
Collapse
|