| E.1 Medical condition or disease under investigation |
| E.1.1 | Medical condition(s) being investigated |
| Cardiovascular disease: History of myocardial infarction; or cerebrovascular atherosclerotic disease (history of presumed ischaemic stroke, transient ischaemic attack or carotid revascularisation); or peripheral arterial disease (i.e. intermittent claudication or history of revascularisation); or diabetes mellitus with any of the above or with other evidence of symptomatic coronary heart disease. |
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| MedDRA Classification |
| E.1.2 Medical condition or disease under investigation |
| E.1.2 | Version | 14.1 |
| E.1.2 | Level | LLT |
| E.1.2 | Classification code | 10051615 |
| E.1.2 | Term | Atherosclerotic cardiovascular disease |
| E.1.2 | System Organ Class | 10047065 - Vascular disorders |
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| E.1.3 | Condition being studied is a rare disease | No |
| E.2 Objective of the trial |
| E.2.1 | Main objective of the trial |
| The primary aim is to assess the effect of raising HDL-cholesterol with extended release niacin 2 g plus MK-0524 40 mg daily (denoted “MK-0524A 2 g”) versus placebo on the time to first “major vascular event” (defined as non-fatal myocardial infarction or coronary death, non-fatal or fatal stroke, or revascularisation). |
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| E.2.2 | Secondary objectives of the trial |
| Secondary aims include assessment of the effects of MK-0524A: on early safety outcomes; on the separate components of the primary endpoint; and on the primary endpoint within major baseline disease subgroups. |
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| E.2.3 | Trial contains a sub-study | No |
| E.3 | Principal inclusion criteria |
•History of myocardial infarction; or •Cerebrovascular atherosclerotic disease (history of presumed ischaemic stroke, transient ischaemic attack or carotid revascularisation); or •Peripheral arterial disease (i.e. intermittent claudication or history of revascularisation); or •Diabetes mellitus with any of the above or with other evidence of symptomatic coronary heart disease (i.e. stable or unstable angina, or a history of coronary revascularisation or acute coronary syndrome).
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| E.4 | Principal exclusion criteria |
•Age <50 or >80 years at invitation to Screening; •Less than 3 months since presentation with acute myocardial infarction, coronary syndrome or stroke (but such patients may be entered later, if appropriate); •Planned revascularisation procedure within 3 months after randomization (but such patients may be entered later, if appropriate); •Definite history of chronic liver disease, or abnormal liver function (i.e. ALT >1.5xULN). (Note: Patients with a history of acute hepatitis are eligible provided this ALT limit is not exceeded); •Breathlessness at rest for any reason; •Severe renal insufficiency (or creatinine >200 µmol/L); •Evidence of active inflammatory muscle disease (e.g. dermatomyositis, polymyositis), or CK >3xULN; •Previous significant adverse reaction to a statin, ezetimibe, niacin or MK-0524; •Active peptic ulcer disease; •Concurrent treatment with: -fibric acid derivative (“fibrate”) -niacin (nicotinic acid) at doses more than 100 mg daily -ezetimibe in combination with either simvastatin 80 mg, or atorvastatin 20-80 mg, or rosuvastatin 10-40 mg daily -any potent CYP3A4 inhibitor, including: macrolide antibiotics (erythromycin, clarithromycin, telithromycin); systemic use of imidazole or triazole antifungals (e.g. itraconazole, ketoconazole); protease inhibitors (antiretroviral drugs for HIV infection); and nefazodone -ciclosporin -amiodarone -verapamil -danazol (Note: Patients who are temporarily taking such drugs may be re-screened when they discontinue them, if considered appropriate.); •Known to be poorly compliant with clinic visits or prescribed medication; •Medical history that might limit the individual’s ability to take trial treatments for the duration of the study (e.g. severe respiratory disease, history of cancer or evidence of spread within last 5 years other than non-melanoma skin cancer, or recent history of alcohol or substance misuse) |
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| E.5 End points |
| E.5.1 | Primary end point(s) |
| The primary comparison will involve an “intention-to-treat” analysis among all randomized patients using the “logrank” test23 of the effects of allocation to MK-0524A versus placebo on major vascular events during the scheduled treatment period of a median of at least 4 years. A major vascular event (MVE) is defined as the composite of non-fatal myocardial infarction or coronary death; non-fatal or fatal stroke; or any revascularisation procedure (including coronary or non-coronary angioplasty or grafting). |
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| E.6 and E.7 Scope of the trial |
| E.6 | Scope of the trial |
| E.6.1 | Diagnosis | No |
| E.6.2 | Prophylaxis | No |
| E.6.3 | Therapy | Yes |
| E.6.4 | Safety | Yes |
| E.6.5 | Efficacy | Yes |
| E.6.6 | Pharmacokinetic | No |
| E.6.7 | Pharmacodynamic | No |
| E.6.8 | Bioequivalence | No |
| E.6.9 | Dose response | No |
| E.6.10 | Pharmacogenetic | No |
| E.6.11 | Pharmacogenomic | Yes |
| E.6.12 | Pharmacoeconomic | Yes |
| E.6.13 | Others | No |
| E.7 | Trial type and phase |
| E.7.1 | Human pharmacology (Phase I) | No |
| E.7.1.1 | First administration to humans | No |
| E.7.1.2 | Bioequivalence study | No |
| E.7.1.3 | Other | No |
| E.7.1.3.1 | Other trial type description | |
| E.7.2 | Therapeutic exploratory (Phase II) | No |
| E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
| E.7.4 | Therapeutic use (Phase IV) | Yes |
| E.8 Design of the trial |
| E.8.1 | Controlled | Yes |
| E.8.1.1 | Randomised | Yes |
| E.8.1.2 | Open | No |
| E.8.1.3 | Single blind | No |
| E.8.1.4 | Double blind | Yes |
| E.8.1.5 | Parallel group | Yes |
| E.8.1.6 | Cross over | No |
| E.8.1.7 | Other | No |
| E.8.2 | Comparator of controlled trial |
| E.8.2.1 | Other medicinal product(s) | No |
| E.8.2.2 | Placebo | Yes |
| E.8.2.3 | Other | No |
| E.8.3 |
The trial involves single site in the Member State concerned
| No |
| E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
| E.8.4.1 | Number of sites anticipated in Member State concerned | 13 |
| E.8.5 | The trial involves multiple Member States | Yes |
| E.8.5.1 | Number of sites anticipated in the EEA | 140 |
| E.8.6 Trial involving sites outside the EEA |
| E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
| E.8.6.2 | Trial being conducted completely outside of the EEA | Information not present in EudraCT |
| E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
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| E.8.7 | Trial has a data monitoring committee | Yes |
| E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
|
| Scheduled duration of treatment is at least 4 years median follow-up and 2300 confirmed major vascular events. The trial will end with a final visit for all participants when the above end points are reached or if the Data Monitoring Committee advises earlier termination. |
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| E.8.9 Initial estimate of the duration of the trial |
| E.8.9.1 | In the Member State concerned years | 6 |
| E.8.9.1 | In the Member State concerned months | 2 |
| E.8.9.1 | In the Member State concerned days | 0 |
| E.8.9.2 | In all countries concerned by the trial years | 6 |
| E.8.9.2 | In all countries concerned by the trial months | 2 |
| E.8.9.2 | In all countries concerned by the trial days | 0 |