E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
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E.1.1.1 | Medical condition in easily understood language |
Abnormal amounts of lipids in the blood |
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E.1.1.2 | Therapeutic area | Diseases [C] - Nutritional and Metabolic Diseases [C18] |
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 | 10058110 |
E.1.2 | Term | Dyslipidemia |
E.1.2 | System Organ Class | 100000004861 |
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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 |
To evaluate the effect of treatment with AMG 145, compared with placebo, on the risk for cardiovascular death, myocardial infarction, stroke, hospitalization for unstable angina, or coronary revascularization, whichever occurs first, in subjects with clinically evident cardiovascular disease |
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E.2.2 | Secondary objectives of the trial |
To evaluate the effect of treatment with AMG 145, compared with placebo, in subjects with clinically evident cardiovascular disease on the risk for:
•cardiovascular death, myocardial infarction, or stroke
•death by any cause
•hospital admissions for worsening heart failure |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
•Signed informed consent
•Male or female ≥ 40 to ≤ 80 years of age at signing of informed consent
•History of clinically evident cardiovascular disease within 5 years of screening as evidenced by ANY of the following:
o diagnosis of myocardial infarction
o diagnosis of stroke
•History of type 2 diabetes or, if not diabetic, ANY of the following:
o age ≥ 65 years (and ≤ 80 years)
o index event within 6 months prior to screening
o additional diagnosis of myocardial infarction or stroke (prior to and excluding index event)
o history of symptomatic peripheral vascular disease (intermittent claudication with ankle-brachial index [ABI] < 0.9, or peripheral vascular revascularization procedure, or amputation due to atherosclerotic disease)
o ≥ 2 of the following risk factors:
-HDL-C < 40 mg/dL (1.0 mmol/L) for men and < 50 mg/dL (1.3 mmol/L) for women by central laboratory at screening
-residual coronary artery disease with ≥ 40% stenosis in ≥ 2 large vessels
-hsCRP > 2.0 mg/L by central laboratory at screening
-current smoker
-age > 60 years
-history of non-MI related coronary revascularization*
-final LDL-C > 130 mg/dL (3.4 mmol/L) or non-HDL-C ≥ 160 mg/dL (4.1 mmol/L) by central laboratory during screening
-metabolic syndrome, defined as ≥ 3 of the following:
- waist circumference > 102 cm (> 40 in.) for men and > 88 cm (> 35 in.) for women
- triglycerides ≥ 150 mg/dL (1.7 mmol/L) by central laboratory at screening
- HDL-C < 40 mg/dL (1.0 mmol/L) for men
and < 50 mg/dL (1.3 mmol/L) for women by central laboratory at screening (Note: if the HDL-C level is one of criterion used to make the diagnosis of metabolic syndrome, it cannot be used as a separate risk factor)
- blood pressure (BP) ≥ 130 / ≥ 85 mmHg
- fasting glucose ≥ 110 mg/dL by central laboratory at screening
•Fasting LDL-C ≥ 70 mg/dL (≥ 1.8 mmol/L) ) or non-HDL-C ≥ 100 mg/dL (> 2.6 mg/dL) by central laboratory during screening after ≥ 4 weeks of stable dose of 20 mg, 40 mg, or 80 mg QD atorvastatin, with or without ezetimibe 10 mg QD
•Fasting triglycerides ≤ 400 mg/dL (4.5 mmol/L) by central laboratory at screening |
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E.4 | Principal exclusion criteria |
•NYHA class III or IV, or last known left ventricular ejection fraction < 30%
•Known hemorrhagic stroke
•Uncontrolled or recurrent ventricular tachycardia
•Planned or expected cardiac surgery or revascularization within 3 months after randomization
•Uncontrolled hypertension defined as sitting systolic blood pressure (SBP) > 180 mmHg or diastolic BP (DBP) > 110 mmHg
•In the 6 weeks prior to LDL-C screening, subject has taken red yeast rice, > 200 mg/day niacin, or prescription lipid-regulating drugs (eg, bile-acid sequestering resins, fibrates and derivatives) other than statins or ezetimibe
•Use of cholesterylester transfer protein (CETP) inhibition treatment within 12 months prior to randomization
•Prior use of PCSK9 inhibition treatment other than AMG 145
•Uncontrolled hypothyroidism or hyperthyroidism as defined by thyroid stimulating hormone (TSH) < 1.0 time the lower limit of normal (LLN) or > 1.5 times the upper limit of normal (ULN), respectively, at screening
•Severe renal dysfunction, defined as an estimated glomerular filtration rate (eGFR) < 20 mL/min/1.73m2 at screening
•Active liver disease or hepatic dysfunction, defined as aspartate aminotransferase (AST) or alanine aminotransferase (ALT) > 2 times the ULN as determined by central laboratory analysis at screening
•Recipient of any major organ transplant (eg, lung, liver, heart, bone marrow)
•Personal or family history of hereditary muscular disorders
•Severe, concomitant non-cardiovascular disease that is expected to reduce life expectancy to less than 3 years
•CK > 5 times the ULN at screening
•Known active infection or major hematologic, renal, metabolic,
gastrointestinal or endocrine dysfunction in the judgment of the investigator
•Malignancy (except non-melanoma skin cancers, cervical in-situ carcinoma, breast ductal carcinoma in situ, or stage 1 prostate
carcinoma) within the last 10 years
•Subject has received drugs that are strong inhibitors of cytochrome P-450 3A4 (Itraconazole, ketoconazole, and other antifungal azoles, macrolide antibiotics erythromycin, clarithromycin, and the ketolide antibiotic telithromycin, HIV protease inhibitors, antidepressant nefazodone and grapefruit juice in large quantities [> 1 quart daily]) within 1 month prior to randomization or is likely to require such treatment during the study period
•Currently enrolled in another investigational device or drug study, or less than 30 days since ending another investigational device or drug study(s), or receiving other investigational agent(s)
•Female subject who has either (1) not used at least 1 highly effective method of birth control for at least 1 month prior to screening or (2) is not willing to use such a method during treatment and for an additional 15 weeks after the end of treatment, unless the subject is sterilized or postmenopausal;
-menopause is defined as 12 months of spontaneous and continuous amenorrhea in a female ≥ 55 years old or 12 months
of spontaneous and continuous amenorrhea with a follicle stimulating hormone (FSH) level > 40 IU/L (or according to the definition of "postmenopausal range" for the laboratory involved) in a female < 55 years old unless the subject has undergone bilateral oophorectomy
- highly effective methods of birth control include not having intercourse or using birth control methods that work at least 99% of the time when used correctly and include: birth control pills, shots, implants, or patches, intrauterine devices (IUDs), tubal ligation/occlusion, sexual activity with a male partner who has had a vasectomy, condom or occlusive cap (diaphragm or
cervical/vault caps) used with spermicide
•Subject is pregnant or breast feeding, or planning to become pregnant during treatment and/ or within 15 weeks after the end of treatment
•Known sensitivity to any of the active substances or their excipients to be administered during dosing or to any statin
•Subject will not be available for protocol-required study visits or procedures, to the best of the subject and investigator’s knowledge
•Subject has any kind of disorder that, in the opinion of the investigator, may compromise the ability of the subject to give written informed consent and/or to comply with all required study procedures. |
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E.5 End points |
E.5.1 | Primary end point(s) |
The primary endpoint is the time to cardiovascular death, myocardial infarction, hospitalization for unstable angina, stroke, or coronary revascularization, whichever occurs first. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
The primary endpoint is the time to cardiovascular death, myocardial infarction, hospitalization for unstable angina, stroke, or coronary revascularization, whichever occurs first. |
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E.5.2 | Secondary end point(s) |
•time to cardiovascular death, myocardial infarction, or stroke, whichever occurs first
•time to death by any cause
•time to first hospitalization for worsening heart failure |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
•time to cardiovascular death, myocardial infarction, or stroke, whichever occurs first
•time to death by any cause
•time to first hospitalization for worsening heart failure |
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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 | No |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | Yes |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | Yes |
E.6.13.1 | Other scope of the trial description |
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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) | No |
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 | Yes |
E.8.1.7.1 | Other trial design description |
cardiovascular outcomes study |
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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.8.2.4 | Number of treatment arms in the trial | 2 |
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.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 200 |
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 | No |
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
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The study is event driven and will conclude when at least 1630 subjects have experienced an event adjudicated as qualifying for the first secondary endpoint (composite of cardiovascular death, myocardial infarction, or stroke). It is expected that at time, approximately 3550 subjects will have experienced an event adjudicated as qualifying for primary endpoint (composite of cardiovascular death, myocardial infarction, stroke, hospitalization for unstable angina, and coronary revascularization). |
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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 | |
E.8.9.1 | In the Member State concerned months | |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial years | 0 |
E.8.9.2 | In all countries concerned by the trial months | 58 |
E.8.9.2 | In all countries concerned by the trial days | 0 |