E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Primary Hyperlipidemia or mixed Dyslipidemia |
|
E.1.1.1 | Medical condition in easily understood language |
|
E.1.1.2 | Therapeutic area | Diseases [C] - Cardiovascular Diseases [C14] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 17.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10020667 |
E.1.2 | Term | Hyperlipidemia |
E.1.2 | System Organ Class | 100000004861 |
|
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 17.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10058110 |
E.1.2 | Term | Dyslipidemia |
E.1.2 | System Organ Class | 100000004861 |
|
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 demonstrate a superior LDL-C lowering effect of PF-04950615 150 mg administered by the SC route Q2wks compared to placebo, in subjects with primary hyperlipidemia or mixed dyslipidemia at high or very high risk for CV events receiving statin therapy and whose LDL-C is ≥100 mg/dL (2.59 mmol/L) |
|
E.2.2 | Secondary objectives of the trial |
To demonstrate a superior effect of PF-04950615 150 mg administered by the SC route Q2wks compared to placebo, in subjects with dyslipidemia and at high or very high risk for CV events receiving statin therapy and whose LDL-C is ≥100 mg/dL (2.59 mmol/L) on:
- Total cholesterol (TC), HDL-C, Triglycerides (TG), and non HDL-C;
- Other lipid parameters, including Apolipoprotein B (ApoB), Apolipoprotein A-I (ApoA-I), Apolipoprotein A-II (ApoA-II), lipoprotein (a)[Lp(a)], very
low density lipoprotein cholesterol (VLDL-C).
Additional information in Protocol, Section 2.1.2 |
|
E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
Subject eligibility should be reviewed and documented by an appropriately qualified member of the investigator’s study team before subjects are included in the study.
Subjects must meet all of the following inclusion criteria to be eligible for enrollment into the study:
1. Evidence of a personally signed and dated informed consent document indicating that the subject (or a legally acceptable representative) has been informed of all pertinent aspects of the study.
2. Subjects who are willing and able to comply with scheduled visits, treatment plan, laboratory tests, and other study procedures.
3. Males and females ≥ 18 years of age where permitted by law.
4. With primary hyperlipidemia or mixed dyslipidemia.
5. Subjects must be on a stable dose of either simvastatin 40 mg or higher, rosuvastatin 10 mg or higher, atorvastatin 20 mg or higher, or pravastatin 40 mg or higher for at least 6 weeks prior to screening.
- There should be no plans at the time of screening and randomization to modify
the dose of statin for the duration of the trial.
6. Subjects should be at high or very high risk of incurring a CV event, defined as:
a. Known CVD or CVD risk equivalents:
- Known history of CVD.
- Coronary heart disease: history of acute myocardial infarction, or evidence of silent myocardial infarction or myocardial ischemia, or history of unstable angina and stable angina pectoris, or history of coronary procedures (coronary angioplasty and coronary artery surgery), or;
- Other clinical atherosclerotic diseases: peripheral arterial disease, or abdominal aortic aneurysm, or carotid artery disease (symptomatic [eg, transient ischemic attack or stroke of carotid origin] or >50 percent stenosis on angiography or ultrasound), or likely other forms of clinical atherosclerotic disease (eg, renal artery disease), Type 2 or Type 1 diabetes, or;
- Chronic kidney disease (CKD), defined as glomerular filtration rate (GFR) calculated by Modification of Diet in Renal Disease (MDRD) formula between 30 and 60 mL/min/1.73m2 (inclusive).
b. Presence of multiple risk factors:
Subjects who do not have past CVD disease or CVD risk equivalents but have 3 or more of the risk factors from the list below:
- Current cigarette smoking defined as any smoking for 30 days or more at the time of screening.
- HDL-C <40 mg/dL (<1.0 mmol/L) at screening or TC/HDL-C ratio>/=6.
- Family history of premature Coronary Heart Disease (CHD in male first-degree relative <55 years; CHD in female first-degree relative <65 years).
- Age (men ≥55 years; women ≥65 years).
- hs-CRP >2.0 mg/L at screening.
7. Lipids should meet the following criteria on a background treatment with a statin:
- Fasting LDL-C >/=100 mg/dL (2.59 mmol/L) at 2 screening visits (screening visits S1 and S3) and the value at the third screening visit (S3) within 7 days (±3 days) of randomization must not be lower or higher than 20% of this initial value (in order to control the variability related to the fasting LDL-C assay), as described in Section 7.1.
Note: If fasting LDL-C at screening visit S3 is lower or higher than 20% of the initial value, LDL-C can be repeated once (within 7 days of randomization), and the subject is eligible if the value of this repeat test is within 20% (inclusive) of the value at screening visit S3.
- All subjects must have fasting TG ≤400 mg/dL (4.51 mmol/L) at the third screening visit (S3).
8. Male and female subjects of childbearing potential must agree to use a highly effective method of contraception throughout the study and for at least 63 days after the last dose of assigned treatment. A subject is of childbearing potential if, in the opinion of the investigator, he/she is biologically capable of having children and is sexually active (Section 4.4.2).
Female subjects who are not of childbearing potential (ie, meet at least one of the following criteria):
- Have undergone a documented hysterectomy and/or bilateral oophorectomy;
- Have medically confirmed ovarian failure or;
- Achieved post-menopausal status, defined as: cessation of regular menses for at least 12 consecutive months with no alternative pathological or physiological cause; and have a serum follicule-stimulating hormone (FSH) level within the laboratory’s reference range for postmenopausal females. |
|
E.4 | Principal exclusion criteria |
Subjects presenting with any of the following will not be included in the study:
1. Subjects who are investigational site staff members directly involved in the conduct of the trial and their family members, site staff members otherwise supervised by the Investigator, or subjects who are Pfizer employees directly involved in the conduct of the trial.
2. Participation in other studies involving small molecule investigational drug(s) (Phases 1-4) within 1 month or 5 half lives, whichever is longer, except for cholesteryl ester transfer protein (CETP) inhibitors (indefinitely), or biological agents within 6 months or 5 half lives, whichever is longer before the current study begins and/or during study participation (the investigator should refer to documents provided by the subject on the other study to determine the investigational product half life). If the blind has been broken and the Investigator knows (with documentation) that the subject received placebo, he/she can be included.
3. Subjects with prior exposure to PF-04950615 or other investigational PCSK9 inhibitor.
4. Subjects who are unable to receive injections, as either a self-injection, or administered by a family member, or home caregiver.
5. History of a cardiovascular or cerebrovascular event or procedure (eg, myocardial infarction, stroke, transient ischemic attack, angioplasty) during the past 90 days.
6. Congestive heart failure, New York Heart Association functional class IV, or Left Ventricular Ejection Fraction measured by imaging <25%.
7. Poorly controlled hypertension at any screening visit or at randomization (defined as the average of two systolic blood pressure measurements greater than 160 mm Hg or the average of two diastolic blood pressure measurements greater than 100 mm Hg, even with treatment). Subjects who have hypertension and are controlled on stable dosages of anti hypertensive medications can be included. An additional blood pressure (BP) may be performed within the hour or at the completion of the office visit, to confirm a reading.
8. History of hemorrhagic stroke or lacunar infarct.
9. Current untreated hypothyroidism or thyroid stimulating hormone (TSH) > upper limit of normal (ULN) at screening. Subjects who are treated and well controlled should be on the stable dose of thyroid hormone for at least 6 months.
10. Current history of alcoholism or drug addiction according to the Diagnostic and Statistical Manual of Mental Disorders (DSM) IV criteria within 12 months prior to screening. Use of any recreational drugs within 12 months prior to screening.
11. History of cancer within the last 5 years (except for cutaneous basal cell or squamous cell cancer resolved by excision).
12. Medical history of positive testing for Human immunodeficiency virus (HIV).
13. Any disease or condition that might compromise the hematological, renal, hepatic, pulmonary, endocrine, central nervous, immune, or gastrointestinal systems (unless deemed not clinically significant by the Investigator and/or the Sponsor) or confound the interpretation of the study results. Examples of such conditions include but are not limited to nephrotic syndrome, uncontrolled diabetes, excessive alcohol consumption,
cholestatic liver disease, unstable mental illness.
14. Use of statins other than atorvastatin, rosuvastatin, simvastatin, pravastatin or use of red yeast rice.
15. Undergoing apheresis or have planned start of apheresis.
16. Initiation of, or change in, non lipid lowering prescription drugs, herbal medicine or supplements (including foods with added plant sterols and stanols) within 6 weeks of screening (exception: initiation or change in multivitamins used for general health purposes are acceptable). Short term use of medications to treat acute conditions, and vaccines are allowed (e.g., antibiotics or allergy medication).
17. Subjects on systemic corticosteroids (ie, oral, intravenous (IV), intramuscular (IM), or intra-articular. The use of corticosteroids by inhalation, topical or ophthalmological is permitted. Subjects receiving topical preparations at high concentrations over large body areas for a long period of time should be discussed with the medical monitor.
18. Subjects taking prescription medications that are contraindicated with the use of statins. Refer to statin product labels for these medications.
19. History of allergic or anaphylactic reaction to any therapeutic or diagnostic monoclonal antibody (IgG protein) or molecules made of components of monoclonal antibodies (eg, Enbrel® which contains the Fc portion of an antibody or Lucentis® which is a Fab).
20. Subjects who are latex-sensitive (due to potential for exposure to latex or dry rubber in
the pre-filled syringe cap during self administration).
21. Any abnormal hematology values, clinical chemistries, urinalysis, or ECGs judged by the
Investigator as clinically significant.
For exclusion conditions 22-29 please refer to the protocol |
|
E.5 End points |
E.5.1 | Primary end point(s) |
Percent change from baseline in fasting LDL-C at week 12. |
|
E.5.1.1 | Timepoint(s) of evaluation of this end point |
|
E.5.2 | Secondary end point(s) |
Key Secondary Endpoints
Percent change from baseline in fasting:
TC, ApoB, and non HDL-C at week 12;
- LDL-C at week 12 in subjects with primary hyperlipidemia (pre-randomization TG <200 mg/dL (2.26 mmol/L);
- LDL-C at week 12 in subjects with mixed dyslipidemia (pre-randomization TG ≥200 mg/dL (2.26 mmol/L);
- Lp(a) at week 12;
- HDL-C at week 12.
Other Secondary Endpoints
- Percent change from baseline in fasting LDL-C at week 24 and week 52;
- Percent change from baseline in fasting LDL-C at week 24 and week 52 by TG cut-off of < or ≥200 mg/dL (2.26 mmol/L);
-Percent change from baseline in fasting TC, non HDL-C, ApoB, Lp(a) and HDL-C at week 24 and week 52;
- Percent change from baseline in fasting, TG, ApoA-I, ApoA-II, and VLDL-C at week 12, week 24 and week 52;
- Absolute change from baseline in fasting LDL-C at week 12 by TG cut-off of < or ≥200 mg/dL (2.26 mmol/L);
- Absolute change from baseline in fasting LDL-C, TC, non HDL-C, Apo B, Lp(a) and HDL-C at week 12;
- Absolute change from baseline in fasting TC/HDL-C ratio and ApoB/ApoA-I ratio at week 12, week 24 and week 52;
- Proportion of subjects achieving fasting LDL-C ≤100 mg/dL (2.59 mmol/L) at week 12, week 24 and week 52;
- Proportion of subjects achieving fasting LDL-C ≤70 mg/dL (1.81 mmol/L) at week 12, week 24 and week 52;
- Plasma PF-04950615 concentrations at week 12, week 24 and week 52.
- Safety endpoints, which are:
- Adverse events (including Type 1 and 3 hypersensitivity reactions and injection site reactions);
- Incidence of anti-drug-antibodies. |
|
E.5.2.1 | Timepoint(s) of evaluation of this end point |
|
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 | Yes |
E.6.7 | Pharmacodynamic | Yes |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
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) | 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 | 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.8.2.4 | 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.8.4.1 | Number of sites anticipated in Member State concerned | 20 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 105 |
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 |
Canada |
Czech Republic |
Finland |
Korea, Republic of |
Netherlands |
Norway |
Poland |
Puerto Rico |
Singapore |
Sweden |
United Kingdom |
United States |
|
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
|
End of Trial in a Member State (MS) of the EU is defined as the time at which it is deemed that sufficient subjects have been recruited and completed the study as stated in the regulatory application and ethics application in the MS. Poor recruitment by a MS is not a reason for premature termination but is considered a normal conclusion to the study in that MS.
For all other participating countries it is defined as Last Subject Last Visit (LSLV). |
|
E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 1 |
E.8.9.1 | In the Member State concerned months | 10 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 1 |
E.8.9.2 | In all countries concerned by the trial months | 10 |
E.8.9.2 | In all countries concerned by the trial days | 0 |