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    Clinical Trial Results:
    A Multicenter, Randomized, Double-blind, Active-controlled Clinical Trial to Evaluate the Efficacy and Safety of a New Formulation of Zenon (Ezetimibe/Rosuvastatin Fixed Dose Combination) in Patients With Primary Hypercholesterolemia, Not Adequately Controlled on Statin Therapy

    Summary
    EudraCT number
    2016-004556-30
    Trial protocol
    SK   CZ   BG   IT  
    Global end of trial date
    04 Mar 2021

    Results information
    Results version number
    v2(current)
    This version publication date
    16 Jan 2023
    First version publication date
    13 Mar 2022
    Other versions
    v1
    Version creation reason
    • Correction of full data set
    Updated safety optional field

    Trial information

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    Trial identification
    Sponsor protocol code
    LPS15021
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    -
    WHO universal trial number (UTN)
    U1111-1202-1326
    Other trial identifiers
    Study name: ZENON
    Sponsors
    Sponsor organisation name
    Sanofi aventis Groupe (SAG)
    Sponsor organisation address
    54,rue La Boetie, Paris, France, 75008
    Public contact
    Trial Transparency Team, Sanofi aventis recherche & développement, Contact-US@sanofi.com
    Scientific contact
    Trial Transparency Team, Sanofi aventis recherche & développement, Contact-US@sanofi.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    31 Mar 2021
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    04 Mar 2021
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To demonstrate the superiority of the fixed dose combination (FDC) rosuvastatin 10 milligrams (mg)/ezetimibe 10 mg (R10/E10) and rosuvastatin 20 mg/ezetimibe 10 mg (R20/E10) compared to up-titration of rosuvastatin 20 mg (R20) and rosuvastatin 40 mg (R40) respectively, and FDC R40/E10 compared to R40 monotherapy, in the reduction of low-density lipoprotein cholesterol (LDL-C) after 6 weeks.
    Protection of trial subjects
    Subjects were fully informed of all pertinent aspects of the clinical trial as well as the possibility to discontinue at any time in language and terms appropriate for the subject and considering the local culture. During the course of the trial, subjects were provided with individual subject cards indicating the nature of the trial the subject is participating, contact details and any information needed in the event of a medical emergency. Collected personal data and human biological samples were processed in compliance with the Sanofi-Aventis Group Personal Data Protection Charter ensuring that the Group abides by the laws governing personal data protection in force in all countries in which it operates.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    25 Oct 2018
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Bulgaria: 3
    Country: Number of subjects enrolled
    Russian Federation: 176
    Country: Number of subjects enrolled
    Mexico: 113
    Country: Number of subjects enrolled
    Poland: 2
    Country: Number of subjects enrolled
    Czechia: 23
    Country: Number of subjects enrolled
    Slovakia: 28
    Country: Number of subjects enrolled
    Ukraine: 107
    Worldwide total number of subjects
    452
    EEA total number of subjects
    56
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    320
    From 65 to 84 years
    132
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    Study was conducted at 72 active centres (that have screened at least 1 subject) in 7 countries. A total of 1453 subjects were screened from 25 October 2018 to 13 November 2020 of which 758 subjects were screening failures. Subjects entered a 6-week stabilisation run-in period after screening done according to previous statin treatment.

    Pre-assignment
    Screening details
    High-risk (HR) subjects were randomised in 1:1 ratio to receive either FDC R10/E10, or rosuvastatin 20 mg monotherapy; very high-risk (VHR) subjects were randomised in 1:1:1 to receive either FDC of R20/E10 or R40/E10 or R40 monotherapy. Randomisation was stratified by country.

    Period 1
    Period 1 title
    Overall study (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    High Risk - Rosuvastatin 10mg / Ezetimibe 10 mg
    Arm description
    Rosuvastatin 10 mg/Ezetimibe 10 mg (R10/E10) + placebo for Rosuvastatin 20 mg, once daily for 6 weeks in high cardiovascular risk (HR) subjects (LDL-C >=100 milligrams per deciliter [mg/dL] and <=190 mg/dL) (or [2.6- 4.9 millimoles per litre {mmol/L}] at end of run-in phase).
    Arm type
    Experimental

    Investigational medicinal product name
    Rosuvastatin 10 mg/Ezetimibe 10 mg
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Rosuvastatin 10 mg/Ezetimibe 10 mg was self-administered by the subject orally once daily for 6 weeks.

    Investigational medicinal product name
    Placebo to match Rosuvastatin 20 mg
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Capsule
    Routes of administration
    Oral use
    Dosage and administration details
    Placebo to match Rosuvastatin 20 mg was self-administered by the subject once daily for 6 weeks.

    Arm title
    High Risk - Rosuvastatin 20 mg
    Arm description
    Rosuvastatin 20 mg (R20) + placebo for Rosuvastatin 10 mg/Ezetimibe 10 mg, once daily for 6 weeks in HR subjects (LDL-C >=100 mg/dL and <=190 mg/dL or [2.6- 4.9 mmol/L] at end of run-in phase).
    Arm type
    Experimental

    Investigational medicinal product name
    Rosuvastatin 20 mg
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Rosuvastatin 20 mg was self-administered by the subject once daily for 6 weeks.

    Investigational medicinal product name
    Placebo to match Rosuvastatin 10 mg/Ezetimibe 10 mg
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Placebo to match Rosuvastatin 10 mg/Ezetimibe 10 mg was self-administered by the subject once daily for 6 weeks.

    Arm title
    Very High Risk - Rosuvastatin 20 mg / Ezetimibe 10mg
    Arm description
    Rosuvastatin 20 mg/Ezetimibe 10 mg (R20/E10) + placebo for Rosuvastatin 40 mg + placebo for Rosuvastatin 40 mg/Ezetimibe 10 mg, once daily for 6 weeks in very high cardiovascular risk (VHR) subjects (LDL-C >=70 mg/dL and <=160 mg/dL or [1.8- 4.1 mmol/L] at end of run-in phase).
    Arm type
    Experimental

    Investigational medicinal product name
    Rosuvastatin 20 mg/Ezetimibe 10 mg
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Rosuvastatin 20 mg/Ezetimibe 10 mg was self-administered by the subject orally once daily for 6 weeks.

    Investigational medicinal product name
    Placebo to match Rosuvastatin 40 mg/Ezetimibe 10 mg
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Placebo to match Rosuvastatin 40 mg/Ezetimibe 10 mg was self-administered by the subject once daily for 6 weeks.

    Investigational medicinal product name
    Placebo to match Rosuvastatin 40 mg
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Capsule
    Routes of administration
    Oral use
    Dosage and administration details
    Placebo to match Rosuvastatin 40 mg was self-administered by the subject once daily for 6 weeks.

    Arm title
    Very High Risk - Rosuvastatin 40 mg / Ezetimibe 10mg
    Arm description
    Rosuvastatin 40 mg/Ezetimibe 10 mg (R40/E10) + placebo for Rosuvastatin 40 mg + placebo for Rosuvastatin 20 mg/Ezetimibe 10 mg, once daily for 6 weeks in VHR subjects (LDL-C >=70 mg/dL and <=160 mg/dL or [1.8- 4.1 mmol/L] at end of run-in phase).
    Arm type
    Experimental

    Investigational medicinal product name
    Rosuvastatin 40 mg/Ezetimibe 10 mg
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Rosuvastatin 40 mg/Ezetimibe 10 mg was self-administered by the subject orally once daily for 6 weeks.

    Investigational medicinal product name
    Placebo to match Rosuvastatin 20 mg/Ezetimibe 10 mg
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Placebo to match Rosuvastatin 20 mg/Ezetimibe 10 mg was self-administered by the subject once daily for 6 weeks.

    Investigational medicinal product name
    Placebo to match Rosuvastatin 40 mg
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Capsule
    Routes of administration
    Oral use
    Dosage and administration details
    Placebo to match Rosuvastatin 40 mg was self-administered by the subject once daily for 6 weeks.

    Arm title
    Very High Risk - Rosuvastatin 40 mg
    Arm description
    Rosuvastatin 40 mg (R40) + placebo for Rosuvastatin 20 mg/Ezetimibe 10 mg + placebo for Rosuvastatin 40 mg/Ezetimibe 10 mg, once daily for 6 weeks in VHR subjects (LDL-C >=70 mg/dL and <=160 mg/dL or [1.8- 4.1 mmol/L] at end of run-in phase).
    Arm type
    Experimental

    Investigational medicinal product name
    Rosuvastatin 40 mg
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Capsule
    Routes of administration
    Oral use
    Dosage and administration details
    Rosuvastatin 40 mg was self-administered by the subject once daily for 6 weeks.

    Investigational medicinal product name
    Placebo to match Rosuvastatin 20 mg/Ezetimibe 10 mg
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Placebo to match Rosuvastatin 20 mg/Ezetimibe 10 mg was self-administered by the subject once daily for 6 weeks.

    Investigational medicinal product name
    Placebo to match Rosuvastatin 40 mg/Ezetimibe 10 mg
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Placebo to match Rosuvastatin 40 mg/Ezetimibe 10 mg was self-administered by the subject once daily for 6 weeks.

    Number of subjects in period 1
    High Risk - Rosuvastatin 10mg / Ezetimibe 10 mg High Risk - Rosuvastatin 20 mg Very High Risk - Rosuvastatin 20 mg / Ezetimibe 10mg Very High Risk - Rosuvastatin 40 mg / Ezetimibe 10mg Very High Risk - Rosuvastatin 40 mg
    Started
    104
    104
    82
    79
    83
    Completed
    104
    102
    80
    75
    82
    Not completed
    0
    2
    2
    4
    1
         Adverse event (AE)
    -
    2
    2
    3
    -
         Other - unspecified
    -
    -
    -
    1
    1

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    High Risk - Rosuvastatin 10mg / Ezetimibe 10 mg
    Reporting group description
    Rosuvastatin 10 mg/Ezetimibe 10 mg (R10/E10) + placebo for Rosuvastatin 20 mg, once daily for 6 weeks in high cardiovascular risk (HR) subjects (LDL-C >=100 milligrams per deciliter [mg/dL] and <=190 mg/dL) (or [2.6- 4.9 millimoles per litre {mmol/L}] at end of run-in phase).

    Reporting group title
    High Risk - Rosuvastatin 20 mg
    Reporting group description
    Rosuvastatin 20 mg (R20) + placebo for Rosuvastatin 10 mg/Ezetimibe 10 mg, once daily for 6 weeks in HR subjects (LDL-C >=100 mg/dL and <=190 mg/dL or [2.6- 4.9 mmol/L] at end of run-in phase).

    Reporting group title
    Very High Risk - Rosuvastatin 20 mg / Ezetimibe 10mg
    Reporting group description
    Rosuvastatin 20 mg/Ezetimibe 10 mg (R20/E10) + placebo for Rosuvastatin 40 mg + placebo for Rosuvastatin 40 mg/Ezetimibe 10 mg, once daily for 6 weeks in very high cardiovascular risk (VHR) subjects (LDL-C >=70 mg/dL and <=160 mg/dL or [1.8- 4.1 mmol/L] at end of run-in phase).

    Reporting group title
    Very High Risk - Rosuvastatin 40 mg / Ezetimibe 10mg
    Reporting group description
    Rosuvastatin 40 mg/Ezetimibe 10 mg (R40/E10) + placebo for Rosuvastatin 40 mg + placebo for Rosuvastatin 20 mg/Ezetimibe 10 mg, once daily for 6 weeks in VHR subjects (LDL-C >=70 mg/dL and <=160 mg/dL or [1.8- 4.1 mmol/L] at end of run-in phase).

    Reporting group title
    Very High Risk - Rosuvastatin 40 mg
    Reporting group description
    Rosuvastatin 40 mg (R40) + placebo for Rosuvastatin 20 mg/Ezetimibe 10 mg + placebo for Rosuvastatin 40 mg/Ezetimibe 10 mg, once daily for 6 weeks in VHR subjects (LDL-C >=70 mg/dL and <=160 mg/dL or [1.8- 4.1 mmol/L] at end of run-in phase).

    Reporting group values
    High Risk - Rosuvastatin 10mg / Ezetimibe 10 mg High Risk - Rosuvastatin 20 mg Very High Risk - Rosuvastatin 20 mg / Ezetimibe 10mg Very High Risk - Rosuvastatin 40 mg / Ezetimibe 10mg Very High Risk - Rosuvastatin 40 mg Total
    Number of subjects
    104 104 82 79 83
    Age categorical
    Units: Subjects
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    56.7 ( 11.10 ) 57.4 ( 10.06 ) 58.9 ( 9.81 ) 62.9 ( 8.82 ) 60.8 ( 11.05 ) -
    Gender categorical
    Units: Subjects
        Female
    69 62 31 34 41 237
        Male
    35 42 51 45 42 215
    Number of previous statin treatments
    Units: Subjects
        1 statin treatment
    104 104 78 77 81 444
        2 statin treatments
    0 0 4 2 2 8
        >2 statin treatments
    0 0 0 0 0 0
    Prior lipid-modifying therapy (LMT) medications
    Units: Subjects
        R10/R10 Calcium (Ca)
    71 73 0 0 0 144
        R20/R20 Ca
    0 0 46 41 43 130
        Atorvastatin/Ca/Ca Trihydrate 40 mg
    32 31 0 0 0 63
        Atorvastatin/Ca/Ca Trihydrate 80 mg
    0 0 36 38 40 114
        Simvastatin 80 mg
    1 0 0 0 0 1
    Duration of hypercholesterolemia
    Units: years
        arithmetic mean (standard deviation)
    3.8 ( 4.42 ) 4.5 ( 5.87 ) 5.6 ( 4.55 ) 6.4 ( 6.17 ) 7.1 ( 5.99 ) -
    Age of onset of hypercholesterolemia
    Units: years
        arithmetic mean (standard deviation)
    53.4 ( 11.41 ) 53.3 ( 11.51 ) 53.7 ( 10.40 ) 57.0 ( 9.60 ) 54.1 ( 10.79 ) -
    Duration of previous statin treatment without discontinuation
    Units: years
        arithmetic mean (standard deviation)
    2.2 ( 2.72 ) 1.9 ( 1.76 ) 2.9 ( 3.62 ) 2.4 ( 2.86 ) 3.3 ( 4.58 ) -

    End points

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    End points reporting groups
    Reporting group title
    High Risk - Rosuvastatin 10mg / Ezetimibe 10 mg
    Reporting group description
    Rosuvastatin 10 mg/Ezetimibe 10 mg (R10/E10) + placebo for Rosuvastatin 20 mg, once daily for 6 weeks in high cardiovascular risk (HR) subjects (LDL-C >=100 milligrams per deciliter [mg/dL] and <=190 mg/dL) (or [2.6- 4.9 millimoles per litre {mmol/L}] at end of run-in phase).

    Reporting group title
    High Risk - Rosuvastatin 20 mg
    Reporting group description
    Rosuvastatin 20 mg (R20) + placebo for Rosuvastatin 10 mg/Ezetimibe 10 mg, once daily for 6 weeks in HR subjects (LDL-C >=100 mg/dL and <=190 mg/dL or [2.6- 4.9 mmol/L] at end of run-in phase).

    Reporting group title
    Very High Risk - Rosuvastatin 20 mg / Ezetimibe 10mg
    Reporting group description
    Rosuvastatin 20 mg/Ezetimibe 10 mg (R20/E10) + placebo for Rosuvastatin 40 mg + placebo for Rosuvastatin 40 mg/Ezetimibe 10 mg, once daily for 6 weeks in very high cardiovascular risk (VHR) subjects (LDL-C >=70 mg/dL and <=160 mg/dL or [1.8- 4.1 mmol/L] at end of run-in phase).

    Reporting group title
    Very High Risk - Rosuvastatin 40 mg / Ezetimibe 10mg
    Reporting group description
    Rosuvastatin 40 mg/Ezetimibe 10 mg (R40/E10) + placebo for Rosuvastatin 40 mg + placebo for Rosuvastatin 20 mg/Ezetimibe 10 mg, once daily for 6 weeks in VHR subjects (LDL-C >=70 mg/dL and <=160 mg/dL or [1.8- 4.1 mmol/L] at end of run-in phase).

    Reporting group title
    Very High Risk - Rosuvastatin 40 mg
    Reporting group description
    Rosuvastatin 40 mg (R40) + placebo for Rosuvastatin 20 mg/Ezetimibe 10 mg + placebo for Rosuvastatin 40 mg/Ezetimibe 10 mg, once daily for 6 weeks in VHR subjects (LDL-C >=70 mg/dL and <=160 mg/dL or [1.8- 4.1 mmol/L] at end of run-in phase).

    Primary: Percent Change from Baseline in Calculated Low-Density Lipoprotein Cholesterol (LDL-C) at Week 6

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    End point title
    Percent Change from Baseline in Calculated Low-Density Lipoprotein Cholesterol (LDL-C) at Week 6
    End point description
    Adjusted least square (LS) means and standard errors (SE) at Week 6 was derived from analyses of covariance (ANCOVA) model with the fixed categorical effect of treatment group, country as well as the continuous fixed covariate of baseline calculated LDL-C value. Analysis was performed on modified intent-to-treat population (mITT) which included all randomised subjects analysed according to the treatment group allocated by randomisation.
    End point type
    Primary
    End point timeframe
    Baseline, Week 6
    End point values
    High Risk - Rosuvastatin 10mg / Ezetimibe 10 mg High Risk - Rosuvastatin 20 mg Very High Risk - Rosuvastatin 20 mg / Ezetimibe 10mg Very High Risk - Rosuvastatin 40 mg / Ezetimibe 10mg Very High Risk - Rosuvastatin 40 mg
    Number of subjects analysed
    97
    97
    79
    78
    78
    Units: percent change
        least squares mean (standard error)
    -27.02 ( 4.14 )
    -21.82 ( 4.25 )
    -26.90 ( 3.60 )
    -34.28 ( 3.68 )
    -14.62 ( 3.63 )
    Statistical analysis title
    HR: R10/E10 versus R20
    Comparison groups
    High Risk - Rosuvastatin 10mg / Ezetimibe 10 mg v High Risk - Rosuvastatin 20 mg
    Number of subjects included in analysis
    194
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.306 [1]
    Method
    ANCOVA
    Parameter type
    LS mean
    Point estimate
    -5.2
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -15.18
         upper limit
    4.78
    Variability estimate
    Standard error of the mean
    Dispersion value
    5.06
    Notes
    [1] - Threshold for significance at 0.05 level.
    Statistical analysis title
    VHR: R40/E10 versus R40
    Comparison groups
    Very High Risk - Rosuvastatin 40 mg / Ezetimibe 10mg v Very High Risk - Rosuvastatin 40 mg
    Number of subjects included in analysis
    156
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.001 [2]
    Method
    ANCOVA
    Parameter type
    LS mean
    Point estimate
    -19.66
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -29.48
         upper limit
    -9.84
    Variability estimate
    Standard error of the mean
    Dispersion value
    4.98
    Notes
    [2] - Threshold for significance at 0.05 level.
    Statistical analysis title
    VHR: R20/E10 versus R40
    Comparison groups
    Very High Risk - Rosuvastatin 20 mg / Ezetimibe 10mg v Very High Risk - Rosuvastatin 40 mg / Ezetimibe 10mg
    Number of subjects included in analysis
    157
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.015 [3]
    Method
    ANCOVA
    Parameter type
    LS mean
    Point estimate
    -12.28
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -22.12
         upper limit
    -2.44
    Variability estimate
    Standard error of the mean
    Dispersion value
    4.99
    Notes
    [3] - Threshold for significance at 0.05 level.

    Secondary: Percent Change from Baseline in Calculated Low-Density Lipoprotein Cholesterol (LDL-C) at Week 6: Subjects Randomised to R10/E10 and R20/E10

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    End point title
    Percent Change from Baseline in Calculated Low-Density Lipoprotein Cholesterol (LDL-C) at Week 6: Subjects Randomised to R10/E10 and R20/E10 [4]
    End point description
    Analysis was performed on mITT population.
    End point type
    Secondary
    End point timeframe
    Baseline, Week 6
    Notes
    [4] - The end point is not reporting statistics for all the arms in the baseline period. It is expected all the baseline period arms will be reported on when providing values for an end point on the baseline period.
    Justification: Endpoint is reporting data for applicable arms in the study.
    End point values
    High Risk - Rosuvastatin 10mg / Ezetimibe 10 mg Very High Risk - Rosuvastatin 20 mg / Ezetimibe 10mg
    Number of subjects analysed
    97
    79
    Units: percent change
        arithmetic mean (confidence interval 95%)
    -25.03 (-33.89 to -16.17)
    -29.25 (-36.84 to -21.65)
    Attachments
    Statistical Analysis for Secondary endpoint
    No statistical analyses for this end point

    Secondary: Percentage of Subjects Achieving LDL-C Target at Week 6

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    End point title
    Percentage of Subjects Achieving LDL-C Target at Week 6
    End point description
    Percentage of subjects achieving lipid goal levels were defined as: - calculated LDL-C <100 mg/dL (2.6 mmol/L) at Week 6 for HR subjects and calculated LDL-C <70 mg/dL (1.8 mmol/L) at Week 6 for VHR subjects. Analysis was performed on mITT population.
    End point type
    Secondary
    End point timeframe
    Week 6
    End point values
    High Risk - Rosuvastatin 10mg / Ezetimibe 10 mg High Risk - Rosuvastatin 20 mg Very High Risk - Rosuvastatin 20 mg / Ezetimibe 10mg Very High Risk - Rosuvastatin 40 mg / Ezetimibe 10mg Very High Risk - Rosuvastatin 40 mg
    Number of subjects analysed
    97
    97
    79
    78
    78
    Units: percentage of subjects
        number (not applicable)
    66.0
    55.7
    59.5
    76.9
    41.0
    Statistical analysis title
    VHR: R40/E10 versus R40
    Statistical analysis description
    A hierarchical testing procedure was used to control the overall type I error and handle multiple endpoint analyses. Testing was then performed sequentially in the order the endpoints are reported for each stratum (HR or VHR). The hierarchical testing sequence continued only if previous endpoint was statistically significant at 0.05 level.
    Comparison groups
    Very High Risk - Rosuvastatin 40 mg / Ezetimibe 10mg v Very High Risk - Rosuvastatin 40 mg
    Number of subjects included in analysis
    156
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.001 [5]
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    7.91
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    3.38
         upper limit
    18.51
    Notes
    [5] - Threshold for significance at 0.05 level.
    Statistical analysis title
    VHR: R20/E10 versus R40
    Statistical analysis description
    A hierarchical testing procedure was used to control the overall type I error and handle multiple endpoint analyses. Testing was then performed sequentially in the order the endpoints are reported for each stratum (HR or VHR). The hierarchical testing sequence continued only if previous endpoint was statistically significant at 0.05 level.
    Comparison groups
    Very High Risk - Rosuvastatin 20 mg / Ezetimibe 10mg v Very High Risk - Rosuvastatin 40 mg
    Number of subjects included in analysis
    157
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.001 [6]
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    3.69
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    1.71
         upper limit
    7.96
    Notes
    [6] - Threshold for significance at 0.05 level.

    Secondary: Percent Change from Baseline in Total Cholesterol Levels at Week 6

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    End point title
    Percent Change from Baseline in Total Cholesterol Levels at Week 6
    End point description
    Adjusted LS means and standard errors at Week 6 was derived from ANCOVA model including the fixed categorical effects of treatment group, country, as well as the continuous fixed covariate of baseline calculated Total-C value. Analysis was performed on mITT population.
    End point type
    Secondary
    End point timeframe
    Baseline, Week 6
    End point values
    High Risk - Rosuvastatin 10mg / Ezetimibe 10 mg High Risk - Rosuvastatin 20 mg Very High Risk - Rosuvastatin 20 mg / Ezetimibe 10mg Very High Risk - Rosuvastatin 40 mg / Ezetimibe 10mg Very High Risk - Rosuvastatin 40 mg
    Number of subjects analysed
    97
    97
    79
    78
    78
    Units: percent change
        least squares mean (standard error)
    -17.37 ( 2.66 )
    -13.71 ( 2.73 )
    -19.12 ( 2.11 )
    -22.33 ( 2.15 )
    -8.83 ( 2.13 )
    Statistical analysis title
    VHR: R40/E10 versus R40
    Statistical analysis description
    A hierarchical testing procedure was used to control the overall type I error and handle multiple endpoint analyses. Testing was then performed sequentially in the order the endpoints are reported for each stratum (HR or VHR). The hierarchical testing sequence continued only if previous endpoint was statistically significant at 0.05 level.
    Comparison groups
    Very High Risk - Rosuvastatin 40 mg / Ezetimibe 10mg v Very High Risk - Rosuvastatin 40 mg
    Number of subjects included in analysis
    156
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.001 [7]
    Method
    ANCOVA
    Parameter type
    LS mean
    Point estimate
    -13.5
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -19.26
         upper limit
    -7.74
    Variability estimate
    Standard error of the mean
    Dispersion value
    2.92
    Notes
    [7] - Threshold for significance at 0.05 level.
    Statistical analysis title
    VHR: R20/E10 versus R40
    Statistical analysis description
    A hierarchical testing procedure was used to control the overall type I error and handle multiple endpoint analyses. Testing was then performed sequentially in the order the endpoints are reported for each stratum (HR or VHR). The hierarchical testing sequence continued only if previous endpoint was statistically significant at 0.05 level.
    Comparison groups
    Very High Risk - Rosuvastatin 20 mg / Ezetimibe 10mg v Very High Risk - Rosuvastatin 40 mg
    Number of subjects included in analysis
    157
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.001 [8]
    Method
    ANCOVA
    Parameter type
    LS mean
    Point estimate
    -10.29
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -16.04
         upper limit
    -4.54
    Variability estimate
    Standard error of the mean
    Dispersion value
    2.92
    Notes
    [8] - Threshold for significance at 0.05 level.

    Secondary: Percent Change from Baseline in High-Density Lipoprotein Cholesterol Levels at Week 6

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    End point title
    Percent Change from Baseline in High-Density Lipoprotein Cholesterol Levels at Week 6
    End point description
    Adjusted LS means and standard errors at Week 6 was derived from ANCOVA model including the fixed categorical effects of treatment group, country, as well as the continuous fixed covariate of baseline calculated high-density lipoprotein Cholesterol levels. Analysis was performed on mITT population.
    End point type
    Secondary
    End point timeframe
    Baseline, Week 6
    End point values
    High Risk - Rosuvastatin 10mg / Ezetimibe 10 mg High Risk - Rosuvastatin 20 mg Very High Risk - Rosuvastatin 20 mg / Ezetimibe 10mg Very High Risk - Rosuvastatin 40 mg / Ezetimibe 10mg Very High Risk - Rosuvastatin 40 mg
    Number of subjects analysed
    97
    97
    79
    78
    78
    Units: percent change
        least squares mean (standard error)
    1.25 ( 2.79 )
    2.10 ( 2.87 )
    -0.23 ( 1.38 )
    -2.66 ( 1.41 )
    2.27 ( 1.39 )
    Statistical analysis title
    VHR: R40/E10 versus R40
    Statistical analysis description
    A hierarchical testing procedure was used to control the overall type I error and handle multiple endpoint analyses. Testing was then performed sequentially in the order the endpoints are reported for each stratum (HR or VHR). The hierarchical testing sequence continued only if previous endpoint was statistically significant at 0.05 level.
    Comparison groups
    Very High Risk - Rosuvastatin 40 mg / Ezetimibe 10mg v Very High Risk - Rosuvastatin 40 mg
    Number of subjects included in analysis
    156
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.01 [9]
    Method
    ANCOVA
    Parameter type
    LS mean
    Point estimate
    -4.92
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -8.68
         upper limit
    -1.16
    Variability estimate
    Standard error of the mean
    Dispersion value
    1.91
    Notes
    [9] - Threshold for significance at 0.05 level.
    Statistical analysis title
    VHR: R20/E10 versus R40
    Statistical analysis description
    A hierarchical testing procedure was used to control the overall type I error and handle multiple endpoint analyses. Testing was then performed sequentially in the order the endpoints are reported for each stratum (HR or VHR). The hierarchical testing sequence continued only if previous endpoint was statistically significant at 0.05 level.
    Comparison groups
    Very High Risk - Rosuvastatin 20 mg / Ezetimibe 10mg v Very High Risk - Rosuvastatin 40 mg
    Number of subjects included in analysis
    157
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.191 [10]
    Method
    ANCOVA
    Parameter type
    LS mean
    Point estimate
    -2.5
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -6.25
         upper limit
    1.26
    Variability estimate
    Standard error of the mean
    Dispersion value
    1.9
    Notes
    [10] - Threshold for significance at 0.05 level.

    Secondary: Percent Change from Baseline in Triglycerides Levels at Week 6

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    End point title
    Percent Change from Baseline in Triglycerides Levels at Week 6
    End point description
    Adjusted LS means and standard errors at Week 6 was derived from ANCOVA model including the fixed categorical effects of treatment group, country, as well as the continuous fixed covariate of baseline calculated triglycerides levels. Analysis was performed on mITT population.
    End point type
    Secondary
    End point timeframe
    Baseline, Week 6
    End point values
    High Risk - Rosuvastatin 10mg / Ezetimibe 10 mg High Risk - Rosuvastatin 20 mg Very High Risk - Rosuvastatin 20 mg / Ezetimibe 10mg Very High Risk - Rosuvastatin 40 mg / Ezetimibe 10mg Very High Risk - Rosuvastatin 40 mg
    Number of subjects analysed
    97
    97
    79
    78
    78
    Units: percent change
        least squares mean (standard error)
    -3.62 ( 4.90 )
    -0.04 ( 5.09 )
    -10.22 ( 3.69 )
    -8.54 ( 3.77 )
    -0.70 ( 3.72 )
    Statistical analysis title
    VHR: R40/E10 versus R40
    Statistical analysis description
    A hierarchical testing procedure was used to control the overall type I error and handle multiple endpoint analyses. Testing was then performed sequentially in the order the endpoints are reported for each stratum (HR or VHR). The hierarchical testing sequence continued only if previous endpoint was statistically significant at 0.05 level.
    Comparison groups
    Very High Risk - Rosuvastatin 40 mg / Ezetimibe 10mg v Very High Risk - Rosuvastatin 40 mg
    Number of subjects included in analysis
    156
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.128 [11]
    Method
    ANCOVA
    Parameter type
    LS mean
    Point estimate
    -7.84
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -17.95
         upper limit
    2.27
    Variability estimate
    Standard error of the mean
    Dispersion value
    5.13
    Notes
    [11] - Threshold for significance at 0.05 level.
    Statistical analysis title
    VHR: R20/E10 versus R40
    Statistical analysis description
    A hierarchical testing procedure was used to control the overall type I error and handle multiple endpoint analyses. Testing was then performed sequentially in the order the endpoints are reported for each stratum (HR or VHR). The hierarchical testing sequence continued only if previous endpoint was statistically significant at 0.05 level.
    Comparison groups
    Very High Risk - Rosuvastatin 20 mg / Ezetimibe 10mg v Very High Risk - Rosuvastatin 40 mg
    Number of subjects included in analysis
    157
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.063 [12]
    Method
    ANCOVA
    Parameter type
    LS mean
    Point estimate
    -9.52
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -19.57
         upper limit
    0.53
    Variability estimate
    Standard error of the mean
    Dispersion value
    5.1
    Notes
    [12] - Threshold for significance at 0.05 level.

    Adverse events

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    Adverse events information [1]
    Timeframe for reporting adverse events
    AEs: signing of informed consent up to end of study (i.e., up to 16 weeks). Time frame for treatment emergent AEs: Double Blind (DB) period: intake of first to last dose of DB investigational medicinal product (IMP)+5 days follow up (i.e., up to 8 weeks).
    Adverse event reporting additional description
    Reported AEs and deaths were treatment emergent AEs that developed/worsened during 'treatment period' (intake of first to last dose of DB IMP+5 days follow up). Safety population: subjects who received at least one dose of double blind IMP; analysed per treatment received.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    23.1
    Reporting groups
    Reporting group title
    High Risk - Rosuvastatin 10mg / Ezetimibe 10 mg
    Reporting group description
    Rosuvastatin 10 mg/Ezetimibe 10 mg (R10/E10) + placebo for Rosuvastatin 20 mg, once daily for 6 weeks in high cardiovascular risk (HR) subjects (LDL-C >=100 milligrams per deciliter [mg/dL] and <=190 mg/dL) (or [2.6- 4.9 millimoles per litre {mmol/L}] at end of run-in phase).

    Reporting group title
    High Risk - Rosuvastatin 20 mg
    Reporting group description
    Rosuvastatin 20 mg (R20) + placebo for Rosuvastatin 10 mg/Ezetimibe 10 mg, once daily for 6 weeks in HR subjects (LDL-C >=100 mg/dL and <=190 mg/dL or [2.6- 4.9 mmol/L] at end of run-in phase).

    Reporting group title
    Very High Risk - Rosuvastatin 20 mg / Ezetimibe 10mg
    Reporting group description
    Rosuvastatin 20 mg/Ezetimibe 10 mg (R20/E10) + placebo for Rosuvastatin 40 mg + placebo for Rosuvastatin 40 mg/Ezetimibe 10 mg, once daily for 6 weeks in very high cardiovascular risk (VHR) subjects (LDL-C >=70 mg/dL and <=160 mg/dL or [1.8- 4.1 mmol/L] at end of run-in phase).

    Reporting group title
    Very High Risk - Rosuvastatin 40 mg / Ezetimibe 10mg
    Reporting group description
    Rosuvastatin 40 mg/Ezetimibe 10 mg (R40/E10) + placebo for Rosuvastatin 40 mg + placebo for Rosuvastatin 20 mg/Ezetimibe 10 mg, once daily for 6 weeks in VHR subjects (LDL-C >=70 mg/dL and <=160 mg/dL or [1.8- 4.1 mmol/L] at end of run-in phase).

    Reporting group title
    Very High Risk - Rosuvastatin 40 mg
    Reporting group description
    Rosuvastatin 40 mg (R40) + placebo for Rosuvastatin 20 mg/Ezetimibe 10 mg + placebo for Rosuvastatin 40 mg/Ezetimibe 10 mg, once daily for 6 weeks in VHR subjects (LDL-C >=70 mg/dL and <=160 mg/dL or [1.8- 4.1 mmol/L] at end of run-in phase).

    Notes
    [1] - There are no non-serious adverse events recorded for these results. It is expected that there will be at least one non-serious adverse event reported.
    Justification: No non-serious AE at the threshold of >5%.
    Serious adverse events
    High Risk - Rosuvastatin 10mg / Ezetimibe 10 mg High Risk - Rosuvastatin 20 mg Very High Risk - Rosuvastatin 20 mg / Ezetimibe 10mg Very High Risk - Rosuvastatin 40 mg / Ezetimibe 10mg Very High Risk - Rosuvastatin 40 mg
    Total subjects affected by serious adverse events
         subjects affected / exposed
    0 / 104 (0.00%)
    2 / 104 (1.92%)
    1 / 82 (1.22%)
    0 / 79 (0.00%)
    0 / 83 (0.00%)
         number of deaths (all causes)
    0
    1
    0
    0
    0
         number of deaths resulting from adverse events
    Injury, poisoning and procedural complications
    Femur Fracture
    alternative dictionary used: MedDRA 23.1
         subjects affected / exposed
    0 / 104 (0.00%)
    1 / 104 (0.96%)
    0 / 82 (0.00%)
    0 / 79 (0.00%)
    0 / 83 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Pulmonary Embolism
    alternative dictionary used: MedDRA 23.1
         subjects affected / exposed
    0 / 104 (0.00%)
    1 / 104 (0.96%)
    0 / 82 (0.00%)
    0 / 79 (0.00%)
    0 / 83 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
    0 / 0
    0 / 0
    Infections and infestations
    Covid-19
    alternative dictionary used: MedDRA 23.1
         subjects affected / exposed
    0 / 104 (0.00%)
    1 / 104 (0.96%)
    0 / 82 (0.00%)
    0 / 79 (0.00%)
    0 / 83 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Pyelonephritis Chronic
    alternative dictionary used: MedDRA 23.1
         subjects affected / exposed
    0 / 104 (0.00%)
    0 / 104 (0.00%)
    1 / 82 (1.22%)
    0 / 79 (0.00%)
    0 / 83 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    High Risk - Rosuvastatin 10mg / Ezetimibe 10 mg High Risk - Rosuvastatin 20 mg Very High Risk - Rosuvastatin 20 mg / Ezetimibe 10mg Very High Risk - Rosuvastatin 40 mg / Ezetimibe 10mg Very High Risk - Rosuvastatin 40 mg
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    0 / 104 (0.00%)
    0 / 104 (0.00%)
    0 / 82 (0.00%)
    0 / 79 (0.00%)
    0 / 83 (0.00%)

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    20 May 2019
    Following changes were made: i) updated the statistical section. Based on study design, inferential approach and/or plans regarding generalisability of the results obtained, all pairwise comparisons did not need to reach statistical significance for a study success. The statistical analysis remained unchanged, only the strategy/interpretation of the results was updated. ii) updated study description to clarify the definition of HR and VHR cardiovascular risk subjects. If Systematic Coronary Risk Evaluation (SCORE) was used as assessment criteria for HR or VHR, the value measured before the starting of LMT was to be taken into consideration. In addition, the definition of screening failure was added. iii) added exclusion criteria to prohibit red yeast rice (RYR) products for at least 6 weeks prior to the Screening Visit and/or plan to take these products before the EOT Visit; it was reported that there was up to a 20% reduction in LDL-C with RYR products at a daily dose of ~2.5-10 mg monacolin (2016 European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) Guidelines for the Management of Dyslipidemias). iv) added eGFR <30 mL/min/1.73m^2 and eGFR >=30 and <=59 mL/min/1.73m^2 for VHR subjects as reasons for permanent treatment discontinuation taking into consideration the IMP contraindications and the subjects’ profile. v) added definition of AEs of special interest (AESI). Pregnancy occurring in a female partner of a male subject included in the study was added as an AESI. vi) the IMP was to be discontinued only in case of pregnancy occurred in female subject included in the study. vii) changes related to the retaining of the records and the study documents by the Investigators for 25 years after the signature of the final study report. viii) clarified fasting conditions by adding the information that the subjects should not drink anything other than water for 10-12 hours before the blood samples collection.
    19 Feb 2020
    Following changes were made: i) amended inclusion criterion to reflect the decrease in the LDL-C lower thresholds at screening for the HR and VHR subjects to allow the recruitment of subjects with better controlled hypercholesterolemia already treated with rosuvastatin that might benefit from the treatment with escalated doses of rosuvastatin or FDC. ii) added an exploratory endpoint in reference to the attaining of the new LDL-C targets, as recommended by the ESC and the EAS 2019 Guidelines for the Management of Dyslipidemias (i.e., an LDL-C reduction of >=50% from baseline and an LDL-C goal of <1.8 mmol/L (<70 mg/dL) for HR subjects and an LDL-C reduction of >=50% from baseline and an LDL-C goal of <1.4 mmol/L (<55 mg/dL) for VHR subjects). iii) aligned the general guidance for the follow-up of laboratory abnormalities and IMP discontinuation in case of alanine aminotransferase or creatine kinase increase with Section 7 “Summary of data and guidance for the Investigator” of the Investigator’s Brochure. iv) updated timing of IMP administration to clarify that in the particular situation when the subjects were treated before V2 with statins in the evening, the first run-in rosuvastatin tablet could be taken in the evening. Similarly, in the particular situation when the subjects had taken the run-in rosuvastatin in the evening, the double-blind IMP could be taken in the evening. The Investigator was to instruct the subjects regarding the IMP administration and to report any AE that they might experience.

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
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