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    Summary
    EudraCT Number:2021-002871-20
    Sponsor's Protocol Code Number:LIB003-012
    National Competent Authority:Spain - AEMPS
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2021-12-17
    Trial results
    Index
    A. PROTOCOL INFORMATION
    B. SPONSOR INFORMATION
    C. APPLICANT IDENTIFICATION
    D. IMP IDENTIFICATION
    D.8 INFORMATION ON PLACEBO
    E. GENERAL INFORMATION ON THE TRIAL
    F. POPULATION OF TRIAL SUBJECTS
    G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
    N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
    P. END OF TRIAL
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedSpain - AEMPS
    A.2EudraCT number2021-002871-20
    A.3Full title of the trial
    Randomized, Open Label, Phase 3 Study to Evaluate the Efficacy and Safety of Lerodalcibep (LIB003) compared to Inclisiran in Patients With Cardiovascular Disease, or at High Risk for Cardiovascular Disease, on Stable Lipid-Lowering Therapy Requiring Additional Low-Density Lipoprotein Cholesterol Reduction (LIBerate-VI)
    Estudio de fase 3, aleatorizado y abierto para evaluar la eficacia y la seguridad de lerodalcibep (LIB003) en comparación con inclisirán en pacientes con enfermedad cardiovascular, o alto riesgo de enfermedad cardiovascular, en tratamiento hipolipemiante estable que precisan una reducción adicional del colesterol unido a las lipoproteínas de baja densidad (LIBerate-VI)
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Study to Evaluate the Efficacy and Safety of the Investigational Drug Lerodalcibep (LIB003) compared to Inclisiran for the Reduction of Cholesterol in Patients with Cardiovascular Disease or at High Risk for Cardiovascular Disease.
    Estudio para evaluar la eficacia y la seguridad del fármaco en investigación lerodalcibep (LIB003) en comparación con inclisirán para reducir el colesterol en pacientes con enfermedad cardiovascular o alto riesgo de enfermedad cardiovascular.
    A.3.2Name or abbreviated title of the trial where available
    LIBerate-VI
    A.4.1Sponsor's protocol code numberLIB003-012
    A.7Trial is part of a Paediatric Investigation Plan No
    A.8EMA Decision number of Paediatric Investigation PlanP/370/2020
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorLIB Therapeutics, LLC
    B.1.3.4CountryUnited States
    B.3.1 and B.3.2Status of the sponsorCommercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportLIB Therapeutics, LLC
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationLIB Therapeutics, LLC
    B.5.2Functional name of contact pointLIB clinical trials
    B.5.3 Address:
    B.5.3.1Street Address5375 Medpace Way
    B.5.3.2Town/ cityCincinnati, OH
    B.5.3.3Post code45227
    B.5.3.4CountryUnited States
    B.5.4Telephone number+1859653-3141
    B.5.6E-mailLIBtrials@libtherapeutics.com
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameLIB003
    D.3.2Product code lerodalcibep
    D.3.4Pharmaceutical form Solution for injection
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPSubcutaneous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNLerodalcibep
    D.3.9.1CAS number 2250073-78-8
    D.3.9.2Current sponsor codeLIB003
    D.3.9.3Other descriptive nameLIB003
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number250
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleComparator
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Leqvio
    D.2.1.1.2Name of the Marketing Authorisation holderNovartis Europharm Limited
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameLeqvio (inclisiran)
    D.3.4Pharmaceutical form Solution for injection/infusion in pre-filled syringe
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPSubcutaneous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNINCLISIRAN
    D.3.9.1CAS number 1639324-58
    D.3.9.4EV Substance CodeSUB182427
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number189
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Patients with atherosclerotic cardiovascular (CV) disease (ASCVD) or high risk of ASCVD who need additional LDL-C reduction
    Pacientes con enfermedad cardiovascular (CV) o alto riesgo de enfermedad aterosclerótica cardiovascular que necesitan una reducción adicional de los niveles de C-LDL
    E.1.1.1Medical condition in easily understood language
    High levels in the blood of "bad" cholesterol has been identified as one of the major risk factors for cardiovascular diseases, which are the main cause mortality in industrialized countries
    Niveles elevados en sangre de colesterol "malo" han sido identificados como uno de los mayores factores de riesgos de las enfermedades CV. Causa principal de muerte en las paises industrializadas.
    E.1.1.2Therapeutic area Diseases [C] - Nutritional and Metabolic Diseases [C18]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.1
    E.1.2Level LLT
    E.1.2Classification code 10007648
    E.1.2Term Cardiovascular disease, unspecified
    E.1.2System Organ Class 100000004849
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    The primary objective of this study is to compare LDL-C reductions at Day 270 of monthly (QM [≤31 days]) dosing of lerodalcibep (LIB003) 300 mg administered subcutaneously (SC) to inclisiran (Leqvio®) 284 mg administered SC at Days 1 and 90 in patients with very-high risk CVD or at high risk for CVD on a stable diet and oral LDL-C-lowering drug therapy.
    El objetivo principal de este estudio consiste en comparar las reducciones del C-LDL obtenidas el día 270 con lerodalcibep (LIB003), 300 mg por vía subcutánea (SC) una vez al mes (≤31 días), y con inclisirán (Leqvio®), 284 mg SC los días 1 y 90, en pacientes con ECV de muy alto riesgo o con alto riesgo de ECV que estén recibiendo una dieta y un tratamiento farmacológico reductor del C-LDL oral estables.
    E.2.2Secondary objectives of the trial
    The secondary objectives of this study will be assessed similarly to the primary objective:
    - To compare the LDL-C-lowering effects with LDL-C calculated by Hopkins formula and preparative ultracentrifugation;
    -To compare safety and tolerability, including the frequency and severity of injection site reactions (ISRs);
    -To compare the effects on serum unbound (free) proprotein convertase subtilisin/kexin type 9 (PCSK9) concentrations;
    -To compare the effects on serum lipids, including total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), non–HDL-C, very low-density lipoprotein cholesterol (VLDL-C), and triglycerides (TG); ---To compare the effects on apolipoprotein (apo) B and lipoprotein (a) (Lp[a]) serum concentrations;
    -To assess percentage of patients achieving current European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines.
    Objetivos 2rios: Comparar: los efectos reductores del C-LDL, calculando este mediante la fórmula de Hopkins o con ultracentrifugación preparatoria •la seguridad y la tolerabilidad, incluidas la frecuencia y la intensidad de las reacciones en el lugar de inyección (RLI) •los efectos sobre la concentración sérica de proproteína convertasa subtilisina/kexina tipo 9 (PCSK9) libre (no unida) • los efectos sobre los lípidos séricos, entre ellos, colesterol total (CT), colesterol unido a las lipoproteínas de alta densidad (C-HDL), colesterol no HDL (C-no HDL), colesterol unido a las lipoproteínas de muy baja densidad (C-VLDL) y triglicéridos (TG) •los efectos sobre las concentraciones séricas de apolipoproteína (apo) B y lipoproteína (a) (Lp[a]).% de pacientes que alcanzan la actual directrices de la Sociedad Europea de Cardiología y de Aterosclerosis (ESC / EAS).
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1.Provision of signed informed consent prior to any study-specific procedure;
    2.Male or female, ≥18 years of age at the first Screening Visit;
    3.Weight of ≥40 kg (88 lb) and body mass index (BMI) ≥16 and ≤42 kg/m2;
    4.At very-high risk for CVD which includes history of stable CVD, defined as previous myocardial infarction (MI) (ST-elevation MI or non-ST-elevation MI), angioplasty, documented coronary artery disease (stress echo, computed tomography [CT] coronary angiography or invasive angiography) or cerebrovascular or peripheral arterial disease without a recent event within 3 months prior to screening (ie, acute coronary syndrome, unstable angina, coronary artery bypass grafting, percutaneous coronary intervention, stroke, MI, carotid endarterectomy);
    OR
    At high risk for CVD (ASCVD risk equivalent) which includes as type 2 diabetes, FH, untreated LDL-C >190 mg/dL or a 10-year risk of a CVE of ≥10% as assessed by the ACC/AHA or ESC/EAS guidelines;
    5.At the defined eligibility visit (screening or post washout/stabilization), a calculated LDL-C (Friedewald) ≥2.3 mmol/L (≥85 mg/dL) and TG ≤4.52 mmol/L (≥400 mg/dL) while on stable lipid-lowering oral drug therapy (including high-intensity statin with or without ezetimibe);
    6.On a stable diet and lipid-lowering oral therapies (high intensity statin with or without any of the following: ezetimibe, bile-acid sequestrants, OM-3 compounds, bezafibrate or fenofibrate, and nicotinic acid) or combinations thereof for at least 4 weeks (excluded oral lipid lowering agents and include non-high intensity statins, mipomersen, lomitapide, gemfibrozil, and bempedoic acid);
    7.Patients previously on a PCSK9 mAb at a dose of 75 mg, 140 mg or 150 mg Q2W must undergo a washout period of ≥4 weeks after the last dose; for those on a dose of alirocumab 300 mg or evolocumab 420 mg Q4W (≤31 days) the washout period is ≥8 weeks following the last dose. For patients who have received an siRNA PCSK9 inhibitor the washout period is ≥360 days post last dose;
    Any decision to stop treatment with a PCSK9 inhibitor prior to study start will be at the discretion of the investigator and outside of the conduct of the clinical trial. Any patient who has recently stopped a PCSK9 inhibitor due to clinical or other reasons or due to completion of a clinical trial will require this wash out period prior to randomization and commencement of study drug.
    8.Women of childbearing potential (WOCBP) must continue using a highly effective form of birth control if sexually active and have a negative urine pregnancy test on Day 1 prior to dosing;
    Note: A woman is considered of childbearing potential, following menarche and until becoming post-menopausal unless permanently sterile. Permanent sterilisation methods include hysterectomy, bilateral salpingectomy and bilateral oophorectomy.
    Highly effective methods of birth control include refraining from heterosexual sexual intercourse during the entire period of risk, birth control pills or patches, intrauterine devices (IUDs), sexual activity with a male partner who has had a vasectomy, or IUD, oral, implantable, or injectable contraceptives. Menopause is defined as 1 year of spontaneous and continuous amenorrhea in a female ≥55 years old or 1 year 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 patient has undergone bilateral oophorectomy. Birth control should be maintained for 60 days after the last dose of study drug (ie, 30 days after the last study visit).
    9.Male patients will either be surgically sterile or agree to continue to use the following forms of contraception if their partner is of childbearing potential and not using a highly effective form of birth control as defined in Inclusion Criterion #8 above: male or female condom with spermicide and a female partner who is sterile or who agrees to use the following contraceptives; diaphragm or cervical cap with spermicide; or IUD, oral, implantable, or injectable contraceptives; and
    10.Male patients must refrain from sperm donation until 90 days following the last dose of study drug.
    1. Obtención del consentimiento informado firmado antes de realizar ningún procedimiento específico del estudio.
    2. Varones o mujeres, ≥ 18 años en la primera visita de selección.
    3. Peso ≥40 kg e índice de masa corporal (IMC) ≥16 y ≤42 kg/m2.
    4. Riesgo muy alto de ECV, lo que incluye antecedentes de ECV estable, definida como infarto de miocardio (IM) previo (IM con elevación del segmento ST o IM sin elevación del segmento ST), angioplastia, enfermedad coronaria documentada (ecocardiograma de esfuerzo, tomografía computarizada [TC], angiografía coronaria o angiografía invasiva) o arteriopatía cerebrovascular o periférica sin un episodio reciente en los 3 meses previos a la selección (p. ej., síndrome coronario agudo, angina inestable, injerto de derivación de arteria coronaria, intervención coronaria percutánea, ictus, IM, endarterectomía carotídea).
    O Riesgo alto de ECV (equivalente de riesgo de ECVA), que incluye diabetes de tipo 2, HF, C-LDL no tratado > 190 mg/dl o riesgo a los 10 años de ECV ≥ 10% según las directrices del ACC/AHA o la ESC/EAS;
    5. En la visita de elegibilidad definida (selección o después del periodo de lavado/estabilización), un C-LDL calculado (según la fórmula de Friedewald) ≥2.3 mmol/l (≥ 85 mg/dl) y ≤4,52 mmol/l (≥400 mg/dl) durante el tratamiento estable con hipolipemiantes orales (es decir, estatinas de gran potencia con o sin ezetimiba).
    6. Estar recibiendo dieta estable y tratamientos orales hipolipemiantes (estatina de gran potencia con o sin alguno de los siguientes: ezetimiba, secuestradores de ácidos biliares, compuestos OM-3, bezafibrato o fenofibrato y ácido nicotínico) o combinaciones de ellos durante al menos 4 semanas (fármacos hipolipemiantes orales excluidos e incluyen estatinas de baja potencia, mipomersén, lomitapida, gemfibrozilo y ácido bempedoico);
    7. Los pacientes tratados con un AcM anti-PCSK9 en dosis de 75, 140 o 150 mg cada 2 semanas deben pasar por un período de lavado durante 4 semanas o más después de la última dosis; en los tratados con una dosis de 300 mg de alirocumab o 420 mg de evolocumab cada 4 semanas (≤ 31 días), el período de lavado es de al menos 8 semanas después de la última dosis. En el caso de los pacientes que hayan recibido un inhibidor de la PCSK9 de ARN de interferencia pequeño (ARNip), el período de lavado es de, como mínimo, 360 días después de la última dosis.
    La decisión de interrumpir el tratamiento con un inhibidor de PCSK9 antes del inicio del estudio quedará a criterio del investigador y al margen de la realización del ensayo clínico. Todo paciente que haya suspendido recientemente un inhibidor de la PCSK9 por motivos clínicos o de otro tipo o por la finalización de un ensayo clínico requerirá este período de lavado antes de la aleatorización y el inicio del fármaco del estudio.
    8. Las mujeres en edad fértil deberán utilizar un método anticonceptivo muy eficaz si son sexualmente activas y tener una prueba de embarazo en orina negativa el día 1 antes de la administración del tratamiento.
    Nota: Se considera que una mujer puede concebir, después de la menarquia y hasta que se convierta en posmenopáusica, a menos que esté esterilizada de forma permanente. Los métodos de esterilización permanente son la histerectomía, la salpingectomía bilateral y la ovariectomía bilateral.
    Son métodos anticonceptivos muy eficaces la abstinencia de relaciones heterosexuales durante todo el período de riesgo, la píldora o los parches anticonceptivos, los dispositivos intrauterinos (DIU), la actividad sexual con una pareja masculina que se haya sometido a una vasectomía, el DIU o los anticonceptivos orales, implantables o inyectables. La menopausia se define como un año de amenorrea espontánea y continua en una mujer ≥ 55 años o un año de amenorrea espontánea y continua con una concentración de folitropina (FSH) >40 UI/l (o según la definición de «intervalo posmenopáusico» del laboratorio afectado) en una mujer de menos de 55 años, a menos que se haya sometido a una ovariectomía bilateral. El uso de métodos anticonceptivos deberá mantenerse durante 60 días después de la última dosis del fármaco del estudio (es decir, 30 días después de la última visita del estudio).
    9. Los pacientes varones estarán esterilizados quirúrgicamente o se comprometerán a seguir utilizando los siguientes métodos anticonceptivos si su pareja está en edad fértil y no utiliza un método anticonceptivo muy eficaz según se define en el criterio de inclusión n.º 8 anterior: preservativo masculino o femenino con espermicida y pareja femenina estéril o que acceda a utilizar los siguientes anticonceptivos; diafragma o capuchón cervical con espermicida; o DIU, anticonceptivos orales, implantables o inyectables; y
    10. Los varones no deben donar semen hasta 90 días después de la última dosis del fármaco del estudio.
    E.4Principal exclusion criteria
    1.Patient not on stable high-intensity statin (daily atorvastatin 40/80 mg or rosuvastatin 20/40 mg)
    2.Use of prohibited oral lipid lowering agents mipomersen or lomitapide within 6 months of screening or gemfibrozil (excluded due to potential increased risk of myotoxicity with statins) within 6 weeks of screening or bempedoic acid within 4 weeks of screening or non-high intensity statins or doses;
    3.Low-density lipoprotein or plasma apheresis within 2 months prior to randomization
    4.Documented history of HoFH defined as clinical and/or genetic with true HoFH (ie, identical pathogenic variants) or compound heterozygous (ie, 2 different pathogenic LDLR variants) or combined heterozygous (2 different pathogenic FH variants such as LDLR plus apo B, or LDLR plus PCSK9 GOF)
    5.History of any prior or active clinical condition or acute and/or unstable systemic disease, including cancer, compromising patient inclusion or preclude completion of the study, at the discretion of the Investigator, including but not limited to clinically significant pulmonary, hematologic, gastrointestinal, endocrine (excluding diabetes), immunologic, dermatologic, neurologic, or psychiatric disease, which in the Investigator’s opinion would not be suitable for the study from a patient safety consideration or could interfere with the results of the study
    6.Moderate to severe renal dysfunction, defined as an estimated glomerular filtration rate <30 mL/min/1.73 m2 at the Screening Visit;
    7.Active liver disease or hepatic dysfunction (eg, cirrhosis, alcoholic liver disease, known hepatitis B or hepatitis C, autoimmune hepatitis, liver failure, liver cancer), history of liver transplant, and/or AST or ALT >2.5 × the ULN as determined by central laboratory analysis at screening (tests that result in ALT or AST up to 3 × ULN may have 1 repeat test to confirm eligibility during the Screening Period);
    8.Uncontrolled thyroid disease: hyperthyroidism or hypothyroidism as defined by thyroid stimulating hormone (TSH) below the lower limit of normal (LLN) or >1.5 × ULN, respectively, at the Screening Visit. If TSH is above/below these cut points, patients can enter if free triiodothyronine (T3) is within the reference range. If controlled, treatment should be stable for at least 3 months prior to the Screening Visit
    9.Uncontrolled Type 1 or Type 2 diabetes mellitus, defined as fasting glucose ≥200 mg/dL and glycated hemoglobin (HbA1c) of >9%
    10.Uncontrolled serious cardiac arrhythmia (sustained ventricular tachycardia, frequent non sustained ventricular tachycardia, any ventricular fibrillation episode, wide-complex tachycardia, atrial fibrillation with rapid ventricular response, and severe second degree or third degree atrioventricular block), MI, unstable angina, percutaneous coronary intervention, coronary artery bypass grafting, placement of implantable cardioverter defibrillator or biventricular pacemaker, aortic valve surgery, or stroke within 3 months prior to the Screening Visit
    11.Planned cardiac surgery or revascularization
    12.New York Heart Association class III-IV heart failure; or patients with last documented left ventricular ejection fraction <30% by standard of care assessments, eg, echocardiography, cardiac magnetic resonance imaging, nuclear imaging, CT angiography, or angiography with ventriculogram, within 12 months;
    13. Uncontrolled hypertension defined as a reproducible (repeated 5 minutes apart) sitting blood pressure ≥180 mmHg systolic or ≥110 mmHg diastolic
    14.Enrolled in another investigational device or drug study, or less than 30 days or 5 half-lives since ending another investigational device or drug study(ies), or receiving other investigational agent(s); such as PCSK9 or Lp(a) siRNA or locked nucleic acid reducing agents within 12 months of the Screening Visit
    15.Unexplained CK >5 × ULN, unless related to exercise or unusual activity in which case 1 repeat test is allowed
    16.Patients who cannot be available for protocol-required study visits or procedures, to the best of the patient’s and Investigator’s knowledge;
    17.A history, within 6 months prior to screening, of prescription drug abuse, illicit drug use, or alcohol abuse according to medical history
    18.Donated or lost a significant volume (>500 mL) of blood or plasma within 30 days prior to randomization
    19.Had a blood transfusion within 4 weeks of randomization or known diagnosis of human immunodeficiency virus
    20.Were previously treated with LIB003 or any adnectin product or have a history of allergy to evolocumab or alirocumab
    21.Patients with a history of allergy to protein-based biologics, including but not limited to mAbs and vaccines, or a history of any significant drug allergy (such as anaphylaxis, hepatotoxicity, or immune-mediated thrombocytopenia or anaemia)
    22.Have any other finding which, in the opinion of the Investigator, would compromise the patient’s safety or participation in the study
    1. Paciente sin tratamiento estable con una estatina de gran potencia (atorvastatina 40/80 mg o rosuvastatina 20/40 mg a diario).
    2. Uso de hipolipemiantes orales prohibidos, mipomersén o lomitapida, en los 6 meses previos a la selección o gemfibrozilo (excluidos por un posible aumento del riesgo de miotoxicidad con las estatinas) en las 6 semanas previas a la selección o ácido bempedónico en las 4 semanas previas a la selección o estatinas o dosis que no sean de gran potencia.
    3. Aféresis de lipoproteínas de baja densidad o plasmaféresis en los 2 meses previos a la aleatorización.
    4. Antecedentes documentados de HFHo, definida como clínica o genética con HFHo verdadera (es decir, variantes patógenas idénticas), heterocigótica compuesta (es decir, 2 variantes de LDLR patógenas diferentes) o heterocigótica combinada (2 variantes de HF patógenas diferentes como LDLR más apo B o LDLR más PCSK9 GOF);
    5. Antecedentes de cualquier trastorno clínico previo o activo o enfermedad sistémica aguda o inestable, entre otros, cáncer, que comprometa la inclusión del paciente o imposibilite la finalización del estudio, a criterio del investigador, entre otros, enfermedades pulmonares, hematológicas, digestivas, endocrinas (excepto diabetes), inmunitarias, dermatológicas, neurológicas o psiquiátricas clínicamente significativas que, en opinión del investigador, no serían convenientes en el estudio atendiendo a la seguridad del paciente o que podrían interferir en los resultados del estudio.
    6. Disfunción renal moderada o grave, definida como una filtración glomerular estimada <30 ml/min/1,73 m2 en la visita de selección.
    7. Hepatopatía o disfunción hepática activas (por ejemplo, cirrosis, hepatopatía alcohólica, hepatitis B o hepatitis C conocida, hepatitis autoinmunitaria, insuficiencia hepática o cáncer de hígado), antecedentes de trasplante de hígado o AST o ALT >2,5 veces el LSN, según la determinación del laboratorio central, en la selección (las pruebas que den lugar a una ALT o AST de hasta 3 veces el LSN podrán repetirse una vez para confirmar la elegibilidad durante el período de selección).
    8. Enfermedad tiroidea no controlada: hipertiroidismo o hipotiroidismo, definido por una concentración de tirotropina (TSH) por debajo del límite inferior de la normalidad (LIN) o >1,5 veces el LSN, respectivamente, en la visita de selección. Si la TSH está por encima o por debajo de estos puntos de corte, los pacientes podrán participar si la triyodotironina (T3) libre está dentro del intervalo de referencia. Si está controlada, el tratamiento deberá mantenerse estable durante al menos 3 meses antes de la visita de selección
    9. Diabetes mellitus de tipo 1 o 2 no controlada, definida como glucosa en ayunas ≥200 mg/dl o hemoglobina glucosilada (HbA1c) >9 %
    10. Arritmia cardíaca grave no controlada (taquicardia ventricular sostenida, taquicardia ventricular no sostenida frecuente, cualquier episodio de fibrilación ventricular, taquicardia de complejo ancho, fibrilación auricular con respuesta ventricular rápida y bloqueo auriculoventricular grave de segundo o tercer grado), IM, angina inestable, intervención percutánea coronaria, injerto de revascularización coronaria, colocación de desfibrilador cardioversor implantable o marcapasos biventricular, cirugía de válvula aórtica o ictus en los tres meses previos a la visita de selección
    11.Cirugía cardíaca planificada o revascularización
    12. Insuficiencia cardíaca de clase III-IV de la New York Heart Association; o pacientes
    con la última fracción de eyección del ventrículo izquierdo documentada <30% por
    evaluaciones estándar de atención, por ejemplo, ecocardiografía, cardiología magnética
    Imágenes por resonancia, imágenes nucleares, angiografía por tomografía computarizada o angiografía con ventriculograma, dentro de los 12 meses
    13. Hipertensión incontrolada definida como reproducible (repetida 5 minutos de diferencia) presión arterial sentado ≥180 mmHg sistólica o ≥110 mmHg diastólico
    14. Inscrito en otro dispositivo de investigación o estudio de medicamentos, o menos de
    30 días o 5 vidas medias desde que se puso fin a otro dispositivo de investigación o estudio (s) de fármacos, o recibir otro (s) agente (s) en investigación; tal como PCSK9 o Lp (a) ARNip o agentes reductores de ácidos nucleicos bloqueados dentro de 12 meses de la visita de selección
    15.CK inexplicable> 5 × LSN, a menos que esté relacionada con el ejercicio o sea inusual
    actividad en cuyo caso se permite 1 prueba repetida
    16.Pacientes que no pueden estar disponibles para visitas de estudio requeridas por el protocolo o procedimientos, según el mejor conocimiento del paciente y del investigador;
    17 Un historial, dentro de los 6 meses previos a la detección, de medicamentos recetados
    abuso, uso de drogas ilícitas o abuso de alcohol según el historial médico

    Por favor, refiera a la continuación de la informacion, en protocolo del estudio, sección 4.2 pagina 37
    E.5 End points
    E.5.1Primary end point(s)
    The primary efficacy endpoint is to assess percent change from baseline (Day 1) in LIB003 compared to inclisiran in LDL-C level at Day 270 (calculated by Friedewald formula).
    El criterio de valoración principal de la eficacia consistirá en evaluar la variación porcentual de la concentración de C-LDL entre el momento basal y el día 270 (mes 9) (según la fórmula de Friedewald)
    E.5.1.1Timepoint(s) of evaluation of this end point
    Day 270
    Dia 270
    E.5.2Secondary end point(s)
    The secondary endpoints will be summarized similarly to the primary endpoints (absolute and/or percent change from baseline compared to inclisiran):
    •Percent change in:
    o LDL-C level at Day 270 (by Hopkins formula); and
    o LDL-C level at Day 270 (by preparative ultracentrifugation);
    •Absolute and percent change (where not assessed prior) from baseline (Day 1) in LDL-C level by Friedewald and Hopkins formulas at all visits;
    •Serum unbound (free) PCSK9 concentrations at Days 1, 90 and 270;
    •Absolute and percent change from baseline (Day 1) in TC, HDL-C, non–HDL-C, VLDL-C, and TG at all visits;
    •Absolute and percent change from baseline (Day 1) in apo B and Lp(a) serum concentrations Day 270; and
    •Percentage of patients achieving current ESC/EAS guidelines at Day 270.
    Los criterios de valoración secundarios se resumirán de forma similar a los criterios de valoración principales (variación absoluta o porcentual con respecto al valor basal en comparación con inclisirán):

    • Variación porcentual de:
    o Concentración de C-LDL el día 270 (según la fórmula de Hopkins).
    o Concentración de C-LDL el día 270 (mediante ultracentrifugación preparatoria).
    • Variación absoluta y porcentual (cuando no haya evaluación previa) de la concentración de C-LDL según las fórmulas de Friedewald y Hopkins entre el momento basal (día 1) y todas las visitas.
    • Concentraciones séricas de PCSK9 libre los días 1, 90 y 270.
    • Variación absoluta y porcentual con respecto al momento basal (día 1) del CT, C-HDL, C no HDL, C-LMBD y TG en todas las visitas.
    • Variación absoluta y porcentual de las concentraciones séricas de apo B y Lp(a) entre el momento basal (día 1) y la semana 270.
    • Porcentaje de pacientes que alcanzaron las directrices actuales de la ESC/EAS el día 270.
    E.5.2.1Timepoint(s) of evaluation of this end point
    Days 1, 90 and 270
    Dias 1,90,y 270
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy Yes
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic Yes
    E.6.7Pharmacodynamic Yes
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) No
    E.7.3Therapeutic confirmatory (Phase III) Yes
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled Yes
    E.8.1.1Randomised Yes
    E.8.1.2Open Yes
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    E.8.1.5Parallel group Yes
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) Yes
    E.8.2.2Placebo No
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial2
    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.8.4.1Number of sites anticipated in Member State concerned4
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA15
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA Yes
    E.8.6.2Trial being conducted completely outside of the EEA No
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    Germany
    Norway
    Spain
    United Kingdom
    France
    E.8.7Trial 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
    The end of the study (“study completion”) is defined as the date of the last protocol-specified visit/assessment (including telephone contact) for the last patient in the study. Patients successfully completing the study may enter into a separate long-term follow-up study.
    El final del estudio se define como la fecha de la última visita / evaluación especificada por el protocolo (incluido el contacto telefónico) del último paciente del estudio. Los pacientes que completen con éxito el estudio pueden participar en un estudio de seguimiento a largo plazo por separado.
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years1
    E.8.9.1In the Member State concerned months1
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years1
    E.8.9.2In all countries concerned by the trial months4
    E.8.9.2In all countries concerned by the trial days0
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 No
    F.1.1.1In Utero No
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.3Newborns (0-27 days) No
    F.1.1.4Infants and toddlers (28 days-23 months) No
    F.1.1.5Children (2-11years) No
    F.1.1.6Adolescents (12-17 years) No
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 120
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 40
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male Yes
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations Yes
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception Yes
    F.3.3.3Pregnant women No
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation No
    F.3.3.6Subjects incapable of giving consent personally No
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state50
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 80
    F.4.2.2In the whole clinical trial 160
    F.5 Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)
    Patients completing treatment will be eligible to continue into a 72-week, OLE study under a separate protocol (LIB003-007) and informed consent.
    Los pacientes que completen el tratamiento serán elegibles para continuar en un estudio OLE de 72 semanas bajo un protocolo separado (LIB003-007) y consentimiento informado.
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2022-04-04
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2022-03-28
    P. End of Trial
    P.End of Trial StatusOngoing
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