Evacetrapib and Cardiovascular Outcomes in High-Risk Vascular Disease.
Evacetrapib and Cardiovascular Outcomes in High-Risk Vascular Disease.
- 2017
Available online from MWHC library: 1993 - present, Available in print through MWHC library: 1980 - present
BACKGROUND: The cholesteryl ester transfer protein inhibitor evacetrapib substantially raises the high-density lipoprotein (HDL) cholesterol level, reduces the low-density lipoprotein (LDL) cholesterol level, and enhances cellular cholesterol efflux capacity. We sought to determine the effect of evacetrapib on major adverse cardiovascular outcomes in patients with high-risk vascular disease. CONCLUSIONS: Although the cholesteryl ester transfer protein inhibitor evacetrapib had favorable effects on established lipid biomarkers, treatment with evacetrapib did not result in a lower rate of cardiovascular events than placebo among patients with high-risk vascular disease. (Funded by Eli Lilly; ACCELERATE ClinicalTrials.gov number, NCT01687998 .). METHODS: In a multicenter, randomized, double-blind, placebo-controlled phase 3 trial, we enrolled 12,092 patients who had at least one of the following conditions: an acute coronary syndrome within the previous 30 to 365 days, cerebrovascular atherosclerotic disease, peripheral vascular arterial disease, or diabetes mellitus with coronary artery disease. Patients were randomly assigned to receive either evacetrapib at a dose of 130 mg or matching placebo, administered daily, in addition to standard medical therapy. The primary efficacy end point was the first occurrence of any component of the composite of death from cardiovascular causes, myocardial infarction, stroke, coronary revascularization, or hospitalization for unstable angina. RESULTS: At 3 months, a 31.1% decrease in the mean LDL cholesterol level was observed with evacetrapib versus a 6.0% increase with placebo, and a 133.2% increase in the mean HDL cholesterol level was seen with evacetrapib versus a 1.6% increase with placebo. After 1363 of the planned 1670 primary end-point events had occurred, the data and safety monitoring board recommended that the trial be terminated early because of a lack of efficacy. After a median of 26 months of evacetrapib or placebo, a primary end-point event occurred in 12.9% of the patients in the evacetrapib group and in 12.8% of those in the placebo group (hazard ratio, 1.01; 95% confidence interval, 0.91 to 1.11; P=0.91).
English
0028-4793
*Anticholesteremic Agents/tu [Therapeutic Use]
*Benzodiazepines/tu [Therapeutic Use]
*Cardiovascular Diseases/pc [Prevention & Control]
*Cholesterol Ester Transfer Proteins/ai [Antagonists & Inhibitors]
Aged
Anticholesteremic Agents/ae [Adverse Effects]
Benzodiazepines/ae [Adverse Effects]
Biomarkers/bl [Blood]
Cardiovascular Diseases/bl [Blood]
Cardiovascular Diseases/dt [Drug Therapy]
Cholesterol, HDL/bl [Blood]
Cholesterol, LDL/bl [Blood]
Diabetes Mellitus/dt [Drug Therapy]
Double-Blind Method
Female
Humans
Intracranial Arteriosclerosis/dt [Drug Therapy]
Male
Middle Aged
Myocardial Ischemia/dt [Drug Therapy]
Peripheral Vascular Diseases/dt [Drug Therapy]
Risk
Treatment Failure
MedStar Health Research Institute
Clinical Trial, Phase III
Journal Article
Multicenter Study
Randomized Controlled Trial
Available online from MWHC library: 1993 - present, Available in print through MWHC library: 1980 - present
BACKGROUND: The cholesteryl ester transfer protein inhibitor evacetrapib substantially raises the high-density lipoprotein (HDL) cholesterol level, reduces the low-density lipoprotein (LDL) cholesterol level, and enhances cellular cholesterol efflux capacity. We sought to determine the effect of evacetrapib on major adverse cardiovascular outcomes in patients with high-risk vascular disease. CONCLUSIONS: Although the cholesteryl ester transfer protein inhibitor evacetrapib had favorable effects on established lipid biomarkers, treatment with evacetrapib did not result in a lower rate of cardiovascular events than placebo among patients with high-risk vascular disease. (Funded by Eli Lilly; ACCELERATE ClinicalTrials.gov number, NCT01687998 .). METHODS: In a multicenter, randomized, double-blind, placebo-controlled phase 3 trial, we enrolled 12,092 patients who had at least one of the following conditions: an acute coronary syndrome within the previous 30 to 365 days, cerebrovascular atherosclerotic disease, peripheral vascular arterial disease, or diabetes mellitus with coronary artery disease. Patients were randomly assigned to receive either evacetrapib at a dose of 130 mg or matching placebo, administered daily, in addition to standard medical therapy. The primary efficacy end point was the first occurrence of any component of the composite of death from cardiovascular causes, myocardial infarction, stroke, coronary revascularization, or hospitalization for unstable angina. RESULTS: At 3 months, a 31.1% decrease in the mean LDL cholesterol level was observed with evacetrapib versus a 6.0% increase with placebo, and a 133.2% increase in the mean HDL cholesterol level was seen with evacetrapib versus a 1.6% increase with placebo. After 1363 of the planned 1670 primary end-point events had occurred, the data and safety monitoring board recommended that the trial be terminated early because of a lack of efficacy. After a median of 26 months of evacetrapib or placebo, a primary end-point event occurred in 12.9% of the patients in the evacetrapib group and in 12.8% of those in the placebo group (hazard ratio, 1.01; 95% confidence interval, 0.91 to 1.11; P=0.91).
English
0028-4793
*Anticholesteremic Agents/tu [Therapeutic Use]
*Benzodiazepines/tu [Therapeutic Use]
*Cardiovascular Diseases/pc [Prevention & Control]
*Cholesterol Ester Transfer Proteins/ai [Antagonists & Inhibitors]
Aged
Anticholesteremic Agents/ae [Adverse Effects]
Benzodiazepines/ae [Adverse Effects]
Biomarkers/bl [Blood]
Cardiovascular Diseases/bl [Blood]
Cardiovascular Diseases/dt [Drug Therapy]
Cholesterol, HDL/bl [Blood]
Cholesterol, LDL/bl [Blood]
Diabetes Mellitus/dt [Drug Therapy]
Double-Blind Method
Female
Humans
Intracranial Arteriosclerosis/dt [Drug Therapy]
Male
Middle Aged
Myocardial Ischemia/dt [Drug Therapy]
Peripheral Vascular Diseases/dt [Drug Therapy]
Risk
Treatment Failure
MedStar Health Research Institute
Clinical Trial, Phase III
Journal Article
Multicenter Study
Randomized Controlled Trial