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EVOlocumab for Early Reduction of LDL-cholesterol Levels in Patients With Acute Coronary Syndromes (EVOPACS) (EVOPACS)

Primary Purpose

Acute Coronary Syndrome

Status
Completed
Phase
Phase 3
Locations
Switzerland
Study Type
Interventional
Intervention
Evolocumab 140 mg/mL
Placebo
Sponsored by
Insel Gruppe AG, University Hospital Bern
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Acute Coronary Syndrome

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

Male or female ≥ 18 years of age;

  • Hospitalized for a recent ACS;
  • LDL-C levels defined as follows:
  • LDL-C ≥70 mg/dL (≥1.8 mmol/L) or non-HDL-C ≥100 mg/dL (≥2.6 mmol/) in patients who have been receiving stable treatment with high-intensity statin within ≥ 4 weeks prior to enrollment (i.e. continuous treatment that has not changed with regard to statin intensity over the past 4 weeks) or, LDL-C ≥90 mg/dL (≥2.3 mmol/L) or non-HDL-C ≥120 mg/dL (≥3.1 mmol/) in patients who have been receiving stable treatment with low- or moderate-intensity statin within ≥ 4 weeks prior to enrollment (i.e. continuous treatment that has not changed with regard to statin intensity over the past 4 weeks), or LDL-C ≥125 mg/dL (≥3.2 mmol/L) or non-HDL-C ≥155 mg/dL (≥4.0 mmol/) in patients who are statin-naïve or have not been on a stable (unchanged) statin regimen for at least 4 weeks prior to enrollment;
  • Ability to understand the requirements of the study and to provide informed consent.

Exclusion Criteria:

  • Unstable clinical status (hemodynamic or electrical instability;
  • Uncontrolled cardiac arrhythmia, defined as recurrent and symptomatic ventricular tachycardia or atrial fibrillation with rapid ventricular response not controlled by medications in the past 3 months prior to screening;
  • Severe renal dysfunction, defined by estimated glomerular filtration rate <30 ml/min/1.73m2;
  • Active liver disease or hepatic dysfunction, either reported in patient medical record or defined by asparate aminotransferase (AST) or alanine aminotransferase (ALT) levels > 3x the upper limit of normal;
  • Reported intolerance to atorvastatin (any dose) OR statin intolerance;
  • Known allergy to contrast medium, heparin, aspirin, ticagrelor or prasugrel;
  • Known sensitivity to any substances to be administered;
  • Patients who previously received evolocumab or other PCSK9 inhibitor;
  • Patient who received cholesterol ester transfer protein inhibitors in the past 12 months prior to screening;
  • Treatment with systemic steroids or systemic cyclosporine in the past 3 months systemic cyclosporine, systemic steroids (eg. intravenous, intramuscular or per os);
  • Known active infection or major hematologic, metabolic, or endocrine dysfunction in the judgment of the Investigator;
  • Patients who will not be available for study-required procedures in the judgment of the Investigator;
  • Current enrollment in another investigational device or drug study;
  • Active malignancy requiring treatment;
  • Female of childbearing potential (age <50 years and last menstruation within the last 12 months), who did not undergo tubal ligation, ovariectomy or hysterectomy.

Sites / Locations

  • Basel University Hospital
  • HFR Kantonsspital
  • Hopitaux Universitaires Geneve
  • Cardiocentro Ticino
  • Centre Hospitalier Universitaire Vaudois
  • University Hospital
  • Bern University Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Placebo Comparator

Arm Label

Evolocumab

Placebo

Arm Description

Evolocumab 140 mg/mL, pre-filled auto-injector pen, 3 injections at day 1 and week 4

Placebo, pre-filled auto-injector pen, 3 injections at day 1 and week 4

Outcomes

Primary Outcome Measures

Percent change in calculated LDL-C in the intent to treat (ITT) population

Secondary Outcome Measures

Number of patients with adverse events and serious adverse events

Full Information

First Posted
September 7, 2017
Last Updated
August 13, 2019
Sponsor
Insel Gruppe AG, University Hospital Bern
Collaborators
Amgen, University of Bern
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1. Study Identification

Unique Protocol Identification Number
NCT03287609
Brief Title
EVOlocumab for Early Reduction of LDL-cholesterol Levels in Patients With Acute Coronary Syndromes (EVOPACS)
Acronym
EVOPACS
Official Title
EVOlocumab for Early Reduction of LDL-cholesterol Levels in Patients With Acute Coronary Syndromes (EVOPACS) - A Randomized, Double-blind, Placebo-controlled Multicenter Study
Study Type
Interventional

2. Study Status

Record Verification Date
August 2019
Overall Recruitment Status
Completed
Study Start Date
January 23, 2018 (Actual)
Primary Completion Date
May 20, 2019 (Actual)
Study Completion Date
August 7, 2019 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Insel Gruppe AG, University Hospital Bern
Collaborators
Amgen, University of Bern

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Reduction of low-density lipoprotein cholesterol (LDL-C) levels effectively reduces the risk of adverse events in patients with established atherosclerotic cardiovascular disease. The clinical benefit of statins in improving clinical outcomes is proportional to the magnitude of LDL-C reduction, is more pronounced in patients with acute coronary syndromes (ACS) compared with stable coronary artery disease, and emerges at very early stages (as early as 4 weeks) after ACS when statins are administered in the acute phase of the event. On the basis of this evidence, early initiation of statin therapy is currently recommended in patients presenting with ACS. Because many patients cannot achieve adequate reduction of LDL-C levels despite treatment with high doses of statins or non-statin lipid-modifying medications, substantial residual risk remains. Moreover, the time of onset of LDL-C reduction takes 2 weeks following initiation of statin therapy. Proprotein convertase subtilisin/kexin type-9 (PCSK9) inhibitors represent a novel class of lipid-lowering drugs leading to rapid, profound, and consistent reductions in LDL-C levels. While the effectiveness of PCSK9 monoclonal antibodies for LDL-C lowering has been established across patient populations without atherosclerotic cardiovascular disease or with stable ischemic heart disease, reduction and attainment of LDL-C target levels has not been explored in the acute setting of ACS - a clinical setting with highest risk of early event recurrence (within the first month). In this study the investigators want to evaluate the safety and effectiveness of the PCSK9 inhibitor evolocumab as compared with placebo, administered in the acute phase of ACS, for reduction of LDL-C levels within 8 weeks in patients receiving guideline-recommended high-intensity statin treatment (atorvastatin 40mg QD).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Acute Coronary Syndrome

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
308 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Evolocumab
Arm Type
Active Comparator
Arm Description
Evolocumab 140 mg/mL, pre-filled auto-injector pen, 3 injections at day 1 and week 4
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Placebo, pre-filled auto-injector pen, 3 injections at day 1 and week 4
Intervention Type
Drug
Intervention Name(s)
Evolocumab 140 mg/mL
Intervention Description
Three injections with pre-filled auto-injector pen at day 1 and at week 4.
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Three injections with pre-filled auto-injector pen at day 1 and at week 4.
Primary Outcome Measure Information:
Title
Percent change in calculated LDL-C in the intent to treat (ITT) population
Time Frame
Baseline to week 8
Secondary Outcome Measure Information:
Title
Number of patients with adverse events and serious adverse events
Time Frame
Baseline to week 8
Other Pre-specified Outcome Measures:
Title
Nominal change in calculated LDL-C
Time Frame
Baseline to week 8
Title
Proportion of patients with LDL-C level <70 mg/dL (<1.8 mmol/L) at week 8
Time Frame
Baseline to week 8
Title
Change in total cholesterol in the ITT population
Time Frame
Baseline to week 8
Title
Change in HDL-C in the ITT population
Time Frame
Baseline to week 8
Title
Change in lipoprotein-a in the ITT population
Time Frame
Baseline to week 8
Title
Change in triglycerides in the ITT population
Time Frame
Baseline to week 8
Title
Change in non-HDL-C in the ITT population
Time Frame
Baseline to week 8
Title
Change in apolipoprotein B in the ITT population
Time Frame
Baseline to week 8
Title
Change in apolipoprotein A-1 in the ITT population
Time Frame
Baseline to week 8
Title
Percent change in high-sensitivity CRP (hs-CRP) in the ITT population
Time Frame
Baseline to week 8
Title
Proportion of patients with hs-CRP level <2 mg/dL at week 8 in the ITT population
Time Frame
Baseline to week 8
Title
Proportion of patients with LDL-C <70 mg/dL and hs-CRP <2 mg/dL at week 8 in the ITT population
Time Frame
Baseline to week 8
Title
Nominal change in Interleukin (IL)-1b and IL-6 in the ITT population
Time Frame
Baseline to week 8
Title
Change in high-sensitivity Troponin T
Time Frame
Baseline to 72 hours
Title
Area under the curve (AUC) at Multiplate with Adenosinediphosphate (ADP) test
Description
Platelet inhibition assessed with Multiplate ADP test at 72 hours and 8 weeks
Time Frame
Baseline to 72 hours and to week 8
Title
Area under the curve (AUC) at Multiplate with Thrombin receptor activating peptide (TRAP) test
Description
Platelet inhibition assessed with Multiplate TRAP test at 72 hours and 8 weeks
Time Frame
Baseline to 72 hours and to week 8
Title
Number of patients with contrast-induced acute kidney injury (CI-AKI) at 72 hours among patients who undergo coronary angiography at baseline
Time Frame
Baseline to 72 hours
Title
Number of patients with adjudicated events (death, cardiovascular death, myocardial infarction, hospitalization for recurrent ACS, hospitalization for heart failure, coronary revascularization, stroke
Time Frame
Baseline to week 8

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male or female ≥ 18 years of age; Hospitalized for a recent ACS; LDL-C levels defined as follows: LDL-C ≥70 mg/dL (≥1.8 mmol/L) or non-HDL-C ≥100 mg/dL (≥2.6 mmol/) in patients who have been receiving stable treatment with high-intensity statin within ≥ 4 weeks prior to enrollment (i.e. continuous treatment that has not changed with regard to statin intensity over the past 4 weeks) or, LDL-C ≥90 mg/dL (≥2.3 mmol/L) or non-HDL-C ≥120 mg/dL (≥3.1 mmol/) in patients who have been receiving stable treatment with low- or moderate-intensity statin within ≥ 4 weeks prior to enrollment (i.e. continuous treatment that has not changed with regard to statin intensity over the past 4 weeks), or LDL-C ≥125 mg/dL (≥3.2 mmol/L) or non-HDL-C ≥155 mg/dL (≥4.0 mmol/) in patients who are statin-naïve or have not been on a stable (unchanged) statin regimen for at least 4 weeks prior to enrollment; Ability to understand the requirements of the study and to provide informed consent. Exclusion Criteria: Unstable clinical status (hemodynamic or electrical instability; Uncontrolled cardiac arrhythmia, defined as recurrent and symptomatic ventricular tachycardia or atrial fibrillation with rapid ventricular response not controlled by medications in the past 3 months prior to screening; Severe renal dysfunction, defined by estimated glomerular filtration rate <30 ml/min/1.73m2; Active liver disease or hepatic dysfunction, either reported in patient medical record or defined by asparate aminotransferase (AST) or alanine aminotransferase (ALT) levels > 3x the upper limit of normal; Reported intolerance to atorvastatin (any dose) OR statin intolerance; Known allergy to contrast medium, heparin, aspirin, ticagrelor or prasugrel; Known sensitivity to any substances to be administered; Patients who previously received evolocumab or other PCSK9 inhibitor; Patient who received cholesterol ester transfer protein inhibitors in the past 12 months prior to screening; Treatment with systemic steroids or systemic cyclosporine in the past 3 months systemic cyclosporine, systemic steroids (eg. intravenous, intramuscular or per os); Known active infection or major hematologic, metabolic, or endocrine dysfunction in the judgment of the Investigator; Patients who will not be available for study-required procedures in the judgment of the Investigator; Current enrollment in another investigational device or drug study; Active malignancy requiring treatment; Female of childbearing potential (age <50 years and last menstruation within the last 12 months), who did not undergo tubal ligation, ovariectomy or hysterectomy.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Stephan Windecker, Prof., MD
Organizational Affiliation
Bern University Hospital
Official's Role
Study Chair
First Name & Middle Initial & Last Name & Degree
Konstantinos Koskinas, MD
Organizational Affiliation
Bern University Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Basel University Hospital
City
Basel
State/Province
BS
ZIP/Postal Code
4031
Country
Switzerland
Facility Name
HFR Kantonsspital
City
Fribourg
State/Province
FR
ZIP/Postal Code
1708
Country
Switzerland
Facility Name
Hopitaux Universitaires Geneve
City
Geneva
State/Province
GE
ZIP/Postal Code
1211
Country
Switzerland
Facility Name
Cardiocentro Ticino
City
Lugano
State/Province
TI
ZIP/Postal Code
6900
Country
Switzerland
Facility Name
Centre Hospitalier Universitaire Vaudois
City
Lausanne
State/Province
VD
Country
Switzerland
Facility Name
University Hospital
City
Zurich
State/Province
ZH
Country
Switzerland
Facility Name
Bern University Hospital
City
Bern
ZIP/Postal Code
3010
Country
Switzerland

12. IPD Sharing Statement

Plan to Share IPD
No
IPD Sharing Plan Description
No plan to make individual participant data available to other researchers
Citations:
PubMed Identifier
28304224
Citation
Sabatine MS, Giugliano RP, Keech AC, Honarpour N, Wiviott SD, Murphy SA, Kuder JF, Wang H, Liu T, Wasserman SM, Sever PS, Pedersen TR; FOURIER Steering Committee and Investigators. Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease. N Engl J Med. 2017 May 4;376(18):1713-1722. doi: 10.1056/NEJMoa1615664. Epub 2017 Mar 17.
Results Reference
result
PubMed Identifier
26578202
Citation
Lipinski MJ, Benedetto U, Escarcega RO, Biondi-Zoccai G, Lhermusier T, Baker NC, Torguson R, Brewer HB Jr, Waksman R. The impact of proprotein convertase subtilisin-kexin type 9 serine protease inhibitors on lipid levels and outcomes in patients with primary hypercholesterolaemia: a network meta-analysis. Eur Heart J. 2016 Feb 7;37(6):536-45. doi: 10.1093/eurheartj/ehv563. Epub 2015 Nov 17.
Results Reference
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PubMed Identifier
16226162
Citation
Ray KK, Cannon CP, McCabe CH, Cairns R, Tonkin AM, Sacks FM, Jackson G, Braunwald E; PROVE IT-TIMI 22 Investigators. Early and late benefits of high-dose atorvastatin in patients with acute coronary syndromes: results from the PROVE IT-TIMI 22 trial. J Am Coll Cardiol. 2005 Oct 18;46(8):1405-10. doi: 10.1016/j.jacc.2005.03.077.
Results Reference
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PubMed Identifier
11277825
Citation
Schwartz GG, Olsson AG, Ezekowitz MD, Ganz P, Oliver MF, Waters D, Zeiher A, Chaitman BR, Leslie S, Stern T; Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) Study Investigators. Effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes: the MIRACL study: a randomized controlled trial. JAMA. 2001 Apr 4;285(13):1711-8. doi: 10.1001/jama.285.13.1711.
Results Reference
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PubMed Identifier
26999484
Citation
Navarese EP, Kolodziejczak M, Kereiakes DJ, Tantry US, O'Connor C, Gurbel PA. Proprotein Convertase Subtilisin/Kexin Type 9 Monoclonal Antibodies for Acute Coronary Syndrome: A Narrative Review. Ann Intern Med. 2016 May 3;164(9):600-7. doi: 10.7326/M15-2994. Epub 2016 Mar 22.
Results Reference
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PubMed Identifier
31479722
Citation
Koskinas KC, Windecker S, Pedrazzini G, Mueller C, Cook S, Matter CM, Muller O, Haner J, Gencer B, Crljenica C, Amini P, Deckarm O, Iglesias JF, Raber L, Heg D, Mach F. Evolocumab for Early Reduction of LDL Cholesterol Levels in Patients With Acute Coronary Syndromes (EVOPACS). J Am Coll Cardiol. 2019 Nov 19;74(20):2452-2462. doi: 10.1016/j.jacc.2019.08.010. Epub 2019 Aug 31.
Results Reference
derived

Learn more about this trial

EVOlocumab for Early Reduction of LDL-cholesterol Levels in Patients With Acute Coronary Syndromes (EVOPACS)

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