Abstract | BACKGROUND AND AIMS: METHODS: In this double-blind trial, HeFH patients ( LDL-C >160 mg/dL) on maximal tolerated LDL-lowering therapy were randomized to mipomersen 200 mg once weekly (n = 104), mipomersen 70 mg thrice weekly (n = 102), or placebo in matching frequency (n = 103) for 60 weeks. Main outcomes were LDL-C, apoB, and lipoprotein(a) levels after 60 weeks of treatment. RESULTS:
Mipomersen 200 mg once weekly and mipomersen 70 mg thrice weekly significantly lowered LDL-C compared with placebo by 21.0% and 18.8%, respectively, and apoB by 22.1% and 21.7% (all p < 0.001). Lipoprotein(a) was significantly lowered by 27.7% (p < 0.001) with thrice-weekly dosing. Injection-site reactions and flu-like symptoms led to discontinuation in 21.2% (200 mg), 17.6% (70 mg), and 5.8% (placebo) of participants. Alanine transaminase was elevated (≥3× upper limit of normal at least once) in 21.2%, 21.6%, and 1.0% of subjects, respectively. CONCLUSIONS:
Mipomersen 200 mg once weekly and 70 mg thrice weekly are effective in lowering apoB-containing lipoproteins in HeFH patients. This is counterbalanced by limited tolerability and increased hepatic transaminase levels in about 21% of patients. The thrice-weekly dosing regimen was associated with lower frequency of flu-like symptoms, which might help avert discontinuation in some patients, but otherwise had no major benefits.
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Authors | Laurens F Reeskamp, John J P Kastelein, Patrick M Moriarty, P Barton Duell, Alberico L Catapano, Raul D Santos, Christie M Ballantyne |
Journal | Atherosclerosis
(Atherosclerosis)
Vol. 280
Pg. 109-117
(01 2019)
ISSN: 1879-1484 [Electronic] Ireland |
PMID | 30500603
(Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Copyright | Copyright © 2018 Elsevier B.V. All rights reserved. |
Chemical References |
- Anticholesteremic Agents
- Apolipoproteins B
- Cholesterol, HDL
- Cholesterol, LDL
- Oligodeoxyribonucleotides, Antisense
- Oligonucleotides
- mipomersen
- Transaminases
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Topics |
- Adult
- Aged
- Anticholesteremic Agents
(therapeutic use)
- Apolipoproteins B
(metabolism)
- Cholesterol, HDL
(blood)
- Cholesterol, LDL
(blood)
- Double-Blind Method
- Female
- Humans
- Hyperlipoproteinemia Type II
(drug therapy)
- Male
- Medication Adherence
- Middle Aged
- Oligodeoxyribonucleotides, Antisense
(therapeutic use)
- Oligonucleotides
(therapeutic use)
- Risk Assessment
- Transaminases
(blood)
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