Effects of Bempedoic Acid/Ezetimibe/High-intensity Statin on Plaque Regression and Stabilisation of Coronary Atherosclerosis Among Patients Without Cardiovascular Events
试验速览
- 阶段
- 3 期
- 状态
- 尚未招募
- 入组人数
- 103
- 试验地点
- 12
- 主要终点
- Annualised change in percentage plaque burden (Δ%PB)
研究概览
简要总结
The overall objective of the trial is to evaluate the effect of the triple therapy consisting of bempedoic acid (BA), ezetimibe (EZE), and high-intensity atorvastatin or rosuvastatin on changes in coronary plaque burden and plaque morphology in patients with coronary atherosclerosis without significant obstructive coronary artery disease and without prior history of an ischemic vascular event.
详细描述
The primary objective is to evaluate the effectiveness of the triple therapy in reducing plaque burden.
The key secondary objective is to assess the efficacy of the triple therapy by evaluating changes in plaque composition and morphology.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •In order to be eligible to participate in this trial, a potential participant must meet all of the following criteria:
- •Age ≥18 years
- •Having provided informed consent for participation in this trial
- •Lipid-lowering treatment-naïve
- •Presence of extensive coronary atherosclerosis meeting all of the criteria below:
- •Unequivocal atherosclerosis in ≥5 American Heart Association (AHA) coronary segments (corresponding to a risk equivalent of obstructive coronary artery disease) and coronary artery disease - reporting and data system (CAD-RADS) category 1, 2, or 3
- •Not expected to be a candidate for revascularisation during the duration of the trial
- •Untreated LDL-C ≥2.6 mmol/L and ≤4.5 mmol/L (where a diet without pharmacological treatment is considered 'untreated')
- •Able to provide informed consent
排除标准
- •A potential participant who meets any of the following criteria will be excluded from participation in this trial:
- •Known or suspected heterozygous or homozygous familial hypercholesterolaemia or familial combined hyperlipidaemia
- •Known contraindication for BA, EZE, atorvastatin, and/or rosuvastatin. A participant with a contraindication for atorvastatin, can be assigned to triple therapy with rosuvastatin, and vice versa.
- •Not expected to remain on a stable dose of high intensity triple therapy for the duration of the trial.
- •History of myocardial infarction, stroke, or peripheral artery disease (PAD), and/or coronary revascularisation (percutaneous coronary intervention [PCI] or coronary artery bypass grafting [CABG])
- •Significant stenosis in the left main artery (≥50%) or proximal LAD artery (≥70%), or 3-vessel coronary artery disease (≥70% stenosis in major branches), clinically indicated for revascularisation
- •Known significant liver disease (e.g., positive hepatitis B or hepatitis C serology) or significant hepatic dysfunction (aspartate aminotransferase [AST] or alanine aminotransferase [ALT] >3 x upper limit of normal [ULN])
- •Known history of gout and/or uric acid levels at Screening ≥6.8 mg/dL
- •Known estimated glomerular filtration rate (eGFR) <40 mL/min/1.73m² and/or receiving dialysis
- •Active malignancy (not including non-melanoma skin cancer)
- •Pregnant or breastfeeding
- •Body mass index (BMI) >35 kg/m²
- •Anticipated life expectancy <52 weeks at the discretion of the local investigator
- •Requiring emergent procedures or having any evidence of ongoing or active clinical instability, including acute chest pain (sudden onset), cardiogenic shock, unstable blood pressure with systolic blood pressure <90 mmHg, severe congestive heart failure (New York Heart Association [NYHA] III or IV), or acute pulmonary oedema
- •Suspicion of acute coronary syndrome (where acute myocardial infarction and unstable angina have not been ruled out)
- •Complex congenital heart disease
- •Known or suspected severe valvular heart disease or valvular heart disease anticipated to require intervention within 52 weeks at the discretion of the local investigator
- •Cardiac arrythmia or tachycardia with significant likelihood of resulting in poor PCD-CTA image quality (especially atrial fibrillation or frequent premature beats)
- •Intracoronary stents
- •Prior pacemaker, internal defibrillator, or abandoned lead implantation
- •Prosthetic heart valves
- •Contraindications to contrast media or other medications needed for proper imaging (e.g., beta blockers and nitroglycerin)
- •Use of any experimental or investigational drug within 40 days or 5 half-lives prior to Screening (whichever is longer), or parallel participation in another interventional study
研究组 & 干预措施
Bempedoic acid (BA)/ezetimibe (EZE) fixed dose combination (FDC) with rosuvastatin or atorvastatin
Treatment-naïve participants with coronary atherosclerosis and primary non-familial hypercholesterolaemia or mixed dyslipidaemia who will receive daily treatment with BA/EZE FDC, together with either 20 mg rosuvastatin or 40 mg atorvastatin.
干预措施: Rosuvastatin (Drug)
Bempedoic acid (BA)/ezetimibe (EZE) fixed dose combination (FDC) with rosuvastatin or atorvastatin
Treatment-naïve participants with coronary atherosclerosis and primary non-familial hypercholesterolaemia or mixed dyslipidaemia who will receive daily treatment with BA/EZE FDC, together with either 20 mg rosuvastatin or 40 mg atorvastatin.
干预措施: Atorvastatin (Drug)
Bempedoic acid (BA)/ezetimibe (EZE) fixed dose combination (FDC) with rosuvastatin or atorvastatin
Treatment-naïve participants with coronary atherosclerosis and primary non-familial hypercholesterolaemia or mixed dyslipidaemia who will receive daily treatment with BA/EZE FDC, together with either 20 mg rosuvastatin or 40 mg atorvastatin.
干预措施: Bempedoic acid (Drug)
Bempedoic acid (BA)/ezetimibe (EZE) fixed dose combination (FDC) with rosuvastatin or atorvastatin
Treatment-naïve participants with coronary atherosclerosis and primary non-familial hypercholesterolaemia or mixed dyslipidaemia who will receive daily treatment with BA/EZE FDC, together with either 20 mg rosuvastatin or 40 mg atorvastatin.
干预措施: Ezetimibe (Drug)
结局指标
主要结局
Annualised change in percentage plaque burden (Δ%PB)
时间窗: Baseline up to 12 months
This endpoint will evaluate the effectiveness of the triple therapy in reducing plaque burden (PB).
次要结局
- Mean absolute changes in atherosclerosis-related biomarker low-density lipoprotein cholesterol (LDL-C)(Baseline up to 12 months)
- Mean absolute changes in atherosclerosis-related biomarker high-density lipoprotein cholesterol (HDL-C)(Baseline up to 12 months)
- Mean absolute changes in atherosclerosis-related biomarker non-high-density lipoprotein cholesterol (non-HDL-C)(Baseline up to 12 months)
- Key Secondary: Annualised change in normalised non-calcified plaque volume (PV)(Baseline up to 12 months)
- Percentage of participants with regression in normalised total plaque volume (TPV), normalised non-calcified PV, and normalised low attenuation PV at EoT (i.e., ΔPV and Δnon-calcified PV, and Δlow-attenuation PV)(Baseline up to 12 months)
- Change in the absolute Agatston coronary artery calcium (CAC) score(Baseline up to 12 months)
- Annualised ΔTotal Plaque Volume (TPV)(Baseline up to 12 months)
- Percentage of participants with regression in TPV (i.e., negative ΔTPV)(Baseline up to 12 months)
- Absolute annualised change in fractional flow reserve derived from computed tomography (FFRCT) of the vessel with the lowest FFR at Baseline(Baseline up to 12 months)
- Absolute annualised change in FFRCT of the average of 3 main epicardial coronary arteries (left anterior descending artery [LAD], circumflex artery [Cx], right coronary artery [RCA])(Baseline up to 12 months)
- Mean absolute changes in atherosclerosis-related biomarker total cholesterol(Baseline up to 12 months)
- Mean absolute changes in atherosclerosis-related biomarkers lipoprotein a (Lp(a)) and apolipoprotein B (apoB)(Baseline up to 12 months)
- Mean absolute changes in atherosclerosis-related biomarker high-sensitive C reactive protein (hs-CRP)(Baseline up to 12 months)
- Annualised changes in Framingham steatosis index (FSI) and fibrosis-4 (Fib-4)(Baseline up to 12 months)
- Cumulative incidence of adverse events (AEs) under triple therapy during the trial(Baseline up to 12 months)
- Rate of treatment discontinuation during the trial(Baseline up to 12 months)