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一项评估依洛尤单抗对糖尿病和血脂异常患者疗效及安全性的随机研究的原理与设计:BERSON临床试验

Rationale and design of a randomized study to assess the efficacy and safety of evolocumab in patients with diabetes and dyslipidemia: The BERSON clinical trial.

作者信息

Lorenzatti Alberto J, Eliaschewitz Freddy G, Chen Yundai, Fialkow Jonathan, Lu Juming, Baass Alexis, Monsalvo Maria Laura, Hsu Hui-Chun, Somaratne Ransi, Ge Junbo

机构信息

Instituto Médico DAMIC/Fundación Rusculleda, Córdoba, Argentina.

Centro de Pesquisas Clínicas, São Paulo, Brazil.

出版信息

Clin Cardiol. 2018 Sep;41(9):1117-1122. doi: 10.1002/clc.23018. Epub 2018 Sep 21.

Abstract

Type 2 diabetes mellitus (T2DM) is a major independent risk factor for cardiovascular disease, and diabetic dyslipidemia is a major contributor to cardiovascular risk in these patients. Here we report the rationale and design of a phase 3, double-blind study specifically designed to evaluate the lipid-lowering efficacy of the proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor evolocumab in patients with T2DM and hyperlipidemia or mixed dyslipidemia who are on background statin therapy. In the BERSON (evolocumaB Efficacy for LDL-C Reduction in subjectS with T2DM On background statiN) trial, patients with T2DM, a screening low-density lipoprotein cholesterol (LDL-C) level of ≥ 2.6 mmol/L (≥100 mg/dL) or ≥ 3.4 mmol/L (≥130 mg/dL), and with or without statin treatment at screening, respectively, were enrolled and started on atorvastatin 20 mg/day for a lipid stabilization period of at least 4 weeks. Then, patients were randomly assigned in a 2:2:1:1 ratio to receive atorvastatin 20 mg once daily plus either evolocumab 140 mg every 2 weeks (Q2W), evolocumab 420 mg every month (QM), placebo Q2W, or placebo QM. The co-primary outcome measures were the percentage change from baseline in LDL-C at week 12 and the percentage change from baseline in LDL-C at the mean of weeks 10 and 12. The BERSON trial has completed enrollment. The study completed in the first half of 2018, and will provide information on the efficacy and safety of evolocumab in patients with T2DM and dyslipidemia.

摘要

2型糖尿病(T2DM)是心血管疾病的主要独立危险因素,而糖尿病血脂异常是这些患者心血管风险的主要促成因素。在此,我们报告一项3期双盲研究的基本原理和设计,该研究专门设计用于评估前蛋白转化酶枯草溶菌素/克新9型(PCSK9)抑制剂依洛尤单抗对接受他汀类药物基础治疗的T2DM和高脂血症或混合性血脂异常患者的降脂疗效。在BERSON(依洛尤单抗对接受他汀类药物基础治疗的T2DM患者降低低密度脂蛋白胆固醇的疗效)试验中,纳入了T2DM患者,其筛查时的低密度脂蛋白胆固醇(LDL-C)水平≥2.6 mmol/L(≥100 mg/dL)或≥3.4 mmol/L(≥130 mg/dL),且筛查时分别接受或未接受他汀类药物治疗,开始服用阿托伐他汀20 mg/天,进行至少4周的血脂稳定期。然后,患者按2:2:1:1的比例随机分配,接受每日一次20 mg阿托伐他汀加每2周一次(Q2W)140 mg依洛尤单抗、每月一次(QM)420 mg依洛尤单抗、Q2W安慰剂或QM安慰剂。共同主要结局指标为第12周时LDL-C相对于基线的变化百分比以及第10周和第12周平均值时LDL-C相对于基线的变化百分比。BERSON试验已完成入组。该研究于2018年上半年完成,将提供依洛尤单抗对T2DM和血脂异常患者的疗效和安全性信息。

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