About this trial
Drug-drug interactions often limit statin optimization in a population of patients prescribed cytochrome P3A4 inhibitors, which include immunosuppressive agents, protease inhibitors, and antifungals. These patients frequently have autoimmune conditions or rheumatologic disorders that require complex drug regimens and are often on low-dose statin therapy or no statin at all, resulting in suboptimal LDL levels despite increased cardiovascular (CV) risk.
There is an unmet clinical need to improve LDL levels in this vulnerable patient population, which faces increased CV risk due to underlying conditions that also contribute to polypharmacy and multiple drug-drug interactions. This study is a randomized, open-label trial evaluating subcutaneous inclisiran plus standard of care for LDL-C lowering in high-risk primary prevention patients with multiple comorbidities (e.g., Type II diabetes, liver disease, chronic kidney disease, autoimmune disease, solid-organ transplant) who are taking five or more medications in which drug-drug interactions prevent optimization of statin therapy.
Eligibility criteria
This trial does not accept healthy volunteersQualifiers
Provision of signed and dated informed consent form.
Stated willingness to comply with all study procedures and availability for the duration of the study, including potential randomization to injections.
Age >18 and <85 years and able to provide self-consent.
Taking five or more prescription drugs at the time of enrollment, of any type.
Disqualifiers
Prior or current use of inclisiran.
Known hypersensitivity or allergy to inclisiran or its components.
Active liver disease or unexplained persistent elevations in liver enzymes (ALT or AST >3x upper limit of normal).
History of rhabdomyolysis or severe muscle-related statin intolerance.
Trial design
Parallel
Treatments tested in this trial
Inclisiran sodium 300 mg (equivalent to 284 mg inclisiran) in 1.5 mL
DrugThe intervention arm will receive subcutaneous injection of inclisiran 284mg at the baseline visit, 3 months and 9 month visit.
Treatment groups
Trial outcomes
Primary outcomes
Change of LDL-Cholesterol
Percent Change in LDL-C from baseline to month 12 of treatment with inclisiran as add on to background lipid-lowering therapy that includes maximally tolerated statin.
Secondary outcomes
Change in Atherogenic Lipid Burden
Absolute and percent change in LDL particle number, apo B, non-HDL, and small dense LDL, lipoprotein(a), from baseline (Visit 1) to month 12 of treatment with inclisiran
Other outcomes
Patient-Reported Experience
Patient-reported outcomes and experiences determined by surveys at each visit (the Standardized Treatment Satisfaction Questionnaire with Medication Relationship of the total number of medications on adherence to lipid lowering therapy).
Incidence of Adverse Events
Incidence of adverse events occurring during treatment with inclisiran.
Sponsors and contacts
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University of California, San Diego
Lead sponsor
Novartis
Collaborator