Praluent, Repatha Spur Rethinking On LDL-Cholesterol As A Surrogate Endpoint
FDA advisors reviewing the PCSK9 inhibitors say reliability of LDL-cholesterol-lowering to predict clinical benefit depends on patient population; they backed the Sanofi/Regeneron and Amgen drugs for patients with genetic cholesterol disorders and very high CV risk, but said approval for lower-risk populations should await outcomes data.
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Sponsors of injectable PCSK9 biologics address questions about the implications of the IMPROVE-IT study, in which the soon-to-be-generic oral Zetia helped bring down LDL cholesterol to a very low level.
Regeneron/Sanofi and Amgen stress the strengths of the Phase III PCSK9 development programs at the American College of Cardiology annual meeting. The mechanism of action holds appeal, but development is taking place at a time of skepticism about surrogate CV markers, following failed trials of other drugs.
The Metabolic and Endocrinologic Advisory Committee accepts LDL lowering as endpoint for homozygous hypercholesterolemia drugs, backing approval of Aegerion’s lomitapide by 13-2 and Genzyme’s mipomersen by 9-6, but hones in on the need for better surrogates for cardiovascular morbidity and mortality.