title: The lipid-lowering effects of lomitapide are unaffected by adjunctive apheresis in patients with homozygous familial hypercholesterolaemia - a post-hoc analysis of a Phase 3, single-arm, open-label trial.
abstract: OBJECTIVE
  Lomitapide (a microsomal triglyceride transfer protein inhibitor) is an adjunctive treatment for homozygous familial hypercholesterolaemia (HoFH), a rare genetic condition characterised by elevated low-density lipoprotein-cholesterol (LDL-C), and premature, severe, accelerated atherosclerosis. Standard of care for HoFH includes lipid-lowering drugs and lipoprotein apheresis. We conducted a post-hoc analysis using data from a Phase 3 study to assess whether concomitant apheresis affected the lipid-lowering efficacy of lomitapide.
  
  
  METHODS
  Existing lipid-lowering therapy, including apheresis, was to remain stable from Week -6 to Week 26. Lomitapide dose was escalated on the basis of individual safety/tolerability from 5 mg to 60 mg a day (maximum). The primary endpoint was mean percent change in LDL-C from baseline to Week 26 (efficacy phase), after which patients remained on lomitapide through Week 78 for safety assessment and further evaluation of efficacy. During this latter period, apheresis could be adjusted. We analysed the impact of apheresis on LDL-C reductions in patients receiving lomitapide.
  
  
  RESULTS
  Of the 29 patients that entered the efficacy phase, 18 (62%) were receiving apheresis at baseline. Twenty-three patients (13 receiving apheresis) completed the Week 26 evaluation. Of the six patients who discontinued in the first 26 weeks, five were receiving apheresis. There were no significant differences in percent change from baseline of LDL-C at Week 26 in patients treated (-48%) and not treated (-55%) with apheresis (p = 0.545). Changes in Lp(a) levels were modest and not different between groups (p = 0.436).
  
  
  CONCLUSIONS
  The LDL-C lowering efficacy of lomitapide is unaffected by lipoprotein apheresis.
authors.affiliation: 'Sapienza' University of Rome, Rome, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Stefanutti
authors.affiliation: University of Cape Town, Cape Town, South Africa.
authors.forename: D J
authors.initials: DJ
authors.lastname: Blom
authors.affiliation: Università di Palermo, Palermo, Italy.
authors.forename: M R
authors.initials: MR
authors.lastname: Averna
authors.affiliation: University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: E A
authors.initials: EA
authors.lastname: Meagher
authors.affiliation: Netcare Private Hospital, Bloemfontein, South Africa.
authors.forename: H dT
authors.initials: Hd
authors.lastname: Theron
authors.affiliation: University of Cape Town, Cape Town, South Africa.
authors.forename: A D
authors.initials: AD
authors.lastname: Marais
authors.affiliation: Robarts Research Institute and University of Western Ontario, London, ON, Canada.
authors.forename: R A
authors.initials: RA
authors.lastname: Hegele
authors.affiliation: Ospedale Niguarda, Milano, Italy.
authors.forename: C R
authors.initials: CR
authors.lastname: Sirtori
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, CA, USA.
authors.forename: P K
authors.initials: PK
authors.lastname: Shah
authors.affiliation: Université de Montreal, Chicoutimi, Canada.
authors.forename: D
authors.initials: D
authors.lastname: Gaudet
authors.affiliation: Università di Ferrara, Ferrara, Italy.
authors.forename: G B
authors.initials: GB
authors.lastname: Vigna
authors.affiliation: University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: B S
authors.initials: BS
authors.lastname: Sachais
authors.affiliation: 'Sapienza' University of Rome, Rome, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Di Giacomo
authors.affiliation: University of Pretoria, South Africa.
authors.forename: A M E
authors.initials: AM
authors.lastname: du Plessis
authors.affiliation: Aegerion Pharmaceuticals, Cambridge, MA, USA.
authors.forename: L T
authors.initials: LT
authors.lastname: Bloedon
authors.affiliation: Veristat, Holliston, MA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Balser
authors.affiliation: University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: D J
authors.initials: DJ
authors.lastname: Rader
authors.affiliation: University of Pennsylvania, Philadelphia, PA, USA. Electronic address: mcuchel@mail.med.upenn.edu.
authors.forename: M
authors.initials: M
authors.lastname: Cuchel
mesh_terms: D000328:Adult; D000924:Anticholesteremic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001562:Benzimidazoles / Q000008:administration & dosage* / Q000009:adverse effects; D015415:Biomarkers / Q000097:blood; D001781:Blood Component Removal / Q000009:adverse effects / Q000379:methods*; D008078:Cholesterol, LDL / Q000097:blood*; D003131:Combined Modality Therapy; D005260:Female; D020022:Genetic Predisposition to Disease; D006720:Homozygote; D006801:Humans; D006938:Hyperlipoproteinemia Type II / Q000097:blood / Q000175:diagnosis / Q000235:genetics / Q000628:therapy*; D017270:Lipoprotein(a) / Q000097:blood; D008297:Male; D010641:Phenotype; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000924:Anticholesteremic Agents; C473731:BMS201038; D001562:Benzimidazoles; D015415:Biomarkers; D008078:Cholesterol, LDL; D017270:Lipoprotein(a)
keywords: Homozygous familial hypercholesterolaemia; Lipoprotein apheresis; Lomitapide