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).

Conclusion: The LDL-C lowering efficacy of lomitapide is unaffected by lipoprotein apheresis.

Trial registration: ClinicalTrials.gov NCT00730236.

Keywords: Homozygous familial hypercholesterolaemia; Lipoprotein apheresis; Lomitapide.

Figure 1

Patient disposition

Figure 2. Individual LDL-C profiles for patients who discontinued apheresis (A–C) or extended apheresis intervals (D–F) during the safety phase of the trial

Lipid parameters were evaluated at a time that was as close as possible to, and before, the scheduled apheresis treatment. Once established, this time point for lipid assessment blood draws was maintained, relative to the previous apheresis visit, so that lipid assessments were always performed at the same point on the LDL rebound curve.