A discussion on recent data updates from the REDUCE-IT trial, and their practical implications for physicians managing cardiovascular risk.
Speaking of triglycerides the reduced trial really helped put triglycerides back on the map again in a way that they haven’t been in probably at least a decade or maybe a couple of decades and reduce it just to recap was a study a randomized clinical trial of over 8 000 patients randomly assigned to icosapendethyl or placebo and followed for a median of 4.9 years
A maximum of 6.2 years and cardiovascular events were assessed so icosapentethyl first of all is epa or icosapenoic acid a highly purified ethyl ester of icosapenoic acid one of the omega-3 fatty acids and it’s a prescription medication not to be confused with supplements that a patient or person could just buy in a store this is a highly purified distilled ethyl
Ester that was studied and reduce it but also had been studied in a couple of other triglyceride lowering trials found to be safe found to be effective and in fact approved for severe hypertriglyceridemia by the fda a number of years ago with the goal of hopefully preventing pancreatitis which of course is a concern when the triglycerides are 500 milligrams per
Deciliter or greater but in reduce it we studied patients with triglyceride levels that were above ideal above 135 per milligrams per deciliter was the inclusion criteria but below that 500 so in patients with that range of triglycerides with ldl that was well controlled on a stent we required statins in the trial an ldl that was even by current standards uh well
Controlled uh there we randomized the patient’s ticosa pentathyl or placebo and the dose of icosapent ethyl was four grams a day total dose or in fact two grams twice a day with meals and the additional risk that patients had to have in addition to the triglycerides being not normal were either established cardiovascular disease which really meant atherosclerosis
Anywhere in the body or diabetes plus additional cardiovascular risk factors so you could say high risk primary prevention so pretty much the full universe of secondary prevention and high risk primary prevention the overall trial was very positive showing a 25 relative risk reduction in first ischemic events including a 26 reduction that was highly statistically
Significant in the end point of cardiovascular death mi or stroke and including a significant 20 relative risk reduction in death from cardiovascular causes so very positive trial a number of different subgroup analyses and secondary analyses have been presented to date showing large reductions for example in revascularization significant reductions in coronary
Artery bypass grafting as an end uh really potent effects in patients with diabetes either in the secondary or primary prevention cohorts from reduce it really a consistency of benefit across multiple pre-specified subgroups so overall a very robust trial with large relative risk reductions also large absolute risk reductions in time the first event and when we
Examined recurrent events so first events and recurrent events equaling total events there are very large reductions of 32 relative reduction in total ischemic events in this population of patients the total number of ischemic events reduced from about 1700 to 1100 or so about 500 less events in this population so very very large absolute risk reduction as well
And of course i’m speaking here to the editors of medical economics i’ve got to mention what the ramifications might be in terms of economics of those sorts of findings obviously the main reason to try to prevent events is for the patient to increase lifespan to increase quality of life to decrease ischemic events in the context of cardiovascular drugs but beyond
That you might imagine then when we’re preventing so many events not just first events but recurrent events what in medical jargon we sometimes call the frequent flyer that keeps coming in with repeated ischemic events well obviously from a health care systems perspective there are enormous financial costs associated with that so if we can reduce first events that’s
Terrific and if we can reduce recurrent events that’s icing on the economic cake so to speak so really in addition to the clinical benefits economic ramifications to the health care system from the findings of reduce it
Transcribed from video
REDUCE-IT Trial Data Updates: Key Takeaways By Drug Topics
