Professional Documents
Culture Documents
(Rosuvastatin)
Contents
Improving Lipid Management CRESTOR Efficacy Safety and Tolerability Clinical Pharmacology CRESTOR Dosing and Administration
GALAXY Programme
TM
Lipid Management
Lipid Management
0.2
0.8
1.0 0 4 8 12 16 20 24 28 32
On-Treatment LDL-C is Closely Related to CHD Events in Statin Trials Lower is Better
30 4S - Placebo 25 Rx - Statin therapy PRA pravastatin ATV - atorvastatin
Secondary Prevention
4S - Rx
20
15
LIPID - Placebo CARE - Placebo LIPID - Rx CARE - Rx Primary Prevention HPS - Placebo HPS - Rx TNT ATV10 PROVE-IT - PRA WOSCOPS Placebo TNT ATV80 PROVE-IT ATV AFCAPS - Placebo AFCAPS - Rx ASCOT - Placebo ASCOT - Rx 40 (1.0) 60 (1.6) 80 (2.1) 100 (2.6) 120 (3.1) 140 (3.6) 160 (4.1) 180 (4.7) 200 (5.2) WOSCOPS - Rx
6
10
TNT
Major cardiovascular events in all randomised subjects atorvastatin 10 mg Mean LDL-C 101 mg/dL Event rate 10.9%
25
20 15 10 5 0 0
0.10 22% RRR (p<0.001) atorvastatin 80 mg Mean LDL-C 77 mg/dL Event rate 8.7% 1 2 3 Years 4 5
atorvastatin 80 mg Median LDL-C reduction 42% LDL-C achieved 62 mg/dL Event rate 22.4%
0.05
0 3 6 9 12 15 18 21 24 27 30 Months of follow-up
Cannon C et al. N Engl J Med 2004;350:1495-1504 LaRosa JC et al. N Engl J Med 2005;352:1425-1435
Relationship Between Changes in LDL-C and HDL-C Levels and CHD Risk
Third Report of the NCEP Expert Panel. NIH Publication No. 01-3670 2001. http://hin.nhlbi.nih.gov/ncep_slds/menu.htm
Many Patients that are Treated are Still not Getting to Goal
2829 patients
1464 (52%) not at goal on starting dose 813 (55%) not titrated 651 (45%) titrated
Patients with an LDL-C goal of <100mg/dL (CHD and/or diabetes mellitus) with HDL-C <45 mg/dL
Foley KA, Simpson RJ, Crouse JR et al. Am J Cardiol 2003;92:79-81
Even With Dose Titration, Many Patients Fail to Achieve LDL-C Goals
The ACCESS Study
80 Atorvastatin 1080 mg Simvastatin 1040 mg Lovastatin 2080 mg 60 Fluvastatin 2080 mg Pravastatin 1040 mg 40
20
Evolution of Lipid Management Guidelines Driving the Need for More Effective Statin Therapy
European 1994 European 1998 European 2003
Lower LDL-C goals; wider target population; need for more effective therapies.
ATP I 1988
ATP II 1993
CRESTOR
Efficacy
5
n=17
10
n=17
20
n=17
40
n=18
10
20 30 40 50 60 70
45 *
52 *
55 *
63 *
CRESTOR vs Comparators
The STELLAR Study
rosuvastatin 10 mg (n=158) rosuvastatin 20 mg (n=164) rosuvastatin 40 mg (n=158) atorvastatin 10 mg (n=158) atorvastatin 20 mg (n=156) atorvastatin 40 mg (n=160) atorvastatin 80 mg (n=167) simvastatin 10 mg (n=167) simvastatin 20 mg (n=164) simvastatin 40 mg (n=159) simvastatin 80 mg (n=165)
Patients (n=2288)
Hypercholesterolaemia
18 years
pravastatin 10 mg (n=162)
pravastatin 20 mg (n=166) pravastatin 40 mg (n=164)
1 Visit: Week: 6
2 2
3 1
4 0 Lipids Safety
5 4 Lipids Safety
6 6 Lipids Safety
10
0
10 20 30 40 50 60 X X X X
n=485
X n=648
*
n=473
n=634
*p<0.002 vs atorvastatin 10 mg; simvastatin 10, 20, 40 mg; pravastatin 10, 20, 40 mg p<0.002 vs atorvastatin 20, 40 mg; simvastatin 20, 40, 80 mg; pravastatin 20, 40 mg p<0.002 vs atorvastatin 40 mg; simvastatin 40, 80 mg; pravastatin 40 mg
Adapted from Jones PH et al. Am J Cardiol 2003;92:152160
10 mg * 10 mg 20 mg 40 mg
20 mg 80 mg
40 mg
10 mg
20 mg
40 mg
80 mg
10 mg
20 mg
40 mg
Rosuvastatin 10 mg (46%)
*p<0.002 vs atorvastatin 10 mg; simvastatin 10, 20, 40 mg; pravastatin 10, 20, 40 mg p<0.002 vs atorvastatin 20, 40 mg; simvastatin 20, 40, 80 mg; pravastatin 20, 40 mg p<0.002 vs atorvastatin 40 mg; simvastatin 40, 80 mg; pravastatin 40 mg
Adapted from Jones PH et al. Am J Cardiol 2003;92:152160
-10
-20
-36%
-40
-60
8 weeks
MERCURY I Schuster
n=529
n=539 n=539
0
Change in LDL-C from baseline (%)
10 20 30
Olsson
n=132 n=132 n=139 n=139
Blasetto
n=389 n=389 n=393 n=393
36 47
n=128 n=128
37
37
35
n=127 n=127
35
n=127 n=127
40
46 47
39
43
50 60
47
50
*p<0.001 vs atorvastatin
Jones PH et al. Am J Cardiol 2003;92:152160 Schuster H et al. Am Heart J 2004; 147: 705-712 Davidson M et al. Am J Cardiol 2002;89:26875 Schwartz G et al. Am Heart J 2004: 148:e4:H1-H9 Olsson AG et al. Am Heart J 2002;144:104451 Blasetto JW et al. Am J Cardiol 2003;91(Suppl):3C10C
Rosuvastatin 10 mg Atorvastatin 10 mg
RADAR Jukema
n=230 n=231
CORALL Wolffenbuttel
n=131 n=132
MERCURY I Schuster
n=539 n=925
-38%
-46% ns
-43%
-44% *
-43% -47%
-44%
** CRESTOR 10 mg atorvastatin 20 mg
Jones PH et al. Am J Cardiol 2003;92:152160. Jukema J et al. Curr Med Res 2005 in press Wolffenbuttel et al. Journal of Internal Medicine 2005; 257: 531-539 Clearfield M et al. Atherosclerosis Supplements 2005;6(1)104 Abs W16-P-014 Schuster H et al. Am Heart J 2004;147:705712.
-10
-20
-30
-40 -51 -55 ns -56 ** -52 -55 *** -48 -54 * Rosuvastatin 40 mg Atorvastatin 80 mg -48
-50
-60
CRESTOR versus other statins Achievement of LDL-C Goals Across Dose Range
Patients achieving 2003 European LDL-C goals
100
87% # 83%
80
* 69% 72%
75% 66%
60
40
36%
20
20% 12% 3%
22%
LDL-C <3mmol/l (115mg/dl) in general; <2.5mmol/l (97mg/dl) for patients with clinically established CVD or type 2 diabetes *p<0.002 vs atorvastatin 10 mg; simvastatin 10, 20, 40 mg; pravastatin 10, 20, 40 mg p<0.002 vs atorvastatin 20 mg; simvastatin 20, 40 mg; pravastatin 20, 40 mg #p<0.002 vs atorvastatin 40 mg; simvastatin 40, 80 mg; pravastatin 40 mg Kritharides L. Eur Heart J Suppl 2004;6(Suppl A):A12-A18
CRESTOR versus other statins Achievement of LDL-C Goals Across Dose Range
Patients achieving NCEP ATP III LDL-C goals#
100
89% 89% 85% 75% 69% 63% 66% 55% 51% 44% 82% 82%
80
* 82%
60
40
31%
20
#LDL-C
goal <100mg/dl for high-risk; <130 for medium risk & <160 for low-risk patients
*p<0.002 vs. simvastatin 10 mg and 20 mg; pravastatin 10 mg, 20 mg and 40 mg p<0.002 vs. atorvastatin 20 mg, simvastatin 20mg and 40 mg; pravastatin 20 mg and 40 mg p<0.002 vs. simvastatin 40 mg and pravastatin 40 mg
12
* 10 8 6 4 2 0 ns
n=473
Rosuvastatin Atorvastatin
n=634
10
20
40
80
10 8 6 4 * 7.7
9.6 9.5
5.6
10 20 40
10 20 40 80
10 20 40 80
10 20 40
Dose (mg)
*p<0.002 vs pravastatin 10 mg p<0.002 vs atorvastatin 20, 40, 80 mg; simvastatin 40 mg; pravastatin 20, 40 mg p<0.002 vs atorvastatin 40, 80 mg; simvastatin 40 mg; pravastatin 40 mg Observed data in ITT population
Adapted from Jones PH et al. Am J Cardiol 2003;92:152160
10 15 20 25 30
12 15 18 20 18
13
20
24 23 26
27
28
*p<0.002 vs pravastatin 10, 20 mg p<0.002 vs simvastatin 40 mg; pravastatin 20, 40 mg p<0.002 vs simvastatin 40 mg; pravastatin 40 mg Adapted from Jones PH et al. Am J Cardiol 2003;92:152160
Safety Profile
CRESTOR
Overall safety & adverse event profile as determined by controlled clinical trials
The Rosuvastatin Clinical Development Programme (n=12,400) included a wide range of patients treated with rosuvastatin 5-40 mg, including many at increased cardiovascular risk, reflecting those seen in general medical practice: Male; 6,530 (53%), Female; 5,870 (47%) Mean age 58 years, No upper age limit; 3,894 (31%) 65 years Diabetes mellitus; 2,073 (17%) Hypertension; 6,472 (52%) Coronary heart disease; 4,487 (36%) Renal impairment: Mild; 5,513 (44%) Moderate; 975 (8%) Severe; 39 (0.3%)
Similar number of adverse events leading to withdrawal as other currently marketed statins
4
3 2
3.2%
1
0
540 mg
1080 mg
rosuvastatin
(n=3912)
atorvastatin
(n=2899)
simvastatin
(n=1457)
pravastatin
(n=1278)
rhabdomyolysis is very rare with rosuvastatin (<0.01%) which is in line with that reported for other currently marketed statins
renal function was maintained or tended to improve slightly with long-term treatment
Atorvastatin
Yes Yes Primarily hepatic No 12 11-14
Simvastatin
Yes Yes Dual renal / hepatic No <5 3
Pravastatin
No No Dual renal / hepatic Yes 18 2
GALAXY ProgrammeTM
The GALAXY ProgrammeTM is a large, comprehensive, long-term and evolving global research initiative sponsored by AstraZeneca investigating cardiovascular risk reduction and patient outcomes with rosuvastatin It has been designed to build on current thinking to address important unanswered questions in statin research Includes studies investigating the effects of rosuvastatin on: atherogenic lipid profile and inflammatory markers atherosclerosis outcomes Will provide additional short- and long-term efficacy and safety data for rosuvastatin
Designed to evaluate whether these effects translate into beneficial effects on atherosclerosis and significant reductions in cardiovascular events.
Schuster H & Fox J. Exp Opin Pharmacother 2004;5:1187-1200
References
Schuster H. Improving lipid management to titrate, combine or switch. Int J Clin Pract, July 2004, 58, 7, 689-694 Gould AL, Rossouw JE, Santanello NC et al. Cholesterol reduction yields clinical benefit: impact of statin trials. Circulation 1998;97:946952. Rosensen RS. Statins: can the new generation make an impression? Exp Opin Emerg Drugs 2004;9(2):269-279. LaRosa J, Grundy S, Waters D, et al. Intensive lipid lowering with atorvastatin in patients with stable coronary disease. N Engl J Med 2005;352:1425-1435. Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high risk individuals: a randomised placebocontrolled trial. Lancet 2002;360:722. Cannon C, Braunwald E, McCabe C et al. Intensive versus Moderate Lipid Lowering with Statins after Acute Coronary Syndromes. N Engl J Med 2004;350 (15):1495-1504 Third Report of the NCEP Expert Panel. NIH Publication No. 01-3670 2001. http://hin.nhlbi.nih.gov/ncep_slds/menu.htm Foley KA, Simpson RJ, Crouse JR et al. Effectiveness of Statin Titration on Low-Density Lipoprotein Cholesterol Goal Attainment in Patients at High Risk of Atherogenic Events. Am J Cardiol 2003;92:79-81 Ballantyne CM, Andrews TC, Hsia JA et al. Correlation of non-high-density lipoprotein cholesterol with apolipoprotein B: effect of 5 hydroxymethylglutaryl coenzyme A reductase inhibitors on non-high-density lipoprotein cholesterol levels. Am J Cardiol 2001;88:265269 Olsson A, McTaggart F, Raza A. Rosuvastatin A highly effective new HMG-Co A reductase inhibitor. Cardiovasc Drug Rev 2002;20:303328 Jones PH, Davidson MH, Stein EA et al for the STELLAR Study Group. Comparison of the efficacy and safety of rosuvastatin versus atorvastatin, simvastatin, and pravastatin across doses (STELLAR Trial) Am J Cardiol 2003;92:152160 Blasetto JW, Stein EA, Brown WV et al. Efficacy of Rosuvastatin Compared with Other Statins as Selected Starting Doses in Hypercholesterolemic Patients and in Special Population Groups. Am J Cardiol 2003;91(Suppl):3C10C. Schuster H, Barter PJ, Stender S et al. Effect of switching to rosuvastatin from atorvastatin or other statins on achievement of international low-density lipoprotein cholesterol goals: MERCURY I trial. Am Heart J 2004;147:705-712 Davidson M, Ma P, Stein EA et al. Comparison of effects on low-density lipoprotein cholesterol and high-density lipoprotein cholesterol with rosuvastatin versus atorvastatin in patients with type IIa or IIb hypercholesterolemia. Am J Cardiol 2002;89:268275 Schwartz GG, Bolognese MA, Tremblay BP et al. Efficacy and safety of rosuvastatin and atorvastatin in patients with hypercholesterolemia and a high risk of coronary heart disease: a randomized, controlled trial. Am Heart J 2004:148:e4:H1-H9
Olsson AG, Istad H, Luurila O et al. Effect of rosuvastatin and atorvastatin compared over 52 weeks of treatment in patients with hypercholesterolemia. Am Heart J 2002;144:10441051
Jukema J, Liem AH, Dunselman PHJM et al. LDL/HDL-C ratio in patients with cardiovascular disease and low HDL-C: results of the the RADAR (Rosuvastatin and Atorvastatin in different Dosages And Reverse cholesterol transport) study. Current Medical Research 2005 in press. Wolffenbuttel B et al. Cholesterol-lowering effects of rosuvastatin compared with atorvastatin in patients with type 2 diabetes CORALL study. J Int Med 2005;257:531-539 Clearfield M, Amerena J, Bassand JP et al. Efficacy and safety of rosuvastatin 10mg versus atorvastatin 20mg: results of the PULSAR study. Atherosclerosis Supplements 2005;6(1)104 Abs W16-P-014. Leiter LA, Rosenson RS, Stein E et al. Rosuvastatin 40mg versus atorvastatin 80mg in high-risk patients with hypercholesterolaemia: early results results of the POLARIS study. Atherosclerosis Supplements 2005;6(1):113 Abs W16-P-051. Kritharides L. Reducing low-density lipoprotein cholesterol treating to target and meeting new European goals. Eur Heart J Suppl 2004;6(Suppl A): A12-A18.