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Epanova

Phase 3

Eligible Men or Women Considered High Risk for Atherosclerotic Cardiovascular Disease (CVD) | Small molecule | Cardiovascular |AstraZeneca PLC|Last Updated: Aug 17, 2021

Success Probability

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Market & Valuation

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Trial Design

RandomizedDouble-BlindACTIVE_CONTROLLEDDMC
Total Trials1
Total Enrollment13,078

FDA Designations

No designations recorded

Clinical trial landscape

Epanova · 7 trials · 6 indications

Phase 3 2Phase 2 2Phase 1 3
NCT02104817Outcomes Study to Assess STatin Residual Risk Reduction With EpaNova in HiGh CV Risk PatienTs With HypertriglyceridemiaEligible Men or Women Considered High Risk for Atherosclerotic Cardiovascular Disease (CVD)
COMPLETED13,078 Analytics
NCT02009865Epanova® for Lowering Very High Triglycerides II (EVOLVE II)Hypertriglyceridemia
COMPLETED379 Analytics
PHASE3COMPLETED
Outcomes Study to Assess STatin Residual Risk Reduction With EpaNova in HiGh CV Risk PatienTs With Hypertriglyceridemia
Eligible Men or Women Considered High Risk for Atherosclerotic Cardiovascular Disease (CVD)Unlock trial analytics
PHASE3COMPLETED
Epanova® for Lowering Very High Triglycerides II (EVOLVE II)
HypertriglyceridemiaUnlock trial analytics

Study Endpoints

Primary Endpoints

The Composite of Major Adverse Cardiovascular Events (MACE)
From the date of randomization and up to completion of the end-of-treatment visit (Month 60) or at study closure

MACE components include: cardiovascular (CV) death, nonfatal myocardial infarction (MI), nonfatal stroke, emergent/elective coronary revascularization, or hospitalization for unstable angina. Participants with no observed events are censored at the earliest of withdrawal of consent date and last study contact (defined as the latest of the dates of assessments contributing to an opportunity to assess as to whether the participant has had every component of the endpoint being analyzed).

Percent Change in Triglyceride for All Subjects
From Baseline to Week 12 Endpoint

This primary endpoint was tested in parallel together with the first of the secondary endpoints, each at 0.025 Type I error rate.

Part A: Serum TG Level.
7 days after enrollment.

For Part A, the distribution of serum TG levels by the degree of pancreatic exocrine insufficiency (PEI) was assessed in patients with Type 2 Diabetes Mellitus (T2DM).

Part B: Baseline Corrected Area Under the Plasma Concentration Time Curve From Time Zero to Last Measurable Concentration (AUC[0-last]) for Total Eicosapentaenoic Acid (EPA) Following Administration of EPANOVA® and OMACOR®.
Blood samples for analysis were taken at 1, 0.5, and 0.05 hours pre-dose, to be used as baseline, and at 1, 2, 3, 4, 5, 6, 7, 8, 10, 24 and 48 hours post-dose.

Baseline corrected AUC(0-last) was measured for total EPA following administration of single oral doses of EPANOVA® 4 g (A) and OMACOR® 4 g (B) (2-way crossover design) to patients with T2DM and different degrees of PEI.

Part B: Baseline Corrected AUC(0-last) for Total Docosahexaenoic Acid (DHA) Following Administration of EPANOVA® and OMACOR®.
Blood samples for analysis were taken at 1, 0.5, and 0.05 hours pre-dose, to be used as baseline, and at 1, 2, 3, 4, 5, 6, 7, 8, 10, 24 and 48 hours post-dose.

Baseline corrected AUC(0-last) was measured for total DHA following administration of single oral doses of EPANOVA® 4 g (A) and OMACOR® 4 g (B) (2-way crossover design) to patients with T2DM and different degrees of PEI.

Part B: Baseline Corrected AUC(0-last) for Total EPA+DHA Following Administration of EPANOVA® and OMACOR®.
Blood samples for analysis were taken at 1, 0.5, and 0.05 hours pre-dose, to be used as baseline, and at 1, 2, 3, 4, 5, 6, 7, 8, 10, 24 and 48 hours post-dose.

Baseline corrected AUC(0-last) was measured for the sum of EPA and DHA (total EPA+DHA) following administration of single oral doses of EPANOVA® 4 g (A) and OMACOR® 4 g (B) (2-way crossover design) to patients with T2DM and different degrees of PEI.

Part B: Baseline Corrected Maximum Plasma Drug Concentration (Cmax) for Total EPA Following Administration of EPANOVA® and OMACOR®.
Blood samples for analysis were taken at 1, 0.5, and 0.05 hours pre-dose, to be used as baseline, and at 1, 2, 3, 4, 5, 6, 7, 8, 10, 24 and 48 hours post-dose.

Baseline corrected Cmax was measured for total EPA following administration of single oral doses of EPANOVA® 4 g (A) and OMACOR® 4 g (B) (2-way crossover design) to patients with T2DM and different degrees of PEI.

Part B: Baseline Corrected Cmax for Total DHA Following Administration of EPANOVA® and OMACOR®.
Blood samples for analysis were taken at 1, 0.5, and 0.05 hours pre-dose, to be used as baseline, and at 1, 2, 3, 4, 5, 6, 7, 8, 10, 24 and 48 hours post-dose.

Baseline corrected Cmax was measured for total DHA following administration of single oral doses of EPANOVA® 4 g (A) and OMACOR® 4 g (B) (2-way crossover design) to patients with T2DM and different degrees of PEI.

Part B: Baseline Corrected Cmax for Total EPA+DHA Following Administration of EPANOVA® and OMACOR®.
Blood samples for analysis were taken at 1, 0.5, and 0.05 hours pre-dose, to be used as baseline, and at 1, 2, 3, 4, 5, 6, 7, 8, 10, 24 and 48 hours post-dose.

Baseline corrected Cmax was measured for the sum of EPA and DHA (total EPA+DHA) following administration of single oral doses of EPANOVA® 4 g (A) and OMACOR® 4 g (B) (2-way crossover design) to patients with T2DM and different degrees of PEI.

AUC(0-t): Area Under the Plasma Concentration-time Curve From 0 to 24 Hours (the Final Time With a Concentration ≥ LOQ)
Blood samples were obtained pre-dose at -1.0, -0.5, and 0 hours and after dose administration at 1, 2, 3, 4, 5, 6, 7, 8, 10, 12 and 24 hours.

Analyses of the outcome measures presented are for baseline-adjusted data for total (esterified and unesterfied) EPA and DHA since the presence of endogenous levels of these fatty acids would likely contribute to intra-subject variability and affect the analyses and interpretation.

AUC(Inf): Area Under the Plasma Concentration-time Curve From 0 to Infinity
Blood samples were obtained pre-dose at -1.0, -0.5, and 0 hours and after dose administration at 1, 2, 3, 4, 5, 6, 7, 8, 10, 12 and 24 hours.

Analyses of the outcome measures presented are for baseline-adjusted data for total (esterified and unesterfied) EPA and DHA since the presence of endogenous levels of these fatty acids would likely contribute to intra-subject variability and affect the analyses and interpretation.

C(Max): Maximum Plasma Concentration
Blood samples were obtained pre-dose at -1.0, -0.5, and 0 hours and after dose administration at 1, 2, 3, 4, 5, 6, 7, 8, 10, 12 and 24 hours.

Analyses of the outcome measures presented are for baseline-adjusted data for total (esterified and unesterfied) EPA and DHA since the presence of endogenous levels of these fatty acids would likely contribute to intra-subject variability and affect the analyses and interpretation.

1. Plasma concentrations versus time profile of EPA and DHA
Blood sample will be collected on Day-1, Day1(-1h, -5min Pre-dose and 1h, 2h, 3h, 4h, 5h, 6h, 7.5h, 9h, 12h, 16h Post-dose),Day2,3,4,7,11,14,16,and Day17 (-5min Pre-dose, 1h, 2h, 3h, 4h, 5h, 6h, 7.5h, 9h, 12h, 16h Post-dose), Day18,19 and Day20

To evaluate the PK of single and multiple oral doses of Epanova in Chinese healthy subjects

2. Observed maximum plasma concentration (Cmax)
Blood sample will be collected on Day-1, Day1(-1h, -5min Pre-dose and 1h, 2h, 3h, 4h, 5h, 6h, 7.5h, 9h, 12h, 16h Post-dose),Day2,3,4,7,11,14,16,and Day17 (-5min Pre-dose, 1h, 2h, 3h, 4h, 5h, 6h, 7.5h, 9h, 12h, 16h Post-dose), Day18,19 and Day20

To evaluate the PK of single and multiple oral doses of Epanova in Chinese healthy subjects

3. Time to reach maximum plasma concentration (tmax)
Blood sample will be collected on Day-1, Day1(-1h, -5min Pre-dose and 1h, 2h, 3h, 4h, 5h, 6h, 7.5h, 9h, 12h, 16h Post-dose),Day2,3,4,7,11,14,16,and Day17 (-5min Pre-dose, 1h, 2h, 3h, 4h, 5h, 6h, 7.5h, 9h, 12h, 16h Post-dose), Day18,19 and Day20

To evaluate the PK of single and multiple oral doses of Epanova in Chinese healthy subjects

4. Terminal half-life
Blood sample will be collected on Day-1, Day1(-1h, -5min Pre-dose and 1h, 2h, 3h, 4h, 5h, 6h, 7.5h, 9h, 12h, 16h Post-dose),Day2,3,4,7,11,14,16,and Day17 (-5min Pre-dose, 1h, 2h, 3h, 4h, 5h, 6h, 7.5h, 9h, 12h, 16h Post-dose), Day18,19 and Day20

To evaluate the PK of single and multiple oral doses of Epanova in Chinese healthy subjects

5. Area under the plasma concentration-time curve from time zero to time of last quantifiable analyte concentration (AUC0-t)), from time zero to 24 hours (AUC0-24h), and from time zero extrapolated to infinity (AUC)
Blood sample will be collected on Day-1, Day1(-1h, -5min Pre-dose and 1h, 2h, 3h, 4h, 5h, 6h, 7.5h, 9h, 12h, 16h Post-dose),Day2,3,4,7,11,14,16,and Day17 (-5min Pre-dose, 1h, 2h, 3h, 4h, 5h, 6h, 7.5h, 9h, 12h, 16h Post-dose), Day18,19 and Day20

To evaluate the PK of single and multiple oral doses of Epanova in Chinese healthy subjects

6. Apparent clearance for parent drug estimated as dose divided by AUC (CL/F)
Blood sample will be collected on Day-1, Day1(-1h, -5min Pre-dose and 1h, 2h, 3h, 4h, 5h, 6h, 7.5h, 9h, 12h, 16h Post-dose),Day2,3,4,7,11,14,16,and Day17 (-5min Pre-dose, 1h, 2h, 3h, 4h, 5h, 6h, 7.5h, 9h, 12h, 16h Post-dose), Day18,19 and Day20

To evaluate the PK of single and multiple oral doses of Epanova in Chinese healthy subjects

Baseline-adjusted AUC0-24 for Plasma Total EPA + Total DHA
participants were followed for the duration of study, up to 12 weeks, each treatment having a 4-week duration and a 4-week wash off period in between.

AUC0-24: Area under the plasma concentration versus time curve, from time 0 to 24 hours after start of the meal

Baseline-adjusted Cmax for Plasma Total EPA + Total DHA
participants were followed for the duration of study, up to 12 weeks, each treatment having a 4-week duration and a 4-week wash off period in between.

Cmax: Maximum measured plasma concentration over the time span specified

ln-transformed Cmax,ss of baseline-adjusted total EPA, total DHA, and total EPA+DHA
Days 1 and 24

ln-transformed Cmax,ss of baseline-adjusted (primary analysis) and unadjusted (secondary analysis) total EPA, total DHA, and total EPA+DHA using a linear mixed effect model.

ln-transformed AUC0-tau of baseline-adjusted total EPA, total DHA, and total EPA+DHA
Days 1 and 24

ln-transformed AUC0-tau of baseline-adjusted (primary analysis) and unadjusted (secondary analysis) total EPA, total DHA, and total EPA+DHA using a linear mixed effect model.

Secondary Endpoints

The Composite of MACE in the Subgroup of Participants With Established CV Disease(CVD) at Baseline
From the date of randomization and up to completion of the end-of-treatment visit (Month 60) or at study closure
The Composite of CV Events
From the date of randomization and up to completion of the end-of-treatment visit (Month 60) or at study closure
The Composite of CV Events in the Subgroup of Participants With Established CV Disease (CVD) at Baseline
From the date of randomization and up to completion of the end-of-treatment visit (Month 60) or at study closure
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Study Design & Arms

AllocationRANDOMIZED
MaskingTRIPLE
ModelPARALLEL
PurposeTREATMENT

Treatment Arms

ArmTypeDescription
EPANOVAEXPERIMENTALEpanova + statin, once daily
Corn oilACTIVE_COMPARATORCorn oil + Statin
Epanova 2 g/dayEXPERIMENTALArm 1
Olive Oil 2 g/dayPLACEBO_COMPARATORArm 2
Sequence ABEXPERIMENTALA single dose of EPANOVA® 4 g (administered as 4 x 1 g capsules) at Visit 4, followed by 10 to 14 days washout, followed by a single dose of OMACOR® 4 g (administered as 4 x 1 g capsules) at Visit 7.
Sequence BAEXPERIMENTALA single dose of OMACOR® 4 g (administered as 4 x 1 g capsules) at Visit 4, followed by 10 to 14 days washout, followed by a single dose of EPANOVA® 4 g (administered as 4 x 1 g capsules) at Visit 7.
Epanova-Lovaza-Epanova-LovazaACTIVE_COMPARATOR -
Lovaza-Epanova-Lovaza-EpanovaACTIVE_COMPARATOR -
E4:L4ACTIVE_COMPARATORCrossover Sequence
L4:E4ACTIVE_COMPARATORCrossover Sequence
E2:L4ACTIVE_COMPARATORCrossover Sequence
L4:E2ACTIVE_COMPARATORCrossover Sequence
RosuvastatinEXPERIMENTALSingle oral dose of 40 mg (1 x 40 mg tablet) rosuvastatin (Crestor®) (Day 1).
Epanova®EXPERIMENTALMultiple oral doses of 2 g (2 x 1 g capsules) Epanova® QD for 10 consecutive days (Days 4 to 13)
Epanova® + Crestor®EXPERIMENTALEpanova® multiple oral doses of 4 g (4 x 1 g capsules) QD for 13 consecutive days (Days 14 to 26) with coadministration of single 40 mg (1 x 40 mg tablet) oral dose of rosuvastatin (Crestor®) with the 11th dose of 4 g Epanova® on Day 24
Vascepa®ACTIVE_COMPARATORVascepa® multiple oral doses of 2 g (2 x 1 g capsules) every 12 hours for 20 consecutive days (Days 1 to 20).

Interventions

NameTypeDescription
Epanova® (omega-3 carboxylic acids)DRUGAdjunct to statin therapy and diet in high risk adult patients for the prevention and reduction of major adverse cardiovascular events (MACE)
corn oil controlDRUGcorn oil control arm
EpanovaDRUGEpanova will be provided in 1 g polyacrylate-coated soft gel capsules. Two capsules will be taken once per day, without regard to meals, for 12 weeks. At clinic visits, study drug will be administered at the clinic after fasting blood draws are complete.
Olive OilDRUGOlive oil will be provided in 1 g polyacrylate-coated soft gel capsules. Two capsules will be taken once per day, without regard to meals, for 12 weeks. At clinic visits, study drug will be administered at the clinic after fasting blood draws are complete.
Omacor® (omega-3-acid ethyl esters)DRUG4 g (administered orally as 4 x 1 g capsules)
Epanova (4 g) and Lovaza (4 g)DRUGSingle dose of Epanova (omefas), 4x1g capsules, taken with low-fat meals, 7 day washout followed by single dose of Lovaza (omega-3-acid ethyl esters), 4x1g capsules, taken with low-fat meals, 7 day washout followed by single dose of Epanova (omefas), 4x1g capsules, taken with high-fat meals, 7 day washout followed by single dose of Lovaza (omega-3-acid ethyl esters, 4x1g capsules, taken with high-fat meals
Lovaza (4 g) and Epanova (4 g)DRUGSingle dose of Lovaza (omega-3-acid ethyl esters), 4x1g capsules, taken with low-fat meals, 7 day washout followed by single dose of Epanova (omefas), 4x1g capsules, taken with low-fat meals, 7 day washout followed by single dose of Lovaza (omega-3-acid ethyl esters,4x1g capsules, taken with high-fat meals, 7 day washout followed by single dose ofEpanova (omefas),4x1g capsules, taken with high-fat meals
LovazaDRUG -
rosuvastatin 40 mg tabletDRUGSingle oral dose of 40 mg (1 x 40 mg tablet) rosuvastatin (Crestor®) (Day 1).
Epanova™ QD (2 x 1 g capsules)DRUGMultiple oral doses of 2 g (2 x 1 g capsules) Epanova™ QD for 10 consecutive days (Days 4 to 13)
Multiple doses of 4 g Epanova™ with single of rosuvastatin 40 mg doseDRUGMultiple oral doses of 4 g Epanova™ QD for 13 consecutive days with coadministration of single 40 mg oral dose of rosuvastatin (Crestor®) with the 11th dose of Epanova™ on Day 24
Multiple (20) oral doses of 2 g Vascepa® every 12 hoursDRUGMultiple oral doses of 2 g (2 x 1 g capsules) Vascepa® every 12 hours for 20 consecutive days (Days 1 to 20).
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Eligibility Criteria

Age Range18 Years to 99 Years
SexALL
Healthy VolunteersNo
Study Sites684

Inclusion Criteria: 1. Men or women, ≥18 years of age. 2. Patient must be on a stable diet and statin\* therapy at least 4 weeks prior to randomization (Visit 2) and meet the following criteria: 1. LDL-C \<100 mg/dL 2. TG level ≥180 and \<500 mg/dL and HDL-C \<42 mg/dL for men or HDL-C \<47 ...

Countries:United StatesAustraliaBelgiumCanadaChinaCzechiaDenmarkEstoniaHungaryItalyJapanLithuaniaMexicoNetherlandsNew ZealandPolandRussiaSouth AfricaSouth KoreaTaiwanUkraineUnited KingdomLatviaSlovakiaSweden
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Frequently asked questions about Epanova

What is Epanova used for?

Epanova is an investigational small molecule being developed for conditions including hypertriglyceridemia, severe hypertriglyceridemia, and as an add-on to statin therapy in patients at high risk for atherosclerotic cardiovascular disease. It has also been studied in type 2 diabetes and healthy subjects. Epanova is not FDA approved and remains in clinical development.

Who makes Epanova?

Epanova is being developed by AstraZeneca PLC, which trades under the ticker AZN. The company has sponsored clinical trials of Epanova across multiple indications, including hypertriglyceridemia and cardiovascular risk reduction.

What phase is Epanova in?

Epanova is in Phase 2 clinical development. While two Phase 3 trials have been completed, the drug remains investigational and has not received FDA approval. The most recent completed trial was a Phase 2 study in type 2 diabetes patients with pancreatic exocrine insufficiency.

What clinical trials is Epanova in?

Epanova has been studied in four completed trials. NCT02009865 (EVOLVE II) tested it in hypertriglyceridemia with 379 patients. NCT02104817 evaluated cardiovascular outcomes in 13,078 high-risk patients. NCT02370537 examined its uptake in type 2 diabetes, and NCT02859129 studied interactions with rosuvastatin in healthy volunteers.

Is Epanova the same as Omacor?

Epanova and Omacor are distinct drugs, though they were compared in a clinical trial. NCT02370537 investigated the uptake of a single dose of Epanova or Omacor in patients with different degrees of pancreatic exocrine insufficiency. Both are omega-3-based products, but they are not the same medication.

What does Epanova target?

Epanova is a small molecule developed for metabolic conditions, but its specific molecular target is not disclosed in the available trial information. Clinical studies have focused on its effects on triglyceride levels and cardiovascular risk reduction rather than a defined biological target.