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Ezetimibe + Rosuvastatin

Phase 3

Hypercholesterolemia | Small molecule | Cardiovascular |Organon & Co.|Last Updated: Aug 15, 2024

Success Probability
Approval Probability 71%
TA Base Rate26%
Adjusted LOA41%
ML RiskLOW_RISK
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Market & Valuation
rNPV $3.2B
Market Size $9.4B
Revenue Basis $1.6B
Competitors 6
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Trial Design
RandomizedDouble-BlindPLACEBO_CONTROLLEDDMCBiomarker
Total Trials28
Total Enrollment29,529
FDA Designations
No designations recorded
Clinical Trials (28)
NCT IDTitlePhaseStatusEnrollmentVelocityDesignStartCompletionLast UpdatedSitesCountries
NCT02741245A Study of the Efficacy and Safety of MK-0653H in Japanese Participants With Hypercholesterolemia (MK-0653H-832)PHASE3 COMPLETED 321Jun 9, 2016Jan 18, 2017May 16, 2024 -
NCT02748057A Clinical Trial to Assess the Long Term Safety and Tolerability of MK-0653H in Japanese Participants With Hypercholesterolemia (MK-0653H-833)PHASE3 COMPLETED 135May 18, 2016Dec 11, 2017May 16, 2024 -
NCT02550288A Clinical Trial to Assess the Efficacy and Safety of MK-0653C in Japanese Participants With Hypercholesterolemia (MK-0653C-383)PHASE3 COMPLETED 309Sep 29, 2015May 30, 2016May 16, 2024 -
NCT01370590A Study to Evaluate the Effectiveness of Ezetimibe/Atorvastatin 10 mg/20 mg Combination Tablet Compared to Marketed Ezetimibe 10 mg and Atorvastatin 20 mg Tablets in Participants With High Cholesterol (MK-0653C-185 AM1)PHASE3 COMPLETED 406Sep 1, 2011Apr 1, 2012Feb 9, 2022 -
NCT01370603A Study to Evaluate the Effectiveness of Ezetimibe/Atorvastatin 10 mg/40 mg Combination Tablet Compared to Marketed Ezetimibe 10 mg and Atorvastatin 40 mg Tablets in Participants With High Cholesterol (MK-0653C-190 AM1)PHASE3 COMPLETED 328Sep 1, 2011May 1, 2012Feb 9, 2022 -
NCT01154036MK0653C in High Cardiovascular Risk Patients With High Cholesterol (Switch Study)(MK-0653C-162)PHASE3 COMPLETED 1,547Jul 1, 2010Oct 1, 2012Feb 9, 2022 -
NCT00782184Ezetimibe/Simvastatin (10 mg/40 mg) vs. the Doubling of Atorvastatin in High Risk Participants (MK-0653A-134 AM1)(COMPLETED)PHASE3 COMPLETED 250Nov 1, 2008Sep 1, 2010May 16, 2024 -
NCT00654095Coadministration of Ezetimibe and Atorvastatin in Patients With Primary Hypercholesterolemia (P05456)PHASE3 COMPLETED 146Dec 1, 2007Jun 1, 2009May 21, 2024 -
NCT00653523Coadministration of Ezetimibe and Simvastatin in Patients With Primary Hypercholesterolemia (P05457)PHASE3 COMPLETED 151Dec 1, 2007Jun 1, 2009May 21, 2024 -
NCT00535405A Study to Assess the Cholesterol Lowering Effect of Ezetimibe/Simvastatin Combination Tablet Compared to Another Cholesterol Lowering Drug in Elderly Patients With High Cholesterol at High or Moderately High Risk for Coronary Heart Disease (0653A-128)PHASE3 COMPLETED 1,289Nov 1, 2007Mar 1, 2009May 16, 2024 -
NCT00418834Ezetimibe and Atorvastatin vs. Atorvastatin in Patients Age 65 and Older at High Risk for Coronary Heart Disease (CHD)(0653-112)PHASE3 COMPLETED 1,053Jan 1, 2007Oct 1, 2008May 14, 2024 -
NCT00413972Effects of Vytorin Versus Placebo in Subjects With Primary Hypercholesterolemia (Study P04420)PHASE3 COMPLETED 392Apr 1, 2006Nov 1, 2006Feb 9, 2022 -
NCT00276484To Evaluate Ezetimibe Plus Atorvastatin Versus Atorvastatin in Patients With High Cholesterol Not Controlled on Atorvastatin 40 mg (0653-090)PHASE3 COMPLETED 579Feb 1, 2006Mar 1, 2008May 14, 2024 -
NCT00276458To Evaluate Ezetimibe Plus Atorvastatin Versus Atorvastatin in Patients With High Cholesterol Not Controlled on Atorvastatin 20 mg (0653-079)(COMPLETED)PHASE3 COMPLETED 196Feb 1, 2006Jan 1, 2008May 13, 2024 -
NCT00271817To Evaluate Ezetimibe/Simvastatin and Niacin (Extended Release Tablet) in Patients With Type IIa or Type IIb Hyperlipidemia (0653A-091)(COMPLETED)PHASE3 COMPLETED 1,220Dec 1, 2005Feb 1, 2008May 16, 2024 -
NCT00101439A Study to Evaluate the Effects of Ezetimibe (MK-0653) on the Postprandial (Following a Meal) Lipoprotein Response in Participants With Primary Hypercholesterolemia (High Cholesterol) (MK-0653-072)(COMPLETED)PHASE3 COMPLETED 58Nov 10, 2005Nov 8, 2006Jun 18, 2024 -
NCT00202878IMPROVE-IT: Examining Outcomes in Subjects With Acute Coronary Syndrome: Vytorin (Ezetimibe/Simvastatin) vs Simvastatin (P04103)PHASE3 COMPLETED 18,144Oct 17, 2005Sep 18, 2014Jun 18, 2024 -
NCT00129402Effects of Ezetimibe With Simvastatin in the Therapy of Adolescents With HeFH (Study P02579)PHASE3 COMPLETED 248Aug 1, 2005Jun 1, 2007Feb 8, 2022 -
NCT00423488Ezetimibe and Simvastatin in Primary Hypercholesterolemia, Diabetes Mellitus Type 2, and Coronary Heart Disease (COMPLETED)PHASE3 COMPLETED 93Jul 12, 2005Feb 16, 2007Feb 9, 2022 -
NCT00650819Comparison of Ezetimibe Plus Simvastatin Versus Ezetimibe or Simvastatin Alone in Subjects With Primary Hypercholesterolemia (Study P03757)(COMPLETED)PHASE3 COMPLETED 240Jun 1, 2004Feb 1, 2005Aug 15, 2024 -
NCT00651404Ezetimibe Plus Atorvastatin Versus Atorvastatin Alone in Subjects With Primary Hypercholesterolemia (Study P03406)PHASE3 COMPLETED 137Jan 1, 2004Dec 1, 2004Feb 17, 2022 -
NCT00650689Ezetimibe Plus Atorvastatin Versus Atorvastatin in Untreated Subjects With Primary Hypercholesterolemia and Coronary Heart Disease (P03396)PHASE3 COMPLETED 122May 1, 2003Dec 1, 2004Feb 17, 2022 -
NCT03882892Long-Term Safety and Tolerability of Ezetimibe (SCH 58235, MK-0653) With Atovastatin (P02154, MK-0653-017)PHASE3 COMPLETED 400Feb 2, 2001Aug 8, 2002May 10, 2024 -
NCT03885921Safety and Tolerability Study of Ezetimibe (SCH 058235/MK-0653) Plus Atorvastatin or Simvastatin in Homozygous Familial Hypercholesterolemia (P01417/MK-0653-019)PHASE3 COMPLETED 44Oct 25, 2000Jul 8, 2003Feb 17, 2022 -
NCT03882996A Long-term Safety and Tolerability Study of Ezetimibe Plus Atorvastatin in Participants With Coronary Heart Disease, Multiple Risk Factors, or Hypercholesterolemia Not Controlled by Atorvastatin (P01418/MK-0653-032)PHASE3 COMPLETED 432Oct 6, 2000Feb 4, 2003Feb 17, 2022 -
NCT03867318Efficacy and Safety Study of Ezetimibe (SCH 58235, MK-0653) in Addition to Atorvastatin in Participants With Coronary Heart Disease or Multiple Cardiovascular Risk Factors (P00693/MK-0653-030)PHASE3 COMPLETED 621Apr 24, 2000Nov 16, 2001May 10, 2024 -
NCT03867110An Efficacy and Safety Study of Ezetimibe (MK-0653, SCH 58235) in Addition to Atorvastatin Compared to Placebo in Participants With Primary Hypercholesterolemia (MK-0653-013)PHASE3 COMPLETED 628Mar 6, 2000Jul 27, 2001May 10, 2024 -
NCT00651144Assessment of Potential Interaction Between Ezetimibe and Rosuvastatin in Healthy Subjects With High Cholesterol (P03317)PHASE1 COMPLETED 40Mar 1, 2003May 1, 2003Feb 17, 2022 -
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Study Endpoints
Primary Endpoints
Percentage Change From Baseline in Low-density Lipoprotein-cholesterol (LDL-C)
Baseline and Week 12

Participants had LDL-C levels assessed at baseline and after 12 weeks of study drug administration. The change from baseline was calculated. Results were reported as a M-estimate.

Percentage of Participants Who Experience at Least 1 Adverse Event (AE)
up to 14 weeks

An AE was defined as any untoward medical occurrence in a subject which does not necessarily have a causal relationship with the treatment. An AE was any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease temporally associated with use of a medicinal product, whether or not considered related to the medicinal product. The percentage of participants that reported at least 1 AE was summarized

Percentage of Participants Who Had Study Drug Discontinued Due to Adverse Event
up to 12 weeks

An AE was defined as any untoward medical occurrence in a subject which does not necessarily have a causal relationship with the treatment. An AE was any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease temporally associated with use of a medicinal product, whether or not considered related to the medicinal product. The percentage of participants that had study drug discontinued due to an AE was summarized.

Percentage of Participants Who Experience 1 or More Gastrointestinal-related AEs
up to 14 weeks

Gastrointestinal-related AEs included all preferred terms within system organ class of Gastrointestinal Disorders except Chapped Lips and Toothache.

Percentage of Participants Who Experience 1 or More Gallbladder-related AEs
up to 14 weeks

Gallbladder-related AEs included Bile Duct Obstruction, Bile Duct Stone, Bile Duct Stenosis, Biliary Colic, Cholangitis, Cholecystectomy, Cholecystitis, Cholelithiasis, Gallbladder Disorder, Gallbladder Perforation, Hepatic Pain, and Hydrocholecystis.

Percentage of Participants Who Experience 1 or More Allergic Reaction or Rash AEs
up to 14 weeks

Allergic Reaction or Rash AEs included Allergy to Arthropod Sting, Anaphylactoid Reaction, Anaphylactic Reaction, Anaphylatic Shock, Anaphylactoid Shock, Angioedema, Conjunctivitis Allergic, Contrast Media Reaction, Dermatitis, Dermatitis Allergic, Dermatitis Atopic, Dermatitis Bullous, Dermatitis Contact, Dermatitis Psoriasiform, Drug Hypersensitivity, Eczema, Eosinophila, Erythema, Eye Allergy, Face Oedema, Hypersensitivity, Mechanical Urticaria, Palmar Erythema, Periorbital Oedema, Photodermatosis, Photosensitivity Allergic reaction, Photosensitivity Reaction, Pigmentation Disorder, Pruritus, Pruritus Generalised, Rash, Rash Erythematous, Rash Follicular, Rash Generalised, Rash Maculo-Papular, Rash Papulosquamous, Rash Pruritic, Rash Pustular, Rash Vesicular, Rhinitis, Rhinitis Allergic, Rosacea, Skin Exfoliation, Skin Disorder, Skin Hyperpigmentation, Skin Lesion, Skin Mass, Skin Ulcer, Subcutaneous Nodule, Swelling Face, Systemic Lupus Erythematosus Rash, Urticaria.

Percentage of Participants Who Experience 1 or More Hepatitis-related AEs
up to 14 weeks

Hepatitis-related AEs included Cholestasis, Cytolytic Hepatitis, Hepatic Cyst, Hepatic Failure, Hepatic Lesion, Hepatic Necrosis, Hepatitis, Hepatitis Cholestatic, Hepatitis Fulminant, Hepatitis Infectious, Hepatocellular Injury, Hepatomegaly, Jaundice, Jaundice Cholestatic.

Percentage of Participants Who Experience Consecutive Elevations in Alanine Aminotransferase (ALT) ≥3 Times Upper Normal Limit (ULN)
up to 12 weeks

Participants had ALT levels assessed throughout the 12 week treatment period. Participants who had 2 consecutive assessments of ALT that were 3 x ULN or greater were recorded. The ALT ULN was 40 U/L.

Percentage of Participants Who Experience Consecutive Elevations in Aspartate Aminotransferase (AST) ≥3 Times Upper Normal Limit (ULN)
up to 12 weeks

Participants had AST levels assessed throughout the 12 week treatment period. Participants who had 2 consecutive assessments of AST that were 3 x ULN or greater were recorded. The AST ULN was 40 U/L..

Percentage of Participants Who Experience Consecutive Elevations in Alanine Aminotransferase (ALT) and/or Aspartate Aminotransferase (AST) ≥3 Times Upper Normal Limit (ULN)
up to 12 weeks

Participants had ALT and AST levels assessed throughout the 12 week treatment period. Participants who had 2 consecutive assessments of ALT and/or AST that were 3 x ULN or greater were recorded. The ALT and AST ULNs were 40 U/L.

Percentage of Participants Who Experience Elevation in Alanine Aminotransferase (ALT) ≥5 Times Upper Normal Limit (ULN)
up to 12 weeks

Participants had ALT levels assessed throughout the 12 week treatment period. Participants who had an assessments of ALT that was 5x ULN or greater were recorded. The ALT ULN was 40 U/L.

Percentage of Participants Who Experience Elevation in Aspartate Aminotransferase (AST) ≥5 Times Upper Normal Limit (ULN)
up to 12 weeks

Participants had AST levels assessed throughout the 12 week treatment period. Participants who had an assessments of AST that was 5x ULN or greater were recorded. The AST ULN was 40 U/L.

Percentage of Participants Who Experience Elevation in Alanine Aminotransferase (ALT) ≥10 Times Upper Normal Limit (ULN)
up to 12 weeks

Participants had ALT levels assessed throughout the 12 week treatment period. Participants who had an assessments of ALT that was 10x ULN or greater were recorded. The ALT ULN was 40 U/L.

Percentage of Participants Who Experience Elevation in Aspartate Aminotransferase (AST) ≥10 Times Upper Normal Limit (ULN)
up to 12 weeks

Participants had AST levels assessed throughout the 12 week treatment period. Participants who had an assessments of AST that was 10x ULN or greater were recorded. The AST ULN was 40 U/L.

Percentage of Participants Who Experience Consecutive Elevations in Alanine Aminotransferase (ALT) and/or Aspartate Aminotransferase (AST) ≥10 Times Upper Normal Limit (ULN)
up to 12 weeks

Participants had ALT and AST levels assessed throughout the 12 week treatment period. Participants who had 2 consecutive assessments of ALT and/or AST that were 10x ULN or greater were recorded. The ALT and AST ULNs were 40 U/L.

Percentage of Participants With Potential Hy's Law Condition
up to 12 weeks

Percentage of Participants with Potential Hy's Law Condition (defined as serum ALT or serum AST elevations \>3xULN, with serum alkalinephosphatase \<2xULN and total bilirubin (TBL) ≥2xULN) was summarized. The ALT and AST ULNs were 40 U/L. The ULN for alkaline phosphatase was 359 IU/L and the ULN for total bilirubin was 1.2 mg/dL.

Percentage of Participants Who Experience Elevations in Creatine Kinase (CK) ≥10 Times ULN
up to 12 weeks

Participants had creatine phosphokinase (CK) levels assessed throughout the 12 week treatment period. Participants who had any CK level that was ≥10 x ULN were recorded. The CK ULNs for males and females were 287 IU/L and 163 IU/L, respectively.

Percentage of Participants Who Experience Elevations in Creatine Kinase (CK) ≥10 Times ULN With Muscle Symptoms
up to 12 weeks

Participants had CK levels assessed throughout the 52 week treatment period. Participants who had any CK level that was ≥10 x ULN and had associated muscle symptoms present within +/- 7 days were recorded. The CK ULNs for males and females were 287 IU/L and 163 IU/L, respectively.

Percentage of Participants Who Experience Elevations in Creatine Kinase (CK) ≥10 Times ULN and Drug-Related Muscle Symptoms
up to 12 weeks

Participants had CK levels assessed throughout the 52 week treatment period. Participants who had any CK level that was ≥10 x ULN and had associated muscle symptoms present within +/- 7 days that were reported as at least possibly-related to study drug were recorded. The CK ULNs for males and females were 287 IU/L and 163 IU/L, respectively.

Percentage of Participants Who Had Study Drug Discontinued Due to an AE
up to 52 weeks

An AE was any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease temporally associated with use of a medicinal product, regardless of whether or not it was considered related to the medicinal product. The percentage of participants who had study drug discontinued due to an AE was summarized.

Percent Change From Baseline in Low-density Lipoprotein Cholesterol (LDL-C) at Week 12
Baseline and Week 12

Participants had LDL-C levels assessed at baseline and after 12 weeks of study drug administration. The change from baseline was calculated.

Percentage of Participants Who Experience 1 or More Gastrointestinal-related Adverse Events (AEs)
up to 14 weeks

Gastrointestinal-related AEs included all preferred terms within system organ class of Gastrointestinal Disorders except Chapped Lips and Toothache.

Percentage of Participants Who Experience Consecutive Elevations in Alanine Aminotransferase (ALT) ≥3 Times Upper Limit of Normal (ULN)
up to 12 weeks

Participants had ALT levels assessed throughout the 12 week treatment period. Participants who had 2 consecutive assessments of ALT that were 3 x ULN or greater were recorded. The ALT ULN was 40 U/L.

Percentage of Participants Who Experience Consecutive Elevations in Aspartate Aminotransferase (AST) ≥3 Times ULN
up to 12 weeks

Participants had AST levels assessed throughout the 12 week treatment period. Participants who had 2 consecutive assessments of AST that were 3 x ULN or greater were recorded. The AST ULN was 40 U/L.

Percentage of Participants Who Experience Consecutive Elevations in ALT and/or AST ≥3 Times ULN
up to 12 weeks

Participants had ALT and AST levels assessed throughout the 12 week treatment period. Participants who had 2 consecutive assessments of ALT and/or AST that were 3 x ULN or greater were recorded. The ALT and AST ULNs were 40 U/L.

Percentage of Participants Who Experience Consecutive Elevations in ALT ≥5 Times ULN
up to 12 weeks

Participants had ALT levels assessed throughout the 12 week treatment period. Participants who had an assessment of ALT that was 5x ULN or greater were recorded. The ALT ULN was 40 U/L.

Percentage of Participants Who Experience Consecutive Elevations in AST ≥5 Times ULN
up to 12 weeks

Participants had AST levels assessed throughout the 12 week treatment period. Participants who had an assessment of AST that was 5x ULN or greater were recorded. AST ULN was 40 U/L.

Percentage of Participants Who Have Consecutive Elevations in ALT and/or AST ≥5 Times ULN
up to 12 weeks

Participants had ALT and AST levels assessed throughout the 12 week treatment period. Participants who had 2 consecutive assessments of ALT and/or AST that were 5 x ULN or greater were recorded. The ALT and AST ULNs were 40 U/L.

Percentage of Participants Who Experience Consecutive Elevations in ALT ≥10 Times ULN
up to 12 weeks

Participants had ALT levels assessed throughout the 12 week treatment period. Participants who had an assessment of ALT that was 10x ULN or greater were recorded. The ALT ULN was 40 U/L.

Percentage of Participants Who Experience Consecutive Elevations in AST ≥10 Times ULN
up to 12 weeks

Participants had AST levels assessed throughout the 12 week treatment period. Participants who had 2 consecutive assessments of AST that were 10x ULN or greater were recorded. The AST ULN was 40 U/L.

Percentage of Participants Who Have Consecutive Elevations in ALT and/or AST ≥10 Times ULN
up to 12 weeks

Participants had ALT and AST levels assessed throughout the 12 week treatment period. Participants who had 2 consecutive assessments of ALT and/or AST that were 10x ULN or greater were recorded. The ALT and AST ULNs were 40 U/L.

Percentage of Participants Who Have Elevations in Creatine Kinase (CK) ≥10xULN
up to 12 weeks

Participants had creatine phosphokinase (CK) levels assessed throughout the 12 week treatment period. Participants who had any CK level that was ≥10 x ULN were recorded. The CK ULNs for males and females were 287 IU/L and 163 IU/L, respectively.

Percentage of Participants Who Have Elevations in CK ≥10xULN With Muscle Symptoms
up to 12 weeks

Participants had CK levels assessed throughout the 12 week treatment period. Participants who had any CK level that was ≥10 x ULN and had associated muscle symptoms present within +/- 7 days were recorded. The CK ULNs for males and females were 287 IU/L and 163 IU/L, respectively.

Percentage of Participants Who Have Elevations in CK ≥10xULN and Drug-Related Muscle Symptoms
up to 12 weeks

Participants had CK levels assessed throughout the 12 week treatment period. Participants who had any CK level that was ≥10 x ULN and had associated muscle symptoms present within +/- 7 days that were reported as at least possibly-related to study drug were recorded. The CK ULNs for males and females were 287 IU/L and 163 IU/L, respectively.

Percent Change From Baseline in Low-density Lipoprotein Cholesterol (LDL-C) After 6 Weeks of Treatment
Baseline and Week 6

Serum LDL-C calculated using Friedewald formula at baseline and after 6 weeks of treatment in each of the 2 treatment periods.

Percent Change From Baseline in Low-Density Lipoprotein-Cholesterol (LDL-C) (Phase I)
Baseline and Week 6 (end of Phase I )

LDL-C levels measured at Baseline and after 6 weeks of treatment (Week 6; end of Phase I). Baseline was defined as the average value of the measurements taken at Visits 3 and 4. LDL-C was calculated using the Friedewald method when triglyceride (TG)\<350 mg/dL (3.95 mmol/L) and beta quantification ultracentrifugation when TG≥350 mg/dL (3.95 mmol/L).

Percent Change From Baseline in Low Density Lipoprotein (LDL)-C
Baseline (Treatment Day 1), Treatment Week 6
Number of Participants With Adverse Events and Adverse Reactions
Throughout 1 year of study

An adverse event is any unfavorable medical event occurring in a subject to whom an investigational product is administered, and a causal relationship between the administered investigational product and an adverse event is not always clarified. That is, an adverse event is any unfavorable or unintended sign (including an abnormal change in laboratory test values), symptom, or disease, and a causal relationship to the relevant investigational product is not considered. Any adverse event that was considered treatment-related was considered an adverse reaction.

Percent Change From Baseline in Low Density Lipoprotein (LDL-C) at Week 12
Baseline and 12 weeks
Percent Change From Baseline in LDL-C at Week 6
Baseline and Week 6
Percent Change in Low-density Lipoprotein Cholesterol (LDL-C) From Baseline to Endpoint After 8 Weeks of Treatment
Baseline, 8 weeks
Percent Change From Baseline to Week 6 in Low-Density Lipoprotein (LDL)-C
Baseline and 6 weeks

Percent Change in LDL-C = \[(week 6 value - baseline value)/baseline value\]\*100%

Percent Change From Baseline in Low Density Lipoprotein-Cholesterol (LDL-C) at Week 6
6 weeks

\[(6 week value - baseline value)/baseline value\]\*100%.

Percent Change From Baseline in Low-Density Lipoprotein-Cholesterol (LDL-C)
Baseline and 24 Weeks

Ezetimibe/simvastatin co-administered with niacin extended release compared to niacin extended release monotherapy on the percent change, from baseline in LDL-C after 24 weeks - 24 Week Measure Minus Baseline

Total Cholesterol Concentration of Chylomicron (Sf≥400) Fractions After a Cholesterol-Rich Test Meal
Immediately prior to consumption of the test meal (baseline) and at 2, 3, 4, and 6 hours after test meal on Day 28 of each treatment period.

On each of 2 days prior to the last day of each treatment period, participants consumed 2 large eggs in the evening. On the morning of the final day of each treatment period, fasting participants were given a site-prepared, cholesterol-enriched milkshake that provided 1114 calories of total energy (\~44% of calories from fat, \~40% of calories from carbohydrate and \~17% of calories from protein) and 504 mg of cholesterol. The milkshake was consumed over a 15-minute period. Plasma samples were collected immediately prior to consumption of the test meal (baseline) and at 2, 3, 4, and 6 hours afterwards for isolation and analysis of lipoprotein fractions. The geometric mean concentration level was calculated using data obtained at all timepoints.

Time to First Occurrence of Cardiovascular Death, Major Coronary Event, or Non-fatal Stroke (Kaplan-Meier Estimate of Percentage of Participants Experiencing a Qualifying Event)
Up to approximately 9 years

The time (in months) from study start to the first occurrence of any of the following clinical outcomes was recorded: cardiovascular death, major coronary Event (non-fatal myocardial infarction \[MI\], documented unstable angina \[UA\] requiring hospitalization, or coronary revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) ≥ 30 days after randomization), or non-fatal Stroke. A Clinical Endpoints Committee (CEC) reviewed and adjudicated each suspected efficacy endpoint event while blinded to treatment. Participants who did not have any endpoint event until last visit or who were lost to follow-up and had no event were censored at the time of last available information (last study visit). The Kaplan-Meier estimate reports the percentage of participants who experienced cardiovascular death, major coronary event, or non-fatal stroke within 7 years from randomization.

Percent Change From Baseline in Low-density Lipoprotein Cholesterol (LDL-C)
baseline to 6 weeks

Least squares mean percent change from Baseline in LDL-C at the end of Step 1 (Week 6) in the pooled groups who received ezetimibe plus simvastatin compared with pooled groups who received simvastatin monotherapy

Percent Change in Low-Density Lipoprotein Cholesterol (LDL-C) From Baseline to Endpoint, After 6 Weeks of Treatment
6 weeks of treatment (from Baseline to Endpoint)
Percent change from baseline in LDL-C concentration.
8 weeks
Percent change from baseline to end of treatment in LDL-C.
6 weeks
Change from baseline to endpoint in LDL-C.
6 weeks
Percentage of Participants Experiencing ≥1 Adverse Event (AE)
Up to 12 months
Percentage of Participants Discontinuing from Study Treatment due to an Adverse Event (AE)
Up to 12 months
Number of Participants Who Experience an Adverse Event (AE)
Up to 24 Months
Number of Participants Who Discontinue Study Treatment Due to an Adverse Event (AE)
Up to 24 Months
Number of participants who experienced an adverse event
Up to 12 months
Number of participants who discontinued study drug due to an adverse event
Up to 12 months
Percentage of Participants Achieving Target Low-Density-Lipoprotein Cholesterol (LDL-C) Levels of ≤100 mg/dL
Week 14

The percentage of participants achieving the target low-density-lipoprotein cholesterol (LDL-C) levels (≤100 mg/dL \[2.59 mmol/L\]) as determined from blood samples following a standard ultracentrifugation/precipitation procedure (β-quantification).

Percentage of Participants With an Adverse Event
14 weeks (Up to 16 weeks)

An adverse event (AE) is defined as any physical or clinical change or disease reported by a participant or observed by the investigator or member of the staff at any time during the study, regardless of potential relationship to study treatment, and included onset or discovery of new illness and exacerbation of any pre-existing condition.

Percentage of Participants Who Discontinued the Study due to an Adverse Event
14 weeks (Up to 16 weeks)

An adverse event (AE) is defined as any physical or clinical change or disease reported by a participant or observed by the investigator or member of the staff at any time during the study, regardless of potential relationship to study treatment, and included onset or discovery of new illness and exacerbation of any pre-existing condition.

Percent Change from Baseline at Week 12 of Plasma Low Density Lipoprotein Cholesterol (LDL-C)
Baseline and Week 12

Plasma LDL-C determined following a standard ultracentrifugation / precipitation (quantification) procedure (direct LDL-C). Participants had LDL-C levels assessed at baseline and after 12 weeks of study drug administration. The percent change from baseline was calculated.

Percent change from baseline in total cholesterol, LDL-C, HDL-C, and triglycerides.
Day 15
Safety: adverse events, laboratory test results, physical examination, vital signs.
Throughout study
Secondary Endpoints
Percentage Change From Baseline in Low-Density Lipoprotein-Cholesterol (LDL-C)
Baseline (predose) and Week 52
Percent Change From Baseline in Total Cholesterol (TC) After 6 Weeks of Treatment
Baseline and Week 6
Percent Change From Baseline in High-density Lipoprotein Cholesterol (HDL-C) After 6 Weeks of Treatment
Baseline and Week 6
Unlock Study Endpoints
Study Design & Arms
AllocationRANDOMIZED
MaskingDOUBLE
ModelPARALLEL
PurposeTREATMENT
Treatment Arms
ArmTypeDescription
Ezetimibe 10 mgACTIVE_COMPARATOR1 Ezetimibe 10 mg tablet and 2 Rosuvastatin placebo capsules once daily for 12 weeks
Rosuvastatin 2.5 mgACTIVE_COMPARATOR1 Rosuvastatin 2.5 mg capsule, 1 Rosuvastatin placebo capsule and 1 Ezetimibe placebo tablet once daily for 12 weeks.
Rosuvastatin 5.0 mgACTIVE_COMPARATOR2 Rosuvastatin 2.5 mg capsules and Ezetimibe placebo tablet once daily for 12 weeks.
Ezetimibe 10 mg+ Rosuvastatin 2.5 mgEXPERIMENTAL1 Ezetimbie 10 mg tablet, 1 Rosuvastatin 2.5 mg capsule and 1 Rosuvastatin placebo capsule once daily for 12 weeks.
Ezetimibe 10 mg+ Rosuvastatin 5.0 mgEXPERIMENTAL1 Ezetimbie 10 mg tablet and 2 Rosuvastatin 2.5 mg capsules once daily for 12 weeks.
Ezetimibe 10 mg + Rosuvastatin 2.5 mgEXPERIMENTAL1 Ezetimibe 10 mg tablet and 1 Rosuvastatin 2.5 mg capsule/tablet orally, once daily for 52 weeks. If participant does not achieve low-density lipoprotein- cholesterol (LDL-C) goal after Week 12, dosage of Rosuvastatin may be increased to 5.0 mg
Ezetimibe 10 mg + Rosuvastatin 5.0 mgEXPERIMENTAL1 Ezetimibe 10 mg tablet and 2 Rosuvastatin 2.5 mg capsules/tablets orally, once daily for 52 weeks.
Atorvastatin 10 mgACTIVE_COMPARATOR1 atorvastatin 10 mg capsule, 1 ezetimide 10 mg placebo tablet, and 1 atorvastatin 10 mg placebo capsule orally once daily for 12 weeks.
Atorvastatin 20 mgACTIVE_COMPARATOR2 atorvastatin 10 mg capsules and 1 ezetimide 10 mg placebo tablet orally, once daily for 12 weeks.
Ezetimibe 10 mg + Atorvastatin 10 mgEXPERIMENTAL1 Ezetimibe 10 mg tablet, 1 atorvastatin 10 mg capsule and 1 atorvastatin 10 mg placebo capsule orally, once daily for 12 weeks
Ezetimibe 10 mg + Atorvastatin 20 mgEXPERIMENTAL1 Ezetimibe 10 mg tablet and 2 atorvastatin 10 mg capsules orally, once daily for 12 weeks
Ezetimibe and atorvastatinACTIVE_COMPARATORMedication will be administered in a double dummy fashion as 3 tablets orally on a daily basis, including 10 mg ezetimibe, 20 mg atorvastatin, and placebo to ezetimibe/atorvastatin.
Ezetimibe/atorvastatin combinationEXPERIMENTALMedication will be administered in a double dummy fashion as 3 tablets orally on a daily basis, including ezetimibe/atorvastatin 10 mg/20 mg, placebo to ezetimibe, and placebo to atorvastatin.
Phase I: ezetimibe (EZ) 10 mg + atorvastatin (Atorva) 10 mgEXPERIMENTALCo-administration of EZ 10 mg tablet + Atorva 10 mg tablet; once daily for 6 weeks
Phase I: Atorvastatin 20 mgACTIVE_COMPARATORAtorvastatin 20 mg tablet once daily for 6 weeks
Phase I: Rosuvastatin 10 mgACTIVE_COMPARATORRosuvastatin 10 mg tablet once daily for 6 weeks
Phase II: EZ 10mg+Atorva 10mgEXPERIMENTALParticipants who had previously received EZ 10 mg + Atorva 10 mg in Phase I and continued on EZ 10 mg + Atorva 10 mg once daily for 6 weeks during Phase II regardless of whether or not LDL-C goals were achieved in Phase I
Phase II: EZ 10mg + Atorva 20mg [A]EXPERIMENTALParticipants who had previously received Atorva 20 mg in Phase I and did not reach LDL-C goal and were switched to EZ 10 mg + Atorva 20 mg once daily for 6 weeks in Phase II
Phase II: Atorva 40mgACTIVE_COMPARATORParticipants who had previously received Atorva 20 mg in Phase I and did not reach LDL-C goal and were switched Atorva 40 mg once daily for 6 weeks in Phase II
Phase II: EZ 10mg + Atorva 20mg [R]EXPERIMENTALParticipants who had previously received Rosuvastatin 10 mg in Phase I and did not reach LDL-C goal and received EZ 10 mg + Atorva 20 mg once daily for 6 weeks in Phase II
Phase II: Rosuvastatin 20mgACTIVE_COMPARATORParticipants who had previously received Rosuvastatin 10 mg in Phase I and did not reach LDL-C goal and were switched to Rosuvastatin 20 mg once daily for 6 weeks in Phase
ezetimibe/simvastatin 10/40EXPERIMENTALParticipants received 20 mg open-label atorvastatin during a 5-week run-in period. Following this run-in period, ezetimibe/simvastatin 10/40 was administered once daily in tablet form during the 6-week double-blind treatment period
atorvastatin 40 mgACTIVE_COMPARATORParticipants received 20 mg open-label atorvastatin during a 5-week run-in period. Following this run-in period, 40 mg atorvastatin was administered once daily in tablet form during the 6-week double-blind treatment period
Ezetimibe + AtorvastatinEXPERIMENTALEzetimibe 10 mg + Atorvastatin 20 mg
Ezetimibe + SimvastatinEXPERIMENTALEzetimibe 10 mg + Simvastatin 20 mg
1EXPERIMENTALEach patient will receive 1 active treatment dose \& 2 Placebo (Pbo) doses or 2 active treatment doses \& 1 Pbo dose at randomization according to a predetermined partial blinding schedule to reduce the number of pills from 5 to 3 per patient per day for 12 weeks.
2EXPERIMENTALEach patient will receive 1 active treatment dose \& 2 Pbo doses or 2 active treatment doses \& 1 Pbo dose at randomization according to a predetermined partial blinding schedule to reduce the number of pills from 5 to 3 per patient per day for 12 weeks.
3EXPERIMENTALEach patient will receive 1 active treatment dose \& 2 Pbo doses or 2 active treatment doses \& 1 Pbo dose at randomization according to a predetermined partial blinding schedule to reduce the number of pills from 5 to 3 per patient per day for 12 weeks.
4EXPERIMENTALEach patient will receive 1 active treatment dose \& 2 Pbo doses or 2 active treatment doses \& 1 Pbo dose at randomization according to a predetermined partial blinding schedule to reduce the number of pills from 5 to 3 per patient per day for 12 weeks.
5EXPERIMENTALEach patient will receive 1 active treatment dose \& 2 Pbo doses or 2 active treatment doses \& 1 Pbo dose at randomization according to a predetermined partial blinding schedule to reduce the number of pills from 5 to 3 per patient per day for 12 weeks.
Vytorin 10/10EXPERIMENTALEzetimibe 10 mg with Simvastatin 10 mg
Vytorin 10/20EXPERIMENTALEzetimibe 10 mg with Simvastatin 20 mg
Vytorin 10/40EXPERIMENTALEzetimibe 10 mg with Simvastatin 40 mg
PlaceboPLACEBO_COMPARATOR -
Part 1 - Arm 1ACTIVE_COMPARATORezetimibe/simvastatin combination tablet + niacin (ER)
Part 1 -Arm 2ACTIVE_COMPARATORezetimibe/simvastatin
Part 1 - Arm 3ACTIVE_COMPARATORNiacin (ER)
Part 2 - Arm 1ACTIVE_COMPARATORezetimibe/simvastatin combination tablet + niacin (ER)
Part 2 - Arm 2PLACEBO_COMPARATORezetimibe/simvastatin combination tablet + niacin (Pbo)
Ezetimibe→PlaceboEXPERIMENTALAfter a 2-week single- blind placebo run-in, participants will receive ezetimibe 10 mg once daily for 4 weeks and then receive placebo once daily for 4 weeks.
Placebo→ EzetimibeEXPERIMENTALAfter a 2-week single- blind placebo run-in, participants will receive placebo once daily for 4 weeks and then receive ezetimibe10 mg once daily for 4 weeks.
ezetimibe/simvastatinEXPERIMENTALOne Ezetimibe 10 mg/simvastatin 40 mg combination tablet and two simvastatin 40 mg placebo tablets once per day.
simvastatinACTIVE_COMPARATOROne simvastatin 40 mg tablet, one ezetimibe/simvastatin combination 10/40 placebo tablet and one simvastatin 40 mg placebo tablet once per day.
Pooled subjects who received ezetimibe with simvastatinEXPERIMENTALPooled subjects who received ezetimibe 10 mg plus simvastatin 10 mg, simvastatin 20 mg, or simvastatin 40 mg
Pooled subjects who received simvastatin monotherapyACTIVE_COMPARATORPooled subjects who received ezetimibe matching placebo plus simvastatin 10 mg, simvastatin 20 mg, or simvastatin 40 mg
Ezetimibe 10 mg + Simvastatin Placebo + Simvastatin 20 mgEXPERIMENTALParticipants were instructed to take one 10-mg ezetimibe tablet and one simvastatin placebo tablet orally in the evening every day for six weeks in addition to their daily, oral, open-label, 20-mg simvastatin tablet.
Ezetimibe Placebo + Simvastatin 40 mgACTIVE_COMPARATORParticipants were instructed to take one ezetimibe placebo tablet and one simvastatin 20-mg tablet orally in the evening every day for six weeks in addition to their daily, oral, open-label, 20-mg simvastatin tablet.
EzetimibeACTIVE_COMPARATOR -
AtorvastatinACTIVE_COMPARATOR -
Placebo + AtorvastatinPLACEBO_COMPARATORParticipants who received placebo in the parent study (P00692) receive placebo (blinded) + atorvastatin (10 mg/day; open-label) in this study.
Ezetimibe+AtorvastatinEXPERIMENTALParticipants receive ezetimibe 10 mg via oral tablet once daily co-administered with atorvastatin 40 mg (starting dose) via oral tablet once daily in the morning (may be titrated up to a maximum daily dose of 80 mg for atorvastatin, if needed) for up to 24 months.
Ezetimibe+SimvastatinEXPERIMENTALParticipants receive ezetimibe 10 mg via oral tablet once daily co-administered with simvastatin 40 mg (starting dose) via oral tablet once daily in the evening (may be titrated up to a maximum daily dose of 80 mg for simvastatin, if needed) for up to 24 months.
Ezetimibe 10 mg + AtorvastatinEXPERIMENTALEzetimibe 10 mg plus atorvastatin 10 to 80 mg daily for up to 12 months
Atorvastatin MonotherapyEXPERIMENTALParticipants receive double-blind atorvastatin 10 mg once daily (QD) via oral tablet PLUS open-label atorvastatin 10 mg QD via oral tablet for the entire duration of the study. Double-blind atorvastatin is to be added to the regimen for participants not achieving LDL-C target (≤100 mg/dL; 2.59 mmol/L). The maximum possible total daily dose of atorvastatin received in this group is 80 mg (10 mg open label plus 70 mg double blind).
Ezetimibe 10 mg + Atorvastatin 40 mgEXPERIMENTALEzetimibe 10 mg (MK-0653, SCH 58235) + Atorvastatin 40 mg is to be taken orally QD in the morning for 12 consecutive weeks.
Atorvastatin 80 mgACTIVE_COMPARATORAtorvastatin 80 mg is to be taken orally QD in the morning for 12 consecutive weeks.
Ezetimibe 10 mg + Atorvastatin 80 mgEXPERIMENTALEzetimibe 10 mg (MK-0653, SCH 58235) + Atorvastatin 80 mg is to be taken orally QD in the morning for 12 consecutive weeks.
Ezetimibe + RosuvastatinEXPERIMENTAL -
RosuvastatinACTIVE_COMPARATOR -
Interventions
NameTypeDescription
Ezetimibe 10 mgDRUG -
Rosuvastatin 2.5 mgDRUG -
Placebo for EzetimibeDRUG -
Placebo for RosuvastatinDRUG -
EzetimibeDRUG -
RosuvastatinDRUG -
Atorvastatin 10 mgDRUG -
Placebo for Ezetimibe 10 mg tabletDRUG -
Placebo for Atorvastatin 10 mg capsuleDRUG -
Diet control/Daily ExerciseBEHAVIORALDiet and Daily exercise program as per Japan Atherosclerosis Society Guideline 2012 (JAS2012)
AtorvastatinDRUG20 mg tablet administered orally once daily
Ezetimibe/atorvastatinDRUGEzetimibe/atorvastatin 10 mg/20 mg combination tablet administered orally once daily
Placebo to atorvastatinDRUGAdministered orally once daily
Placebo to ezetimibeDRUGAdministered orally once daily
Placebo to ezetimibe/atorvastatinDRUGAdministered orally once daily
Comparator: rosuvastatinDRUG -
ezetimibe/simvastatin 10/40DRUGezetimibe/simvastatin 10/40 tablet once daily for 6 weeks.
atorvastatin 40 mgDRUGatorvastatin 40 mg tablet once daily for 6 weeks
atorvastatin 20 mgDRUGAll participants will take atorvastatin 20 mg tablet once daily for the 5 week run-in period before randomization
SimvastatinDRUGSimvastatin 20 mg daily
Ezetimibe 10 mg/simvastatin 20 mgDRUGEzetimibe 10 mg/simvastatin 20 mg and Placebo for atorvastatin once daily for 12 weeks
Ezetimibe 10 mg/simvastatin 40 mgDRUGEzetimibe 10 mg/simvastatin 40 mg and Placebo for atorvastatin once daily for 12 weeks
ezetimibe and atorvastatinDRUGezetimibe 10 mg and atorvastatin 10 mg daily for 12 weeks
Placebo (unspecified)DRUGPlacebo (unspecified) daily for 12 weeks
ezetimibe with simvastatinDRUGEzetimibe 10 mg with Simvastatin 10 mg once daily for a total of eight weeks
PlaceboDRUGPlacebo once daily for a total of eight weeks
Comparator: atorvastatinDRUGAtorvastatin 40mg tablet po qd (by mouth, once a day) for 6 weeks
Comparator: PlaceboDRUGAtorvastatin 20mg Pbo and ezetimibe 10mg Pbo tablets po qd (by mouth, once a day). for 6 weeks
Comparator: ezetimibeDRUGAtorvastatin 20mg and ezetimibe 10mg tablets po qd (by mouth, once a day). for 6 weeks.
Comparator: Placebo.DRUGAtorvastatin 40mg Pbo tablets po qd (by mouth, once a day). for 6 weeks.
Comparator: ezetimibe/simvastatin + niacin (ER)DRUGezetimibe/simvastatin 10/20mg tablet + niacin (ER) tablet, titrating to 2g, po qd. Treatment time will be \~24 weeks
Comparator: Placebo to ezetimibe/simvastatinDRUGezetimibe/simvastatin (Pbo) tablet. Treatment time will be \~24 weeks.
Comparator: niacin (ER) tabletDRUGniacin (ER) tablet, titrating to 2g, po qd. Treatment time will be \~24 weeks
Comparator: ezetimibe (+) simvastatinDRUGezetimibe/simvastatin 10/20mg tablet. Treatment time will be \~24 weeks.
Comparator: Placebo to Niacin (ER)DRUGNiacin (ER) (Pbo) tablet. Treatment time will be \~24 weeks.
Comparator: ezetimibe/simvastatin and niacin (ER)DRUGezetimibe/simvastatin 10/20mg tablet + niacin (ER) tablet 2g, po qd. Treatment time will be \~40 additional weeks for a total of 64 weeks
Comparator: ezetimibe and simvastatinDRUGezetimibe/simvastatin 10/20mg tablet. Treatment time will be \~40 additional weeks for a total of 64 weeks
ezetimibe/simvastatinDRUGEzetimibe/simvastatin 10/40 mg per day from randomization through the end of participation. As per the original protocol, if LDL-C response was inadequate, the dose of simvastatin in the VYTORIN arm or simvastatin arm, could be increased to 80 mg (Note: per June 2011 protocol amendment, criteria for continued use of 80 mg simvastatin were modified and new increases of simvastatin dose to 80 mg were stopped).
Placebo for simvastatin 40 mgDRUGone or two tablets orally daily
Placebo for ezetimibe 10 mg/simvastatin 40 mg combinationDRUGone tablet orally daily.
Simvastatin 20 mgDRUG1 x 20-mg tablet, provided as open-label study treatment
Ezetimibe PlaceboDRUG1 tablet matching ezetimibe 10-mg tablet, provided as blinded study treatment
Simvastatin PlaceboDRUG1 tablet matching 20-mg simvastatin tablet, provided as blinded study treatment
Ezetimibe + SimvastatinDRUGezetimibe 10 mg plus simvastatin 20 mg once daily for 8 weeks
Ezetimibe + AtorvastatinDRUGoral tablets: ezetimibe 10 mg + atorvastatin 10 mg once daily for 6 weeks
AtovastatinDRUGAtorvastatin 10, 20, and 40 mg tablets at a daily dose of 10 to 80 mg
Placebo for AtorvastatinDRUGSingle placebo tablet administered orally QD
Atorvastatin 80 mgDRUG -
Ezetimibe + RosuvastatinDRUGoral tablets; rosuvastatin 10 mg + ezetimibe 10 mg, once daily for 14 days
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Eligibility Criteria
Age Range20 Years — 80 Years
SexALL
Healthy VolunteersNo

Inclusion Criteria: * Japanese * Outpatient with hypercholesterolemia * Female participant who is of reproductive potential has to agree to remain abstinent or use (or partner use) two acceptable methods of birth control from date of signed informed consent to the 14 days after the last dose of stu...

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