To Evaluate Ezetimibe/Simvastatin and Niacin (Extended Release Tablet) in Patients With Type IIa or Type IIb Hyperlipidemia - Study Results

Study Type:	Interventional
Study Design:	Randomized, Double Blind (Subject, Investigator), Active Control, Parallel Assignment
Condition:	Hypercholesterolemia
Interventions:	Drug: Comparator: ezetimibe/simvastatin + niacin (ER) Drug: Comparator: Placebo to ezetimibe/simvastatin Drug: Comparator: niacin (ER) tablet Drug: Comparator: ezetimibe (+) simvastatin Drug: Comparator: Placebo to Niacin (ER) Drug: Comparator: ezetimibe/simvastatin and niacin (ER) Drug: Comparator: ezetimibe and simvastatin Drug: Comparator: Placebo to niacin (ER)

Participant Flow

Recruitment Details

Key information relevant to the recruitment process for the overall study, such as dates of the recruitment period and locations
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Pre-Assignment Details

Significant events and approaches for the overall study following participant enrollment, but prior to group assignment
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Reporting Groups

	Description
Niacin	(Part 1): Niacin titrated to 2000 mg taken orally once daily for 24 weeks. During the first 12 weeks of the study, patients randomized to the niacin containing arms started taking niacin 500 mg and had their niacin dose increased 500 mg every 4 weeks to 2000 mg. Patients in this treatment group were ramdomly reassigned for Part 2 of the study to one of two treatment groups- two-thirds of the patients enrolled in the niacin treatment group were randomly assigned to receive ezetimibe/simvastatin + niacin (ER) and the other one-third were randomly assigned to receive ezetimibe/simvastatin alone.
Ezetimibe/Simvastatin	(Part 1): Ezetimibe/Simvastatin 10/20 mg taken orally once daily for 24 weeks. (Part 2): Ezetimibe/Simvastatin 10/20 mg taken orally once daily for 40 additional weeks for a total of 64 weeks.
Ezetimibe/Simvastatin + Niacin	(Part 1): Ezetimibe/Simvastatin 10/20 mg + Niacin (titrated to 2000 mg as noted above) taken orally once daily for 24 weeks. (Part 2): Ezetimibe/Simvastatin 10/20 mg + Niacin 2000 mg taken orally once daily for 40 additional weeks for a total of 64 weeks.

Description

Niacin

(Part 1): Niacin titrated to 2000 mg taken orally once daily for 24 weeks. During the first 12 weeks of the study, patients randomized to the niacin containing arms started taking niacin 500 mg and had their niacin dose increased 500 mg every 4 weeks to 2000 mg. Patients in this treatment group were ramdomly reassigned for Part 2 of the study to one of two treatment groups- two-thirds of the patients enrolled in the niacin treatment group were randomly assigned to receive ezetimibe/simvastatin + niacin (ER) and the other one-third were randomly assigned to receive ezetimibe/simvastatin alone.

Ezetimibe/Simvastatin

(Part 1): Ezetimibe/Simvastatin 10/20 mg taken orally once daily for 24 weeks.

(Part 2): Ezetimibe/Simvastatin 10/20 mg taken orally once daily for 40 additional weeks for a total of 64 weeks.

Ezetimibe/Simvastatin + Niacin

(Part 1): Ezetimibe/Simvastatin 10/20 mg + Niacin (titrated to 2000 mg as noted above) taken orally once daily for 24 weeks.

(Part 2): Ezetimibe/Simvastatin 10/20 mg + Niacin 2000 mg taken orally once daily for 40 additional weeks for a total of 64 weeks.

Participant Flow for 2 periods

Period: Part 1

	Niacin	Ezetimibe/Simvastatin	Ezetimibe/Simvastatin + Niacin
STARTED	272	272	676
COMPLETED	166^[1]	213^[2]	391^[3]
NOT COMPLETED	106	59	285
Adverse Event	68	25	156
Lost to Follow-up	6	8	24
Protocol Violation	5	4	7
Patient Moved	3	1	5
Withdrawal by Subject	23	17	45
LDL < 50 mg/dL	1	4	48

[1]	6 patients who completed Part 1 did not continue to Part 2; 1 patient never received drug in Part 2
[2]	1 patient who completed Part 1 did not continue to Part 2
[3]	11 patients who completed Part 1 did not continue to Part 2

Period: Part 2

	Niacin	Ezetimibe/Simvastatin	Ezetimibe/Simvastatin + Niacin
STARTED	0^[1]	266^[2]	485^[3]
COMPLETED	0	234	401
NOT COMPLETED	0	32	84
Adverse Event	0	17	33
Lack of Efficacy	0	1	6
Lost to Follow-up	0	6	18
Protocol Violation	0	3	5
Patient Moved	0	0	5
Withdrawal by Subject	0	2	13
LDL < 50 mg/dL	0	3	4

[1]	Patients completing the niacin group in Part 1, were re-allocated to one of the two arms in Part 2
[2]	Includes 54 patients re-allocated from the niacin group in Part 1
[3]	Includes 105 patients re-allocated from the niacin group in Part 1

Baseline Characteristics

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Reporting Groups

	Description
Niacin	(Part 1): Niacin titrated to 2000 mg taken orally once daily for 24 weeks. During the first 12 weeks of the study, patients randomized to the niacin containing arms started taking niacin 500 mg and had their niacin dose increased 500 mg every 4 weeks to 2000 mg.
Ezetimibe/Simvastatin	(Part 1): Ezetimibe/Simvastatin 10/20 mg taken orally once daily for 24 weeks. (Part 2): Ezetimibe/Simvastatin 10/20 mg taken orally once daily for 40 additional weeks for a total of 64 weeks.
Ezetimibe/Simvastatin + Niacin	(Part 1): Ezetimibe/Simvastatin 10/20 mg + Niacin (titrated to 2000 mg as noted above) taken orally once daily for 24 weeks. (Part 2): Ezetimibe/Simvastatin 10/20 mg + Niacin 2000 mg taken orally once daily for 40 additional weeks for a total of 64 weeks.

Description

Niacin

Ezetimibe/Simvastatin

(Part 1): Ezetimibe/Simvastatin 10/20 mg taken orally once daily for 24 weeks.

(Part 2): Ezetimibe/Simvastatin 10/20 mg taken orally once daily for 40 additional weeks for a total of 64 weeks.

Ezetimibe/Simvastatin + Niacin

(Part 1): Ezetimibe/Simvastatin 10/20 mg + Niacin (titrated to 2000 mg as noted above) taken orally once daily for 24 weeks.

(Part 2): Ezetimibe/Simvastatin 10/20 mg + Niacin 2000 mg taken orally once daily for 40 additional weeks for a total of 64 weeks.

Baseline Measures

	Niacin	Ezetimibe/Simvastatin	Ezetimibe/Simvastatin + Niacin	Total
Number of Participants [units: participants]	272	272	676	1220
Age [units: years] Mean ± Standard Deviation	56.4 ± 10.6	57.5 ± 10.3	56.9 ± 10.9	56.9 ± 10.7
Gender [units: participants]
Female	136	120	352	608
Male	136	152	324	612
Race/Ethnicity, Customized [units: participants]
Asian	11	4	11	26
Black	13	17	38	68
Hispanic	14	11	49	74
Other	3	0	2	5
White	231	240	576	1047
Body Mass Index [units: Participants]
<25 kg/m2	48	39	135	222
25 to <30 kg/m2	110	119	252	481
30 to <40 kg/m2	97	94	251	442
≥ 40 kg/m2	16	19	34	69
No BMI Data	1	1	4	6

Outcome Measures

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1. Primary:

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

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2. Primary:

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

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3. Secondary:

Percent Change From Baseline in Non-High-Density Lipoprotein-Cholesterol (Non-HDL-C) [ Baseline and 24 weeks ]

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4. Secondary:

Percent Change From Baseline in High-Density Lipoprotein-Cholesterol (HDL-C) [ Baseline and 24 weeks ]

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5. Secondary:

Percent Change From Baseline in Triglycerides (TG) [ baseline and 24 Weeks ]

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6. Secondary:

Percent Change From Baseline in High-Density Lipoprotein-Cholesterol (HDL-C) [ Baseline and 64 weeks ]

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7. Secondary:

Percent Change From Baseline in Triglycerides (TG) [ Baseline and 64 weeks ]

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8. Secondary:

Percent Change From Baseline in Non-High-Density Lipoprotein-Cholesterol (Non-HDL-C) [ Baseline and 64 weeks ]

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9. Secondary:

Percent Change From Baseline in Low-Density Lipoprotein-Cholesterol (LDL-C) [ Baseline and 64 weeks ]

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10. Secondary:

Percent Change From Baseline in Non-High-Density Lipoprotein-Cholesterol (Non-HDL-C) [ Baseline and 24 weeks ]

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Serious Adverse Events

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Other Adverse Events

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Time Frame	No text entered.
Additional Description	No text entered.

Frequency Threshold

Threshold above which other adverse events are reported	2%

Reporting Groups

	Description
Niacin	Niacin group from Part 1
Ezetimibe/Simvastatin	Ezetimibe/Simvastatin group from Part 1
Ezetimibe/Simvastatin + Niacin	Ezetimibe/Simvastatin + Niacin group from Part 1
Ezetimibe/Simvastatin - Part 2	EZ/Simva group from Part 2 All-Treated Patient as Treated Population
Ezetimibe/Simvastatin + Niacin - Part 2	Ezetimibe/Simvastatin + Niacin group from Part 2 All-Treated Patient as Treated Population

Other Adverse Events

	Niacin	Ezetimibe/Simvastatin	Ezetimibe/Simvastatin + Niacin	Ezetimibe/Simvastatin - Part 2	Ezetimibe/Simvastatin + Niacin - Part 2
Total, other (not including serious) adverse events
# participants affected	121	428	185	175	505
Gastrointestinal disorders
Constipation * # participants affected / at risk	0/272 (0.00%)	0/670 (0.00%)	0/272 (0.00%)	8/326 (2.45%)	10/775 (1.29%)
Diarrhoea * # participants affected / at risk	9/272 (3.31%)	27/670 (4.03%)	10/272 (3.68%)	12/326 (3.68%)	47/775 (6.06%)
Dyspepsia * # participants affected / at risk	0/272 (0.00%)	0/670 (0.00%)	0/272 (0.00%)	7/326 (2.15%)	7/775 (0.90%)
Nausea * # participants affected / at risk	8/272 (2.94%)	28/670 (4.18%)	11/272 (4.04%)	12/326 (3.68%)	32/775 (4.13%)
Vomiting * # participants affected / at risk	5/272 (1.84%)	14/670 (2.09%)	5/272 (1.84%)	7/326 (2.15%)	22/775 (2.84%)
General disorders
Fatigue * # participants affected / at risk	7/272 (2.57%)	13/670 (1.94%)	6/272 (2.21%)	9/326 (2.76%)	18/775 (2.32%)
Infections and infestations
Bronchitis * # participants affected / at risk	0/272 (0.00%)	0/670 (0.00%)	0/272 (0.00%)	10/326 (3.07%)	24/775 (3.10%)
Gastroenteritis Viral * # participants affected / at risk	0/272 (0.00%)	0/670 (0.00%)	0/272 (0.00%)	8/326 (2.45%)	22/775 (2.84%)
Nasopharyngitis * # participants affected / at risk	9/272 (3.31%)	16/670 (2.39%)	9/272 (3.31%)	15/326 (4.60%)	33/775 (4.26%)
Sinusitis * # participants affected / at risk	7/272 (2.57%)	21/670 (3.13%)	5/272 (1.84%)	17/326 (5.21%)	35/775 (4.52%)
Upper Respiratory Tract Infection * # participants affected / at risk	13/272 (4.78%)	27/670 (4.03%)	9/272 (3.31%)	24/326 (7.36%)	56/775 (7.23%)
Urinary Tract Infection * # participants affected / at risk	7/272 (2.57%)	6/670 (0.90%)	3/272 (1.10%)	8/326 (2.45%)	10/775 (1.29%)
Musculoskeletal and connective tissue disorders
Arthralgia * # participants affected / at risk	13/272 (4.78%)	18/670 (2.69%)	8/272 (2.94%)	20/326 (6.13%)	31/775 (4.00%)
Back Pain * # participants affected / at risk	5/272 (1.84%)	14/670 (2.09%)	7/272 (2.57%)	12/326 (3.68%)	26/775 (3.35%)
Muscle Spasms * # participants affected / at risk	8/272 (2.94%)	10/670 (1.49%)	7/272 (2.57%)	11/326 (3.37%)	16/775 (2.06%)
Musculoskeletal Pain * # participants affected / at risk	0/272 (0.00%)	0/670 (0.00%)	0/272 (0.00%)	10/326 (3.07%)	13/775 (1.68%)
Myalgia * # participants affected / at risk	8/272 (2.94%)	18/670 (2.69%)	5/272 (1.84%)	14/326 (4.29%)	28/775 (3.61%)
Pain In Extremity * # participants affected / at risk	7/272 (2.57%)	16/670 (2.39%)	8/272 (2.94%)	12/326 (3.68%)	25/775 (3.23%)
Nervous system disorders
Dizziness * # participants affected / at risk	7/272 (2.57%)	17/670 (2.54%)	6/272 (2.21%)	11/326 (3.37%)	26/775 (3.35%)
Headache * # participants affected / at risk	8/272 (2.94%)	13/670 (1.94%)	12/272 (4.41%)	14/326 (4.29%)	18/775 (2.32%)
Paraesthesia * # participants affected / at risk	2/272 (0.74%)	25/670 (3.73%)	14/272 (5.15%)	4/326 (1.23%)	29/775 (3.74%)
Psychiatric disorders
Insomnia * # participants affected / at risk	6/272 (2.21%)	6/670 (0.90%)	6/272 (2.21%)	8/326 (2.45%)	7/775 (0.90%)
Respiratory, thoracic and mediastinal disorders
Cough * # participants affected / at risk	0/272 (0.00%)	0/670 (0.00%)	0/272 (0.00%)	8/326 (2.45%)	17/775 (2.19%)
Pharyngolaryngeal Pain * # participants affected / at risk	3/272 (1.10%)	8/670 (1.19%)	6/272 (2.21%)	7/326 (2.15%)	12/775 (1.55%)
Skin and subcutaneous tissue disorders
Pruritus * # participants affected / at risk	4/272 (1.47%)	79/670 (11.79%)	35/272 (12.87%)	4/326 (1.23%)	86/775 (11.10%)
Rash * # participants affected / at risk	4/272 (1.47%)	32/670 (4.78%)	15/272 (5.51%)	6/326 (1.84%)	41/775 (5.29%)
Vascular disorders
Flushing * # participants affected / at risk	15/272 (5.51%)	274/670 (40.90%)	108/272 (39.71%)	17/326 (5.21%)	288/775 (37.16%)
Hot Flush * # participants affected / at risk	3/272 (1.10%)	15/670 (2.24%)	5/272 (1.84%)	4/326 (1.23%)	18/775 (2.32%)
Hypertension * # participants affected / at risk	0/272 (0.00%)	0/670 (0.00%)	0/272 (0.00%)	9/326 (2.76%)	3/775 (0.39%)

*	Indicates events were collected by non-systematic assessment.

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Certain Agreements:

All Principal Investigators ARE employed by the organization sponsoring the study.

Limitations and Caveats

Limitations of the study, such as early termination leading to small numbers of participants analyzed and technical problems with measurement leading to unreliable or uninterpretable data
Part 1 population is all patients enrolled in Part 1 of the study. Part 2 is those patients who received either niacin, ezetimibe/simvastatin, or ezetimibe/simvastatin + niacin during Part 1 until they finished the study at week 64 or discontinued.

Results Point of Contact:

Name/Title: Executive Vice President, Clinical and Quantitative Sciences
Organization: Merck & Co., Inc.
phone: 1-800-672-6372

Publications:

Guyton JR, Brown BG, Fazio S, Polis A, Tomassini JE, Tershakovec AM. Lipid-altering efficacy and safety of ezetimibe/simvastatin coadministered with extended-release niacin in patients with type IIa or type IIb hyperlipidemia. J Am Coll Cardiol. 2008 Apr 22;51(16):1564-72.

Responsible Party:	Merck & Co., Inc. ( Executive Vice President, Clinical and Quantitative Sciences )
Study ID Numbers:	2005_091, MK0653A-091
Study First Received:	January 3, 2006
Results First Received:	February 13, 2009
Last Updated:	November 6, 2009
ClinicalTrials.gov Identifier:	NCT00271817 History of Changes
Health Authority:	United States: Food and Drug Administration