Amarin Corporation plc (NASDAQ:AMRN), a pharmaceutical company
focused on improving cardiovascular health, today provided an
update on the growing interest in information on Amarin’s
REDUCE-IT™ study and the potential for use of Vascepa® (icosapent
ethyl) in studied patients at risk for a cardiovascular event.
Cardiovascular disease (CVD) is worldwide the #1 killer of men and
women.1,2 REDUCE-IT studied the effects of Vascepa on the reduction
of major adverse cardiovascular events in a high-risk patient
population. The study results are currently under regulatory review
in the United States and Canada.
Publications Increasingly Highlight REDUCE-IT and
Vascepa
Publications and other scientific discussions
have been appearing globally with increasing regularity regarding
the large unmet need to treat residual risk in CVD after standard
of care statin therapy and the opportunity to potentially improve
patient care in the studied high-risk patient population. New
examples are now observed multiple times in most weeks. Many
of these examples are supported by sources unaffiliated with
Amarin. And, while many of the authors are U.S. based, an
increasing number of examples are from Europe and Asia.
Recent examples include:
- ANMCO Position paper: New perspectives on the role of n-3
polyunsaturated fatty acids in cardiovascular prevention3
- Considerations for Treating with Icosapent Ethyl4
- Predicting Risk for Incident Heart Failure with Omega-3 Fatty
Acids: From MESA5
- Strategies to Overcome Residual Risk During Statins Era6
- Optimal Non-invasive Strategies to Reduce Recurrent
Atherosclerotic Cardiovascular Disease Risk7
- Cardiovascular, electrophysiologic, and hematologic effects of
omega-3 fatty acids beyond reducing hypertriglyceridemia: as it
pertains to the recently published REDUCE-IT trial8
- Rounding the corner on residual risk: Implications of REDUCE-IT
for omega-3 polyunsaturated fatty acids treatment in secondary
prevention of atherosclerotic cardiovascular disease9
- Risk of Total Events with Icosapent Ethyl: Can We Reduce It?
10
- Major Randomized Clinical Trials in Cardiovascular Disease
Prevention Presented at the 2019 American College of Cardiology
Annual Scientific Session11
- Targeting RNA to lower triglycerides: long strides from short
molecules12
- Fish Oil and Cardiometabolic Diseases: Recent Updates and
Controversies13
These publications demonstrate increasing
interest in REDUCE-IT results and are referenced here for the
convenience of Amarin’s investors.
Potential Mechanisms of Action of
Vascepa
In recent years there have been multiple
publications exploring the multifactorial effects associated with
Vascepa and its unique active ingredient, as well as the importance
of that ingredient remaining stable (e.g., free from oxidation) and
the importance of adequate dosing in at-risk patients. These
publications are summarized on Amarin’s website at
www.amarincorp.com.
While these publications have been of interest
to certain researchers and healthcare professionals, the recently
posted oral presentation of research from Dr. Preston Mason has
been gathering increasing attention in the investment community.
This presentation, part of a continuing medical education (CME)
program titled, Biologic Basis of EPA to Reduce Atherosclerosis
Burden14 can be seen at:
https://reachmd.com/programs/video-library/biologic-basis-epa-reduce-atherosclerosis-burden/10541/.
The CME is intended for research and healthcare professionals and
was supported by an unrestricted educational grant from
Amarin. It presents an overview of certain, but not all,
biological and mechanistic workings associated with
eicosapentaenoic acid (EPA) and the differences studied between EPA
and various other agents that also have favorable effects on lipid
parameters such as triglycerides (TGs), including docosahexaenoic
acid (DHA).
Mechanisms responsible for the benefits shown in
REDUCE-IT were not the focal point of the REDUCE-IT study
design. Potential mechanisms include TG reduction,
antithrombotic effects, antiplatelet or anticoagulant effects,
effects on stabilization and/or regression of coronary plaque and
inflammation reduction. More study is needed to determine to
what extent, if any, these effects or others may be responsible for
the CV risk reduction benefits demonstrated with use of Vascepa in
REDUCE-IT.
Medical Society Updates
The American Heart Association (AHA) issued a
scientific advisory on August 19, 2019 titled, Omega-3 Fatty Acids
for the Management of Hypertriglyceridemia: A Science Advisory From
the American Heart Association15. This advisory recognizes that
elevated triglycerides may be a causal factor for CVD and that
dietary supplements are not recommended, nor FDA approved, to treat
medical conditions. Vascepa is the only drug listed in this
advisory that, in addition to lowering TGs, has an associated CVD
outcomes study that showed CVD risk reduction. REDUCE-IT
studied whether the collective multifactorial effects associated
with Vascepa could lower cardiovascular events such as heart
attacks, stroke and death. REDUCE-IT met its primary endpoint
and multiple secondary endpoints but was not designed to
demonstrate that lowering TG levels would lower CV risk in the
patient population studied.
Earlier this year, the American Diabetes
Association® (ADA) issued important updates to its Standards of
Medical Care in Diabetes for 2019 (Standards of Care)16, including
updates related to the results of the REDUCE-IT cardiovascular
outcomes study. These updates included recommendations based on the
results of REDUCE-IT17,18 in both primary and secondary prevention
populations and resulted in a revision to the Living Standards of
Care to now include the recommendation that icosapent ethyl “…be
considered for patients with diabetes and atherosclerotic
cardiovascular disease (ASCVD) or other cardiac risk factors on a
statin with controlled low-density cholesterol (LDL-C), but with
elevated triglycerides (135-499) to reduce cardiovascular
risk.”
Comment from Amarin’s President and
CEO
“We appreciate the growing attention to Vascepa.
We believe REDUCE-IT was a well-designed and well-conducted study
from which the results were robust. REDUCE-IT results have
been extensively and repeatedly examined and presented globally in
scientific congresses and publications. We appreciate that
the medical community has been scrutinizing these results and is
increasingly acting on how best to apply them to improve patient
care,” commented John Thero, president and chief executive officer
of Amarin. “For many years, medical professionals have sought a
proven therapy to help prevent cardiovascular events beyond the
current standards of care. Many millions of people worldwide could
potentially benefit from Vascepa as a cost-effective therapy.
Amarin looks forward to further examination of REDUCE-IT results at
the planned FDA advisory committee meeting scheduled for November
14, 2019 as a pathway to what we believe will be an approval of
expanded labeling for Vascepa based on REDUCE-IT results.”
About Amarin
Amarin Corporation plc. is a rapidly growing,
innovative pharmaceutical company focused on developing
therapeutics to improve cardiovascular health. Amarin’s product
development program leverages its extensive experience in
polyunsaturated fatty acids and lipid
science. Vascepa (icosapent ethyl) is Amarin's first
FDA-approved drug and is available by prescription in the United
States, Lebanon and the United Arab Emirates. Amarin’s commercial
partners are pursuing additional regulatory approvals for Vascepa
in Canada, China and the Middle East. For more information about
Amarin, visit www.amarincorp.com.
About REDUCE-IT™
REDUCE-IT17 was an 8,179-patient multinational
cardiovascular outcomes study completed in 2018. REDUCE-IT
evaluated the effect of prescription pure EPA therapy as an add-on
to statins in patients with high cardiovascular risk who, despite
stable statin therapy, had elevated triglyceride levels (at least
135 mg/dL). A large portion of the male and female patients
enrolled in this outcomes study were diagnosed with type 2
diabetes.
More information on the REDUCE-IT study results can be found
at www.amarincorp.com.
About Cardiovascular Disease
Worldwide, cardiovascular disease (CVD) remains
the #1 killer of men and women. In the United States CVD leads to
one in every three deaths – one death approximately every 38
seconds – with annual treatment cost in excess of $500
billion.1,2
Multiple primary and secondary
prevention trials have shown a significant reduction of 25% to
35% in the risk of cardiovascular
events with statin therapy, leaving significant
persistent residual risk despite the achievement of target LDL-C
levels.19
Beyond the cardiovascular risk associated with
LDL-C, genetic, epidemiologic, clinical and real-world data suggest
that patients with elevated triglycerides (TG) (fats in the blood),
and TG-rich lipoproteins, are at increased risk for cardiovascular
disease.20-23
About Vascepa® (icosapent
ethyl) Capsules
Vascepa (icosapent ethyl) capsules are a
single-molecule prescription product consisting of the omega-3 acid
commonly known as EPA in ethyl-ester form. Vascepa is not
fish oil, but is derived from fish through a stringent and complex
FDA-regulated manufacturing process designed to effectively
eliminate impurities and isolate and protect the single molecule
active ingredient from degradation. Vascepa, known in
scientific literature as AMR101, has been designated a new chemical
entity by the FDA. Amarin has been issued multiple patents
internationally based on the unique clinical profile
of Vascepa, including the drug’s ability to lower triglyceride
levels in relevant patient populations without raising
LDL-cholesterol levels.
Indication and Usage Based on Current FDA-Approved Label (not
including REDUCE-IT results)
- Vascepa (icosapent ethyl) is indicated as an adjunct to
diet to reduce triglyceride (TG) levels in adult patients with
severe (≥500 mg/dL) hypertriglyceridemia.
- The effect of Vascepa on the risk for pancreatitis
and cardiovascular mortality and morbidity in patients with severe
hypertriglyceridemia has not been determined.
Important Safety Information for Vascepa Based on
Current FDA-Approved Label (not including REDUCE-IT
results) (Includes Data from Two 12-Week Studies (n=622)
(MARINE and ANCHOR) of Patients with Triglycerides Values of 200 to
2000 mg/dL)
- Vascepa is contraindicated in patients with known
hypersensitivity (e.g., anaphylactic reaction)
to Vascepa or any of its components.
- In patients with hepatic impairment, monitor ALT and AST levels
periodically during therapy.
- Use with caution in patients with known hypersensitivity to
fish and/or shellfish.
- The most common reported adverse reaction (incidence >2% and
greater than placebo) was arthralgia (2.3% for Vascepa, 1.0%
for placebo). There was no reported adverse reaction >3% and
greater than placebo.
- Adverse events and product complaints may be reported by
calling 1-855-VASCEPA or the FDA at 1-800-FDA-1088.
- Patients receiving treatment with Vascepa and other
drugs affecting coagulation (e.g., anti-platelet agents) should be
monitored periodically.
- Patients should be advised to
swallow Vascepa capsules whole; not to break open, crush,
dissolve, or chew Vascepa.
FULL VASCEPA PRESCRIBING INFORMATION CAN BE FOUND
AT WWW.VASCEPA.COM.
Important Safety Information for Vascepa based on
REDUCE-IT, as previously reported in The New England
Journal of Medicine1 publication of the primary results of the
REDUCE-IT study:
- Excluding the major adverse cardiovascular events (MACE)
results described above, overall adverse event rates in REDUCE-IT
were similar across the statin plus Vascepa and the
statin plus placebo treatment groups.
- There were no significant differences between treatments in the
overall rate of treatment emergent adverse events or serious
adverse events leading to withdrawal of study drug.
- There was no serious adverse event (SAE) occurring at a
frequency of >2% which occurred at a numerically higher rate in
the statin plus Vascepa treatment group than in the
statin plus placebo treatment group.
- Adverse events (AEs) occurring in 5% or greater of patients and
more frequently with Vascepa than placebo were: –
peripheral edema (6.5% Vascepa patients versus 5.0%
placebo patients), although there was no increase in the rate of
heart failure in Vascepa patients – constipation
(5.4% Vascepa patients versus 3.6% placebo patients),
although mineral oil, as used as placebo, is known to lower
constipation, and – atrial fibrillation
(5.3% Vascepa patients versus 3.9% placebo patients),
although there were reductions in rates of cardiac arrest, sudden
death and myocardial infarctions observed
in Vascepa patients
- There were numerically more SAEs related to bleeding in the
statin plus Vascepa treatment group although overall
rates were low with no fatal bleeding observed in either group and
no significant difference in adjudicated hemorrhagic stroke or
serious central nervous system or gastrointestinal bleeding events
between treatments.
- In summary, Vascepa was well tolerated with a safety
profile generally consistent with clinical experience associated
with omega-3 fatty acids and current FDA-approved labeling of such
products.
Vascepa has been approved for use by the
United States Food and Drug Administration (FDA) as an adjunct to
diet to reduce triglyceride levels in adult patients with severe
(≥500 mg/dL) hypertriglyceridemia. FDA has not yet opined on a
supplemental new drug application related to REDUCE-IT. FDA has not
reviewed the information herein or determined whether to
approve Vascepa for use to reduce the risk of MACE.
Nothing in this press release should be construed as promoting the
use of Vascepa in any indication that has not been
approved by the FDA.
Important Cautionary Information About These
Data
Further REDUCE-IT data assessment and data
release could yield additional useful information to inform greater
understanding of the trial outcome. For example, detailed data
assessment by regulatory authorities, such as the FDA and
Health Canada, will continue and take several months to complete
and announce. The FDA advisory committee process and the final
evaluation by regulatory authorities of the totality of efficacy
and safety data from REDUCE-IT may include some or all of the
following, as well as other considerations: new information or
analyses affecting the degree of treatment benefit on studied
endpoints; study conduct and data robustness, quality, integrity
and consistency; additional safety data considerations and
risk/benefit considerations; and consideration of REDUCE-IT results
in the context of other clinical studies. Because regulatory
reviews are typically fluid and not definitive interactions between
sponsor and agency on individual elements of an application and
related information, Amarin does not plan to update investors on
ongoing communications with regulatory authorities. Amarin plans to
announce the final outcome of such regulatory reviews when
appropriate.
Forward-Looking Statements
This press release contains forward-looking
statements, including statements about anticipated regulatory
review of the REDUCE-IT sNDA and the outcome of such review and the
potential of Vascepa to improve patient care in millions of
diseased patients. These forward-looking statements are not
promises or guarantees and involve substantial risks and
uncertainties. Among the factors that could cause actual results to
differ materially from those described or projected herein include
the following: uncertainties associated generally with research and
development, clinical trials and related regulatory reviews and
approvals; the risk that data interpretations or other information
from third parties, the regulatory review process, regulatory
authorities and in connection with an advisory committee could be
made public that are negative or may delay approval or limit
Vascepa’s marketability; the risk that special protocol assessment
(SPA) agreements with the FDA are not a guarantee that FDA will
approve a product candidate; the risk associated with the FDA's
rescinding the REDUCE-IT SPA agreement; the risk related to FDA
advisory committee meetings; and the risk that the FDA may not
complete its review of the REDUCE-IT sNDA within the timing
expected. A further list and description of these risks,
uncertainties and other risks associated with an investment in
Amarin can be found in Amarin's filings with the U.S. Securities
and Exchange Commission, including its most recent Quarterly Report
on Form 10-Q. Existing and prospective investors are cautioned not
to place undue reliance on these forward-looking statements, which
speak only as of the date hereof. Amarin undertakes no obligation
to update or revise the information contained in this press
release, whether as a result of new information, future events or
circumstances or otherwise
Availability of Other Information About
Amarin
Investors and others should note that Amarin
communicates with its investors and the public using the company
website (www.amarincorp.com), the investor relations website
(investor.amarincorp.com), including but not limited to investor
presentations and investor FAQs, Securities and Exchange Commission
filings, press releases, public conference calls and webcasts. The
information that Amarin posts on these channels and websites could
be deemed to be material information. As a result, Amarin
encourages investors, the media, and others interested in Amarin to
review the information that is posted on these channels, including
the investor relations website, on a regular basis. This list of
channels may be updated from time to time on Amarin’s investor
relations website and may include social media channels. The
contents of Amarin’s website or these channels, or any other
website that may be accessed from its website or these channels,
shall not be deemed incorporated by reference in any filing under
the Securities Act of 1933.
References
1 American Heart Association. 2018. Disease and Stroke
Statistics-2018 Update.2 American Heart Association. 2017.
Cardiovascular disease: A costly burden for America projections
through 2035.3 Colivicchi F, Vagnarelli F, Caldarola P, et al.
ANMCO Position paper: New perspectives on the role of n-3
polyunsaturated fatty acids in cardiovascular prevention. G Ital
Cardiol 2019; 20 (7): 431-438.4 Bhatt DL. Considerations for
Treating with Icosapent Ethyl. MD Magazine. 2019.5 Block RC,
Liu L, Herrington DM, et al. Predicting Risk for Incident Heart
Failure with Omega-3 Fatty Acids: From MESA. JACC Heart Fail.
2019;(8):651-661.6 Cho IK, Yu J, Hayashi T, et al. Strategies
to Overcome Residual Risk During Statins Era. Circ J. 2019 Aug 6.
doi: 10.1253/circj.CJ-19-0624. [Epub ahead of
print]7 Jones-O'Connor M, Natarajan P. Optimal Non-Invasive
Strategies to Reduce Recurrent Atherosclerotic Cardiovascular
Disease Risk. Curr Treat Options Cardiovasc Med.
2019;21(8):38.8 Sheikh O, Vande Hei AG, Battisha A, et al.
Cardiovascular, electrophysiologic, and hematologic effects of
omega-3 fatty acids beyond reducing hypertriglyceridemia: as it
pertains to the recently published REDUCE-IT trial. Cardiovasc
Diabetol. 2019 Jun 24;18(1):84.9 Baum SJ, Scholz KP. Rounding
the corner on residual risk: Implications of REDUCE-IT for omega-3
polyunsaturated fatty acids treatment in secondary prevention of
atherosclerotic cardiovascular disease. Clin Cardiol. 2019. Epub
ahead of print. DOI: 10.1002/clc.2322010 Granger CB, Nelson
AJ, Pagidipati NJ. Risk of Total Events with Icosapent Ethyl: Can
We Reduce It? J Am Coll Cardiol. 2019;73(22):2803-2805.11 Al
Rifai, M., Jia, X., Al-Mallah, M.H. et al. Major Randomized
Clinical Trials in Cardiovascular Disease Prevention Presented at
the 2019 American College of Cardiology Annual Scientific Session.
Curr Atheroscler Rep (2019) 21: 31.
https://doi.org/10.1007/s11883-019-0789-312 Arman Q, Libby P,
Bhatt DL. Targeting RNA to lower triglycerides: long strides from
short molecules. European Society of Cardiology.
https://doi.org/10.1093/eurheartj/ehz321 13 Tummala R,
Ghosh RK, Jain V, Devanabanda AR, Bandyopadhay D, Deedwania P,
Aronow WS. Fish Oil and Cardiometabolic Diseases: Recent Updates
and Controversies. Am J Med. 2019 May 8. pii:
S0002-9343(19)30392-4. doi: 10.1016/j.amjmed.2019.04.027. Epub
ahead of print.14 Mason RP. Biologic Basis of EPA to Reduce
Atherosclerosis Burden. Reach MD. 2019. 15 Skulas-Ray AC,
Wilson PWF, Harris WS, et al. Omega-3 Fatty Acids for the
Management of Hypertriglyceridemia: A Science Advisory From the
American Heart Association. 2019. 16 American Diabetes
Association. Diabetes Care 2019 Jan; 42(Supplement 1): S103-S123.
https://doi.org/10.2337/dc19-S01017 Bhatt DL, Steg PG, Miller
M, et al. Cardiovascular Risk Reduction with Icosapent Ethyl for
Hypertriglyceridemia. N Engl J
Med 2019;380:11-22.18 Bhatt DL, Steg PG, Miller M, et al.
Effects of Icosapent Ethyl on Total Ischemic Events: From
REDUCE-IT. J Am Coll Cardiol 2019;73(22):2791-2802.19 Ganda
OP, Bhatt DL, Mason RP, et al. Unmet need for adjunctive
dyslipidemia therapy in hypertriglyceridemia management. J Am
Coll Cardiol. 2018;72(3):330-343.20 Budoff M. Triglycerides
and triglyceride-rich lipoproteins in the causal pathway of
cardiovascular disease. Am J Cardiol.
2016;118:138-145.21 Toth PP, Granowitz C, Hull M, et al. High
triglycerides are associated with increased cardiovascular events,
medical costs, and resource use: A real-world administrative claims
analysis of statin-treated patients with high residual
cardiovascular risk. J Am Heart
Assoc. 2018;7(15):e008740.22 Nordestgaard BG.
Triglyceride-rich lipoproteins and atherosclerotic cardiovascular
disease - New insights from epidemiology, genetics, and
biology. Circ Res. 2016;118:547-563.23 Nordestgaard BG,
Varbo A. Triglycerides and cardiovascular
disease. Lancet. 2014;384:626–635.
Amarin Contact Information
Investor Relations Inquiries: Elisabeth Schwartz Investor
Relations Amarin Corporation plc In U.S.: +1 (908) 719-1315
investor.relations@amarincorp.com
Lee M. Stern Solebury Trout In U.S.: +1 (646)
378-2992lstern@soleburytrout.com
Media Inquiries: Gwen Fisher Corporate Communications Amarin
Corporation plc In U.S.: +1 (908) 325-0735
pr@amarincorp.com
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