JAMA Network Open has published “Cost-effectiveness of Icosapent
Ethyl for High-risk Patients With Hypertriglyceridemia Despite
Statin Treatment,”1 which evaluated the more than 8,000 patients
recruited to participate in the REDUCE-IT® (Reduction of
Cardiovascular Events with Icosapent-Ethyl Intervention Trial)
clinical trial. REDUCE-IT was a global cardiovascular outcomes
study designed to assess the cardioprotective efficacy and safety
of VASCEPA® (icosapent ethyl) as an add-on to statin therapy
in reducing major cardiovascular events in a high-risk patient
population.2 The evaluation found that icosapent ethyl (IPE)
yielded more quality-adjusted life years (QALYs) than standard care
both within the trial period and over a lifetime projection.
The design of this evaluation included an in-trial
cost-effectiveness analysis using patient-level study data from
REDUCE-IT, as well as a lifetime analysis using a microsimulation
model and data from published literature. The modeling efforts
employed in the analysis utilized patient-level data, which is a
more detailed and rigorous approach than typical cost-effectiveness
analyses where many assumptions and data from literature are
utilized. The lifetime analysis required modeling to estimate
survival, event rates, adherence, and costs; there is considerable
uncertainty to these values beyond the trial period, although the
model performed well compared with the 4.9-year follow-up
available. The analyses were performed from a U.S. healthcare
sector perspective.
The evaluation looked at the 8,179 patients with
hypertriglyceridemia despite stable statin therapy who were
recruited between 2011 and 2018 for the REDUCE-IT clinical trial.
Patients were randomized to IPE (4 grams per day) plus a statin or
placebo plus a statin and followed a median of 4.9 years. The costs
utilized for IPE in the model included a publicly available SSR
Health net cost of $4.16 per day after rebates, and the wholesale
acquisition cost of $9.28 per day. The evaluation was intended to
measure incremental QALYs, total direct healthcare costs (2019
USD), and cost-effectiveness. The costs used in the study are from
the U.S. healthcare system and cannot be directly applied to other
countries.
“What this study shows us is that for high-risk patients –
despite statin treatment – icosapent ethyl is cost-effective at
commonly accepted willingness-to-pay thresholds,” said lead author
William S. Weintraub, MD, of the MedStar Health Research Institute
at the MedStar Washington (DC) Hospital Center. “A telling
additional finding was that the outcomes data for total events –
first and subsequent – significantly favor IPE compared with
standard of care for cardiovascular death, nonfatal myocardial
infarction, nonfatal stroke, revascularization, and unstable
angina.”
This recent JAMA Network Open paper adds to the body of
knowledge citing the safety, effectiveness, and
cost-effectiveness/value of VASCEPA in the US market.3 In 2019, a
study reported by the Institute for Clinical and Economic Review
(ICER) – an independent non-profit organization that seeks to
improve healthcare value by providing comprehensive clinical and
cost-effectiveness analyses of treatments, tests, and procedures –
reported that IPE is cost-effective in high-risk
populations.4 VASCEPA has also been added to 26 global
guidelines, scientific or consensus statements to reduce
atherosclerotic cardiovascular disease risk in the population
studied in REDUCE-IT.5
“Given the demonstrated efficacy of IPE in high-risk
statin-treated patients that originally came out of the REDUCE-IT
trial, this analysis in JAMA Network Open gives further support
that VASCEPA is a significant addition to our armamentarium against
cardiovascular disease, and we are proud to have
priced VASCEPA to be cost-effective at commonly accepted
willingness-to-pay thresholds,” said Steven Ketchum, PhD, EVP,
Chief Scientific Officer and President, Research & Development
at Amarin.
About Amarin Amarin is an innovative
pharmaceutical company leading a new paradigm in cardiovascular
disease management. From our foundation in scientific research to
our focus on clinical trials, and now our commercial expansion, we
are evolving and growing rapidly. Amarin has offices in
Bridgewater, New Jersey in the United States, Dublin in Ireland,
Zug in Switzerland, and other countries in Europe as well as
commercial partners and suppliers around the world. We are
committed to increasing the scientific understanding of the
cardiovascular risk that persists beyond traditional therapies and
advancing the treatment of that risk.
About Cardiovascular Risk Cardiovascular
disease is the number one cause of death in the world. In the
United States alone, cardiovascular disease results in 859,000
deaths per year6 and the number of deaths in the United States
attributed to cardiovascular disease continues to rise. In
addition, in the United States there are 605,000 new and 200,000
recurrent heart attacks per year (approximately 1 every 40
seconds). Stroke rates are 795,000 per year (approximately 1 every
40 seconds), accounting for 1 of every 19 U.S. deaths. In
aggregate, in the United States alone, there are more than 2.4
million major adverse cardiovascular events per year from
cardiovascular disease or, on average, 1 every 13 seconds.
Controlling bad cholesterol, also known as LDL-C, is one way to
reduce a patient’s risk for cardiovascular events, such as heart
attack, stroke or death. However, even with the achievement of
target LDL-C levels, millions of patients still have significant
and persistent risk of cardiovascular events, especially those
patients with elevated triglycerides. Statin therapy has been shown
to control LDL-C, thereby reducing the risk of cardiovascular
events by 25-35%.7 Significant cardiovascular risk remains after
statin therapy. People with elevated triglycerides have 35% more
cardiovascular events compared to people with normal (in range)
triglycerides taking statins.8,9,10
About REDUCE-IT® REDUCE-IT was a global
cardiovascular outcomes study designed to evaluate the effect of
VASCEPA in adult patients with LDL-C controlled to between 41-100
mg/dL (median baseline 75 mg/dL) by statin therapy and various
cardiovascular risk factors including persistent elevated
triglycerides between 135-499 mg/dL (median baseline 216 mg/dL) and
either established cardiovascular disease (secondary prevention
cohort) or diabetes mellitus and at least one other cardiovascular
risk factor (primary prevention cohort). REDUCE-IT, conducted over
seven years and completed in 2018, followed 8,179 patients at over
400 clinical sites in 11 countries with the largest number of sites
located within the United States. REDUCE-IT was conducted based on
a special protocol assessment agreement with FDA. The design of the
REDUCE-IT study was published in March 2017 in Clinical
Cardiology.11 The primary results of REDUCE-IT were published in
The New England Journal of Medicine in November 2018.12 The total
events results of REDUCE-IT were published in the Journal of the
American College of Cardiology in March 2019.13 These and other
publications can be found in the R&D section on the company’s
website at www.amarincorp.com.
About VASCEPA® (icosapent ethyl)
CapsulesVASCEPA (icosapent ethyl) capsules are the
first-and-only prescription treatment approved by the U.S. Food and
Drug Administration (FDA) comprised solely of the active
ingredient, icosapent ethyl (IPE), a unique form of
eicosapentaenoic acid. VASCEPA was launched in the United States in
January 2020 as the first and only drug approved by the U.S. FDA
for treatment of the studied high-risk patients with persistent
cardiovascular risk after statin therapy. VASCEPA was initially
launched in the United States in 2013 based on the drug’s initial
FDA approved indication for use as an adjunct therapy to diet to
reduce triglyceride levels in adult patients with severe (≥500
mg/dL) hypertriglyceridemia. Since launch, VASCEPA has been
prescribed over ten million times. VASCEPA is covered by most major
medical insurance plans. In addition to the United States, VASCEPA
is approved and sold in Canada, Lebanon and the United Arab
Emirates. In Europe, in March 2021 marketing authorization was
granted to icosapent ethyl in the European Union for the reduction
of risk of cardiovascular events in patients at high cardiovascular
risk, under the brand name VAZKEPA.
Indications and Limitation of Use (in the United
States)
VASCEPA is indicated:
- As an adjunct to maximally tolerated
statin therapy to reduce the risk of myocardial infarction, stroke,
coronary revascularization and unstable angina requiring
hospitalization in adult patients with elevated triglyceride (TG)
levels (≥ 150 mg/dL) and
- established
cardiovascular disease or
- diabetes mellitus
and two or more additional risk factors for cardiovascular
disease.
- As an adjunct to diet to reduce TG
levels in adult patients with severe (≥ 500 mg/dL)
hypertriglyceridemia.
The effect of VASCEPA on the risk for pancreatitis in patients
with severe hypertriglyceridemia has not been determined.
Important Safety Information
- VASCEPA is contraindicated in patients
with known hypersensitivity (e.g., anaphylactic reaction) to
VASCEPA or any of its components.
- VASCEPA was associated with an
increased risk (3% vs 2%) of atrial fibrillation or atrial flutter
requiring hospitalization in a double-blind, placebo-controlled
trial. The incidence of atrial fibrillation was greater in patients
with a previous history of atrial fibrillation or atrial
flutter.
- It is not known whether patients with
allergies to fish and/or shellfish are at an increased risk of an
allergic reaction to VASCEPA. Patients with such allergies should
discontinue VASCEPA if any reactions occur.
- VASCEPA was associated with an
increased risk (12% vs 10%) of bleeding in a double-blind,
placebo-controlled trial. The incidence of bleeding was greater in
patients receiving concomitant antithrombotic medications, such as
aspirin, clopidogrel or warfarin.
- Common adverse reactions in the
cardiovascular outcomes trial (incidence ≥3% and ≥1% more frequent
than placebo): musculoskeletal pain (4% vs 3%), peripheral edema
(7% vs 5%), constipation (5% vs 4%), gout (4% vs 3%), and atrial
fibrillation (5% vs 4%).
- Common adverse reactions in the
hypertriglyceridemia trials (incidence >1% more frequent than
placebo): arthralgia (2% vs 1%) and oropharyngeal pain (1% vs
0.3%).
- Adverse events may be reported by
calling 1-855-VASCEPA or the FDA at 1-800-FDA-1088.
- Patients receiving VASCEPA and
concomitant anticoagulants and/or anti-platelet agents should be
monitored for bleeding.
Key clinical effects of VASCEPA on major adverse cardiovascular
events are included in the Clinical Studies section of the
prescribing information for VASCEPA as set forth below:
Effect of VASCEPA on Time to First
Occurrence of Cardiovascular Events in Patients with
Elevated Triglyceride levels and Other Risk Factors for
Cardiovascular Disease in REDUCE-IT
|
VASCEPA |
Placebo |
VASCEPA vs Placebo |
N = 4089n (%) |
Incidence Rate (per 100 patient
years) |
N = 4090n (%) |
Incidence Rate (per 100 patient
years) |
Hazard Ratio (95% CI) |
Primary composite endpoint |
Cardiovascular death, myocardial infarction, stroke, coronary
revascularization, hospitalization for unstable angina (5-point
MACE) |
705(17.2) |
4.3 |
901(22.0) |
5.7 |
0.75(0.68, 0.83) |
Key secondary composite endpoint |
Cardiovascular death, myocardial infarction, stroke (3-point
MACE) |
459(11.2) |
2.7 |
606(14.8) |
3.7 |
0.74(0.65, 0.83) |
Other secondary endpoints |
Fatal or non-fatal myocardial infarction |
250(6.1) |
1.5 |
355(8.7) |
2.1 |
0.69(0.58, 0.81) |
Emergent or urgent coronary revascularization |
216(5.3) |
1.3 |
321(7.8) |
1.9 |
0.65(0.55, 0.78) |
Cardiovascular death [1] |
174(4.3) |
1.0 |
213(5.2) |
1.2 |
0.80(0.66, 0.98) |
Hospitalization for unstable angina [2] |
108(2.6) |
0.6 |
157(3.8) |
0.9 |
0.68(0.53, 0.87) |
Fatal or non-fatal stroke |
98(2.4) |
0.6 |
134(3.3) |
0.8 |
0.72(0.55, 0.93) |
[1] Includes adjudicated cardiovascular deaths and deaths of
undetermined causality.[2] Determined to be caused by myocardial
ischemia by invasive/non-invasive testing and requiring emergent
hospitalization. |
FULL U.S. FDA-APPROVED VASCEPA
PRESCRIBING INFORMATION CAN BE FOUND
AT WWW.VASCEPA.COM.
Forward-Looking StatementsThis press release
contains forward-looking statements which are made pursuant to the
safe harbor provisions of the Private Securities Litigation Reform
Act of 1995, including beliefs about the world-wide market
potential for VASCEPA (marketed as VAZKEPA in Europe); beliefs that
Amarin has the unique opportunity to lead a new paradigm in
cardiovascular disease management worldwide and beliefs about the
safety, effectiveness and cost effectiveness of VASCEPA. These
forward-looking statements are not promises or guarantees and
involve substantial risks and uncertainties. Amarin's ability to
effectively commercialize VASCEPA and maintain or grow market share
will depend in part on Amarin’s ability to continue to effectively
finance its business, VASCEPA approval in geographies outside the
U.S., efforts of third parties, Amarin’s ability to create and
increase market demand for VASCEPA through education, marketing and
sales activities, to achieve broad market acceptance of VASCEPA, to
receive adequate levels of reimbursement from third-party payers,
to develop and maintain a consistent source of commercial supply at
a competitive price, to comply with legal and regulatory
requirements in connection with the sale and promotion of VASCEPA
and to secure, maintain and defend its patent protection for
VASCEPA. Among the factors that could cause actual results to
differ materially from those described or projected herein include
the following: the possibility that VASCEPA may not receive
regulatory approval in geographies on expected timelines or at all,
the risk that additional generic versions of VASCEPA will enter the
market and that generic versions of VASCEPA will achieve greater
market share and more commercial supply than anticipated; the risk
that the scope and duration of the COVID-19 pandemic will continue
to impact access to and sales of VASCEPA; the risk that Amarin has
overestimated the market potential for VASCEPA in the U.S., Europe
and other geographies; risks associated with Amarin's expanded
enterprise; uncertainties associated generally with research and
development, clinical trials and related regulatory approvals; the
risk that sales may not meet expectations and related cost may
increase beyond expectations; the risk that patents may be
determined to not be infringed or not be valid in patent litigation
and applications may not result in issued patents sufficient to
protect the VASCEPA franchise. 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 Amarin’s quarterly
report on Form 10-Q for the quarter ended September 30, 2021.
Existing and prospective investors are cautioned not to place undue
reliance on these forward-looking statements, which speak only as
of the date they are made. Amarin undertakes no obligation to
update or revise the information contained in its forward-looking
statements, whether as a result of new information, future events
or circumstances or otherwise. Amarin’s forward-looking statements
do not reflect the potential impact of significant transactions the
company may enter into, such as mergers, acquisitions,
dispositions, joint ventures or any material agreements that Amarin
may enter into, amend or terminate. Availability of Other
Information About Amarin communicates with its investors and the
public using the company website (www.amarincorp.com) and the
investor relations website (investor.amarincorp.com), including but
not limited to investor presentations and 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.
Amarin Contact Information
Investor Inquiries: Investor Relations Amarin Corporation plc In
U.S.: +1 (908) 719-1315 IR@amarincorp.com (investor inquiries)
Solebury Trout In U.S.: +1 (646) 378-2992
amarinir@troutgroup.com
Media Inquiries: Communications Amarin Corporation plc In U.S.:
+1 (908) 892-2028 PR@amarincorp.com (media inquiries)
1 JAMA Netw Open. 2022;5(2):e2148172.
doi:10.1001/jamanetworkopen.2021.48172 (accessed February 15, 2022
at
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2789004)2
Bhatt DL, Steg PG, Miller M, et al. Cardiovascular Risk Reduction
with Icosapent Ethyl for Hypertriglyceridemia. N Engl J Med
2019;380:11-22.3 William S Weintraub, MedStar Washington Hosp Ctr,
Washington, DC; Deepak L Bhatt, Brigham and Women's Hosp, Boston,
MA; Zugui Zhang, Christiana Care Health System, Newark, DE et al.,
Cost-Effectiveness of Icosapent Ethyl in REDUCE-IT. Presented at
American Heart Association 2019 Scientific Sessions (November
2019).4
https://icer.org/wp-content/uploads/2020/10/ICER_CVD_Final_Evidence_Report_101719_.pdf5
https://investor.amarincorp.com/static-files/cd8eef19-197e-4114-8612-e0ab7498301e
(slide 10)6 American Heart Association. Heart Disease and Stroke
Statistics—2020 Update: A Report From the American Heart
Association. Circulation. 2020;141:e139-e596.7 Ganda OP, Bhatt DL,
Mason RP, et al. Unmet need for adjunctive dyslipidemia therapy in
hypertriglyceridemia management. J Am Coll Cardiol.
2018;72(3):330-343.8 Budoff M. Triglycerides and triglyceride-rich
lipoproteins in the causal pathway of cardiovascular disease. Am J
Cardiol. 2016;118:138-145.9 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):e008740.10 Nordestgaard BG. Triglyceride-rich
lipoproteins and atherosclerotic cardiovascular disease - New
insights from epidemiology, genetics, and biology. Circ Res.
2016;118:547-563.11 Bhatt DL, Steg PG, Brinton E, et al., on behalf
of the REDUCE-IT Investigators. Rationale and Design of REDUCE-IT:
Reduction of Cardiovascular Events with Icosapent
Ethyl–Intervention Trial. Clin Cardiol. 2017;40:138-148.12 Bhatt
DL, Steg PG, Miller M, et al., on behalf of the REDUCE-IT
Investigators. Cardiovascular Risk Reduction with Icosapent Ethyl
for Hypertriglyceridemia. N Engl J Med. 2019;380:11-22.13 Bhatt DL,
Steg PG, Miller M, et al., on behalf of the REDUCE-IT
Investigators. Reduction in first and total ischemic events with
icosapent ethyl across baseline triglyceride tertiles. J Am Coll
Cardiol. 2019;74:1159-1161.
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