Amarin Highlights Key Data Providing Mechanistic Insights into Eicosapentaenoic Acid (EPA) at ACC.24
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Insights
Understanding the interaction between statins and eicosapentaenoic acid (EPA) has significant implications for cardiovascular health management. The synergistic effect of EPA with high-intensity statin therapy, as indicated by the enhanced expression of detoxification proteins, suggests a potential advancement in reducing oxidative stress. Oxidative stress is a known contributor to endothelial dysfunction, which is a precursor to atherosclerosis and subsequent cardiovascular events.
Moreover, the modulation of proteins that regulate platelet activity and nitric oxide bioavailability is particularly noteworthy. Platelets play a critical role in thrombosis and nitric oxide is essential for vascular homeostasis. Enhancements in these areas could lead to a decrease in atherothrombotic events, which are significant causes of morbidity and mortality among patients with cardiovascular disease.
The findings related to the inhibition of Lipoprotein(a) [Lp(a)] oxidation by EPA provide a promising avenue for treatment strategies, especially considering the limited options currently available for managing elevated Lp(a) levels. The antioxidant properties of EPA could be a valuable addition to the arsenal against cardiovascular disease, potentially lowering the risk for patients with high Lp(a) levels.
The data presented could have a substantial impact on the market positioning of VASCEPA/VAZKEPA, particularly if these findings translate into clinical benefits in ongoing or future outcome trials. The pharmaceutical industry is highly competitive and unique mechanisms of action can differentiate a drug within a crowded market. The potential for VASCEPA/VAZKEPA to offer additive benefits over statin therapy alone could lead to an expansion of its target patient population and increase its market share.
Investors should monitor the progress of these findings through clinical trials and regulatory review processes, as positive results could lead to label expansions and increased prescribing by healthcare professionals. However, it is also important to consider the costs associated with further research and development, as well as the potential for increased marketing expenses to promote these new benefits.
From a financial perspective, the implications for Amarin Corporation's revenue and market capitalization could be significant. Patent protection and exclusivity periods for VASCEPA/VAZKEPA will also be critical factors in determining the long-term financial impact of these findings.
The clinical implications of these studies for practicing cardiologists could be considerable. The potential to enhance the protective effects of statins with EPA could lead to a new standard of care in the management of patients at risk for cardiovascular events. This approach aligns with the current trend towards personalized medicine, where treatments are tailored to the individual characteristics of each patient.
However, it is essential to approach these findings with cautious optimism until they are validated in large-scale clinical trials. As a cardiologist, the safety profile of combined EPA and statin therapy will be of utmost importance, as well as understanding the specific patient populations that may benefit the most from this treatment strategy.
Finally, the impact on healthcare systems and payers will depend on the cost-effectiveness of adding EPA to high-intensity statin therapy. If proven effective, this combination therapy must be accessible and affordable to achieve widespread adoption and improve patient outcomes on a large scale.
Data Further Advance Understanding of VASCEPA®/VAZKEPA® Potential Mechanism of Action
DUBLIN, Ireland and BRIDGEWATER, N.J., April 08, 2024 (GLOBE NEWSWIRE) -- Amarin Corporation plc (NASDAQ:AMRN) today highlighted three data presentations at ACC.24 showcasing the mechanistic activity of Eicosapentaenoic acid (EPA), including the potential effects of EPA on endothelial cell dysfunction and on oxidation of samples enriched with Lp(a).
”The data presented at ACC.24 provide new evidence surrounding the mechanism of action for VASCEPA/VAZKEPA, including the effect of the compound in combination with high-intensity statin on endothelial cell function during inflammation and the compound’s effect on Lp(a) levels,” said R. Preston Mason, Ph.D., Brigham and Women’s Hospital. “These learnings further advance understanding of how EPA and VASCEPA/VAZKEPA work to reduce cardiovascular events in at-risk patients.”
The studies and their key findings are outlined below:
This analysis measured the separate and combined effects of EPA and rosuvastatin on expression of proteins involved in detoxification in vascular endothelial cells under inflammatory conditions with angiotensin II (Ang II).
The combination of EPA and rosuvastatin favorably modulated the expression of proteins related to oxidative stress and detoxification under disease-like conditions. These findings indicate that the net benefits of a high intensity statin and EPA, compared to statin alone, on expression of detoxification proteins during inflammation may contribute to reduced atherothrombotic risk in outcome trials.
In this analysis, investigators compared the separate and combined effects of EPA and rosuvastatin on expression of proteins that regulate platelet signaling and nitric oxide (NO) levels in human umbilical vein endothelial cells (HUVECs) subjected to angiotensin II (Ang II) stimulus.
The combination of EPA and rosuvastatin favorably modulated proteins involved in platelet degranulation and NO bioavailability in HUVECs under inflammatory conditions to a greater extent than their separate treatments. The beneficial effects of a high intensity statin and EPA on endothelial dysfunction may contribute to reduced atherothrombotic risk in outcome trials.
Elevated Lp(a) levels are an independent and causal risk factor for cardiovascular (CV) disease with limited treatments available. Oxidized Lp(a) stimulates foam cell formation, endothelial dysfunction, and inflammation.
In this analysis, investigators tested EPA effects on oxidation of samples enriched with Lp(a) compared to the fully saturated eicosaenoic acid (EA; 20:0) and Trolox, a water-soluble analog of Vitamin E.
Investigators found that EPA inhibited oxidation of Lp(a) enriched plasma in a time-dependent fashion consistent with a free radical scavenging mechanism. The potent antioxidant actions of EPA may contribute to reduced CV events in REDUCE-IT, including among those subjects with elevated Lp(a).
About Amarin
Amarin is an innovative pharmaceutical company leading a new paradigm in cardiovascular disease management. We are committed to increasing the scientific understanding of the cardiovascular risk that persists beyond traditional therapies and advancing the treatment of that risk for patients worldwide. 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.
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.1 The primary results of REDUCE-IT were published in The New England Journal of Medicine in November 2018.2 The total events results of REDUCE-IT were published in the Journal of the American College of Cardiology in March 2019.3 These and other publications can be found in the R&D section on the company’s website at www.amarincorp.com.
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 year.4 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
About VASCEPA®/VAZKEPA® (icosapent ethyl) Capsules
VASCEPA (icosapent ethyl) capsules are the first 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 drug approved by the U.S. FDA for treatment of the studied high-risk patients with persistent cardiovascular risk despite being on 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 more than twenty million times. VASCEPA is covered by most major medical insurance plans. In addition to the United States, VASCEPA is approved and sold in Canada, China, 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. In April 2021 marketing authorization for VAZKEPA (icosapent ethyl) was granted in Great Britain (applying to England, Scotland and Wales). VAZKEPA (icosapent ethyl) is currently approved and sold in Europe in Sweden, Denmark, Finland, Austria, the UK, Spain and the Netherlands.
United States
Indications and Limitation of Use
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% vs2% ) 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% vs10% ) 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% vs3% ), peripheral edema (7% vs5% ), constipation (5% vs4% ), gout (4% vs3% ), and atrial fibrillation (5% vs4% ). - Common adverse reactions in the hypertriglyceridemia trials (incidence >
1% more frequent than placebo): arthralgia (2% vs1% ) and oropharyngeal pain (1% vs0.3% ). - 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.
FULL U.S. FDA-APPROVED VASCEPA PRESCRIBING INFORMATION CAN BE FOUND AT WWW.VASCEPA.COM.
Europe
For further information about the Summary of Product Characteristics (SmPC) for VAZKEPA® in Europe, please click here.
Globally, prescribing information varies; refer to the individual country product label for complete information.
Forward-Looking Statements
This 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 potential for VASCEPA (marketed as VAZKEPA in Europe); beliefs about icosapent ethyl (IPE)’s role concerning appropriate patients suffering from cardiovascular disease (CVD) and potential population health impact, as well as general beliefs about the safety and effectiveness of VASCEPA. These forward-looking statements are not promises or guarantees and involve substantial risks and uncertainties. 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 annual report on Form 10-K for the full year ended 2023. 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 (amarincorp.com/investor-relations), 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 & Media Inquiries:
Mark Marmur
Amarin Corporation plc
PR@amarincorp.com
Investor.relations@amarincorp.com
_____________________________________________________________
1 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.
2 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
3 Bhatt DL, Steg PG, Miller M, et al., on behalf of the REDUCE-IT Investigators. Effects of Icosapent Ethyl on Total Ischemic Events: From REDUCE-IT. J Am Coll Cardiol. 2019;73:2791-2802.
4 American Heart Association. Heart Disease and Stroke Statistics—2020 Update: A Report From the American Heart Association. Circulation. 2020;141:e139-e596.
5 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.
6 Budoff M. Triglycerides and triglyceride-rich lipoproteins in the causal pathway of cardiovascular disease. Am J Cardiol. 2016;118:138-145.
7 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.
8 Nordestgaard BG. Triglyceride-rich lipoproteins and atherosclerotic cardiovascular disease - New insights from epidemiology, genetics, and biology. Circ Res. 2016;118:547-563
FAQ
What did Amarin plc (AMRN) highlight at ACC.24?
What were the key findings of the analysis on EPA and a High Intensity Statin in endothelial cells?
How did EPA and Rosuvastatin affect endothelial proteins and platelet activity?
What was the impact of EPA on Lipoprotein(a) oxidation in vitro?
