Merck (NYSE: MRK), known as MSD outside of the United States and Canada, today announced the initiation of the company’s Phase 3 clinical program, CORALreef, for MK-0616, an investigational, oral proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor, being evaluated for the treatment of adults with hypercholesterolemia. This is the first Phase 3 clinical program for an oral PCSK9 inhibitor. The first participants are now enrolling in two registrational Phase 3 studies evaluating low-density lipoprotein (LDL) cholesterol reduction: CORALreef Lipids and CORALreef HeFH. Merck also plans to initiate a Phase 3 cardiovascular outcomes study, CORALreef Outcomes by the end of 2023.
PCSK9 is a validated target for lowering LDL cholesterol. However, there are no oral PCSK9 inhibitors available to physicians and patients. The Phase 3 CORALreef program follows robust Phase 2b results presented at ACC.23/WCC, in which MK-0616 significantly reduced LDL cholesterol compared to placebo at all doses studied in participants with hypercholesterolemia with a broad spectrum of atherosclerotic cardiovascular disease (ASCVD) risk, including participants on high-intensity statin therapy. MK-0616 was generally well-tolerated.
“Elevated LDL cholesterol is a major risk factor for cardiovascular disease, the leading cause of death worldwide. Despite several well-established lipid-lowering therapies, millions of people globally do not achieve and maintain their desired LDL cholesterol treatment goals, leaving them at risk for cardiac events,” said Dr. Marc Sabatine, Chair of the Thrombolysis in Myocardial Infarction (TIMI) Study Group, the Lewis Dexter, MD, Distinguished Chair in Cardiovascular Medicine at Brigham and Women’s Hospital, and a Professor of Medicine at Harvard Medical School. “MK-0616 showed statistically significant LDL cholesterol lowering activity in the Phase 2 trial and has the unique aspect of being a once daily pill. With its novel modality among PCSK9 inhibitors, MK-0616 could provide an important option for patients for the treatment of hypercholesterolemia.”
“The initiation of a comprehensive Phase 3 program is an important milestone in our goal to offer a highly effective oral medication that could be accessed by a broad population and potentially allow substantially more people to reach their LDL treatment goals,” said Dr. Joerg Koglin, senior vice president, global clinical development, Merck Research Laboratories. “In acknowledgment of the significant racial, ethnic and gender disparities in cardiovascular care, Merck is taking proactive measures to engage potential participants from populations that have historically been underrepresented in clinical trials of this type.”
CORALreef Lipids (NCT05952856) is a randomized, double-blind study enrolling a broad group of participants, including participants with history of at least one major ASCVD event and those at intermediate to high risk for a first event. Participants must be treated with stable lipid lowering therapies, including at least a moderate or high intensity statin, or have documented statin intolerance. The primary objective of this study is to evaluate the efficacy of MK-0616 compared with placebo on the mean percent change from baseline in LDL cholesterol at Week 24. Participants will receive 20 mg of MK-0616 orally once daily for up to 52 weeks or placebo, on top of their background lipid lowering therapies.
CORALreef HeFH (NCT05952869) is a similar study, focused on adult participants with heterozygous familial hypercholesterolemia, who are being treated with stable lipid lowering therapies, including at least a moderate or high intensity statin. The estimated primary completion date for CORALreef Lipids and CORALreef HeFH studies is September 2025.
CORALreef Outcomes (TIMI 77) (NCT06008756) is a randomized, double-blind study in adult participants with high cardiovascular risk, who are being treated with stable lipid lowering therapies, including at least a moderate or high intensity statin. The primary objective is to evaluate the efficacy of MK-0616 compared with placebo, on top of background lipid lowering therapies, in increasing the time to the first occurrence of one of the following events: coronary heart disease death, ischemic stroke, myocardial infarction, acute limb ischemia or major amputation, or urgent arterial revascularization. Merck is collaborating with the TIMI Study Group, a leading academic research organization for cardiovascular clinical trials, on the CORALreef Outcomes study. The estimated primary completion date is November 2029.
Merck’s broad, global Phase 3 program for MK-0616 aims to enroll approximately 17,000 participants across the CORALreef Lipids, CORALreef HeFH and CORALreef Outcomes studies.
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