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HPS2-THRIVE: Eligibility
Men and women
Aged 50-80 years
Prior history of: myocardial infarction;
ischaemic stroke or TIA;
peripheral arterial disease; or
diabetes with other CHD
No contra-indication to study treatments
No significant liver, kidney or muscle disease
Randomization
(25,673)
Placebo
(12,835)
Men
83%
83%
21,229 (83%)
Age (years)
64.9
64.9
64.9 (7.5)
Coronary
78%
78%
20,137 (78%)
Cerebrovascular
32%
32%
8170 (32%)
Peripheral arterial
13%
12%
3214 (13%)
Diabetes
32%
32%
8299 (32%)
% or mean (SD)
All
Prior disease
128 (22)
3.32 (0.57)
Direct-LDL
63 (17)
1.64 (0.44)
HDL
44 (11)
1.14 (0.29)
125 (74)
1.43 (0.84)
Triglycerides*
Placebo
(12,835)
Excess
16.4%
7.9%
8.5%
Skin
5.4%
1.2%
4.2%
Gastrointestinal
3.9%
1.7%
2.1%
Musculoskeletal
1.8%
1.0%
0.8%
Diabetes-related
0.9%
0.4%
0.5%
Liver
0.4%
0.3%
0.1%
Other
4.1%
3.3%
0.8%
Any non-medical
8.9%
8.7%
0.3%
Any reason
25.4%
16.6%
8.7%
Any medical
3.7% <0.0001
1.8% <0.0001
Infection
1.4% <0.0001
Gastrointestinal
1.0% <0.0001
Musculoskeletal
ERN/LRPT
Active
0.7%
0.0008
Placebo
0.4%
0.05
Bleeding
0.7%
0.0002
Skin
0.3%
0.0026
Heart failure
4
6
8
Percentage of patients
10
12
ERN/LRPT Placebo
8.7%
1.0%
1.1%
1.1%
5.8%
0.3%
0.7%
1.2%
1.55 (1.32-1.82)
3.09 (1.81-5.27)
1.50 (0.96-2.35)
0.93 (0.62-1.40)
460
(11.1%)
311
(7.5%)
1.55 (1.34-1.78)
792
(9.1%)
632
(7.3%)
1.27 (1.14-1.41)
Musculoskeletal
Myopathy
Gout
Other
Any musculoskeletal SAE
Skin
Rash
Ulcer
Other
Any skin SAE
ERN/LRPT
(12,838)
Placebo
(12,835)
0.8%
1.9%
0.9%
1.0%
0.6%
1.4%
0.7%
1.0%
1.53 (1.14-2.05)
1.37 (1.13-1.65)
1.39 (1.06-1.83)
0.99 (0.77-1.27)
620
(4.8%)
491
(3.8%)
1.28 (1.13-1.44)
0.6%
0.3%
2.9%
0.1%
0.2%
2.7%
4.43 (2.62-7.50)
1.91 (1.16-3.15)
1.08 (0.93-1.25)
481
(3.7%)
385
(3.0%)
1.26 (1.10-1.44)
0.4%
0.2%
0.1%
0.3%
0.1%
0.0%
1.63 (1.07-2.48)
1.61 (0.82-3.14)
2.59 (1.05-6.37)
86
(0.7%)
51
(0.4%)
1.67 (1.20-2.34)
ERN/LRPT
(12,838)
4.3%
0.9%
0.6%
0.5%
2.4%
3.7%
0.8%
0.5%
0.3%
1.7%
1.17 (1.03-1.32)
1.07 (0.82-1.39)
1.26 (0.91-1.75)
1.66 (1.14-2.43)
1.38 (1.16-1.63)
1031
(8.0%)
853
(6.6%)
1.22 (1.12-1.34)
0.8%
1.1%
0.6%
0.6%
0.9%
0.4%
1.53 (1.14-2.05)
1.17 (0.92-1.50)
1.66 (1.18-2.34)
326
(2.5%)
238
(1.9%)
1.38 (1.17-1.62)
LDL-C
(mg/dL)
HDL-C
(mg/dL)
-12
-35
-7
-31
-10
-33
(-0.25)
(0.16)
-0.37
STUDY AVERAGE
(mmol/L)
Triglycerides
(mg/dL)
Proportional
reduction in risk
<0.01
8%
9%
10%
12%
67%
78%
86%
96%
43%
56%
68%
87%
20
15
15.0%
14.5%
10
Placebo
ERN/LRPT
Years of follow-up
Randomized allocation
ERN/LRPT Placebo
(12838)
(12835)
Non-fatal MI
Coronary death
0.93 (0.82-1.07)
1.04 (0.89-1.22)
0.33
0.63
0.96 (0.87-1.07)
0.51
Ischaemic stroke
Haemorrhagic stroke
0.94 (0.82-1.08)
1.28 (0.97-1.69)
0.37
0.08
Any stroke
1.00 (0.88-1.13)
0.56
Coronary revasc
Non-coronary revasc
0.89 (0.80-0.99)
0.92 (0.77-1.09)
0.04
0.33
Any revascularization
0.90 (0.82-0.99)
0.03
0.96 (0.90-1.03)
0.29
0.8
ERN/LRPT better
1.0
1.2
Placebo better
Randomized allocation
ERN/LRPT
Placebo
(12,838)
(12,835)
Het or trend
(uncorrected p value)
0.00
(p=0.98)
Sex
Male
Female
3.21
(p=0.07)
Region
Europe
China
3.61
(p=0.06)
Statin-based therapy
Simvastatin 40mg
Ezetimibe/simvastatin
1.28
(p=0.26)
All
3.5% SE 3.3
reduction
LDL-C
HDL-C
Age (years)
<65
65 <70
70
12,932
5624
7117
-10
-11
-8
5
7
7
Sex
Male
Female
21,229
4444
-10
-8
6
7
Region
Europe
China
14,741
10,932
-12
-7
7
5
Statin-based therapy
Simvastatin 40mg
Ezetimibe/simvastatin
13,542
12,131
-8
-12
6
7
All
25,673
-10
Het or trend
Risk ratio & 95% CI (uncorrected p value)
0.00
(p=0.96)
Cerebrovascular disease
Yes
616 (15.2%) 656 (16.0%)
No
1080 (12.3%) 1102 (12.6%)
0.10
(p=0.75)
1.66
(p=0.20)
Diabetes mellitus
Yes
No
0.00
(p=0.98)
All
3.5% SE 3.3
reduction
0.8
1.0
1.2
LDL-C
HDL-C
20,137
5536
-10
-10
6
7
Cerebrovascular disease
Yes
No
8170
17,503
-9
-10
6
7
-11
-9
7
6
Diabetes mellitus
Yes
No
8299
17,374
-8
-10
7
6
All
25,673
-10
Randomized allocation
ERN/LRPT Placebo
(12838)
(12835)
HDL cholesterol
<35 (0.9)
35 <43
43 (1.1)
0.20
(p=0.66)
LDL cholesterol
<58 (1.5)
58 <77
77 (2.0)
5.91
(p=0.02)
Triglycerides
<89 (1.0)
89 <151
151 (1.7)
All
Het or trend
(uncorrected p value)
0.66
(p=0.42)
3.5% SE 3.3
reduction
0.8
1.0
1.2
Patients
LDL-C
HDL-C
HDL cholesterol
<35 (0.9)
35 <43
43 (1.1)
4900
8135
12,638
-7
-9
-11
5
6
7
LDL cholesterol
<58 (1.5)
58 <77
77 (2.0)
9860
11,054
4759
-7
-10
-15
6
6
7
Triglycerides
<89 (1.0)
89 <151
151 (1.7)
8297
10,801
6575
-9
-10
-10
6
6
6
All
25,673
-10
Coronary
Other cardiac
Stroke
Other vascular
Vascular
Neoplastic
Hepatic
Other medical
Non-medical
Unknown
Non-vascular
Any cause
0.8
1.0
1.2
HPS2-THRIVE: SUMMARY
Significant excesses of serious adverse events (SAEs) due to
known and unrecognised side-effects of niacin. Over 4 years,
ER niacin/laropiprant caused SAEs in ~30 patients per 1000
No significant benefit of ER niacin/laropiprant on the primary
outcome of major vascular events when added to effective
statin-based LDL-lowering therapy
No clear evidence of differences in efficacy or safety in
different types of patient (except for an excess of statinrelated myopathy in Chinese patients)
www.ctsu.ox.ac.uk/thrive
Back up slides
113
140
27
23
208
40
88
Any cancer*
Non-melanoma skin
Recurrence of pre-rand
cancer
0.8
* Excluding non-melanoma skin cancer.
ERN/LRPT better
1.0
1.2
Placebo better
0.67
ERN/LRPT
(12838)
Placebo
(12835)
Het or trend
522 (16.9%)
478 (11.7%)
291 (10.9%)
405 (13.5%)
520
467
316
455
(uncorrected p value)
0.00
(p=0.95)
(16.8%)
(11.5%)
(11.8%)
(15.2%)
2.88
(p=0.09)
3.5% SE 3.3
reduction
0.8
1.0
1.2
Placebo
(12,835)
Het or trend
(uncorrected p value)
399 (16.3%)
546 (13.5%)
813 (12.8%)
0.20
(p=0.66)
679 (13.8%)
761 (13.7%)
318 (13.5%)
5.91
(p=0.02)
592 (14.7%)
565 (13.3%)
601 (13.2%)
3.58
(p=0.06)
609 (14.2%)
597 (13.4%)
552 (13.4%)
0.03
(p=0.86)
All
3.5% SE 3.3
reduction
1.0