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Dual PCSK9 Inhibition With Inclisiran and Alirocumab in Secondary Prevention (PCSK9-DUO)

28. Mai 2026 aktualisiert von: University Medical Centre Ljubljana

PCSK9-DUO Trial: Dual PCSK9 Inhibition With Inclisiran and Alirocumab in Patients With High Cardiovascular Risk in Secondary Prevention

This study will evaluate the effectiveness and safety of combining two different types of PCSK9 inhibitors, inclisiran and alirocumab, in patients with high cardiovascular risk who are unable to tolerate statins.

Lowering low-density lipoprotein cholesterol (LDL-C) is essential to reduce the risk of cardiovascular events. While PCSK9 inhibitors are effective, many patients treated with a single agent do not reach recommended LDL-C targets, especially those who cannot take statins.

Inclisiran and alirocumab reduce LDL-C through different mechanisms. Inclisiran decreases the production of PCSK9 in the liver, while alirocumab binds circulating PCSK9 in the blood. Combining these therapies may lead to a greater reduction in LDL-C levels.

In this randomized, open-label clinical trial, approximately 60 patients in secondary prevention will be assigned to one of three groups: inclisiran alone, alirocumab alone, or a combination of both treatments. Patients will be followed for 9 months with regular clinical and laboratory assessments.

The main goal of the study is to determine whether combination therapy leads to greater LDL-C reduction compared to each treatment alone. Secondary objectives include assessing the proportion of patients achieving target LDL-C levels and evaluating treatment safety and tolerability.

Studienübersicht

Status

Rekrutierung

Bedingungen

Intervention / Behandlung

Detaillierte Beschreibung

Atherosclerotic cardiovascular disease remains a leading cause of morbidity and mortality, with elevated low-density lipoprotein cholesterol (LDL-C) being a major modifiable risk factor. Despite the availability of effective lipid-lowering therapies, a substantial proportion of high-risk patients fail to achieve recommended LDL-C targets, particularly those with statin intolerance.

Proprotein convertase subtilisin/kexin type 9 (PCSK9) plays a key role in regulating LDL receptor degradation and plasma LDL-C levels. Pharmacological inhibition of PCSK9 has emerged as an effective strategy to reduce LDL-C. Two distinct therapeutic approaches are currently available: monoclonal antibodies (such as alirocumab), which neutralize circulating PCSK9, and small interfering RNA therapies (such as inclisiran), which reduce hepatic production of PCSK9.

Although both approaches have demonstrated efficacy, real-world data suggest that monotherapy may not be sufficient for many high-risk patients. The combination of these two mechanisms may provide additive or synergistic effects, leading to more profound LDL-C reduction.

This study is designed as a prospective, randomized, open-label, monocentric clinical trial. Approximately 60 adult patients in secondary prevention with statin intolerance and elevated LDL-C (2.5-5.0 mmol/L) will be enrolled. Participants will be randomized in a 1:1:1 ratio to receive inclisiran, alirocumab, or a combination of both therapies.

Inclisiran will be administered subcutaneously at baseline and at 3 months. Alirocumab will be administered subcutaneously at a dose of 300 mg every 4 weeks in a supervised clinical setting. Patients will be followed for 9 months, with study visits at baseline, 1 month, 3 months, 6 months, and 9 months.

The primary endpoint is the percentage change in LDL-C from baseline at 3 and 9 months. Secondary endpoints include the proportion of patients achieving guideline-recommended LDL-C targets, changes in other lipid parameters, and safety outcomes including adverse events and treatment tolerability.

This study aims to provide proof-of-concept evidence on the effectiveness and safety of dual PCSK9 inhibition using complementary mechanisms, with potential implications for improving lipid management in high-risk, statin-intolerant patients.

Studientyp

Interventionell

Einschreibung (Geschätzt)

60

Phase

  • Phase 4

Kontakte und Standorte

Dieser Abschnitt enthält die Kontaktdaten derjenigen, die die Studie durchführen, und Informationen darüber, wo diese Studie durchgeführt wird.

Studienkontakt

Studieren Sie die Kontaktsicherung

Studienorte

      • Ljubljana, Slowenien, 1000
        • Rekrutierung
        • University Medical Centre Ljubljana
        • Kontakt:
        • Kontakt:
        • Hauptermittler:
          • Jan Kafol, MD
        • Unterermittler:
          • Zlatko Fras, MD, PhD
        • Unterermittler:
          • Borut Jug, MD, PhD
        • Unterermittler:
          • Marko Novakovic, MD, PhD

Teilnahmekriterien

Forscher suchen nach Personen, die einer bestimmten Beschreibung entsprechen, die als Auswahlkriterien bezeichnet werden. Einige Beispiele für diese Kriterien sind der allgemeine Gesundheitszustand einer Person oder frühere Behandlungen.

Zulassungskriterien

Studienberechtigtes Alter

  • Erwachsene
  • Älterer Erwachsener

Akzeptiert gesunde Freiwillige

Nein

Beschreibung

Inclusion Criteria:

  • Adults aged ≥18 years
  • Established atherosclerotic cardiovascular disease (secondary prevention), defined as prior cardiovascular events or imaging-confirmed atherosclerosis (e.g., coronary artery disease on angiography or CT, carotid plaque on ultrasound, or peripheral arterial disease).
  • Eligible for PCSK9 inhibitor therapy according to national clinical criteria
  • Fasting LDL cholesterol ≥2.5 mmol/L and ≤5.0 mmol/L at screening
  • Documented statin intolerance or contraindication to statin therapy
  • On stable background lipid-lowering therapy (including ezetimibe if applicable) for at least 4 weeks prior to enrollment
  • Able and willing to provide written informed consent

Exclusion Criteria:

  • Eligibility for PCSK9 inhibitor therapy solely based on elevated lipoprotein(a) >1000 mg/L with LDL-C below inclusion threshold
  • Prior use of any PCSK9 inhibitor (alirocumab, evolocumab or inclisiran) before enrollment
  • Planned initiation or modification of lipid-lowering therapy during the study period
  • Known homozygous familial hypercholesterolemia
  • Active liver disease or alanine aminotransferase (ALT) or aspartate aminotransferase (AST) >3× upper limit of normal
  • Severe renal impairment (eGFR <30 mL/min/1.73 m²)
  • Active malignancy or life expectancy <1 year
  • Pregnancy, breastfeeding, or women of childbearing potential not using effective contraception
  • Known hypersensitivity to inclisiran, alirocumab, or any of their excipients
  • Participation in another interventional clinical trial within 30 days prior to enrollment
  • Any condition that, in the opinion of the investigator, would interfere with study participation or interpretation of results

Studienplan

Dieser Abschnitt enthält Einzelheiten zum Studienplan, einschließlich des Studiendesigns und der Messung der Studieninhalte.

Wie ist die Studie aufgebaut?

Designdetails

  • Hauptzweck: Behandlung
  • Zuteilung: Zufällig
  • Interventionsmodell: Parallele Zuordnung
  • Maskierung: Keine (Offenes Etikett)

Waffen und Interventionen

Teilnehmergruppe / Arm
Intervention / Behandlung
Experimental: Inclisiran
Participants receive inclisiran 284 mg administered subcutaneously at baseline and at 3 months. Patients will be followed for 9 months with scheduled clinical and laboratory assessments.
Participants receive inclisiran 284 mg administered subcutaneously at baseline (Day 0) and at Month 3.
Experimental: Alirocumab
Participants receive alirocumab 300 mg administered subcutaneously every four weeks in a supervised clinical setting for 9 months. Patients will be followed with regular clinical and laboratory assessments.
Participants receive alirocumab 300 mg administered subcutaneously every four weeks in a supervised clinical setting for 9 months.
Experimental: Inclisiran Plus Alirocumab
Participants receive inclisiran 284 mg administered subcutaneously at baseline and at 3 months, in combination with alirocumab 300 mg administered subcutaneously every four weeks in a supervised clinical setting for 9 months. Patients will be followed with scheduled clinical and laboratory assessments.
Participants receive inclisiran 284 mg administered subcutaneously at baseline (Day 0) and at Month 3.
Participants receive alirocumab 300 mg administered subcutaneously every four weeks in a supervised clinical setting for 9 months.

Was misst die Studie?

Primäre Ergebnismessungen

Ergebnis Maßnahme
Maßnahmenbeschreibung
Zeitfenster
Percent Change in LDL-C From Baseline
Zeitfenster: 3 months and 9 months
Percent change in low-density lipoprotein cholesterol (LDL-C) from baseline at 3 months and 9 months, comparing inclisiran, alirocumab, and combination therapy.
3 months and 9 months

Sekundäre Ergebnismessungen

Ergebnis Maßnahme
Maßnahmenbeschreibung
Zeitfenster
Trajectory of Percent Change in LDL-C From Baseline
Zeitfenster: 1, 3, 6, and 9 months
Percent change in LDL-C from baseline at each scheduled follow-up visit to assess early response and durability of treatment effect.
1, 3, 6, and 9 months
Proportion of Participants Achieving LDL-C <1.4 mmol/L
Zeitfenster: 1, 3, 6, and 9 months
Proportion of participants achieving LDL-C below 1.4 mmol/L at each scheduled follow-up visit.
1, 3, 6, and 9 months
Change in Apolipoprotein B From Baseline
Zeitfenster: 1, 3, 6, and 9 months
Absolute and percent change in apolipoprotein B from baseline.
1, 3, 6, and 9 months
Change in Non-HDL Cholesterol From Baseline
Zeitfenster: 1, 3, 6, and 9 months
Absolute and percent change in non-HDL cholesterol from baseline.
1, 3, 6, and 9 months
Change in Lipoprotein(a) From Baseline
Zeitfenster: 1, 3, 6, and 9 months
Absolute and percent change in lipoprotein(a) from baseline.
1, 3, 6, and 9 months
Incidence of Adverse Events
Zeitfenster: Up to 9 months
Number and proportion of participants experiencing any adverse event during the study.
Up to 9 months
Treatment Discontinuation Due to Adverse Events
Zeitfenster: Up to 9 months
Proportion of participants who discontinue assigned study treatment because of adverse events.
Up to 9 months
Change in Circulating PCSK9 Concentration From Baseline
Zeitfenster: 1, 3, 6, and 9 months
Absolute and percent change in circulating PCSK9 concentration to assess pharmacodynamic effects of treatment.
1, 3, 6, and 9 months
Change From Baseline in LDL-C Concentration
Zeitfenster: 1, 3, 6, and 9 months
Absolute change in LDL-C concentration compared with baseline at each scheduled follow-up visit.
1, 3, 6, and 9 months
Change From Baseline in Total Cholesterol, HDL Cholesterol, and Triglyceride Concentrations
Zeitfenster: 1, 3, 6, and 9 months
Change in serum total cholesterol, HDL cholesterol, and triglyceride concentrations compared with baseline values.
1, 3, 6, and 9 months

Andere Ergebnismessungen

Ergebnis Maßnahme
Maßnahmenbeschreibung
Zeitfenster
Incidence of Injection-Site Reactions
Zeitfenster: Up to 9 months
Number and proportion of participants experiencing injection-site reactions.
Up to 9 months
Treatment Adherence
Zeitfenster: Up to 9 months
Adherence to assigned therapy assessed by documented administration of inclisiran and alirocumab.
Up to 9 months
Major Adverse Cardiovascular Events
Zeitfenster: Up to 9 months
Exploratory assessment of cardiovascular death, myocardial infarction, stroke, urgent coronary revascularization, or hospitalization for unstable angina.
Up to 9 months

Mitarbeiter und Ermittler

Hier finden Sie Personen und Organisationen, die an dieser Studie beteiligt sind.

Sponsor

Ermittler

  • Studienstuhl: Zlatko Fras, MD, PhD, University Medical Centre Ljubljana
  • Hauptermittler: Jan Kafol, MD, University Medical Centre Ljubljana

Publikationen und hilfreiche Links

Die Bereitstellung dieser Publikationen erfolgt freiwillig durch die für die Eingabe von Informationen über die Studie verantwortliche Person. Diese können sich auf alles beziehen, was mit dem Studium zu tun hat.

Allgemeine Veröffentlichungen

Studienaufzeichnungsdaten

Diese Daten verfolgen den Fortschritt der Übermittlung von Studienaufzeichnungen und zusammenfassenden Ergebnissen an ClinicalTrials.gov. Studienaufzeichnungen und gemeldete Ergebnisse werden von der National Library of Medicine (NLM) überprüft, um sicherzustellen, dass sie bestimmten Qualitätskontrollstandards entsprechen, bevor sie auf der öffentlichen Website veröffentlicht werden.

Haupttermine studieren

Studienbeginn (Tatsächlich)

18. Mai 2026

Primärer Abschluss (Geschätzt)

1. Mai 2027

Studienabschluss (Geschätzt)

1. Juni 2027

Studienanmeldedaten

Zuerst eingereicht

5. Mai 2026

Zuerst eingereicht, das die QC-Kriterien erfüllt hat

5. Mai 2026

Zuerst gepostet (Tatsächlich)

12. Mai 2026

Studienaufzeichnungsaktualisierungen

Letztes Update gepostet (Tatsächlich)

2. Juni 2026

Letztes eingereichtes Update, das die QC-Kriterien erfüllt

28. Mai 2026

Zuletzt verifiziert

1. Mai 2026

Mehr Informationen

Begriffe im Zusammenhang mit dieser Studie

Andere Studien-ID-Nummern

  • UKC-PCSK9-DUO

Plan für individuelle Teilnehmerdaten (IPD)

Planen Sie, individuelle Teilnehmerdaten (IPD) zu teilen?

JA

Beschreibung des IPD-Plans

De-identified individual participant data (IPD) underlying the results reported in this study will be made available upon reasonable request to qualified researchers. Data sharing will be subject to approval by the study investigators and institutional policies, and will require a data use agreement to ensure appropriate use and protection of participant confidentiality.

IPD-Sharing-Zeitrahmen

Individual participant data and supporting documents will be available beginning 6 months following publication of the primary results and ending 5 years after publication.

IPD-Sharing-Zugriffskriterien

De-identified individual participant data, study protocol, statistical analysis plan, and informed consent form will be made available to qualified researchers who provide a methodologically sound research proposal. Data access will be subject to approval by the study investigators and the sponsoring institution. A data use agreement will be required to ensure appropriate use of the data and protection of participant confidentiality. Requests for access should be directed to the principal investigator.

Art der unterstützenden IPD-Freigabeinformationen

  • STUDIENPROTOKOLL
  • SAFT
  • ICF

Arzneimittel- und Geräteinformationen, Studienunterlagen

Studiert ein von der US-amerikanischen FDA reguliertes Arzneimittelprodukt

Nein

Studiert ein von der US-amerikanischen FDA reguliertes Geräteprodukt

Nein

Produkt, das in den USA hergestellt und aus den USA exportiert wird

Nein

Diese Informationen wurden ohne Änderungen direkt von der Website clinicaltrials.gov abgerufen. Wenn Sie Ihre Studiendaten ändern, entfernen oder aktualisieren möchten, wenden Sie sich bitte an register@clinicaltrials.gov. Sobald eine Änderung auf clinicaltrials.gov implementiert wird, wird diese automatisch auch auf unserer Website aktualisiert .