Kowa Pharmaceuticals America, Inc., a pharmaceutical company specializing primarily in the area of cardiometabolic diseases, and Eli Lilly and Company have announced the results of the PREVAIL US study (Pitavastatin compaREd with praVAstatin In Lowering LDL-C in the US) which evaluated the efficacy of Livalo (pitavastatin) 4 mg compared with pravastatin 40 mg in reducing low-density lipoprotein cholesterol (LDL-C), the primary endpoint, as well as effects on other lipid parameters and lipoprotein particles in adult patients with primary hyperlipidemia or mixed dyslipidemia.

Study results were presented during two poster sessions at the National Lipid Association's (NLA) Scientific Sessions in Scottsdale, Arizona.

PREVAIL US was designed as a superiority trial for the primary endpoint, LDL-C reduction, and evaluated the adult population age 18-80 with primary hyperlipidemia or mixed dyslipidemia. Livalo 4 mg showed superior LDL-C reduction compared with pravastatin 40 mg after 12 weeks of therapy. The study did not compare Livalo 4 mg with pravastatin 80 mg.

Data for secondary endpoints showed LIVALO 4 mg reduced apolipoprotein B (Apo-B), non-HDL-C, and total cholesterol compared with pravastatin 40 mg and improved high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG).1 In addition, the effect of LIVALO and pravastatin on individual lipoprotein particles was evaluated as a pre-specified exploratory analysis using nuclear magnetic resonance (NMR) spectroscopy. LIVALO showed significantly greater reductions in total LDL particle (LDL-P) concentration and increases in HDL particle (HDL-P) concentration and size.

“We are very pleased with the results of PREVAIL US, which are consistent with previous trials evaluating Livalo's effect on LDL-C reduction,” said Dr Craig Sponseller, vice president of Medical Affairs at Kowa Pharmaceuticals America, Inc. “Although the clinical relevance of these data require further study, these data are important as they represent the first of such particle analysis with Livalo.”

PREVAIL US study investigator, Dr Kari Uusinarkaus, Fellow of the National Lipid Association, and associate medical director, Adult Primary Care and Disease Management Departments, Colorado Springs Health Partners, explains, “We continue to research and pursue a greater understanding on the effect of lipid-modifying agents, particularly statins, on lipoprotein particles and the use of direct measures of particle number and size in advancing our clinical assessment of dyslipidemia and its treatment.”

In the 12-week, phase IV, multi-centre, randomized, double-blind study, 328 adults meeting the established profile for inclusion were randomly assigned to receive once-daily morning doses of Livalo 4 mg or pravastatin 40 mg. Full lipid panels and lipoprotein particle assessments using nuclear magnetic resonance (NMR) were performed on blood samples drawn on Day 1 and following the final dose at 12 weeks.

The data were presented in two posters at the NLA meeting. In the first poster, "Pitavastatin 4 mg is Superior to Pravastatin 40 mg in LDL-C Reduction: Results from PREVAIL US Trial in Primary Hyperlipidemia or Mixed Dyslipidemia," subjects treated with Livalo 4 mg experienced a median percent reduction in LDL-C of 38.1 per cent over the treatment period compared to a 26.4 per cent median percent reduction in patients randomized to pravastatin 40 mg. Livalo reduced total cholesterol by 25.8 per cent, with pravastatin showing a total cholesterol reduction of 18.3 per cent. Livalo treated patients experienced a significant 26.9 per cent reduction in Apo B compared with a 17.7 per cent reduction associated with pravastatin.

In the second poster, “Pitavastatin 4 mg Significantly Reduces LDL-P and Increases HDL Size Compared with Pravastatin 40 mg: Results from PREVAIL US,” the pre-specified, exploratory objective was to evaluate Livalo 4 mg vs. pravastatin 40 mg on lipoprotein particle concentrations and size. Livalo 4 mg significantly reduced the concentration of LDL-P by 517.0 nanomoles per litre (nmol/L) compared with 396.0 nmol/L for pravastatin 40 mg (p < 0.001). Both LIVALO and pravastatin increased HDL-P with a mean percent change in HDL-P of 9.59 per cent versus 7.03 per cent, respectively (p=0.045). Significant increases in HDL size, and small HDL, as well as significant decreases in VLDL-P and IDL-P were also noted for Livalo compared with pravastatin over the 12-week study period. Improvement was observed in Apo A1, medium and large HDL for both agents, but were not statistically different between treatment arms. Additional studies are needed to better understand the clinical impact.

No clinically important differences in the safety profiles were observed between Livalo and pravastatin in PREVAIL US. The overall incidence of treatment-emergent adverse events (TEAEs) was similar between treatment groups (47.6 per cent for Livalo and 44.5 per cent for pravastatin), and most events were mild or moderate in severity. The most frequently reported drug-related TEAEs were muscle spasms and myalgia (each of which occurred at an incidence of 1.8 per cent for Livalo and 1.2 per cent for pravastatin).

Livalo is a HMG-CoA reductase inhibitor indicated for patients with primary hyperlipidemia and mixed dyslipidemia as an adjunctive therapy to diet to reduce elevated total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), apolipoprotein B (Apo B), triglycerides (TG), and to increase high-density lipoprotein cholesterol (HDL-C).

Kowa Company, Ltd. (KCL) is a privately held multinational company headquartered in Nagoya, Japan is actively engaged in various manufacturing and commercial activities in the fields of pharmaceutical, life science, information technology, textiles, machinery and various consumer products.