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Message: Re: Placebo rate now that 250 MACE has been reached

"Is there any other placebo population that is similar to this our trial.....I remember you talking about 2 trials and that we should have an even higher placebo rate than them because we have sicker patients (because of,... sorry I forget again)......If we were to know what the global (not the per 100 patient years) placebo rate of similar treated patients, and maybe add a percent or 2 to that cause we have sicker patients)"   

Copying from this this post with light edits. There are some more tidbits on information in this post. By the way, it looks like you went through this a couple months ago in this post

EXAMINE and ELIXA are really the only two trials with similar patient populations as BETonMACE that I know of. EXAMINE was diabetic patients with ACS event within 90 days. ELIXA was diabetic patients with ACS event within 180 days. The time to randomization following ACS event was 45 days (mean) and 72 days (median), respectively, for EXAMINE and ELIXA. BETonMACE time to randomization following ACS event is median 34 days (see AHA 2018 poster), which suggests, but does not guarantee, that BETonMACE patients are at higher risk than those in ELIXA or EXAMINE. Additionally, BETonMACE has a low-HDL requirement that wasn't in place for ELIXA or EXAMINE, which may increase the risk of BETonMACE patients above those in ELIXA and EXAMINE. However, a lot of diabetic patients have low-HDL already, so it is uncertain how much this will increase the risk. 

For ELIXA,  placebo event rate was ~13% at median follow up of 25 months, which equates to ~6.4 events per 100 patient years. However, this was 4-point MACE including unstable angina, which only comprised about 2.5% of total 4-point MACE events. So 97.5% of total events were 3-point MACE events.

For EXAMINE, placebo event rate was ~12% at median follow up 1.46 years. This is for 3-point MACE. They don't state an events per 100 patient year value in the trial publication, but I estimate about ~8.1 events per 100 patient years.

BETonMACE will likely have a mean follow up of about 26 months according to AHA 2018 poster in November 2018. This mean dosing period will likely turn out to be longer than 26 months, since the trial may have been expected to end sooner but didn't. The median BETonMACE dosing period will likely be somewhere around 25 months, since patient #1200 was enrolled around March 17, 2017 and the start of trial wrap up was announced April 18th, 2019. The AHA poster also states that the assumed primary event rate in BETonMACE placebo group was 7 event per 100 patient years. This value is kind of right in between the actual EXAMINE and ELIXA placebo event rates. If one trusts that the ELIXA and EXAMINE population event rates are reproducible (they are only 2 trials, so reproducibility is not guaranteed), then one might interpret this 7 events per 100 patient years as a conservative underestimate for BETonMACE, since BETonMACE has an additional low-HDL requirement and a shorter time from randomization to index ACS event.

I hope this info helps!

BearDownAZ

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