The biggest-ever trial in heart failure was stopped early due to the fact of a extremely statistically significant reduction in cardiovascular mortality, in accordance to 1 of the trial’s two principal investigators.
Earlier today I reported that the PARADIGM-HF trial testing LCZ696, a novel, first-in-class Angiotensin Receptor Neprilysin Inhibitor (ARNI), had been stopped early due to the fact the trial had demonstrated a considerable reduction in the combined major endpoint of cardiovascular death and heart failure hospitalization. This info was taken from a Novartis press release.
But it turns out that the press release wasn’t entirely accurate. For after, a business appears to have in fact downplayed a optimistic discovering in its trial. In accordance to Milton Packer, the trial’s co-Principal Investigator, the information is a lot more persuasive than may possibly be gathered from the press release. (I spoke with Packer at the American University of Cardiology meeting in Washington, DC.)
In general when a trial has a mixed endpoint– for PARADIGM-HF it was the mixture of cardiovascular death and heart failure hospitalization– the results are largely driven by the “softer” part of the endpoint (in this case, heart failure hospitalization and not the “harder” endpoint of cardiovascular death.) This usually prospects to criticism when a trial has been technically superior in minimizing a combined endpoint but shows small or no effect on the harder, more crucial endpoint.
We will not know the full final results of PARADIGM-HF until finally they are presented at a medical meeting, maybe the European Society of Cardiology meeting in August in Barcelona. But in accordance to Packer, the trial will certainly show a huge and convincing reduction in the far more essential endpoint part, cardiovascular death.
Packer advised me that the stopping rule for the trial was “the most conservative stopping rule in any clinical trial I have ever been concerned with.” A lot more importantly, he stated, “the stopping rule was not on the primary endpoint, it was on cardiovascular death. It was a stopping rule that required a really high level of statistical significance for early termination.” And it was based mostly on this stopping rule that “the Data and Monitoring Board decided that stopping the trial was proper.”
Packer explained “the press release implies that the trial was stopped for the primary endpoint but that was not the situation, the trial was stopped for a persuasive impact on cardiovascular mortality alone, and my enthusiasm was based mostly on that very persuasive impact.”
Packer also advised me that the trial had been powered to detect a variation in cardiovascular mortality, so the finding may possibly not be quite so sudden. This also explains the trial’s huge dimension.