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BACKGROUND	Homozygous familial hypercholesterolaemia is a rare , serious disorder caused by very low or absent plasma clearance of LDL , substantially raised LDL cholesterol , and accelerated development of cardiovascular disease .
BACKGROUND	Conventional lipid-lowering treatments are modestly effective .
BACKGROUND	Evolocumab , a monoclonal antibody to proprotein convertase subtilisin/kexin type 9 ( PCSK9 ) , reduced LDL cholesterol by 16 % in a pilot study .
BACKGROUND	We now report results with evolocumab in a randomised , double-blind , placebo-controlled phase 3 trial .
METHODS	This randomised , double-blind , placebo-controlled phase 3 trial was undertaken at 17 sites in ten countries in North America , Europe , the Middle East , and South Africa .
METHODS	50 eligible patients ( aged 12 years ) with homozygous familial hypercholesterolaemia , on stable lipid-regulating therapy for at least 4 weeks , and not receiving lipoprotein apheresis , were randomly allocated by a computer-generated randomisation sequence in a 2:1 ratio to receive subcutaneous evolocumab 420 mg or placebo every 4 weeks for 12 weeks .
METHODS	Randomisation was stratified by LDL cholesterol at screening ( < 11 mmol/L or 11 mmol/L ) and implemented by a computerised interactive voice-response system .
METHODS	Patients , study personnel , and the funder were masked to treatment and to the efficacy results by the central laboratory not returning LDL cholesterol or any lipid results to the clinical sites after the baseline visit .
METHODS	The primary endpoint was percentage change in ultracentrifugation LDL cholesterol from baseline at week 12 compared with placebo , analysed by intention-to-treat .
METHODS	This trial is registered with ClinicalTrials.gov , number NCT01588496 .
RESULTS	Of the 50 eligible patients randomly assigned to the two treatment groups , 49 actually received the study drug and completed the study ( 16 in the placebo group and 33 in the evolocumab group ) .
RESULTS	Compared with placebo , evolocumab significantly reduced ultracentrifugation LDL cholesterol at 12 weeks by 309 % ( 95 % CI -439 % to -180 % ; p < 00001 ) .
RESULTS	Treatment-emergent adverse events occurred in ten ( 63 % ) of 16 patients in the placebo group and 12 ( 36 % ) of 33 in the evolocumab group .
RESULTS	No serious clinical or laboratory adverse events occurred , and no anti-evolocumab antibody development was detected during the study .
CONCLUSIONS	In patients with homozygous familial hypercholesterolaemia receiving stable background lipid-lowering treatment and not on apheresis , evolocumab 420 mg administered every 4 weeks was well tolerated and significantly reduced LDL cholesterol compared with placebo .
BACKGROUND	Amgen Inc. .

