The Cardiovascular Multi-dimensional Observational Investigation of the Use of PCSK9 Inhibitors (cvMOBIUS)

Study Overview
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Brief Summary
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cvMOBIUS is a North American registry of patients with ASCVD aimed at understanding patterns of care in ASCVD while evaluating the real world effectiveness of PCSK9 inhibitors.

Detailed Description
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The purpose of this registry is to evaluate the effectiveness of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors (PCSK9i) to reduce cardiovascular events among subjects presenting with a recent atherosclerotic cardiovascular disease (ASCVD) event in real-world practice. A total of 8500 patients with a recent cardiovascular event who are likely to be eligible for non-statin lipid lowering therapy will be enrolled and followed prospectively for five years. In addition, the study will assess longitudinal patterns of lipid control, clinical outcomes, and LLT including statins, ezetimibe, and PCSK9 inhibitors in adults with an ASCVD event and/or revascularization. This study will also compare the clinical characteristics and outcomes of subjects enrolled in both arms of the registry to understand the strengths and limitations of data harvested directly from electronic health record (EHR) systems as compared with prospectively collected information.

Official Title
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The Cardiovascular Multi-dimensional Observational Investigation of the Use of PCSK9 Inhibitors (cvMOBIUS)

Conditions
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ASCVD

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adults age ≥ 40 years One or both of the following: Hospitalization for a clinical ASCVD event: acute (MI), UA, IS, or critical limb ischemia (CLI) within 18 months of enrollment NOTE: subjects must have been admitted to the hospital. Those who are admitted and discharged in less than 24 hours are eligible for the study. Subjects who have been admitted to the ER for a clinical ASCVD event and not admitted to the hospital are not eligible for enrollment. Coronary, peripheral, or carotid revascularization including percutaneous or surgical revascularization in the past 18 months Note: Revascularization procedures can occur in the inpatient or outpatient setting. One of the following: Low-density lipoprotein (LDL) ≥ 70 mg/dL (1.81 mmol/L) with no plans for immediate initiation or titration of statin therapy (Note: Subjects should not be enrolled into study during initiation/titration of statins until they have a stable LDL-C measurement > 4 weeks after their last statin change and no immediate plans for future titration). Newly started on PCSK9i after the index hospitalization/procedure and prior to enrollment (but no more than 6 months prior to enrollment) with pre-PCSK9i treatment LDL-C value available and known background LLT any time prior to PCSK9i initiation. Planned follow-up within the health system. Exclusion Criteria: Unable or unwilling to provide informed consent, including but not limited to cognitive or language barriers (reading or comprehension) Lack of phone or email for contact Evidence of end stage renal disease (ESRD) or stage 5 chronic kidney disease (CKD) Anticipated life expectancy less than 6 months On a PCSK9i prior to their qualifying event; Note: Subjects with prior PCSK9i use occurring and ending before the 12-month period prior to enrollment and before the index ASCVD event will be considered for inclusion. EHR Arm Criteria: Subjects are eligible to be included in the EHR arm of the registry if they are: Adults age ≥ 40 years of age Have at least 1 inpatient or outpatient diagnosis of clinical ASCVD within 12 months prior to enrollment including CHD, ischemic cerebrovascular disease, atherosclerotic PAD, or prior coronary or peripheral or carotid revascularization. No exclusion criteria will be applied.

Ages Eligible for Study
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Minimum Age: 40 Years
Maximum Age: 99 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Consented Arm<br>Subjects with a recent (within 18 months) hospitalization for myocardial infarction, unstable angina, ischemic stroke, or critical limb ischemia, and subjects undergoing coronary, peripheral, or carotid revascularization, including surgical and percutaneous revascularization, with an LDL-C greater than or equal to 70 mg/dL who may be eligible for PCSK9 inhibitor therapy. | |
| Electronic Health Record (EHR) arm<br>Subjects with an inpatient or outpatient diagnosis of clinical ASCVD within the prior 12 months including coronary heart disease, ischemic cerebrovascular disease, atherosclerotic peripheral arterial disease, or prior coronary or peripheral or carotid revascularization. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Incident event rate for the composite of all-cause mortality, non-fatal myocardial infarction (MI), and non-fatal ischemic stroke (IS). | Number of incident all-cause deaths, non-fatal MI, and non-fatal IS events (whichever occurs first) divided by the person-time at risk | Through study completion, a minimum of 4.5 years and maximum of 5 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Incident event rate for all-cause mortality | Number of all-cause deaths divided by the person-time at risk | Through study completion, a minimum of 4.5 years and maximum of 5 years | 
| Incident event rate for non-fatal MI | Number of incident non-fatal MI events divided by the person-time at risk | Through study completion, a minimum of 4.5 years and maximum of 5 years | 
| Incident event rate for non-fatal IS | Number incident non-fatal IS events divided by the person-time at risk | Through study completion, a minimum of 4.5 years and maximum of 5 years | 
| Incident rate of coronary or peripheral or carotid revascularication procedures | Number of incident coronary or peripherial or carotid revascularization procedures | Through study completion, a minimum of 4.5 years and maximum of 5 years | 
| Incident event rate for major adverse limb events (MALE) including amputation | Number of incident MALE events divided by the person-time at risk. MALE is defined as the composite of ALI, major amputation (above the knee or below the knee, excluding forefoot or toe), or urgent revascularization (thrombolysis or urgent vascular intervention for ischemia). | Through study completion, a minimum of 4.5 years and maximum of 5 years | 
| Incident event rate for cardiovascular death | Number of cardiovascular deaths divided by the person-time at risk | Through study completion, a minimum of 4.5 years and maximum of 5 years | 
| Incident event rate for transient ischemic attack (TIA) | Number of incident TIA events divided by the person-time at risk | Through study completion, a minimum of 4.5 years and maximum of 5 years | 
| Incident event rate for unstable angina (UA) | Number of incident UA events divided by the person-time at risk | Through study completion, a minimum of 4.5 years and maximum of 5 years | 
| Longitudinal patterns of lipid control, use of and persistence with lipid lowering therapies (LLT) including statins, ezetimibe, and PCSK9 inhibitors | Describe patterns of lipid control and LLT's over time | Through study completion, a minimum of 4.5 years and maximum of 5 years | 
| The strengths and limitations of data harvested directly from electronic health record (EHR) systems as compared with prospectively collected information | Describe and compare clinical characteristics, ASCVD events, patterns of lipid control, and use of LLT's assessed via prospective data collection to those captured directly via an EHR data harvest. | Through study completion, a minimum of 4.5 years and maximum of 5 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Lipids, Lipid-lowering therapy, Coronary heart disease, Peripheral arterial disease, Proprotein convertase subtilisin/kexin type 9 inhibition, Effectiveness