• Michelle L O'Donoghue, Eugene Braunwald, Harvey D White, Dylan P Steen, Mary Ann Lukas, Elizabeth Tarka, P Gabriel Steg, Judith S Hochman, Christoph Bode, Aldo P Maggioni, KyungAh Im, Jennifer B Shannon, Richard Y Davies, Sabina A Murphy, Sharon E Crugnale, Stephen D Wiviott, Marc P Bonaca, David F Watson, W Douglas Weaver, Patrick W Serruys, Christopher P Cannon, SOLID-TIMI 52 Investigators, and Dylan L Steen.
• TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
• JAMA. 2014 Sep 10;312(10):1006-15.

ImportanceLipoprotein-associated phospholipase A2 (Lp-PLA2) has been hypothesized to be involved in atherogenesis through pathways related to inflammation. Darapladib is an oral, selective inhibitor of the Lp-PLA2 enzyme.ObjectiveTo evaluate the efficacy and safety of darapladib in patients after an acute coronary syndrome (ACS) event.Design, Setting, And ParticipantsSOLID-TIMI 52 was a multinational, double-blind, placebo-controlled trial that randomized 13,026 participants within 30 days of hospitalization with an ACS (non-ST-elevation or ST-elevation myocardial infarction [MI]) at 868 sites in 36 countries.InterventionsPatients were randomized to either once-daily darapladib (160 mg) or placebo on a background of guideline-recommended therapy. Patients were followed up for a median of 2.5 years between December 7, 2009, and December 6, 2013.Main Outcomes And MeasuresThe primary end point (major coronary events) was the composite of coronary heart disease (CHD) death, MI, or urgent coronary revascularization for myocardial ischemia. Kaplan-Meier event rates are reported at 3 years.ResultsDuring a median duration of 2.5 years, the primary end point occurred in 903 patients in the darapladib group and 910 in the placebo group (16.3% vs 15.6% at 3 years; hazard ratio [HR], 1.00 [95% CI, 0.91-1.09]; P = .93). The composite of cardiovascular death, MI, or stroke occurred in 824 in the darapladib group and 838 in the placebo group (15.0% vs 15.0% at 3 years; HR, 0.99 [95% CI, 0.90-1.09]; P = .78). There were no differences between the treatment groups for additional secondary end points, for individual components of the primary end point, or in all-cause mortality (371 events in the darapladib group and 395 in the placebo group [7.3% vs 7.1% at 3 years; HR, 0.94 [95% CI, 0.82-1.08]; P = .40). Patients were more likely to report an odor-related concern in the darapladib group vs the placebo group (11.5% vs 2.5%) and also more likely to report diarrhea (10.6% vs 5.6%).Conclusions And RelevanceIn patients who experienced an ACS event, direct inhibition of Lp-PLA2 with darapladib added to optimal medical therapy and initiated within 30 days of hospitalization did not reduce the risk of major coronary events.Trial Registrationclinicaltrials.gov Identifier: NCT01000727.

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