P010. Evaluation of the Efficacy and Safety of AKCEA-TTR-LRx (ION-682884) in Patients with Transthyretin-mediated Amyloid Cardiomyopathy: The CARDIO-TTRansform Study

Autor: Cecilia Monteiro, Qingqing Yang, Nick Viney, Arnt V. Kristen, Merrill D. Benson, Rodney H. Falk, Louis O'Dea, Brett P. Monia, Li Tai, Eugene Schneider, Mathew S. Maurer, Gustavo Buchele, Sotirios Tsimikas, Brambatti Michela, Richard S. Geary
Rok vydání: 2021
Předmět:
Zdroj: Heart & Lung. 50:565-566
ISSN: 0147-9563
Popis: Background Transthyretin amyloidosis cardiomyopathy (ATTR-CM) is a fatal condition, leading to heart failure (HF) and ultimately death. ATTR-CM is caused by misfolding and aggregation of transthyretin (TTR), a protein produced by the liver. Depending on the presence or absence of a destabilizing mutation in the TTR gene, the disease can be classified as hereditary ATTR-CM (hATTR-CM) or wild-type ATTR-CM (wtATTR-CM), respectively. Despite the treatment with a TTR stabilizer, tafamidis, recently approved in the United States for the treatment of ATTR-CM, disease progression still occurs. AKCEA-TTR-LRX (ION-682884) is an antisense oligonucleotide (ASO) that inhibits the production of TTR. It has a similar design and sequence as inotersen (the parent compound), but is conjugated to a triantennary N-acetyl galactosamine (GalNAc3) moiety for selective receptor-mediated delivery to hepatocytes, the principal source of systemically circulating TTR. This delivery approach has yielded an up to 30-fold increase in potency and improved the safety and tolerability profiles of ASOs in human clinical trials. Conjugation of this ligand allows the use of a lower dose to achieve improved pharmacodynamic results. In a phase 1, randomized, placebo-controlled study, AKCEA-TTR-LRX given at a 45 mg, 60 mg or 90 mg dose, by subcutaneous (SC) injection every four weeks in 36 healthy volunteers achieved a mean pre-steady state reduction in serum TTR of 86%, 91% and 94%, respectively, compared to baseline. The dosage regimen of 45 mg SC every four weeks (27-fold lower exposure vs the inotersen dose in NEURO-TTR trial) was chosen for the pivotal phase 3 study. Methods CARDIO-TTRansform (ClinicalTrials.gov NCT04136171) is a Phase 3 global, double-blind, randomized, placebo-controlled study assessing the efficacy and safety of AKCEA-TTR-L Rx in hATTR-CM or wtATTR-CM patients receiving available background standard of care (SoC) therapy. Approximately 750 patients around the world with a history of HF due to ATTR-CM will be randomized 1:1 to receive either AKCEA-TTR-LRx 45 mg or placebo administered by SC injection once every 4 weeks. Key inclusion criteria include diagnosis of ATTR-CM by biopsy or positive PYP/DPD/HMDP scan, interventricular septum thickness >12mm, NT-proBNP > 600 pg/mL, NYHA class I-III and 6-minute walk distance (6MWD) >150 m. Key exclusion criteria include, platelet count = 750 mg/g. Concomitant treatment with tafamidis as SoC for ATTR-CM is allowed. The study consists of a 120-week Treatment Period. Primary efficacy endpoint is the composite of cardiovascular (CV) mortality and recurrent CV clinical events at Week 120 study visit using the Andersen-Gill method. Secondary endpoints include the change from baseline in the 6MWD, KCCQ score, CV clinical events, CV death and all-cause of mortality at Week 120. Conclusions Despite recent advances, additional efficacious, safe and convenient treatment options for ATTR-CM are needed. The CARDIO-TTRansform trial is a large Phase 3 trial designed to evaluate the clinical efficacy and safety of AKCEA-TTR-LRx compared to placebo in patients with ATTR-CM receiving available SoC therapy.
Databáze: OpenAIRE
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