Safety, Tolerability, Pharmacokinetics, and Pharmacodynamics of ISIS-APO(a)Rx in Participants With High Lipoprotein(a)

Phase 2

Completed

• Conditions: Elevated Lipoprotein(a)
• Interventions: Drug: Placebo; Drug: ISIS-APO(a)Rx

• Registration Number: NCT02160899
• Lead Sponsor: Ionis Pharmaceuticals, Inc.

Brief Summary

The purpose is to assess the safety, tolerability, pharmacokinetics, and pharmacodynamics of ISIS-APO(a)Rx given to participants with high lipoprotein(a) for 12 weeks.

Detailed Description

Lipoprotein(a) \[Lp(a)\] is a genetic variant of low-density lipoprotein (LDL) in which the apolipoprotein B (apoB) -100 component of LDL is linked by a disulfide bond to apolipoprotein(a) \[apo(a)\], the distinct protein component of Lp(a) that is mainly responsible for its signature structural and functional properties. Lp(a) is now recognized as an important genetic risk factor for coronary artery disease, stroke and aortic stenosis.

The purpose of this study is to determine if ISIS-APO(a)Rx can reduce the production of apolipoprotein(a), or apo(a). This study will enroll 50 participants with Lipoprotein(a) ≥50 and \<175 mg/dL and 10 participants with Lipoprotein(a) ≥175 mg/dL.

Study Timeline

• Study Start: 2014-06
• Study First Submitted: 2014-06-05
• Study First Submitted QC: 2014-06-09
• Study First Posted: 2014-06-11
• Primary Completion: 2015-11
• Study Completion: 2015-11
• Results First Submitted: 2019-11-21
• Status Verified: 2019-12
• Results First Submitted QC: 2019-12-17
• Last Update Submitted: 2019-12-17
• Results First Posted: 2019-12-20
• Last Update Posted: 2019-12-20

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 64

Inclusion Criteria

• Males or females aged 18-65 inclusive
• Females must be non-pregnant and non-lactating, and either surgically sterile (e.g., tubal occlusion, hysterectomy, bilateral salpingectomy, bilateral oophorectomy) or post-menopausal (defined as 12 months of spontaneous amenorrhea without an alternative medical cause and follicle-stimulating hormone (FSH) levels in the postmenopausal range for the laboratory involved)
• Males must be surgically sterile, abstinent or if engaged in sexual relations with a female of child-bearing potential, the participant must be using an acceptable contraceptive method from the time of signing the informed consent form until at least 16 weeks after the last dose of Study Drug
• Body mass index (BMI) ≤40 kg/m2
• Lipoprotein(a) ≥50 and <175 mg/dL at time of screening (Cohort A)
• Lipoprotein(a) ≥175 mg/dL at time of screening (Cohort B)

Exclusion Criteria

• Clinically significant abnormalities in medical history (e.g., documented previous myocardial infarction, percutaneous coronary intervention (PCI), or major surgery within 3 months of screening, planned surgery that would occur during the study) or physical examination at screening
• Clinically significant abnormalities in screening laboratory values that would render a participant unsuitable for inclusion
• Active infection requiring systemic antiviral or antimicrobial therapy that will not be completed prior to Study Day 1
• Known history or positive test for human immunodeficiency virus (HIV), hepatitis C, or chronic hepatitis B
• Malignancy within 5 years, except for basal or squamous cell carcinoma of the skin or carcinoma in situ of the cervix that has been successfully treated
• History of bleeding diathesis or coagulopathy
• Recent history of, or current drug or alcohol abuse
• Participant with Lp(a) ≥50 and <175 mg/dL may not receive concomitant niacin therapy during the period 8 weeks prior to screening through the end of the Post-Treatment Evaluation Period
• Use of statins, ezetimibe or fibrates unless on a stable regimen for at least 8 weeks prior to dosing and will remain on a stable regimen for the duration of the study
• Use of lipid or Lp(a)-specific apheresis within 4 weeks prior to Screening through the end of the Post-Treatment Evaluation Period
• Use of concomitant drugs (including herbal or over-the-counter (OTC) medications other than ibuprofen, Benadryl or topical steroids) unless authorized by the Sponsor Medical Monitor
• Blood donation of 50-499 mL within 30 days of screening or of >499 mL within 8 weeks of screening
• Have any other conditions, which, in the opinion of the Investigator would make the participant unsuitable for inclusion, or could interfere with the participant participating in or completing the study

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Cohort A: Placebo	Placebo	Participants will receive placebo (normal saline) subcutaneously on Days 1, 8, 15, 22, 29, 36, 43, 50, 57, 64, 71, and 78.
Cohort A: ISIS-APO(a)Rx < 2000 mg	ISIS-APO(a)Rx	Participants will receive ISIS-APO(a)Rx subcutaneously: 100 mg on Days 1, 8, 15, and 22; 200 mg on Days 29, 36, 43, and 50 unless down-titrated; and 300 mg on Days 57, 64, 71, and 78 unless down-titrated.
Cohort A: ISIS-APO(a)Rx >= 2000 mg	ISIS-APO(a)Rx	Participants will receive ISIS-APO(a)Rx subcutaneously: 100 mg on Days 1, 8, 15, and 22; 200 mg on Days 29, 36, 43, and 50 unless down-titrated; and 300 mg on Days 57, 64, 71, and 78 unless down-titrated.
Cohort B: Placebo	Placebo	Participants will receive placebo (normal saline) subcutaneously on Days 1, 8, 15, 22, 29, 36, 43, 50, 57, 64, 71, and 78.
Cohort B: ISIS-APO(a)Rx < 2000 mg	ISIS-APO(a)Rx	Participants will receive ISIS-APO(a)Rx subcutaneously: 100 mg on Days 1, 8, 15, and 22; 200 mg on Days 29, 36, 43, and 50 unless down-titrated; and 300 mg on Days 57, 64, 71, and 78 unless down-titrated.
Cohort B: ISIS-APO(a)Rx >= 2000 mg	ISIS-APO(a)Rx	Participants will receive ISIS-APO(a)Rx subcutaneously: 100 mg on Days 1, 8, 15, and 22; 200 mg on Days 29, 36, 43, and 50 unless down-titrated; and 300 mg on Days 57, 64, 71, and 78 unless down-titrated.

Primary Outcome Measures

Name	Time	Method
Percent Change From Baseline in Lipoprotein Lp(a) Plasma Concentration at Day 85/Day 99	Day 85/Day 99	Data are reported for evaluable participants.
Number of Participants With at Least One Treatment-emergent Adverse Event (TEAE)	Up to approximately 32 weeks	An adverse event is any unfavorable and unintended sign (including a clinically significant abnormal laboratory finding, for example), symptom, or disease temporally associated with the study or use of investigational drug product, whether or not the AE is considered related to the investigational drug product.

Trial Locations

Locations (13)

Otto-von Guericke Universitaet, Uniklinik Magdeburg; 🇩🇪 Magdeburg, Germany

Newcastle Upon Tyne Hospitals; 🇬🇧 Newcastle Upon Tyne, United Kingdom

Barlow Medical Centre; 🇬🇧 Manchester, United Kingdom

Sint Franciscus Gasthuis; 🇳🇱 Rotterdam, Netherlands

Uniklinik Koeln, Zentrum fuer Endokrinologie, Diabetologie und Praeventivmedizin (ZEDP); 🇩🇪 Koln, Germany

Chicoutimi Hospital; 🇨🇦 Chicoutimi, Quebec, Canada

Heart of England NHS Foundation Trust; 🇬🇧 Birmingham, United Kingdom

Herlev University Hospital; 🇩🇰 Herlev, Denmark

Academic Hospital Maastricht; 🇳🇱 Maastricht, Netherlands

Clinique des Maladies Lipidiques de Quebec Inc.; 🇨🇦 Quebec, Canada

University of Amsterdam - Dept. of Vascular Medicine F4-109; 🇳🇱 Amsterdam, Netherlands

Charite - University Hospital Berlin - Campus Virchow - Hospital; 🇩🇪 Berlin, Germany

University Medical Center Utrecht; 🇳🇱 Utrecht, Netherlands