Akcea Therapeutics and Ionis Pharmaceuticals announced positive topline results from the Phase 2 study of AKCEA-APOCIII-LRx in the treatment of patients with hypertriglyceridemia who are at risk for or have established cardiovascular disease (CVD). The study met the primary endpoint of significant triglyceride lowering and multiple secondary endpoints with a favorable safety and tolerability profile.
The objective of the Phase 2 study was to evaluate the safety and efficacy of different doses and dosing frequencies of AKCEA-APOCIII-LRx. The multicenter, randomized, double-blind, placebo-controlled, dose-ranging study included 114 patients with a clinical diagnosis of CVD or who are at high risk of CVD. Participants were administered AKCEA-APOCIII-LRx or placebo via subcutaneous injection for at least six months with some patients being treated up to a year. Weekly, bi-weekly, and monthly dosing was explored in four cohorts with doses ranging from 10 mg to 50 mg of total monthly dose. Observations from the AKCEA-APOCIII-LRx study included:
- Statistically significant dose-dependent reductions in fasting triglycerides compared to placebo at all dose levels
- At the highest once monthly dose of 50 mg, more than 90% of patients achieved serum triglycerides of ≤ 150 mg/dL, compared to less than 5% of patients in the placebo group; mean triglyceride levels of patients at baseline was 285 mg/dL
- Significant reductions in multiple additional risk factors, including apoC-III, very low-density lipoprotein (VLDL-C) and remnant cholesterol, compared to placebo
- Statistically significant increases in high-density lipoprotein cholesterol (HDL-C) compared to placebo at all dose levels
- Treatment-emergent adverse events (TEAEs) were comparable between active and placebo groups. The most common adverse event was injection site reactions (ISRs). ISRs were mostly mild, infrequent and primarily occurred in the weekly dose group. In the highest monthly dose group, the occurrence of ISRs was similar to the placebo group
- There were no safety signals, including those related to platelet counts, liver function or renal function
- Approximately 85% of patients completed treatment and the rate of treatment discontinuation was comparable between the active and placebo groups
"We are very encouraged that patients achieved a significant reduction in apoC-III and triglyceride levels in this study, with the majority reaching triglyceride levels below the recognized threshold for cardiovascular risk. These data further validate the consistent efficacy and safety profile that we have seen across Ionis' LICA technology platform," said Louis O'Dea, M.D., chief medical officer at Akcea Therapeutics. "Based on the positive results from this study, we plan to rapidly pursue development of AKCEA- APOCIII-LRx for familial chylomicronemia syndrome or FCS. Because we were able to achieve substantial triglyceride lowering with this investigational medicine, we are also considering developing it for other rare and common diseases associated with elevated triglycerides. We are very grateful to the patients, families and physicians who participated in this study and are excited about the potential to bring this much needed therapy to patients."
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AKCEA-APOCIII-LRx was discovered by Ionis and has been co-developed by Akcea and Ionis. It is an antisense drug developed using Ionis' proprietary LIgand Conjugated Antisense (LICA) technology platform and is designed to inhibit production of apolipoprotein C-III (apoC-III), a protein produced in the liver that plays a central role in the regulation of serum triglycerides.
AKCEA-APOCIII-LRx is a ligand conjugated antisense (LICA) drug designed to reduce the production of apolipoprotein C-III, or apoC-III. ApoC-III is a protein produced in the liver that plays a central role in the regulation of serum triglycerides. Genetically reduced levels of apoC-III are correlated to lower levels of triglycerides and lower risk of cardiovascular disease whereas elevated levels of apoC-III correlate with high triglyceride levels that have been associated with multiple metabolic abnormalities, such as insulin resistance and/or metabolic syndrome as well as elevated cardiovascular event risk. AKCEA-APOCIII-LRx is in Phase 2 development for hypertriglyceridemia and established cardiovascular disease. Akcea and Ionis intend to pursue development in familial chylomicronemia syndrome, or FCS, and are considering pursuing development in additional indications.