A Study of Inclisiran in Participants With Homozygous Familial Hypercholesterolemia (HoFH)

Novartis Pharmaceuticals56 enrolled

Overview

This study was a Phase III,A two-part (double-blind placebo-controlled/open-label) multicenter study to evaluate safety, tolerability, and efficacy of inclisiran in subjects with homozygous familial hypercholesterolemia (HoFH).

This study had two sequential parts: * Part 1: 6-month double-blind period in which subjects were randomized to receive either inclisiran or placebo * Part 2: 18-month open-label follow-up period; placebo-treated subjects from Part 1 were transitioned to inclisiran at Day 180 and all subjects who participated in an open-label follow-up period of inclisiran only

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Enrollment

Conditions

Homozygous Familial Hypercholesterolemia

Interventions

Inclisiran Sodium for injectionDRUG

Inclisiran is a synthetic, chemically modified small interfering ribonucleic acid (siRNA) targeting proprotein convertase subtilisin kexin type 9 (PCSK9) messenger ribonucleic acid (mRNA) with a covalently attached triantennary N-acetylgalactosamine (GalNAc) ligand.

PlaceboDRUG

Sterile normal saline (0.9% sodium chloride in water for injection)

PlacebosDRUG

Sterile normal saline (0.9% sodium chloride in water for injection)

Eligibility

Sex: ALLMin age: 18 YearsMax age: 80 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: 1. Diagnosis of HoFH by genetic confirmation or a clinical diagnosis based on a history of an untreated LDL-C concentration \>500 mg/dL (13 mmol/L) together with either xanthoma before 10 years of age or evidence of heterozygous familial hypercholesterolemia in both parents 2. Stable on a low-fat diet. 3. Subjects on statins should be receiving a maximally tolerated dose. Maximum tolerated dose is defined as the maximum dose of statin that can be taken on a regular basis without intolerable adverse events. 4. Subjects not receiving statins must have documented evidence of intolerance to at least two different statins. 5. Subjects on lipid-lower therapies (such as statin and/or ezetimibe) should be on a stable dose for ≥30 days before screening with no planned medication or dose change during study participation. 6. Fasting central laboratory LDL-C concentration ≥130 mg/dL (3.4 mmol/L). 7. Triglyceride concentration \<400 mg/dL (4.5 mmol/L) 8. No current or planned renal dialysis or renal transplantation 9. Subjects on a documented regimen of LDL or plasma apheresis will be allowed to continue the apheresis during the study, if needed. 10. Subjects must be willing and able to give written informed consent before initiation of any study-related procedures. The subject should be willing to comply with all required study procedures. 11. Willing to follow all study procedures including adherence to dietary guidelines, study visits, fasting blood draws, and compliance with study treatment regimens. Exclusion Criteria: 1. Use of Mipomersen or Lomitapide therapy within 5 months of screening 2. Treatment (within 90 days of screening) with monoclonal antibodies directed towards PCSK9 3. New York Heart Association (NYHA) class IV heart failure or last known left ventricular ejection fraction \<25% 4. Major adverse cardiovascular event within 3 months prior to randomization 5. Planned cardiac surgery or revascularization 6. Uncontrolled severe hypertension: systolic blood pressure \>180 mmHg or diastolic blood pressure \>110 mmHg prior to randomization despite anti-hypertensive therapy 7. Active liver disease defined as any known current infectious, neoplastic, or metabolic pathology of the liver or unexplained alanine aminotransferase (ALT), aspartate aminotransferase (AST), elevation \>3x ULN, or total bilirubin \>2x upper limit of normal (ULN) at screening confirmed by a repeat measurement at least 1 week apart 8. Severe concomitant noncardiovascular disease that carries the risk of reducing life expectancy to less than the duration of the trial 9. History of malignancy that required surgery (excluding local and wide-local excision), radiation therapy and/or commencement of systemic therapy as treatment during the 3 years prior to randomization 10. Females who are pregnant or nursing, or who are of childbearing potential and unwilling to use at least one acceptable effective method of contraception (eg, oral contraceptives, barrier methods, approved contraceptive implant, long- term injectable contraception, intrauterine device) for the entire duration of the study. Exemptions from this criterion: 1. Women \>2 years postmenopausal (defined as 1 year or longer since their last menstrual period) AND more than 55 years of age 2. Postmenopausal women (as defined above) and less than 55 years of age with a negative pregnancy test within 24 hours of enrolment 3. Women who are surgically sterilized at least 3 months prior to enrolment 11. Known history of alcohol and/or drug abuse within 5 years 12. Any condition that according to the investigator could interfere with the conduct of the study, such as but not limited to: 1. Subjects who are unable to communicate or to cooperate with the investigator. 2. Unable to understand the protocol requirements, instructions and study-related restrictions, the nature, scope, and possible consequences of the study (including subjects whose cooperation is doubtful due to drug abuse or alcohol dependency) 3. Unlikely to comply with the protocol requirements, instructions, and study-related restrictions (eg, uncooperative attitude, inability to return for follow-up visits, and improbability of completing the study) 4. Have any medical or surgical condition, which in the opinion of the investigator would put the subject at increased risk from participating in the study 5. Persons directly involved in the conduct of the study 13. Any uncontrolled or serious disease, or any medical or surgical condition, that may either interfere with participation in the clinical study, and/or put the subject at significant risk (according to investigator's \[or delegate\] judgment) if he/she participates in the clinical study 14. Any underlying known disease, or surgical, physical, or medical condition that, in the opinion of the Investigator, might interfere with the interpretation of clinical study results 15. Treatment with other investigational medicinal products or devices within 30 days or 5 half-lives of the screening visit, whichever is longer 16. Previous participation in the study 17. Hypersensitivity to any of the ingredients of Inclisiran The above information is not intended to contain all considerations relevant to a participant's potential participation in a clinical trial.

Locations (13)

(50852-001) Queen Mary Hospital

Hong Kong, Hong Kong

(50972-001) Hadassah Hospital Lipid Research Ein Kerem

Jerusalem, Israel

(50007-001) Research Institute of Complex Issues of Cardiovascular Diseases

Outcomes

Primary Outcomes

Percent Change in Low-Density Lipoprotein Cholesterol (LDL-C) From Baseline to Day 150

Percentage Change in LDL-C levels from Baseline to Day 150

Time frame: Baseline, Day 150

Secondary Outcomes

Absolute Change in Low-Density Lipoprotein Cholesterol (LDL-C) From Baseline to Day 150

Absolute Change in LDL-C levels (mg/dL) from baseline to Day 150

Time frame: Baseline, Day 150

Percent Change in Low-Density Lipoprotein Cholesterol (LDL-C) From Baseline to Subsequent Visits up to Day 180

Percentage Change in LDL-C levels from baseline to subsequent visits on Days 90, 150, and 180

Time frame: Baseline, Days 90, 150, 180

Percent Change in Low-Density Lipoprotein Cholesterol (LDL-C) From Baseline to Subsequent Visits up to Day 720

Percentage Change in LDL-C levels from baseline to subsequent visits up to Day 720

Time frame: Baseline, Days 270, 330, 450, 510, 630, 690, and 720

Absolute Change in Low-Density Lipoprotein Cholesterol (LDL-C) From Baseline to Subsequent Visits up to Day 180

Absolute change in LDL-C levels (mg/dL) from baseline to subsequent visits on Days 90, 150 and 180 based on the

Time frame: Baseline, Days 90, 150, 180

Absolute Change in Low-Density Lipoprotein Cholesterol (LDL-C) From Baseline to Subsequent Visits up to Day 720

Absolute change in LDL-C levels from Baseline to Subsequent Visits up to Day 720

Time frame: Baseline, Days 270, 330, 450, 510, 630, 690, and 720

Percent Change in Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) From Baseline to Subsequent Visits up to Day 180

Data from ClinicalTrials.gov

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(50007-003) National Medical Research Centre of Cardiology

Moscow, Russia

(50007-002) Hospital for War Veterans

Saint Petersburg, Russia

(50381-001) Clinical Center of Serbia

Belgrade, Serbia

(50027-001) Johannesburg Hospital

Johannesburg, South Africa

(50886-001) Taipei Veterans General Hospital

Taipei, Taiwan

(50090-002) University of Health Sciences

Etlik, Turkey (Türkiye)

(50090-003) Istanbul University

Istanbul, Turkey (Türkiye)

...and 3 more locations

Percentage Change in PCSK9 from baseline to subsequent visits up to Day 180

Time frame: Baseline, Days 90, 150, 180

Percent Change in Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) From Baseline to Subsequent Visits up to Day 720

Percentage Change in PCSK9 from baseline to subsequent visits up to Day 720

Time frame: Baseline, Days 270, 330, 450, 510, 630, 690, and 720

Absolute Change in Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) From Baseline to Subsequent Visits up to Day 180

Absolute Change in PCSK9 from baseline to subsequent visits up to Day 180

Time frame: Baseline, Days 90, 150, 180

Absolute Change in Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) From Baseline to Subsequent Visits up to Day 720

Absolute Change in PCSK9 from baseline to subsequent visits up to Day 720

Time frame: Baseline, Days 270, 330, 450, 510, 630, 690, and 720

Percent Change in Total Cholesterol From Baseline to Subsequent Visits up to Day 180

Percentage change in total cholesterol from baseline to subsequent visits up to Day 180

Time frame: Baseline, Days 90, 150 and 180

Absolute Change in Total Cholesterol From Baseline to Subsequent Visits up to Day 180

Absolute Change in total cholesterol from baseline to subsequent visits up to Day 180

Time frame: Baseline, Days 90, 150, 180

Percent Change in Total Cholesterol From Baseline to Subsequent Visits up to Day 720

Percentage change in total cholesterol from baseline to subsequent visits up to Day 720

Time frame: Baseline, Days 270, 330, 450, 510, 630, 690, and 720

Absolute Change in Total Cholesterol From Baseline to Subsequent Visits up to Day 720

Absolute Change in total cholesterol from baseline to subsequent visits up to Day 720

Time frame: Baseline, Days 270, 330, 450, 510, 630, 690, and 720

Percent Change in Apolipoprotein B (apoB) From Baseline to Subsequent Visits up to Day 180

Percentage change in Apolipoprotein B (apoB) from baseline to subsequent visits up to Day 180 demonstrated by Mixed Model Repeated Measures statisitical method.

Time frame: Baseline, Days 90, 150, 180

Percent Change in Apolipoprotein B (apoB) From Baseline to Subsequent Visits up to Day 720

Percentage Change in Apolipoprotein B (apoB) from baseline to subsequent visits up to Day 720

Time frame: Baseline, Days 270, 330, 450, 510, 630, 690, and 720

Absolute Change in Apolipoprotein B (apoB) From Baseline to Subsequent Visits up to Day 180

Absolute change in Apolipoprotein B (apoB) from baseline to subsequent visits up to Day 180

Time frame: Baseline, Days 90, 150, 180

Absolute Change in Apolipoprotein B (Apo B) From Baseline to Subsequent Visits up to Day 720

Absolute Change in Apolipoprotein B (Apo B) from baseline to subsequent visits up to Day 720

Time frame: Baseline, Days 270, 330, 450, 510, 630, 690, and 720

Percent Change in Non-HDL Cholesterol (Non-HDL-C) From Baseline to Subsequent Visits up to Day 180

Percentage change in non-HDL-C levels from baseline to subsequent visits up to Day 180

Time frame: Baseline, Days 90, 150, 180

Percent Change in Non-HDL Cholesterol (Non-HDL-C) From Baseline to Subsequent Visits up to Day 720

Percentage Change in non-HDL-C from Baseline to subsequent visits up to Day 720

Time frame: Baseline, Days 270, 330, 450, 510, 630, 690, and 720

Absolute Change in Non-HDL Cholesterol (Non-HDL-C) From Baseline to Subsequent Visits up to Day 180

Absolute change in non-HDL-C levels from Baseline to subsequent visits up to Day 180

Time frame: Baseline, Days 90, 150, 180

Absolute Change in Non-HDL Cholesterol (Non-HDL-C) From Baseline to Subsequent Visits up to Day 720

Absolute Change in non-HDL Cholesterol (non-HDL-C) from Baseline to Subsequent Visits up to Day 720

Time frame: Baseline, Days 270, 330, 450, 510, 630, 690, and 720

Individual Responsiveness of Subjects: Part 1

Individual Responsiveness of Subjects defined as the number of subjects reaching on treatment LDL-C levels of \<25 mg/dL, \<50 mg/dL, \<70 mg/dL, and \<100 mg/dL up to Day 180

Time frame: Days 150, 180

Individual Responsiveness of Subjects: Part 2

Individual Responsiveness of Subjects defined as the number of subjects reaching on treatment LDL-C levels of \<25 mg/dL, \<50 mg/dL, \<70 mg/dL, and \<100 mg/dL up to Day 720

Time frame: Days 330, 510, 690 and 720

Proportional Responsiveness: Part 1

Number of participants in each group who attain global lipid targets for their indication

Time frame: Days 150, 180

Proportional Responsiveness of Subjects: Part 2

Number of participants in each group who attain global lipid targets for their indication

Time frame: Days 330, 510, 690 and 720

LDL-C Reduction ≥20% or ≥30% From Baseline: Part 1

Proportion of subjects in each group with ≥20% or ≥30% LDL-C reduction from Baseline in Part 1 (Days 90, 150, 180)

Time frame: Baseline, Days 90, 150, 180

LDL-C Reduction ≥20% or ≥30% From Baseline: Part 2

Proportion of subjects in each group with ≥20% or ≥30% LDL-C reduction from Baseline in Part 2 (Days 330, 510, 690, and 720)

Time frame: Baseline, Days 330, 510, 690, and 720

Percent Change in High-Density Lipoprotein Cholesterol Levels (HDL-C) From Baseline to Subsequent Visits up to Day 180

Percentage Change in HDL-C levels (mg/dL) from baseline to subsequent visits on Day 90, 150, and 180

Time frame: Baseline, Days 90, 150, 180

Percent Change in High-Density Lipoprotein Cholesterol Levels (HDL-C) From Baseline to Subsequent Visits up to Day 720

Percentage change in LDL-C levels from Baseline to Subsequent Visits up to Day 720

Time frame: Baseline, Days 330, 450, 510, 630, 690, and 720

Absolute Change in High-Density Lipoprotein Cholesterol Levels (HDL-C) From Baseline to Subsequent Visits up to Day 180

Absolute Change in HDL-C levels (mg/dL) from baseline to subsequent visits on Day 90, 150, and 180

Time frame: Baseline, Days 90, 150, 180

Absolute Change in High-Density Lipoprotein Cholesterol Levels (HDL-C) From Baseline to Subsequent Visits up to Day 720

Absolute change in LDL-C levels from Baseline to Subsequent Visits up to Day 720

Time frame: Baseline, Days 330, 450, 510, 630, 690, and 720

Absolute Change in Very-Low-Density Lipoprotein Cholesterol (VLDL-C) From Baseline to Subsequent Visits up to Day 180

Absolute Change in VLDL-C levels from baseline to subsequent visits on Days 90, 150, and 180

Time frame: Baseline, Days 90, 150, 180

Absolute Change in Very-Low-Density-Lipoprotein Cholesterol Levels (VLDL-C) From Baseline to Subsequent Visits up to Day 720

Absolute change in VLDL-C levels from Baseline to Subsequent Visits up to Day 720

Time frame: Baseline, Days 330, 450, 510, 630, 690, and 720

Percent Change in Very-Low-Density Lipoprotein Cholesterol (VLDL-C) From Baseline to Subsequent Visits up to Day 180

Percentage Change in VLDL-C levels (mg/dL) from baseline to subsequent visits on Days 90, 150, and 180

Time frame: Baseline, Days 90, 150, 180

Percent Change in Very-Low-Density-Lipoprotein Cholesterol Levels (VLDL-C) From Baseline to Subsequent Visits up to Day 720

Percentage change in VLDL-C levels from Baseline to Subsequent Visits up to Day 720

Time frame: Baseline, Days 330, 450, 510, 630, 690, and 720

Absolute Change in Apolipoprotein A-1 (Apo-A1) mg/dL From Baseline to Subsequent Visits up to Day 180

Absolute Change in Apolipoprotein A-1 (Apo-A1) from baseline to subsequent visits on Days 90, 150, and 180

Time frame: Baseline, Days 90, 150, 180

Absolute Change Apolipoprotein A-1 (Apo-A1) From Baseline to Subsequent Visits up to Day 720

Absolute change in Apolipoprotein A-1 (Apo-A1) from Baseline to Subsequent Visits up to Day 720

Time frame: Baseline, Days 330, 450, 510, 630, 690, and 720

Percent Change in Apolipoprotein A-1 (Apo-A1) From Baseline to Subsequent Visits up to Day 180

Percentage Change in Apolipoprotein A-1 (Apo-A1) from baseline to subsequent visits on Day 90, 150, and 180

Time frame: Baseline, Days 90, 150, 180

Percent Change Apolipoprotein A-1 (Apo-A1) From Baseline to Subsequent Visits up to Day 720

Percentage change in Apolipoprotein A-1 (Apo-A1) from Baseline to Subsequent Visits up to Day 720

Time frame: Baseline, Days 330, 450, 510, 630, 690, and 720

Percent Change in Lipoprotein(a) [Lp(a)] From Baseline to Subsequent Visits up to Day 180

Percentage Change in Lp(a) from Baseline to Subsequent Visits up to Day 180

Time frame: Baseline, Days 90, 150, 180

Percent Change in Lipoprotein(a) [Lp(a)] From Baseline to Subsequent Visits up to Day 720

Percentage change in Lp(a) from Baseline to Subsequent Visits up to Day 720

Time frame: Baseline, Days 330, 450, 510, 630, 690, and 720

Absolute Change in Lipoprotein(a) [Lp(a)] From Baseline to Subsequent Visits up to Day 180

Absolute Change in Lp(a) from baseline to subsequent visits up to Day 180

Time frame: Baseline, Days 90, 150, 180

Absolute Change in Lipoprotein(a) [Lp(a)] From Baseline to Subsequent Visits up to Day 720

Absolute change in Lp(a) from Baseline to Subsequent Visits up to Day 720

Time frame: Baseline, Days 330, 450, 510, 630, 690, and 720

Percent Change in High-Sensitivity C-Reactive Protein (hsCRP) From Baseline to Subsequent Visits up to Day 180: Part 1

Percent change in hsCRP from Baseline to subsequent visits up to Day 180

Time frame: Baseline, Days 90, 150, 180

Percent Change in High-Sensitivity C-Reactive Protein (hsCRP) From Baseline to Subsequent Visits up to Day 720: Part 2

Percentage change in hsCRP from baseline to subsequent visits up to Day 720

Time frame: Baseline, Days 330, 510 ,690, 720

Absolute Change in High-Sensitivity C-Reactive Protein (hsCRP) From Baseline to Subsequent Visits up to Day 180: Part 1

Absolute Change in High-Sensitivity C-Reactive Protein (hsCRP) from Baseline to subsequent visits up to Day 180

Time frame: Baseline, Days 90, 150, 180

Absolute Change in High-Sensitivity C-Reactive Protein (hsCRP) From Baseline to Subsequent Visits up to Day 720: Part 2

Absolute Change in High-Sensitivity C-Reactive Protein (hsCRP) from baseline to subsequent visits up to Day 720

Time frame: Baseline, Days 330, 510, 690, 720

Percent Change in Apo-B From Baseline to Day 150

Percentage change in Apo-B from baseline to Day 150 as demonstrated using the ANCOVA statisitical model.

Time frame: Baseline, Day 150

Percent Change in Non-HDL-C From Baseline to Day 150

Percentage Change in non-HDL-C from baseline to Day 150 as demonstrated using the ANCOVA statisitical model.

Time frame: Baseline, Day 150

Percent Change in Total Cholesterol From Baseline to Day 150

Percentage change in total cholesterol from baseline to Day 150 as demonstrated using the ANCOVA statisitical model.

Time frame: Baseline, Day 150

Proportion of Subjects With ≥30% LDL-C Reduction of From Baseline at Day 150

Number of participants in each group with ≥30% LDL-C reduction from baseline at Day 150 using the Regression Logistic Statistical Model

Time frame: Baseline, Day 150