A Phase 3 interventional study of Volanesorsen in Familial Chylomicronemia Syndrome, Lipoprotein Lipase Deficiency and Hyperlipoproteinemia Type 1, sponsored by Akcea Therapeutics. Completed at 34 sites in 11 countries. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2021-08-26.
Sponsored by Akcea Therapeutics · Phase 3, Interventional, and Treatment
An open-label study of volanesorsen (ISIS 304801) administered subcutaneously to participants with FCS.
This is a multi-center, open-label study for FCS participants rolling over from the ISIS 304801-CS6 (NCT02211209) index study, FCS participants rolling over from the ISIS 304801-CS16 (NCT02300233) index study and Treatment-naïve group. All participants were to receive volanesorsen 300 milligrams (mg) once per week for 52 weeks. Participants were allowed dose adjustment/dose reduction based on monitoring rules. Participants had the option of continuing dosing for an additional 52 weeks (France: up to an additional 104 weeks for a total of 156 weeks) until an expanded access program was approved and available in their country. Participants who were not participating in an expanded access program were to enter a 13-week (France: 26-week) post-treatment evaluation period.
Group 1 and 2:
Group 3:
Exclusion Criteria:
Group 1 and 2:
Group 3:
Treatment naïve group included combined group of ISIS 304801-CS7 (CS7-New) study participant and participant on placebo in index studies (ISIS 304801-CS6 \[NCT02211209\] and ISIS 304801-CS16 \[NCT02300233\]), were to receive 300 mg of volanesorsen as single SC once weekly for Weeks 1-52 of this study. Participants were allowed dose adjustment/dose reduction based on monitoring rules. Following Week 52 visit, participants had option of participating in expanded access program or continuing treatment with 300 mg of volanesorsen as single SC once-weekly for up to additional 52 weeks (Weeks 53-104) and in France participants, up to additional 104 weeks for total of 156 weeks (Weeks 105 to Week 156) until expanded access program was approved and available in their country. Participants who were not participating in expanded access program were to enter 13-week post-treatment (PT) evaluation period and in France, participants not continuing treatment were to enter 26-week PT follow-up period.
Drug: Volanesorsen
Participants with FCS rolling over from the ISIS 304801-CS6 (NCT02211209) index study after receiving volanesorsen, were to receive 300 mg of volanesorsen as a single SC injection once weekly for Weeks 1-52 of this study. Participants were allowed dose adjustment/dose reduction based on monitoring rules. Following the Week 52 visit, participants had the option of participating in an expanded access program or continuing treatment with 300 mg of volanesorsen as a single SC injection once-weekly for up to an additional 52 weeks (Weeks 53-104) and in France participants, up to an additional 104 weeks for total of 156 weeks of treatment (Weeks 105 to Week 156) of this study until an expanded access program was approved and available in their country. Participants who were not participating in an expanded access program were to enter a 13-week post-treatment evaluation period and in France, participants not continuing treatment were to enter a 26-week post-treatment follow-up period.
Drug: Volanesorsen
Participants with FCS rolling over from the ISIS 304801-CS16 (NCT02300233) index study after receiving volanesorsen, were to receive 300 mg of volanesorsen as a single SC injection once weekly for Weeks 1-52 of this study. Participants were allowed dose adjustment/dose reduction based on monitoring rules. Following the Week 52 visit, participants had the option of participating in an expanded access program or continuing treatment with 300 mg of volanesorsen as a single SC injection once-weekly for up to an additional 52 weeks (Weeks 53-104) and in France participants, up to an additional 104 weeks for total of 156 weeks of treatment (Weeks 105 to Week 156) of this study until an expanded access program was approved and available in their country. Participants who were not participating in an expanded access program were to enter a 13-week post-treatment evaluation period and in France, participants not continuing treatment were to enter a 26-week post-treatment follow-up period.
Drug: Volanesorsen
300 mg volanesorsen administered via SC injection.
Also known as: IONIS-APOCIIIRx, ISIS 304801
Mean Percent Change From Baseline in Fasting Triglyceride (TG)
Baseline for treatment-naïve group was defined as the average of open-label Day 1 pre-dose assessment and the last measurement prior to open-label Day 1. Baseline for CS6-volanesorsen and CS16-volanesorsen arm groups was defined as the average of index study Day 1 pre-dose assessment and the last measurement prior index study Day 1. The values at the Month 3 analysis time point were defined as the average of the Week 12 (Day 78) and Week 13 (Day 85) fasting assessments. The Month 6 analysis time point was at the end of Month 6, and the values were defined as the average of the Week 25 (Day 169) and Week 26 (Day 176) fasting assessments. The values at the Month 12 analysis time point were defined as the average of the Week 50 (Day 344) and Week 52 (Day 358) fasting assessments.
Time frame: Baseline and Months 3, 6, and 12
Number of Participants With Treatment-emergent Adverse Events (TEAEs)
An adverse event (AE) was defined as any unfavorable and unintended sign (including a clinically significant abnormal laboratory finding), symptom, or disease temporally associated with the study or use of investigational drug product, whether or not the AE was considered related to the investigational drug product. A TEAE was defined as any AE starting or getting worse on or after the first dose of the study drug.
Time frame: From first dose of study drug to end of follow-up period [Up to Week 182]
The study was conducted at 19 study centers in Canada, France, Italy, Netherlands, South Africa, Spain, United Kingdom and the United States from 23 December 2015 to 15 January 2020.
| Milestone | Treatment-naïve Group | CS6-Volanesorsen | CS16-Volanesorsen |
|---|---|---|---|
| Started | 51 | 14 | 3 |
| Completed | 36 | 7 | 3 |
| Not completed | 15 | 7 | 0 |
| Withdrew: Investigator judgment | 1 | 0 | 0 |
| Withdrew: Voluntary withdrawal | 6 | 2 | 0 |
| Withdrew: Adverse event or serious adverse event (sae) | 8 | 5 | 0 |
| Milestone | Treatment-naïve Group | CS6-Volanesorsen | CS16-Volanesorsen |
|---|---|---|---|
| Started | 36 | 7 | 3 |
| Completed | 15 | 5 | 1 |
| Not completed | 21 | 2 | 2 |
| Withdrew: Investigator judgment | 1 | 0 | 0 |
| Withdrew: Voluntary withdrawal | 4 | 0 | 1 |
| Withdrew: Adverse event or sae | 7 | 0 | 0 |
| Withdrew: Other | 1 | 0 | 1 |
| Withdrew: Transferred to early access programs | 8 | 2 | 0 |
| Milestone | Treatment-naïve Group | CS6-Volanesorsen | CS16-Volanesorsen |
|---|---|---|---|
| Started | 1 | 0 | 1 |
| Completed | 0 | 0 | 0 |
| Not completed | 1 | 0 | 1 |
| Withdrew: Adverse event or sae | 0 | 0 | 1 |
| Withdrew: Transferred to commercial treatment | 1 | 0 | 0 |
Baseline for treatment-naïve group was defined as the average of open-label Day 1 pre-dose assessment and the last measurement prior to open-label Day 1. Baseline for CS6-volanesorsen and CS16-volanesorsen arm groups was defined as the average of index study Day 1 pre-dose assessment and the last measurement prior index study Day 1. The values at the Month 3 analysis time point were defined as the average of the Week 12 (Day 78) and Week 13 (Day 85) fasting assessments. The Month 6 analysis time point was at the end of Month 6, and the values were defined as the average of the Week 25 (Day 169) and Week 26 (Day 176) fasting assessments. The values at the Month 12 analysis time point were defined as the average of the Week 50 (Day 344) and Week 52 (Day 358) fasting assessments.
| percent change | Treatment-naïve Group | CS6-Volanesorsen | CS16-Volanesorsen |
|---|---|---|---|
| Percent Change at Month 3 | -59.8 ± 37.0 | -49.2 ± 34.8 | -64.9 ± 9.1 |
| Percent Change at Month 6 | -45.5 ± 42.9 | -54.8 ± 23.8 | -43.0 ± 19.7 |
| Percent Change at Month 12 | -36.3 ± 44.2 | -35.1 ± 45.6 | -41.6 ± 36.3 |
An adverse event (AE) was defined as any unfavorable and unintended sign (including a clinically significant abnormal laboratory finding), symptom, or disease temporally associated with the study or use of investigational drug product, whether or not the AE was considered related to the investigational drug product. A TEAE was defined as any AE starting or getting worse on or after the first dose of the study drug.
| Participants | Treatment-naïve Group | CS6-Volanesorsen | CS16-Volanesorsen |
|---|---|---|---|
| Number of Participants With Treatment-emergent Adverse Events (TEAEs) | 51 | 14 | 3 |
Collected over From first dose of study drug to end of follow-up period [Up to Week 182]. Non-serious events are listed at a 5% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Treatment-naïve Group | 0/51 (0%) | 13/51 (25.5%) | 51/51 (100%) |
| CS6-Volanesorsen | 0/14 (0%) | 2/14 (14.3%) | 14/14 (100%) |
| CS16-Volanesorsen | 0/3 (0%) | 2/3 (66.7%) | 3/3 (100%) |
| Event | Treatment-naïve Group | CS6-Volanesorsen | CS16-Volanesorsen |
|---|---|---|---|
| Pancreatitis chronicGastrointestinal disorders | 0/51 | 0/14 | 1/3 |
| ThrombocytopeniaBlood and lymphatic system disorders | 3/51 | 0/14 | 1/3 |
| Clavicle fractureInjury, poisoning and procedural complications | 0/51 | 0/14 | 1/3 |
| MyalgiaMusculoskeletal and connective tissue disorders | 0/51 | 1/14 | 0/3 |
| Focal segmental glomerulosclerosisRenal and urinary disorders | 0/51 | 1/14 | 0/3 |
| PancreatitisGastrointestinal disorders | 2/51 | 0/14 | 0/3 |
| Pancreatitis acuteGastrointestinal disorders | 2/51 | 0/14 | 0/3 |
| ArthritisMusculoskeletal and connective tissue disorders | 1/51 | 0/14 | 0/3 |
| Intervertebral disc protrusionMusculoskeletal and connective tissue disorders | 1/51 | 0/14 | 0/3 |
| Tendon calcificationMusculoskeletal and connective tissue disorders | 1/51 | 0/14 | 0/3 |
| Event | Treatment-naïve Group | CS6-Volanesorsen | CS16-Volanesorsen |
|---|---|---|---|
| Abdominal painGastrointestinal disorders | 14/51 | 5/14 | 3/3 |
| Injection site erythemaGeneral disorders | 36/51 | 7/14 | 1/3 |
| AstheniaGeneral disorders | 3/51 | 2/14 | 2/3 |
| ThrombocytopeniaBlood and lymphatic system disorders | 9/51 | 1/14 | 2/3 |
| PruritusSkin and subcutaneous tissue disorders | 1/51 | 2/14 | 2/3 |
| DepressionPsychiatric disorders | 2/51 | 0/14 | 2/3 |
| AnxietyPsychiatric disorders | 1/51 | 0/14 | 2/3 |
| HypothyroidismEndocrine disorders | 1/51 | 0/14 | 2/3 |
| Injection site painGeneral disorders | 21/51 | 3/14 | 0/3 |
| NasopharyngitisInfections and infestations | 21/51 | 4/14 | 0/3 |
Full Analysis Set (FAS) included all participants who were enrolled and received at least one dose of study drug and who had an open-label study baseline triglyceride (TG) assessment.
| Age, Continuous(years) | Treatment-naïve Group | CS6-Volanesorsen | CS16-Volanesorsen | Total |
|---|---|---|---|---|
| Mean | 47 ± 14 | 48 ± 14 | 48 ± 11 | 47 ± 13 |
| Sex: Female, Male(Participants) | Treatment-naïve Group | CS6-Volanesorsen | CS16-Volanesorsen | Total |
|---|---|---|---|---|
| Female | 34 | 7 | 2 | 43 |
| Male | 17 | 7 | 1 | 25 |
| Ethnicity (NIH/OMB)(Participants) | Treatment-naïve Group | CS6-Volanesorsen | CS16-Volanesorsen | Total |
|---|---|---|---|---|
| Hispanic or Latino | 2 | 0 | 0 | 2 |
| Not Hispanic or Latino | 49 | 14 | 3 | 66 |
| Unknown or Not Reported | 0 | 0 | 0 | 0 |
| Race/Ethnicity, Customized(Participants) | Treatment-naïve Group | CS6-Volanesorsen | CS16-Volanesorsen | Total |
|---|---|---|---|---|
| Race — White | 39 | 11 | 3 | 53 |
| Race — Asian | 11 | 3 | 0 | 14 |
| Race — Other Race | 1 | 0 | 0 | 1 |
| Fasting Triglyceride (TG)(milligrams per decilitre (mg/dL)) | Treatment-naïve Group | CS6-Volanesorsen | CS16-Volanesorsen | Total |
|---|---|---|---|---|
| Mean | 2341 ± 1193 | 1523 ± 946 | 2081 ± 706 | 2161 ± 1166 |
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Akcea Therapeutics