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CompletedNCT02658175Updated Aug 26, 2021Results posted

The Approach Open Label Study: A Study of Volanesorsen (Formerly IONIS-APOCIIIRx) in Participants With Familial Chylomicronemia Syndrome

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

Phase
Phase 3
Study type
Interventional
Enrollment
68
Allocation
Non-randomized
Ages
18 Years and older
Sex
All
01

Study summary

An open-label study of volanesorsen (ISIS 304801) administered subcutaneously to participants with FCS.

Read the detailed description

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.

02

Conditions studied

  • Familial Chylomicronemia Syndrome
  • Lipoprotein Lipase Deficiency
  • Hyperlipoproteinemia Type 1
03

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • Must give written informed consent to participate in the study (signed and dated) and any authorization required by law.
  • Able and willing to participate in a 65-week study.

Group 1 and 2:

  • Satisfactory completion of ISIS 304801-CS6 (NCT02211209) or ISIS 304801-CS16 (NCT02300233) index studies with an acceptable safety profile, per Sponsor and Investigator judgment.

Group 3:

  • Participants who did not participate in the CS6 or CS16 index studies and meet additional inclusion criteria of FCS may enroll in the study.
  • History of chylomicronemia.
  • A diagnosis of FCS (Type 1 Hyperlipoproteinemia.)
  • Fasting triglycerides greater than or equal to (≥)750 milligrams per deciliter [mg/dL] (8.4 millimoles per liter [mmol/L]) at Screening.

Exclusion criteria

Exclusion Criteria:

  • Unwilling to comply with lifestyle requirements for the duration of the study.

Group 1 and 2:

  • Have any new condition or worsening of existing condition which in the opinion of the Investigator would make the participant unsuitable for enrollment, or could interfere with the participant participating in or completing the study.

Group 3:

  • Diabetes mellitus if newly diagnosed or if hemoglobin A1c (HbA1c)≥ 9.0%.
  • Active pancreatitis within 4 weeks of screening.
  • Acute Coronary Syndrome within 6 months of screening.
  • Major surgery within 3 months of screening.
  • Treatment with Glybera therapy within 2 years of screening.
  • Have any other conditions in the opinion of the investigator which could interfere with the participant participating in or completing the study.
04

Study design

Phase
Phase 3
Primary purpose
Treatment
Allocation
Non-randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
68 participants (actual)

Study arms

  • Experimental
    Treatment-naïve Group

    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

  • Experimental
    CS6-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

  • Experimental
    CS16-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

Interventions

  • DrugVolanesorsen

    300 mg volanesorsen administered via SC injection.

    Also known as: IONIS-APOCIIIRx, ISIS 304801

05

What researchers measure

Primary outcomes

  1. 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

  2. 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]

06

Results

Posted Aug 26, 2021

Participant flow

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.

Treatment Period: Weeks 1 to 52
Participant flow — Treatment Period: Weeks 1 to 52
MilestoneTreatment-naïve GroupCS6-VolanesorsenCS16-Volanesorsen
Started51143
Completed3673
Not completed1570
Withdrew: Investigator judgment100
Withdrew: Voluntary withdrawal620
Withdrew: Adverse event or serious adverse event (sae)850
1st Extended Treatment: Weeks 53 to 104
Participant flow — 1st Extended Treatment: Weeks 53 to 104
MilestoneTreatment-naïve GroupCS6-VolanesorsenCS16-Volanesorsen
Started3673
Completed1551
Not completed2122
Withdrew: Investigator judgment100
Withdrew: Voluntary withdrawal401
Withdrew: Adverse event or sae700
Withdrew: Other101
Withdrew: Transferred to early access programs820
2nd Extended Treatment: Weeks 105 to156
Participant flow — 2nd Extended Treatment: Weeks 105 to156
MilestoneTreatment-naïve GroupCS6-VolanesorsenCS16-Volanesorsen
Started101
Completed000
Not completed101
Withdrew: Adverse event or sae001
Withdrew: Transferred to commercial treatment100

Outcome measures

PrimaryMean 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
Reported as:
Mean · percent change
Mean Percent Change From Baseline in Fasting Triglyceride (TG)
percent changeTreatment-naïve GroupCS6-VolanesorsenCS16-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
PrimaryNumber 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]
Reported as:
Count of participants · Participants
Number of Participants With Treatment-emergent Adverse Events (TEAEs)
ParticipantsTreatment-naïve GroupCS6-VolanesorsenCS16-Volanesorsen
Number of Participants With Treatment-emergent Adverse Events (TEAEs)51143

Adverse events

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.

Adverse event summary by group
GroupDeathsSeriousOther
Treatment-naïve Group0/51 (0%)13/51 (25.5%)51/51 (100%)
CS6-Volanesorsen0/14 (0%)2/14 (14.3%)14/14 (100%)
CS16-Volanesorsen0/3 (0%)2/3 (66.7%)3/3 (100%)
Most frequent serious events
Showing 10 of 17
Most frequent serious events
EventTreatment-naïve GroupCS6-VolanesorsenCS16-Volanesorsen
Pancreatitis chronicGastrointestinal disorders0/510/141/3
ThrombocytopeniaBlood and lymphatic system disorders3/510/141/3
Clavicle fractureInjury, poisoning and procedural complications0/510/141/3
MyalgiaMusculoskeletal and connective tissue disorders0/511/140/3
Focal segmental glomerulosclerosisRenal and urinary disorders0/511/140/3
PancreatitisGastrointestinal disorders2/510/140/3
Pancreatitis acuteGastrointestinal disorders2/510/140/3
ArthritisMusculoskeletal and connective tissue disorders1/510/140/3
Intervertebral disc protrusionMusculoskeletal and connective tissue disorders1/510/140/3
Tendon calcificationMusculoskeletal and connective tissue disorders1/510/140/3
Most frequent other events
Showing 10 of 126
Most frequent other events
EventTreatment-naïve GroupCS6-VolanesorsenCS16-Volanesorsen
Abdominal painGastrointestinal disorders14/515/143/3
Injection site erythemaGeneral disorders36/517/141/3
AstheniaGeneral disorders3/512/142/3
ThrombocytopeniaBlood and lymphatic system disorders9/511/142/3
PruritusSkin and subcutaneous tissue disorders1/512/142/3
DepressionPsychiatric disorders2/510/142/3
AnxietyPsychiatric disorders1/510/142/3
HypothyroidismEndocrine disorders1/510/142/3
Injection site painGeneral disorders21/513/140/3
NasopharyngitisInfections and infestations21/514/140/3

Baseline characteristics

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
Age, Continuous(years)Treatment-naïve GroupCS6-VolanesorsenCS16-VolanesorsenTotal
Mean47 ± 1448 ± 1448 ± 1147 ± 13
Sex: Female, Male
Sex: Female, Male(Participants)Treatment-naïve GroupCS6-VolanesorsenCS16-VolanesorsenTotal
Female347243
Male177125
Ethnicity (NIH/OMB)
Ethnicity (NIH/OMB)(Participants)Treatment-naïve GroupCS6-VolanesorsenCS16-VolanesorsenTotal
Hispanic or Latino2002
Not Hispanic or Latino4914366
Unknown or Not Reported0000
Race/Ethnicity, Customized
Race/Ethnicity, Customized(Participants)Treatment-naïve GroupCS6-VolanesorsenCS16-VolanesorsenTotal
Race — White3911353
Race — Asian113014
Race — Other Race1001
Fasting Triglyceride (TG)
Fasting Triglyceride (TG)(milligrams per decilitre (mg/dL))Treatment-naïve GroupCS6-VolanesorsenCS16-VolanesorsenTotal
Mean2341 ± 11931523 ± 9462081 ± 7062161 ± 1166
07

Study locations

34 sites
  • IONIS Investigative Site
    Huntington Beach, California 94143, United States
  • IONIS Investigative Site
    San Francisco, California 94143, United States
  • IONIS Investigative Site
    Boca Raton, Florida 33434, United States
  • IONIS Investigative Site
    Boston, Massachusetts 02114, United States
  • IONIS Investigative Site
    Philadelphia, Pennsylvania 19104, United States
  • IONIS Investigative Site
    Houston, Texas 77030, United States
  • IONIS Investigative Site
    Norfolk, Virginia 23510, United States
  • IONIS Investigative Site
    Seattle, Washington 98104, United States
  • IONIS Investigative Site
    Sao Paulo, 04040-001, Brazil
  • IONIS Investigative Site
    Sao Paulo, CEP-05403-000, Brazil
  • IONIS Investigative Site
    Vancouver, British Columbia V6Z1Y6, Canada
  • IONIS Investigative Site
    Chicoutimi, Quebec G7H 7K9, Canada
  • IONIS Investigative Site
    Montreal, Quebec H2W 1R7, Canada
  • IONIS Investigative Site
    Quebec, G1V 4W2, Canada
  • IONIS Investigative Site
    Paris, Cedex 13 75013, France
  • IONIS Investigative Site
    Marseille Cedex 05, 13385, France
  • IONIS Investigative Site
    Nantes cedex 1, 44800, France
  • IONIS Investigative Site
    Berlin, 13353, Germany
  • IONIS Investigative Site
    Cologne, 50937, Germany
  • IONIS Investigative Site
    Safed, 13110, Israel
  • IONIS Investigative Site
    Palermo, 90127, Italy
  • IONIS Investigative Site
    Roma, 00161, Italy
  • IONIS Investigative Site
    Rome, 00161, Italy
  • IONIS Investigative Site
    Amsterdam-Zuidoost, 1105 AZ, Netherlands
  • IONIS Investigative Site
    Cape Town, 7925, South Africa
  • IONIS Investigative Site
    Barcelona, 08036, Spain
  • IONIS Investigative Site
    La Coruna, 15001, Spain
  • IONIS Investigative Site
    Madrid, 28007, Spain
  • IONIS Investigative Site
    Sevilla, 41013, Spain
  • IONIS Investigative Site
    Zaragoza, 50009, Spain
  • IONIS Investigative Site
    Birmingham, B9 5SS, United Kingdom
  • IONIS Investigative Site
    London, SE1 7EH, United Kingdom
  • IONIS Investigative Site
    Manchester, M13 9WL, United Kingdom
  • IONIS Investigative Site
    Manchester, M23 9LT, United Kingdom
08

References and documents

Study documents

  • Study protocol · May 1, 2019
  • Statistical analysis plan · Mar 28, 2019

Documents are hosted by the registry — open the source record to download them.

09

Registry details

Key details

Study ID
NCT02658175
Lead sponsor
Akcea Therapeutics
Collaborators
Ionis Pharmaceuticals, Inc.
Responsible party
Sponsor
First posted
Jan 18, 2016
Start date
Dec 23, 2015
Primary completion
Jan 15, 2020
Completion
Jan 15, 2020
Results posted
Aug 26, 2021
Last update
Aug 26, 2021

Oversight

Data monitoring committee
Yes
FDA-regulated drug
Yes
View the source record on ClinicalTrials.gov ↗

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