CClinicalTrials.gg
CompletedNCT03070782Updated Oct 30, 2020Results posted

Phase 2 Study of ISIS 681257 (AKCEA-APO(a)-LRx) in Participants With Hyperlipoproteinemia(a) and Cardiovascular Disease

A Phase 2 interventional study of ISIS 681257 and Placebo in Elevated Lipoprotein(a) and Cardiovascular Disease, sponsored by Akcea Therapeutics. Completed at 32 sites in 5 countries. Open to participants aged 18 Years to 80 Years. Per ClinicalTrials.gov, last updated 2020-10-30.

Sponsored by Akcea Therapeutics · Phase 2, Interventional, and Treatment

Phase
Phase 2
Study type
Interventional
Enrollment
286
Allocation
Randomized
Ages
18 Years to 80 Years
Sex
All
01

Study summary

This is a multicenter, randomized, double-blind, placebo-controlled, dose-ranging study to evaluate the safety, including tolerability, of ISIS 681257 and to assess the efficacy of different doses and dosing regimens of ISIS 681257 for reduction of plasma Lipoprotein(a) [Lp(a)] levels in participants with hyperlipoproteinemia(a) and established cardiovascular disease (CVD).

02

Conditions studied

  • Elevated Lipoprotein(a)
  • Cardiovascular Disease

Keywords

  • IONIS-APO(a)-LRx
  • AKCEA-APO(a)-LRx
  • Dyslipidemia
  • Dyslipoproteinemia
  • Hyperlipidemia
  • Hyperlipoproteinemia
  • Hyperlipoproteinemia(a)
  • Hyperlipoproteinemia a
  • Lipoprotein
  • Lipoprotein(a)
  • Lipoprotein a
  • Lp(a)
  • Lp a
03

In context

Cardiovascular Diseases

4,904 studies on the registry are indexed under Cardiovascular Diseases; 919 are open to participants now.

This study's enrollment of 286 is above the median of 100 across 2,738 interventional studies indexed under Cardiovascular Diseases.

Browse Cardiovascular Diseases studies →

Lead sponsor

Akcea Therapeutics is the lead sponsor of 15 studies on the registry; 1 is open to participants now.

Of its 9 completed or terminated interventional studies of FDA-regulated products, 8 (89%) have results posted.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
18 Years to 80 Years
Sexes eligible
All
Accepts healthy volunteers
No

Eligibility criteria

Key Inclusion Criteria:

  • Clinical diagnosis of CVD defined as documented coronary artery disease, stroke, or peripheral artery disease
  • Lp(a) plasma level ≥ 60 mg/dL
  • Must be on standard-of-care preventative therapy for other than elevated Lp(a) CVD risk factors

Key Exclusion Criteria:

  • Within 6 months of Screening: acute coronary syndrome, major cardiac surgery, or stroke/TIA
  • Within 3 months of Screening: coronary, carotid, or peripheral arterial revascularization, major non-cardiac surgery, or lipoprotein apheresis
  • Heart failure New York Heart Association (NYHA) class IV
05

Study design

Phase
Phase 2
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Triple (Participant, Investigator, Outcomes assessor)
Enrollment
286 participants (actual)

Study arms

  • Experimental
    Cohort A: ISIS 681257: 20 mg Q4W

    Cohort A participants received 20 milligrams (mg) ISIS 681257, subcutaneous (SC) injection, once every 4 weeks (Q4W), for up to 49 weeks and a maximum of 13 doses.

    Drug: ISIS 681257

  • Experimental
    Cohort B: ISIS 681257: 40 mg Q4W

    Cohort B participants received 40 mg of ISIS 681257, SC injection, once Q4W, for up to 49 weeks and a maximum of 13 doses.

    Drug: ISIS 681257

  • Experimental
    Cohort C: ISIS 681257: 60 mg Q4W

    Cohort C participants received 60 mg of ISIS 681257, SC injection, once Q4W, for up to 49 weeks and a maximum of 13 doses.

    Drug: ISIS 681257

  • Experimental
    Cohort D: ISIS 681257: 20 mg Q2W

    Cohort D participants received 20 mg of ISIS 681257, SC injection, once every 2 weeks (Q2W), for up to 51 weeks and a maximum of 26 doses.

    Drug: ISIS 681257

  • Experimental
    Cohort E: ISIS 681257: 20 mg QW

    Cohort E participants received 20 mg of ISIS 681257, SC injection, once weekly (QW), for up to 52 weeks and a maximum of 52 doses.

    Drug: ISIS 681257

  • Placebo comparator
    Placebo

    Participants in each cohort were randomized to receive placebo at a dose-matched volume of study drug (ISIS 681257).

    Drug: Placebo

Interventions

  • DrugISIS 681257

    ISIS 681257 solution for SC injection.

    Also known as: AKCEA-APO(a)-LRx, IONIS-APO(a)-LRx, TQJ230 and Pelacarsen

  • DrugPlacebo

    Sterile normal saline (0.9% NaCl)

06

What researchers measure

Primary outcomes

  1. Percent Change From Baseline in Fasting Lipoprotein A [Lp(a)] at the Primary Analysis Time Point

    An ANCOVA model was performed on the log ratio of Lp(a) value at the Primary Analysis Time Point to Lp(a) value at Baseline. The estimate of the log ratio was converted back to the original scale and percent change was calculated using formula: = (ratio of Lp(a) value at the Primary Analysis Time Point to Lp(a) value at Baseline - 1) × 100.

    Time frame: Baseline and Month 6 (Week 25 for Cohorts A, B and C and Week 27 for Cohorts D and E)

  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. TEAEs was defined as any AE with onset after the first administration of study medication through the end of the study, or any event that was present at baseline but worsened in intensity or was subsequently considered drug-related by the Investigator through the end of the study.

    Time frame: Up to 16 weeks post treatment period (up to approximately 1.3 years)

  3. Number of Participants With TEAEs by Maximum Severity

    An 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. TEAEs was defined as any AE with onset after the first administration of study medication through the end of the study, or any event that was present at baseline but worsened in intensity or was subsequently considered drug-related by the Investigator through the end of the study. The severity of TEAEs was assessed based on the National Cancer Institute's (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 4.03. TEAEs were graded on a 5-point scale where 1 = Mild, 2 = Moderate, 3 = Severe, 4 = Potentially life-threatening and 5 = Death.

    Time frame: Up to 16 weeks post treatment period (up to approximately 1.3 years)

  4. Number of Participants With TEAEs Leading to Study Discontinuation

    An 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. TEAE was defined as any AE with onset after the first administration of study medication through the end of the study, or any event that was present at baseline but worsened in intensity or was subsequently considered drug-related by the Investigator through the end of the study.

    Time frame: Up to 16 weeks post treatment period (up to approximately 1.3 years)

Secondary outcomes

  1. Percent Change From Baseline in Fasting Low-Density Lipoprotein Cholesterol (LDL-C)

    An ANCOVA model was performed on the log ratio of LDL-C value at the Primary Analysis Time Point to LDL-C value at Baseline. The estimate of the log ratio was converted back to the original scale and percent change was calculated using formula: = (ratio of LDL-C value at the Primary Analysis Time Point to LDL-C value at Baseline - 1) × 100.

    Time frame: Baseline and Month 6 (Week 25 for Cohorts A, B and C and Week 27 for Cohorts D and E)

  2. Percentage of Participants Who Achieved Plasma Lp(a) ≤ 125 Nanomoles Per Liter (Nmol/L) or ≤ 50 Milligrams Per Deciliter (mg/dL)

    The percentage of participants who achieved ≤ 125 nmol/L or ≤ 50 mg/dL in fasting Lp(a) at the primary analysis time point were compared between each ISIS 681257 treatment group and pooled placebo group using a logistic regression model with log-transformed baseline Lp(a) as a covariate.

    Time frame: Baseline and Month 6 (Week 25 for Cohorts A, B and C and Week 27 for Cohorts D and E)

  3. Percentage of Participants Who Achieved Plasma Lp(a) ≤ 75 Nmol/L or ≤ 30 mg/dL

    The percentage of participants who achieved ≤ 75 nmol/L or ≤ 30 mg/dL in fasting Lp(a) at the primary analysis time point were compared between each ISIS 681257 treatment group and pooled placebo group using a logistic regression model with log-transformed baseline Lp(a) as a covariate.

    Time frame: Baseline and Month 6 (Week 25 for Cohorts A, B and C and Week 27 for Cohorts D and E)

  4. Percent Change From Baseline in the Plasma Levels of Apolipoprotein B (apoB)

    An ANCOVA model was performed on the log ratio of apoB value at the Primary Analysis Time Point to apoB value at Baseline. The estimate of the log ratio was converted back to the original scale and percent change was calculated using formula: = (ratio of apoB value at the Primary Analysis Time Point to apoB value at Baseline - 1) × 100.

    Time frame: Baseline and Month 6 (Week 25 for Cohorts A, B and C and Week 27 for Cohorts D and E)

  5. Percent Change From Baseline in the Plasma Levels of Oxidized Phospholipids (OxPL) on Apolipoprotein(a) [OxPL-apo(a)]

    An ANCOVA model was performed on the log ratio of OxPL-apo(a) value at the Primary Analysis Time Point to OxPL-apo(a) value at Baseline. The estimate of the log ratio was converted back to the original scale and percent change was calculated using formula: = (ratio of OxPL-apo(a) value at the Primary Analysis Time Point to OxPL-apo(a) value at Baseline - 1) × 100.

    Time frame: Baseline and Month 6 (Week 25 for Cohorts A, B and C and Week 27 for Cohorts D and E)

  6. Percent Change From Baseline in the Plasma Levels of Oxidized Phospholipids (OxPL) on Apolipoprotein B (OxPL-apoB)

    An ANCOVA model was performed on the log ratio of OxPL-apoB value at the Primary Analysis Time Point to OxPL-apoB value at Baseline. The estimate of the log ratio was converted back to the original scale and percent change was calculated using formula: = (ratio of OxPL-apoB value at the Primary Analysis Time Point to OxPL-apoB value at Baseline - 1) × 100.

    Time frame: Baseline and Month 6 (Week 25 for Cohorts A, B and C and Week 27 for Cohorts D and E)

Other outcomes

  1. To Evaluate Plasma Cmax of ISIS 681257 Across Different Doses and Dose Regimens.

    Cmax will be calculated for the treatment groups.

    Time frame: 6 months

  2. To Evaluate Plasma Tmax of ISIS 681257 Across Different Doses and Dose Regimens.

    Tmax will be calculated for the treatment groups.

    Time frame: 6 months

  3. To Evaluate Plasma AUC Values of ISIS 681257 Across Different Doses and Dose Regimens.

    AUC values will be calculated for the treatment groups.

    Time frame: 6 months

07

Results

Posted Oct 30, 2020

Participant flow

Participants with a clinical diagnosis of hyperlipoproteinemia(a) and established CVD were enrolled in 31 study centers in United States, Canada, Denmark, Germany and Netherlands between 7th March 2017 to 13th November 2018.

Participant flow — Overall Study
MilestoneCohort A: ISIS 681257: 20 mg Q4WCohort B: ISIS 681257: 40 mg Q4WCohort C: ISIS 681257: 60 mg Q4WCohort D: ISIS 681257: 20 mg Q2WCohort E: ISIS 681257: 20 mg QWPlacebo
Started484847484847
Completed414743433640
Not completed7145127
Withdrew: Adverse event303162
Withdrew: Withdrawal by subject211043
Withdrew: Reason not specified200121
Withdrew: Ineligibility000101
Withdrew: Pregnancy000100
Withdrew: Investigator judgement000100

Outcome measures

PrimaryPercent Change From Baseline in Fasting Lipoprotein A [Lp(a)] at the Primary Analysis Time Point

An ANCOVA model was performed on the log ratio of Lp(a) value at the Primary Analysis Time Point to Lp(a) value at Baseline. The estimate of the log ratio was converted back to the original scale and percent change was calculated using formula: = (ratio of Lp(a) value at the Primary Analysis Time Point to Lp(a) value at Baseline - 1) × 100.

Time frame:
Baseline and Month 6 (Week 25 for Cohorts A, B and C and Week 27 for Cohorts D and E)
Reported as:
Geometric mean · percent change
Percent Change From Baseline in Fasting Lipoprotein A [Lp(a)] at the Primary Analysis Time Point
percent changeCohort A: ISIS 681257: 20 mg Q4WCohort B: ISIS 681257: 40 mg Q4WCohort C: ISIS 681257: 60 mg Q4WCohort D: ISIS 681257: 20 mg Q2WCohort E: ISIS 681257: 20 mg QWPlacebo
Percent Change From Baseline in Fasting Lipoprotein A [Lp(a)] at the Primary Analysis Time Point-35 (-45 to -22)-56 (-63 to -48)-72 (-76 to -67)-58 (-65 to -50)-80 (-83 to -76)-6 (-21 to 12)
Statistical analysis
  • Cohort A: ISIS 681257: 20 mg Q4W vs Placebo · ANCOVA · p = 0.0032 · Mean difference in % cfb: -31 · 95% CI -46 to -12Mean difference in percent (%) change from baseline (CFB) based on difference in least square mean (LSM) of log (Primary Analysis Time Point/Baseline) was estimated.
  • Cohort B: ISIS 681257: 40 mg Q4W vs Placebo · ANCOVA · p = <.0001 · Mean difference in % cfb: -54 · 95% CI -64 to -41Mean difference in percent (%) change from baseline (CFB) based on difference in LSM of log (Primary Analysis Time Point/Baseline) was estimated.
  • Cohort C: ISIS 681257: 60 mg Q4W vs Placebo · ANCOVA · p = <.0001 · Mean difference in % cfb: -70 · 95% CI -77 to -62Mean difference in percent (%) change from baseline (CFB) based on difference in LSM of log (Primary Analysis Time Point/Baseline) was estimated.
  • Cohort D: ISIS 681257: 20 mg Q2W vs Placebo · ANCOVA · p = <.0001 · Mean difference in % cfb: -56 · 95% CI -65 to -43Mean difference in percent (%) change from baseline (CFB) based on difference in LSM of log (Primary Analysis Time Point/Baseline) was estimated.
  • Cohort E: ISIS 681257: 20 mg QW vs Placebo · ANCOVA · p = <.0001 · Mean difference in % cfb: -78 · 95% CI -83 to -72Mean difference in percent (%) change from baseline (CFB) based on difference in LSM of log (Primary Analysis Time Point/Baseline) was estimated.
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. TEAEs was defined as any AE with onset after the first administration of study medication through the end of the study, or any event that was present at baseline but worsened in intensity or was subsequently considered drug-related by the Investigator through the end of the study.

Time frame:
Up to 16 weeks post treatment period (up to approximately 1.3 years)
Reported as:
Count of participants · Participants
Number of Participants With Treatment Emergent Adverse Events (TEAEs)
ParticipantsCohort A: ISIS 681257: 20 mg Q4WCohort B: ISIS 681257: 40 mg Q4WCohort C: ISIS 681257: 60 mg Q4WCohort D: ISIS 681257: 20 mg Q2WCohort E: ISIS 681257: 20 mg QWPlacebo
Number of Participants With Treatment Emergent Adverse Events (TEAEs)464343414441
PrimaryNumber of Participants With TEAEs by Maximum Severity

An 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. TEAEs was defined as any AE with onset after the first administration of study medication through the end of the study, or any event that was present at baseline but worsened in intensity or was subsequently considered drug-related by the Investigator through the end of the study. The severity of TEAEs was assessed based on the National Cancer Institute's (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 4.03. TEAEs were graded on a 5-point scale where 1 = Mild, 2 = Moderate, 3 = Severe, 4 = Potentially life-threatening and 5 = Death.

Time frame:
Up to 16 weeks post treatment period (up to approximately 1.3 years)
Reported as:
Count of participants · Participants
Number of Participants With TEAEs by Maximum Severity
ParticipantsCohort A: ISIS 681257: 20 mg Q4WCohort B: ISIS 681257: 40 mg Q4WCohort C: ISIS 681257: 60 mg Q4WCohort D: ISIS 681257: 20 mg Q2WCohort E: ISIS 681257: 20 mg QWPlacebo
Mild202116242122
Moderate201921152016
Severe636233
PrimaryNumber of Participants With TEAEs Leading to Study Discontinuation

An 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. TEAE was defined as any AE with onset after the first administration of study medication through the end of the study, or any event that was present at baseline but worsened in intensity or was subsequently considered drug-related by the Investigator through the end of the study.

Time frame:
Up to 16 weeks post treatment period (up to approximately 1.3 years)
Reported as:
Count of participants · Participants
Number of Participants With TEAEs Leading to Study Discontinuation
ParticipantsCohort A: ISIS 681257: 20 mg Q4WCohort B: ISIS 681257: 40 mg Q4WCohort C: ISIS 681257: 60 mg Q4WCohort D: ISIS 681257: 20 mg Q2WCohort E: ISIS 681257: 20 mg QWPlacebo
Number of Participants With TEAEs Leading to Study Discontinuation303162
SecondaryPercent Change From Baseline in Fasting Low-Density Lipoprotein Cholesterol (LDL-C)

An ANCOVA model was performed on the log ratio of LDL-C value at the Primary Analysis Time Point to LDL-C value at Baseline. The estimate of the log ratio was converted back to the original scale and percent change was calculated using formula: = (ratio of LDL-C value at the Primary Analysis Time Point to LDL-C value at Baseline - 1) × 100.

Time frame:
Baseline and Month 6 (Week 25 for Cohorts A, B and C and Week 27 for Cohorts D and E)
Reported as:
Geometric mean · percent change
Percent Change From Baseline in Fasting Low-Density Lipoprotein Cholesterol (LDL-C)
percent changeCohort A: ISIS 681257: 20 mg Q4WCohort B: ISIS 681257: 40 mg Q4WCohort C: ISIS 681257: 60 mg Q4WCohort D: ISIS 681257: 20 mg Q2WCohort E: ISIS 681257: 20 mg QWPlacebo
Percent Change From Baseline in Fasting Low-Density Lipoprotein Cholesterol (LDL-C)-7 (-16 to 3)-26 (-33 to -18)-16 (-24 to -7)-17 (-25 to -8)-23 (-31 to -14)-1 (-11 to 9)
Statistical analysis
  • Cohort A: ISIS 681257: 20 mg Q4W vs Placebo · ANCOVA · p = 0.4407 · Mean difference in % cfb: -6 · 95% CI -19 to 9Mean difference in percent (%) change from baseline (CFB) based on difference in LSM of log (Primary Analysis Time Point/Baseline) was estimated.
  • Cohort B: ISIS 681257: 40 mg Q4W vs Placebo · ANCOVA · p = <.0001 · Mean difference in % cfb: -25 · 95% CI -35 to -13Mean difference in percent (%) change from baseline (CFB) based on difference in LSM of log (Primary Analysis Time Point/Baseline) was estimated.
  • Cohort C: ISIS 681257: 60 mg Q4W vs Placebo · ANCOVA · p = 0.0368 · Mean difference in % cfb: -14 · 95% CI -26 to -1Mean difference in percent (%) change from baseline (CFB) based on difference in LSM of log (Primary Analysis Time Point/Baseline) was estimated.
  • Cohort D: ISIS 681257: 20 mg Q2W vs Placebo · ANCOVA · p = 0.0216 · Mean difference in % cfb: -16 · 95% CI -28 to -3Mean difference in percent (%) change from baseline (CFB) based on difference in LSM of log (Primary Analysis Time Point/Baseline) was estimated.
  • Cohort E: ISIS 681257: 20 mg QW vs Placebo · ANCOVA · p = 0.0012 · Mean difference in % cfb: -22 · 95% CI -33 to -9Mean difference in percent (%) change from baseline (CFB) based on difference in LSM of log (Primary Analysis Time Point/Baseline) was estimated.
SecondaryPercentage of Participants Who Achieved Plasma Lp(a) ≤ 125 Nanomoles Per Liter (Nmol/L) or ≤ 50 Milligrams Per Deciliter (mg/dL)

The percentage of participants who achieved ≤ 125 nmol/L or ≤ 50 mg/dL in fasting Lp(a) at the primary analysis time point were compared between each ISIS 681257 treatment group and pooled placebo group using a logistic regression model with log-transformed baseline Lp(a) as a covariate.

Time frame:
Baseline and Month 6 (Week 25 for Cohorts A, B and C and Week 27 for Cohorts D and E)
Reported as:
Number · percentage of participants
Percentage of Participants Who Achieved Plasma Lp(a) ≤ 125 Nanomoles Per Liter (Nmol/L) or ≤ 50 Milligrams Per Deciliter (mg/dL)
percentage of participantsCohort A: ISIS 681257: 20 mg Q4WCohort B: ISIS 681257: 40 mg Q4WCohort C: ISIS 681257: 60 mg Q4WCohort D: ISIS 681257: 20 mg Q2WCohort E: ISIS 681257: 20 mg QWPlacebo
Percentage of Participants Who Achieved Plasma Lp(a) ≤ 125 Nanomoles Per Liter (Nmol/L) or ≤ 50 Milligrams Per Deciliter (mg/dL)22.962.580.964.697.96.4
Statistical analysis
  • Cohort A: ISIS 681257: 20 mg Q4W vs Placebo · Regression, Logistic · p = 0.0286 · Odds ratio (or): 4.98 · 95% CI 1.2 to 21.0
  • Cohort B: ISIS 681257: 40 mg Q4W vs Placebo · Regression, Logistic · p = <.0001 · Odds ratio (or): 31.07 · 95% CI 7.3 to 131.4
  • Cohort C: ISIS 681257: 60 mg Q4W vs Placebo · Regression, Logistic · p = <.0001 · Odds ratio (or): 122.81 · 95% CI 24.0 to 627.4
  • Cohort D: ISIS 681257: 20 mg Q2W vs Placebo · Regression, Logistic · p = <.0001 · Odds ratio (or): 43.78 · 95% CI 9.8 to 195.0
  • Cohort E: ISIS 681257: 20 mg QW vs Placebo · Regression, Logistic · p = <.0001 · Odds ratio (or): 1124.56 · 95% CI 109.3 to 11571
SecondaryPercentage of Participants Who Achieved Plasma Lp(a) ≤ 75 Nmol/L or ≤ 30 mg/dL

The percentage of participants who achieved ≤ 75 nmol/L or ≤ 30 mg/dL in fasting Lp(a) at the primary analysis time point were compared between each ISIS 681257 treatment group and pooled placebo group using a logistic regression model with log-transformed baseline Lp(a) as a covariate.

Time frame:
Baseline and Month 6 (Week 25 for Cohorts A, B and C and Week 27 for Cohorts D and E)
Reported as:
Number · percentage of participants
Percentage of Participants Who Achieved Plasma Lp(a) ≤ 75 Nmol/L or ≤ 30 mg/dL
percentage of participantsCohort A: ISIS 681257: 20 mg Q4WCohort B: ISIS 681257: 40 mg Q4WCohort C: ISIS 681257: 60 mg Q4WCohort D: ISIS 681257: 20 mg Q2WCohort E: ISIS 681257: 20 mg QWPlacebo
Percentage of Participants Who Achieved Plasma Lp(a) ≤ 75 Nmol/L or ≤ 30 mg/dL6.325.053.233.370.80
Statistical analysis
  • Cohort A: ISIS 681257: 20 mg Q4W vs Placebo · Regression, Logistic · p = 0.2007 · Odds ratio (or): 7.34 · 95% CI 0.3 to 155.3
  • Cohort B: ISIS 681257: 40 mg Q4W vs Placebo · Regression, Logistic · p = 0.0258 · Odds ratio (or): 27.92 · 95% CI 1.5 to 521.5
  • Cohort C: ISIS 681257: 60 mg Q4W vs Placebo · Regression, Logistic · p = 0.0014 · Odds ratio (or): 113.92 · 95% CI 6.2 to 2098.5
  • Cohort D: ISIS 681257: 20 mg Q2W vs Placebo · Regression, Logistic · p = 0.0063 · Odds ratio (or): 59.85 · 95% CI 3.2 to 1128.0
  • Cohort E: ISIS 681257: 20 mg QW vs Placebo · Regression, Logistic · p = <.0001 · Odds ratio (or): 347.02 · 95% CI 18.3 to 6597.9
SecondaryPercent Change From Baseline in the Plasma Levels of Apolipoprotein B (apoB)

An ANCOVA model was performed on the log ratio of apoB value at the Primary Analysis Time Point to apoB value at Baseline. The estimate of the log ratio was converted back to the original scale and percent change was calculated using formula: = (ratio of apoB value at the Primary Analysis Time Point to apoB value at Baseline - 1) × 100.

Time frame:
Baseline and Month 6 (Week 25 for Cohorts A, B and C and Week 27 for Cohorts D and E)
Reported as:
Geometric mean · percent change
Percent Change From Baseline in the Plasma Levels of Apolipoprotein B (apoB)
percent changeCohort A: ISIS 681257: 20 mg Q4WCohort B: ISIS 681257: 40 mg Q4WCohort C: ISIS 681257: 60 mg Q4WCohort D: ISIS 681257: 20 mg Q2WCohort E: ISIS 681257: 20 mg QWPlacebo
Percent Change From Baseline in the Plasma Levels of Apolipoprotein B (apoB)-3 (-9 to 4)-15 (-20 to -10)-8 (-14 to -2)-9 (-15 to -3)-16 (-21 to -10)1 (-5 to 8)
Statistical analysis
  • Cohort A: ISIS 681257: 20 mg Q4W vs Placebo · ANCOVA · p = 0.4022 · Mean difference in % cfb: -4 · 95% CI -12 to 5Mean difference in percent (%) change from baseline (CFB) based on difference in LSM of log (Primary Analysis Time Point/Baseline) was estimated.
  • Cohort B: ISIS 681257: 40 mg Q4W vs Placebo · ANCOVA · p = <.0001 · Mean difference in % cfb: -16 · 95% CI -23 to -9Mean difference in percent (%) change from baseline (CFB) based on difference in LSM of log (Primary Analysis Time Point/Baseline) was estimated.
  • Cohort C: ISIS 681257: 60 mg Q4W vs Placebo · ANCOVA · p = 0.0323 · Mean difference in % cfb: -9 · 95% CI -17 to -1Mean difference in percent (%) change from baseline (CFB) based on difference in LSM of log (Primary Analysis Time Point/Baseline) was estimated.
  • Cohort D: ISIS 681257: 20 mg Q2W vs Placebo · ANCOVA · p = 0.0157 · Mean difference in % cfb: -10 · 95% CI -18 to -2Mean difference in percent (%) change from baseline (CFB) based on difference in LSM of log (Primary Analysis Time Point/Baseline) was estimated.
  • Cohort E: ISIS 681257: 20 mg QW vs Placebo · ANCOVA · p = <.0001 · Mean difference in % cfb: -17 · 95% CI -24 to -9Mean difference in percent (%) change from baseline (CFB) based on difference in LSM of log (Primary Analysis Time Point/Baseline) was estimated.
SecondaryPercent Change From Baseline in the Plasma Levels of Oxidized Phospholipids (OxPL) on Apolipoprotein(a) [OxPL-apo(a)]

An ANCOVA model was performed on the log ratio of OxPL-apo(a) value at the Primary Analysis Time Point to OxPL-apo(a) value at Baseline. The estimate of the log ratio was converted back to the original scale and percent change was calculated using formula: = (ratio of OxPL-apo(a) value at the Primary Analysis Time Point to OxPL-apo(a) value at Baseline - 1) × 100.

Time frame:
Baseline and Month 6 (Week 25 for Cohorts A, B and C and Week 27 for Cohorts D and E)
Reported as:
Geometric mean · percent change
Percent Change From Baseline in the Plasma Levels of Oxidized Phospholipids (OxPL) on Apolipoprotein(a) [OxPL-apo(a)]
percent changeCohort A: ISIS 681257: 20 mg Q4WCohort B: ISIS 681257: 40 mg Q4WCohort C: ISIS 681257: 60 mg Q4WCohort D: ISIS 681257: 20 mg Q2WCohort E: ISIS 681257: 20 mg QWPlacebo
Percent Change From Baseline in the Plasma Levels of Oxidized Phospholipids (OxPL) on Apolipoprotein(a) [OxPL-apo(a)]-28 (-41 to -12)-49 (-58 to -38)-63 (-70 to -55)-45 (-55 to -33)-70 (-75 to -62)-20 (-35 to -2)
Statistical analysis
  • Cohort A: ISIS 681257: 20 mg Q4W vs Placebo · ANCOVA · p = 0.4956 · Mean difference in % cfb: -9 · 95% CI -32 to 21Mean difference in percent (%) change from baseline (CFB) based on difference in LSM of log (Primary Analysis Time Point/Baseline) was estimated.
  • Cohort B: ISIS 681257: 40 mg Q4W vs Placebo · ANCOVA · p = 0.0027 · Mean difference in % cfb: -36 · 95% CI -52 to -14Mean difference in percent (%) change from baseline (CFB) based on difference in LSM of log (Primary Analysis Time Point/Baseline) was estimated.
  • Cohort C: ISIS 681257: 60 mg Q4W vs Placebo · ANCOVA · p = <.0001 · Mean difference in % cfb: -54 · 95% CI -65 to -38Mean difference in percent (%) change from baseline (CFB) based on difference in LSM of log (Primary Analysis Time Point/Baseline) was estimated.
  • Cohort D: ISIS 681257: 20 mg Q2W vs Placebo · ANCOVA · p = 0.0114 · Mean difference in % cfb: -31 · 95% CI -48 to -8Mean difference in percent (%) change from baseline (CFB) based on difference in LSM of log (Primary Analysis Time Point/Baseline) was estimated.
  • Cohort E: ISIS 681257: 20 mg QW vs Placebo · ANCOVA · p = <.0001 · Mean difference in % cfb: -62 · 95% CI -72 to -49Mean difference in percent (%) change from baseline (CFB) based on difference in LSM of log (Primary Analysis Time Point/Baseline) was estimated.
SecondaryPercent Change From Baseline in the Plasma Levels of Oxidized Phospholipids (OxPL) on Apolipoprotein B (OxPL-apoB)

An ANCOVA model was performed on the log ratio of OxPL-apoB value at the Primary Analysis Time Point to OxPL-apoB value at Baseline. The estimate of the log ratio was converted back to the original scale and percent change was calculated using formula: = (ratio of OxPL-apoB value at the Primary Analysis Time Point to OxPL-apoB value at Baseline - 1) × 100.

Time frame:
Baseline and Month 6 (Week 25 for Cohorts A, B and C and Week 27 for Cohorts D and E)
Reported as:
Geometric mean · percent change
Percent Change From Baseline in the Plasma Levels of Oxidized Phospholipids (OxPL) on Apolipoprotein B (OxPL-apoB)
percent changeCohort A: ISIS 681257: 20 mg Q4WCohort B: ISIS 681257: 40 mg Q4WCohort C: ISIS 681257: 60 mg Q4WCohort D: ISIS 681257: 20 mg Q2WCohort E: ISIS 681257: 20 mg QWPlacebo
Percent Change From Baseline in the Plasma Levels of Oxidized Phospholipids (OxPL) on Apolipoprotein B (OxPL-apoB)-37 (-52 to -17)-57 (-67 to -45)-79 (-84 to -73)-64 (-72 to -53)-88 (-91 to -84)14 (-12 to 49)
Statistical analysis
  • Cohort A: ISIS 681257: 20 mg Q4W vs Placebo · ANCOVA · p = 0.0020 · Mean difference in % cfb: -45 · 95% CI -62 to -19Mean difference in percent (%) change from baseline (CFB) based on difference in LSM of log (Primary Analysis Time Point/Baseline) was estimated.
  • Cohort B: ISIS 681257: 40 mg Q4W vs Placebo · ANCOVA · p = <.0001 · Mean difference in % cfb: -63 · 95% CI -74 to -46Mean difference in percent (%) change from baseline (CFB) based on difference in LSM of log (Primary Analysis Time Point/Baseline) was estimated.
  • Cohort C: ISIS 681257: 60 mg Q4W vs Placebo · ANCOVA · p = <.0001 · Mean difference in % cfb: -82 · 95% CI -87 to -73Mean difference in percent (%) change from baseline (CFB) based on difference in LSM of log (Primary Analysis Time Point/Baseline) was estimated.
  • Cohort D: ISIS 681257: 20 mg Q2W vs Placebo · ANCOVA · p = <.0001 · Mean difference in % cfb: -68 · 95% CI -78 to -54Mean difference in percent (%) change from baseline (CFB) based on difference in LSM of log (Primary Analysis Time Point/Baseline) was estimated.
  • Cohort E: ISIS 681257: 20 mg QW vs Placebo · ANCOVA · p = <.0001 · Mean difference in % cfb: -89 · 95% CI -93 to -84Mean difference in percent (%) change from baseline (CFB) based on difference in LSM of log (Primary Analysis Time Point/Baseline) was estimated.
Other pre-specifiedTo Evaluate Plasma Cmax of ISIS 681257 Across Different Doses and Dose Regimens.

Cmax will be calculated for the treatment groups.

Time frame:
6 months

Results for this outcome have not been posted.

Other pre-specifiedTo Evaluate Plasma Tmax of ISIS 681257 Across Different Doses and Dose Regimens.

Tmax will be calculated for the treatment groups.

Time frame:
6 months

Results for this outcome have not been posted.

Other pre-specifiedTo Evaluate Plasma AUC Values of ISIS 681257 Across Different Doses and Dose Regimens.

AUC values will be calculated for the treatment groups.

Time frame:
6 months

Results for this outcome have not been posted.

Adverse events

Collected over Up to 16 weeks post-treatment period (up to approximately 1.3 years). Non-serious events are listed at a 5% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
Cohort A: ISIS 681257: 20 mg Q4W0/48 (0%)7/48 (14.6%)38/48 (79.2%)
Cohort B: ISIS 681257: 40 mg Q4W0/48 (0%)7/48 (14.6%)42/48 (87.5%)
Cohort C: ISIS 681257: 60 mg Q4W1/47 (2.1%)7/47 (14.9%)40/47 (85.1%)
Cohort D: ISIS 681257: 20 mg Q2W0/48 (0%)3/48 (6.3%)36/48 (75%)
Cohort E: ISIS 681257: 20 mg QW1/48 (2.1%)4/48 (8.3%)42/48 (87.5%)
Placebo0/47 (0%)3/47 (6.4%)36/47 (76.6%)
Most frequent serious events
Showing 10 of 29
Most frequent serious events
EventCohort A: ISIS 681257: 20 mg Q4WCohort B: ISIS 681257: 40 mg Q4WCohort C: ISIS 681257: 60 mg Q4WCohort D: ISIS 681257: 20 mg Q2WCohort E: ISIS 681257: 20 mg QWPlacebo
Acute myocardial infarctionCardiac disorders2/480/481/471/480/480/47
Angina unstableCardiac disorders1/480/481/471/480/480/47
Angina pectorisCardiac disorders1/481/480/470/480/481/47
Ventricular tachycardiaCardiac disorders0/480/481/470/480/480/47
Radius fractureInjury, poisoning and procedural complications0/480/481/470/480/480/47
Road traffic accidentInjury, poisoning and procedural complications0/480/481/470/480/480/47
Gastrointestinal anastomotic stenosisInjury, poisoning and procedural complications0/480/480/470/480/481/47
CystGeneral disorders0/480/480/470/480/481/47
Lung neoplasm malignantNeoplasms benign, malignant and unspecified (incl cysts and polyps)0/480/481/470/480/480/47
Ischaemic strokeNervous system disorders0/480/480/470/480/481/47
Most frequent other events
Showing 10 of 46
Most frequent other events
EventCohort A: ISIS 681257: 20 mg Q4WCohort B: ISIS 681257: 40 mg Q4WCohort C: ISIS 681257: 60 mg Q4WCohort D: ISIS 681257: 20 mg Q2WCohort E: ISIS 681257: 20 mg QWPlacebo
Injection site erythemaGeneral disorders3/4813/4813/4711/4822/480/47
Viral upper respiratory tract infectionInfections and infestations8/4810/488/478/4815/4811/47
Urinary tract infectionInfections and infestations7/487/4810/476/489/483/47
MyalgiaMusculoskeletal and connective tissue disorders4/485/4810/476/483/485/47
FatigueGeneral disorders8/487/482/471/483/481/47
Angina pectorisCardiac disorders8/483/482/471/482/481/47
Back painMusculoskeletal and connective tissue disorders2/487/482/471/484/483/47
HeadacheNervous system disorders6/487/484/474/486/485/47
CoughRespiratory, thoracic and mediastinal disorders2/483/483/472/486/485/47
Upper respiratory tract infectionInfections and infestations4/483/480/473/484/485/47

Baseline characteristics

Safety Set included all participants who were randomized and received at least 1 dose of study drug (ISIS 681257 or placebo).

Age, Continuous
Age, Continuous(years)Cohort A: ISIS 681257: 20 mg Q4WCohort B: ISIS 681257: 40 mg Q4WCohort C: ISIS 681257: 60 mg Q4WCohort D: ISIS 681257: 20 mg Q2WCohort E: ISIS 681257: 20 mg QWPlaceboTotal
Mean60.0 (38 to 77)61.3 (39 to 80)62.2 (40 to 79)57.9 (30 to 76)58.9 (40 to 75)59.9 (34 to 76)60.0 (30 to 80)
Sex: Female, Male
Sex: Female, Male(Participants)Cohort A: ISIS 681257: 20 mg Q4WCohort B: ISIS 681257: 40 mg Q4WCohort C: ISIS 681257: 60 mg Q4WCohort D: ISIS 681257: 20 mg Q2WCohort E: ISIS 681257: 20 mg QWPlaceboTotal
Female19121417201597
Male293633312832189
Ethnicity (NIH/OMB)
Ethnicity (NIH/OMB)(Participants)Cohort A: ISIS 681257: 20 mg Q4WCohort B: ISIS 681257: 40 mg Q4WCohort C: ISIS 681257: 60 mg Q4WCohort D: ISIS 681257: 20 mg Q2WCohort E: ISIS 681257: 20 mg QWPlaceboTotal
Hispanic or Latino2100115
Not Hispanic or Latino464747484746281
Unknown or Not Reported0000000
Race (NIH/OMB)
Race (NIH/OMB)(Participants)Cohort A: ISIS 681257: 20 mg Q4WCohort B: ISIS 681257: 40 mg Q4WCohort C: ISIS 681257: 60 mg Q4WCohort D: ISIS 681257: 20 mg Q2WCohort E: ISIS 681257: 20 mg QWPlaceboTotal
American Indian or Alaska Native0000000
Asian1000012
Native Hawaiian or Other Pacific Islander0000000
Black or African American2300106
White444547474746276
More than one race0000000
Unknown or Not Reported1001002
08

Study locations

32 sites
  • Clinical Site
    Cottonwood, Arizona 86326, United States
  • Clinical Site
    Huntington Beach, California 92648, United States
  • Clinical Site
    La Jolla, California 92103, United States
  • Clinical Site
    Los Angeles, California 90048, United States
  • Clinical Site
    Stanford, California 94305, United States
  • Clinical Site
    Colorado Springs, Colorado 80909, United States
  • Clinical Site
    Boca Raton, Florida 33434, United States
  • Clinical Site
    Jacksonville, Florida 32216, United States
  • Clinical Site
    Kansas City, Kansas 66160, United States
  • Clinical Site
    Baltimore, Maryland 21201, United States
  • Clinical Site
    Boston, Massachusetts 02114, United States
  • Clinical Site
    Cooperstown, New York 13326, United States
  • Clinical Site
    New York, New York 10016, United States
  • Clinical Site
    New York, New York 10029, United States
  • Clinical Site
    Cleveland, Ohio 44195, United States
  • Clinical Site
    Portland, Oregon 97239, United States
  • Clinical Site
    Lancaster, Pennsylvania 17602, United States
  • Clinical Site
    Philadelphia, Pennsylvania 19104, United States
  • Clinical Site
    Providence, Rhode Island 02906, United States
  • Clinical Site
    Houston, Texas 77030, United States
  • Clinical Site
    Falls Church, Virginia 22042, United States
  • Clinical Site
    Milwaukee, Wisconsin 53215, United States
  • Clinical Site
    Chicoutimi, Quebec G7H7K9, Canada
  • Clinical Site
    Montreal, Quebec H1T 1C8, Canada
  • Clinical Site
    Montréal, Quebec H3H 2L9, Canada
  • Clinical Site
    Québec, Quebec G1V4W2, Canada
  • Clinical Site
    Ottawa, K1Y4W7, Canada
  • Clinical Site
    Herlev, 2730, Denmark
  • Clinical Site
    Viborg, 8800, Denmark
  • Clinical Site
    Berlin, 13353, Germany
  • Clinical Site
    Cologne, 50937, Germany
  • Clinical Site
    Amsterdam, 1105AZ, Netherlands
09

References and documents

Publications

  • Stiekema LCA, Prange KHM, Hoogeveen RM, Verweij SL, Kroon J, Schnitzler JG, Dzobo KE, Cupido AJ, Tsimikas S, Stroes ESG, de Winther MPJ, Bahjat M. Potent lipoprotein(a) lowering following apolipoprotein(a) antisense treatment reduces the pro-inflammatory activation of circulating monocytes in patients with elevated lipoprotein(a). Eur Heart J. 2020 Jun 21;41(24):2262-2271. doi: 10.1093/eurheartj/ehaa171. PubMed 32268367 ↗
  • Tsimikas S, Karwatowska-Prokopczuk E, Gouni-Berthold I, Tardif JC, Baum SJ, Steinhagen-Thiessen E, Shapiro MD, Stroes ES, Moriarty PM, Nordestgaard BG, Xia S, Guerriero J, Viney NJ, O'Dea L, Witztum JL; AKCEA-APO(a)-LRx Study Investigators. Lipoprotein(a) Reduction in Persons with Cardiovascular Disease. N Engl J Med. 2020 Jan 16;382(3):244-255. doi: 10.1056/NEJMoa1905239. Epub 2020 Jan 1. PubMed 31893580 ↗

Study documents

  • Study protocol · Jan 25, 2018
  • Statistical analysis plan · Jun 7, 2018

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

Individual participant data

Plan to share: No

10

Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Oct 30, 2020, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
11

Registry details

Key details

Study ID
NCT03070782
Lead sponsor
Akcea Therapeutics
Collaborators
Ionis Pharmaceuticals, Inc.
Responsible party
Sponsor
First posted
Mar 6, 2017
Start date
Mar 7, 2017
Primary completion
Jul 26, 2018
Completion
Nov 13, 2018
Results posted
Oct 30, 2020
Last update
Oct 30, 2020

Oversight

Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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