Eplontersen Met Co-Primary and Secondary Endpoints in Interim Analysis of the NEURO-TTRansform Phase III Trial for Hereditary Transthyretin-Mediated Amyloid Polyneuropathy (ATTRv-PN)
New Drug Application filing anticipated based on positive data from interim analysis
High-level results showed the trial also met its secondary endpoint of change from baseline in the Norfolk Quality of Life Questionnaire-Diabetic Neuropathy (Norfolk QoL-DN) showing treatment with eplontersen significantly improved patient-reported quality of life versus external placebo group. In the trial, eplontersen demonstrated a favorable safety and tolerability profile with no specific concerns.
ATTRv-PN is a debilitating disease that leads to peripheral nerve damage with motor disability within five years of diagnosis and, without treatment, is generally fatal within a decade3. Eplontersen, formerly known as IONIS-TTR-LRx, is a ligand-conjugated antisense (LICA) investigational medicine designed to reduce the production of TTR protein at its source to treat both hereditary and non-hereditary forms of ATTR2,4-6.
Based on the 35-week interim trial results, the companies will seek regulatory approval for eplontersenand plan to file a new drug application with the
As part of a global development and commercialization agreement with Ionis, eplontersen will be jointly developed and commercialized by both companies in the US and will be developed and commercialized in the rest of the world by
Eplontersen was granted Orphan Drug Designation in the US and is also currently being evaluated in the CARDIO-TTRansform Phase III trial for amyloid transthyretin cardiomyopathy (ATTR-CM)4,6, a systemic, progressive and fatal condition that leads to progressive heart failure and death within four years from diagnosis7-9.
ATTR cardiomyopathy and polyneuropathy are progressive systemic diseases caused by aging or genetic mutations, resulting in misfolded TTR protein and accumulation as amyloid fibrils in the cardiac myocardium and peripheral nerves, respectively2,6-8. In patients with ATTR, both hereditary and wild type (non-hereditary), TTR protein builds up as fibrils in tissues, such as the peripheral nerves and heart, gastrointestinal system, eyes, kidneys, central nervous system, thyroid and bone marrow7,8,10. The presence of TTR fibrils interferes with the normal functions of these tissues8. As the TTR protein fibrils accumulate, more tissue damage occurs and the disease worsens, resulting in poor quality of life (QoL) and eventually death8. Worldwide, there are an estimated 300,000 - 500,000 patients with ATTR-CM10 and about 40,000 patients with ATTRv-PN8.
NEURO-TTRansform is a global, open-label, randomized trial evaluating the efficacy and safety of eplontersen in patients with ATTRv-PN2,5. The trial has enrolled adult patients with ATTRv-PN Stage 1 or Stage 2 and will be compared to the external placebo group from the TEGSEDI® (inotersen) NEURO-TTR registrational trial that Ionis completed in 20172,5. The final primary endpoint analysis will be completed at week 66 and all patients will be followed until week 85, when they will have the option to transition into the open-label extension trial2. The co-primary endpoints in the interim analysis were percent change from baseline in serum TTR concentration and change in the mNIS+7 versus external placebo group at week 352,5. The mNIS+7 uses highly standardized, quantitative, and referenced assessments to quantify muscle weakness, muscle stretch reflexes, sensory loss, and autonomic impairment1. The secondary endpoint was change from baseline in the Norfolk QoL-DN score versus external placebo group at week 352,5. The Norfolk QoL-DN is a patient-reported questionnaire capturing neuropathy-related QoL11.
Eplontersenis a LICA investigational medicine designed to reduce the production of transthyretin, or TTR protein, to treat all types of ATTR, a systemic, progressive and fatal disease2,4-6.
Cardiovascular, Renal and Metabolism (CVRM), part of BioPharmaceuticals, forms one of AstraZeneca’s three disease areas and is a key growth driver for the Company. By following the science to understand more clearly the underlying links between the heart, kidneys and pancreas,
- Dyck PJB, et al. Development of measures of polyneuropathy impairment in hATTR amyloidosis: from NIS to mNIS +7. J Neurol Sci. 2019;405:116424.
- Coelho T, et al. Design and Rationale of the Global Phase 3 NEURO-TTRansform Study of Antisense Oligonucleotide AKCEA-TTR-LRx(ION-682884-CS3) in Hereditary Transthyretin-Mediated Amyloid Polyneuropathy. Neurol Ther. 2021 Jun;10(1):375-389.
- Cortese A, et al. Diagnostic challenges in hereditary transthyretin amyloidosis with polyneuropathy: avoiding misdiagnosis of a treatable hereditary neuropathy. J Neurol Neurosurg Psychiatry. 2017;88(5):457-458.
ClinicalTrials.gov [Internet]. CARDIO-TTRansform: A Study to Evaluate the Efficacy and Safety of Eplontersen (Formerly Known as, IONIS-TTR-LRx and AKCEA-TTR-LRx) in Participants With Transthyretin-Mediated Amyloid Cardiomyopathy (ATTR CM) [cited
18 June 2022]. Available from: https://clinicaltrials.gov/ct2/show/NCT04136171.
ClinicalTrials.gov [Internet]. NEURO-TTRansform: A Study to Evaluate the Efficacy and Safety of Eplontersen (Formerly Known as ION-682884, IONIS-TTR-LRx and AKCEA-TTR-LRx) in Participants With Hereditary Transthyretin-Mediated Amyloid Polyneuropathy [cited
18 June 2022]. Available from: https://clinicaltrials.gov/ct2/show/NCT04136184.
- Viney N, et al. Ligand conjugated antisense oligonucleotide for the treatment of transthyretin amyloidosis: preclinical and phase 1 data. ESC Heart Failure. 2020;8(1):652-661.
- Gertz M, et al. Avoiding misdiagnosis: expert consensus recommendations for the suspicion and diagnosis of transthyretin amyloidosis for the general practitioner. BMC Fam Pract. 220;21(1):198.
- Rintell D, et al. Patient and family experience with transthyretin amyloid cardiomyopathy (ATTR-CM and polyneuropathy (ATTR-PN) amyloidosis: results of two focus groups. Orphanet J Rare Dis. 2021;16:7.
Lauppe RE, et al. Nationwide prevalence and characteristics of transthyretin amyloid cardiomyopathy in
Sweden. Open Heart. 2021;8(2):e001755.
Ionis Pharmaceuticals, Inc., [Internet]. Annual Report, 2022 [cited
18 June 2022]. Available from: https://ir.ionispharma.com/static-files/285deeed-625c-4d5b-beff-8490f93622ce.
- Vinik EJ, et al. Norfolk QOL-DN: validation of a patient reported outcome measure in transthyretin familial amyloid polyneuropathy. J Peripher Nerv Syst. 2014;19(2):104-114.
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