Atherosclerotic Cardiovascular DiseasePhase 2ORION-1NCT02597127
Trial to Evaluate the Effect of ALN-PCSSC Treatment on Low Density Lipoprotein Cholesterol (LDL-C)
A Phase 2 study testing ALN-PCSSC and Normal Saline in people with Atherosclerotic Cardiovascular Disease and Familial Hypercholesterolemia, run by The Medicines Company at 54 sites in 5 countries.
Trial summary
This study is a Phase II, placebo-controlled, double-blind, randomized trial in 480 participants with atherosclerotic cardiovascular disease (ASCVD) or ASCVD-risk equivalents (for example, diabetes and familial hypercholesterolemia) and elevated LDL-C despite maximum tolerated dose of LDL-C lowering therapies to… Read more about this study
- Who is it for?
- Ages 18 to 99 years
- Conditions the study is for
- Atherosclerotic Cardiovascular Disease, Familial Hypercholesterolemia, Diabetes
- What is being tested?
- ALN-PCSSC and Normal Saline
- Type of treatment
- Injection or infusion
- Could I receive a placebo?
- Yes, some participants may receive a placebo
- How many people
- 501 participants
- Where
- 54 sitesin 5 countries
- Study dates
- Jan 2016to 7 Jun 2017
- Phase
- Phase 2
- Are there results?
- Yes, posted in the registrySummary in the doctors' view
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 99 years
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Male or female participants ≥18 years of age.
- History of ASCVD or ASCVD-risk equivalents (symptomatic atherosclerosis, Type 2 diabetes, familial hypercholesterolemia, including participants whose 10-year risk of a CV event assessed by Framingham Risk Score (Framingham Risk Score >20%) or equivalent has a target LDL-C of <100 mg/deciliter [dL]).
- Serum LDL-C ≥1.8 millimole (mmol)/liter (L) (≥70 mg/dL) for ASCVD participants or ≥2.6 mmol/L (≥100 mg/dL) for ASCVD-risk equivalent participants at screening.
- Fasting triglyceride <4.52 mmol/L (<400 mg/dL) at screening.
- Calculated glomerular filtration rate 30 mL/min or higher by estimated glomerular filtration rate (eGFR) using standardized local clinical methodology.
- Participants on statins should be receiving a maximally tolerated dose (investigator's discretion).
- Participants 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.
- Willing and able to give informed consent before initiation of any study-related procedures and willing to comply with all required study procedures.
Who cannot join
- 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 participant at significant risk (according to investigator's [or delegate] judgment) if he/she participates in the clinical study.
- An underlying known disease, or surgical, physical, or medical condition that, in the opinion of the investigator (or delegate), might interfere with interpretation of the clinical study results.
- New York Heart Association (NYHA) class II, III, or IV heart failure or last known left ventricular ejection fraction <30%.
- Cardiac arrhythmia within 3 months prior to randomization that is not controlled by medication or via ablation.
- Any history of hemorrhagic stroke.
- Major adverse cardiac event within 6 months prior to randomization.
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- Uncontrolled severe hypertension: systolic blood pressure >180 millimeters of mercury (mmHg) or diastolic blood pressure >110 mmHg prior to randomization despite anti-hypertensive therapy.
- Poorly controlled Type 2 diabetes, such as, glycated hemoglobin A1c (HbA1c)>10.0% prior to randomization.
- Active liver disease defined as any known current infectious, neoplastic, or metabolic pathology of the liver or unexplained alanine aminotransferase (ALT) or aspartate aminotransferase (AST) elevation >2x the upper limit of normal (ULN), or total bilirubin elevation >1.5x ULN at screening confirmed by a repeat measurement at least 1 week apart.
- Serious comorbid disease in which the life expectancy of the participant is shorter than the duration of the trial (for example, acute systemic infection, cancer, or other serious illnesses). This includes all cancers with the exception of treated basal-cell carcinoma occurring >5 years before screening.
- Females who are pregnant or nursing, or who are of childbearing potential and unwilling to use at least two methods of contraception (oral contraceptives, barrier methods, approved contraceptive implant, long-term injectable contraception, intrauterine device or tubal litigation) for the entire duration of the study. Women who are >2 years postmenopausal defined as ≥1 year since last menstrual period and if less than 55 years old with a negative pregnancy test within 24 hours of randomization or surgically sterile are exempt from this exclusion.
- Males who are unwilling to use an acceptable method of birth control during the entire study period (such as, condom with spermicide).
- Known history of alcohol and/or drug abuse within the last 5 years.
- Treatment with other investigational medicinal products or devices within 30 days or five half˗lives, whichever is longer.
- Use of other investigational medicinal products or devices during the course of the study.
- Any condition that according to the investigator could interfere with the conduct of the study, such as but not limited to the following:
- Inappropriate for this study, including participants who are unable to communicate or to cooperate with the investigator.
- Unable to understand the protocol requirements, instructions and study-related restrictions, the nature, scope, and possible consequences of the study (including participants whose cooperation is doubtful due to drug abuse or alcohol dependency).
- Unlikely to comply with the protocol requirements, instructions, and study-related restrictions (for example, uncooperative attitude, inability to return for follow-up visits, and improbability of completing the study).
- Have any medical or surgical condition, which in the opinion of the investigator would put the participants at increased risk from participating in the study.
- Involved with, or a relative of, someone directly involved in the conduct of the study.
- Any known cognitive impairment (for example, Alzheimer's disease)
- Previous or current treatment (within 90 days of screening) with monoclonal antibodies directed at PCSK9.
Trial locations and contacts
54 sites in 5 countries.
54 sites in 5 countries
Netherlands14 sites
Amsterdam Medical Center
Amsterdam, 1105 AZ
Deventer Ziekenhuis
Deventer, 7416 SE
Andromed Eindhoven
Eindhoven, 5611 NV
Admiraal de Ruyter Hospital, Cardiology
Goes, 4462 RA
Bethesda Diabetes Research Center
Hoogeveen, 7909 AA
Medisch Centrum Gorecht
Hoogezand, 9603 AE
VOC Hoorn
Hoorn, 0031229284320
Leids Universitair Medisch Centrum (LUMC)
Leiden, 2333 ZA
Andromed Rotterdam
Rotterdam, 3021 HC
Haga Hospital
The Hague, 2545 CH
Diakonessenhuis, Vascular Policlinic
Utrecht, 3582 KE
UMC Utrecht
Utrecht, 3584 CX
VieCurie Venlo, Cardiology
Venlo, 5912 BL
Albert Schweitzer Hospital, Cardiology
Zwijndrecht, 3331 LZ
United Kingdom14 sites
Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust
Birmingham, B15 2TH
Edinburgh Royal Infirmary
Edinburgh, EH16 4SA
The Royal Devon and Exeter NHS Trust
Exeter, EX2 5DW
Fowey River Practice
Fowey, PL23 1DT
Buckinghamshire NHS Trust
High Wycombe, HP11 2TT
Oak Tree Surgery
Liskeard, Oak Tree Surgery
Royal Free Hospital
London, NW3 2QG
Central Manchester University Hospital NHS Foundation Trust
Manchester, M13 9WL
The Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital
Newcastle upon Tyne, NE1 4LP
The Alverton Practice
Penzance, TR18 4JH
Knowle House Surgery
Plymouth, PL5 3JB
Brannel Surgery
St Austell, St. Austell
Rame Medical Ltd (Rame Research)
Torpoint, PL11 2TB
Worcestershire Acute NHS Trust
Worcester, WR5 1DD
Canada12 sites
Brampton Research Associates
Brampton, Ontario, L6Z 4N5
ECOGENE-21 Clinical Trials Center
Chicoutimi, Quebec, G7H 7K9
Lawson Health Research Institute
London, Ontario, N6C 2R5
Clinic Sante Cardio MC
Montreal, Quebec, H1T 3Y7
Institut de Recherches Cliniques de Montreal
Montreal, Quebec, H2W 1R7
Université Laval Quebec
Québec, Quebec, G1V 4G5
Clinique des maladies lipidique Quebec
Québec, Quebec, G1V 4W2
Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke (CIUSSS de l'Estrie - CHUS)
Sherbrooke, Quebec, J1H 5N4
Eastern Regional Health Authority, Patient Research Centre
St. John's, Newfoundland and Labrador, A1B 3V6
St. Michael's Hospital
Toronto, Ontario, M5C 2T2
St. Paul's Hospital
Vancouver, British Columbia, V6Z 1Y6
St. Boniface Hospital
Winnipeg, Manitoba, R2H 2A6
United States8 sites
Amarillo Heart Clinical Research Institute, Inc.
Amarillo, Texas, 79106
Metabolic And Atherosclerosis Research Center
Cincinnati, Ohio, 45227
Sterling Research Group
Cincinnati, Ohio, 45246
Wellmont CVA Heart Institute
Greeneville, Tennessee, 37745
Midwest Institute For Clinical Research
Indianapolis, Indiana, 46260
Jacksonville Center for Clinical Research
Jacksonville, Florida, 32216
Mount Sinai Icahn School of Medicine
New York, New York, 10029
National Clinical Research, Inc.
Richmond, Virginia, 23294
Germany6 sites
Medical University Berlin
Berlin, 12203
Medical Center Essen
Essen, 45355
University Hospital Frankfurt
Frankfurt, 60590
University Heart Center Hamburg
Hamburg, 20251
Medical University Hospital Heidelberg, Internal medicine III
Heidelberg, 69120
Technical University Munich, German Heart Center
Munich, 80636
About this study
Official title: A Placebo-controlled, Double-blind, Randomized Trial to Compare the Effect of Different Doses of ALN-PCSSC Given as Single or Multiple Subcutaneous Injections in Subjects With High Cardiovascular Risk and Elevated LDL-C
This study is a Phase II, placebo-controlled, double-blind, randomized trial in 480 participants with atherosclerotic cardiovascular disease (ASCVD) or ASCVD-risk equivalents (for example, diabetes and familial hypercholesterolemia) and elevated LDL-C despite maximum tolerated dose of LDL-C lowering therapies to evaluate the efficacy, safety, and tolerability of ALN-PCSSC injection(s).
Read the detailed description
Participants will be screened and 480 eligible participants will be randomized: 60 participants per each of six ALN-PCSSC dose groups plus 120 participants total across the placebo groups (20 participants each to match each of the six drug dose groups). Treatment allocation will be stratified by country and by current use of statins or other lipid-modifying therapies. Each participant will receive either one or two injections on Day 1 or a single injection on Day 1 and on Day 90 of blinded ALN-PCSSC or placebo.
Formation of anti-drug antibodies (ADA) will be assessed on Day 1 (prior to and 4 hours after the injection) and on Days 30, 60, 90, 120, 150, 180 (Days 150 and 180 only in participants who receive a second dose of study drug), and 210 or until any ADA response becomes negative within the study duration.
The independent Data Monitoring Committee (DMC) will review safety data beginning after the first 40 participants receive the first injection of ALN-PCSSC or placebo and complete the Day 14 follow-up visit. Thereafter, the DMC will review safety data every 2 months until the end of the trial. A recommendation may be taken to stop or amend the study at any of these reviews.
On Day 1, all eligible participants will be randomized and receive the first subcutaneous (SC) administration of ALN-PCSSC or placebo. After the first study drug administration, the participant will be observed in the clinic for at least 4 hours post injection before being discharged. Participants will return at Day 14 and then at monthly intervals for 6 months. Participants randomized to receive a second dose of study drug will receive the second injection of ALN-PCSSC or placebo at the Day 90 visit.
Efficacy assessments will include the measurement of the effects of ALN-PCSSC on levels of LDL-C lipids and lipoproteins including total cholesterol (TC), triglycerides, high-density lipoprotein cholesterol (HDL-C), non-HDL-C, very low-density lipoprotein (VLDL), apolipoprotein A1 (Apo-AI), apolipoprotein B (Apo-B), lipoprotein (a) [Lp(a)], C-reactive protein (CRP), and proprotein convertase subtilisin/kexin type 9 (PCSK9).
End of study (EOS) evaluations will be conducted at the EOS visit (Day 210). The expected duration of the participants' involvement in the study will be approximately 374 days, which includes screening, study drug administration, the course of single or multiple injections, and the follow-up period to Day 360.
Participants completing the study to Day 210 will be given the opportunity to enroll in a separate long-term extension study. Any participants in whom LDL-C levels have not returned to >80% of baseline values will continue to be followed as part of this study until either this level has been reached or until a maximum of Day 360, at which point they will be given the opportunity to enroll in the long-term extension study. At each visit, LDL-C levels, adverse events, serious adverse events, concomitant medications, and safety laboratory assessments will be collected.
Objectives:
Primary:
To evaluate the effect of ALN-PCSSC treatment on LDL-C levels at Day 180.
Secondary:
To evaluate the effect of ALN-PCSSC on the following:
- LDL-C at Day 90
- LDL-C levels at other time points
- PCSK9 levels over time
- Other lipids, lipoproteins, apolipoproteins
- Proportion of participants achieving pre-specified global lipid guidelines
- Individual responsiveness to different doses
- Duration of lipid-lowering effect of different doses
- Safety and tolerability profile of ALN-PCSSC
Exploratory:
To collect/evaluate the effect of ALN-PCSSC on the following:
- Cardiovascular (CV) events such as CV death, non-fatal myocardial infarction, resuscitated cardiac arrest and non-fatal stroke (ischemic and hemorrhagic)
- Evaluation of ADA for the investigational product
- Being tested
- ALN-PCSSC, Normal Saline
- Medical subject headings
- Atherosclerosis, Hyperlipoproteinemia Type II, Diabetes Mellitus
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
ALN-PCSSCDrug
Also called PCSK9 synthesis inhibitor, Inclisiran
ALN-PCSSC is a small interfering ribonucleic acid (RNA) that inhibits PCSK9 synthesis and is given as SC injections
Normal SalineDrug
Saline (sterile, normal, 0.9%) solution given as SC injections
| Study group | Role | What they receive |
|---|---|---|
| ALN-PCSSC 200 mg (bi-annual dosing) | Experimental | ALN-PCSSC 200 milligram (mg) SC administration once at Day 1 Receives: Drug: ALN-PCSSC |
| ALN-PCSSC 300 mg (bi-annual dosing) | Experimental | ALN-PCSSC 300 mg SC administration once at Day 1 Receives: Drug: ALN-PCSSC |
| ALN-PCSSC 500 mg (bi-annual dosing) | Experimental | ALN-PCSSC 500 mg SC administration once at Day 1 Receives: Drug: ALN-PCSSC |
| Normal Saline (bi-annual dosing) | Placebo comparator | Saline SC administration once at Day 1 Receives: Drug: Normal Saline |
| ALN-PCSSC 100 mg (quarterly dosing) | Experimental | ALN-PCSSC 100 mg SC administration twice at Day 1 and Day 90 Receives: Drug: ALN-PCSSC |
| ALN-PCSSC 200 mg (quarterly dosing) | Experimental | ALN-PCSSC 200 mg SC administration twice at Day 1 and Day 90 Receives: Drug: ALN-PCSSC |
| ALN-PCSSC 300 mg (quarterly dosing) | Experimental | ALN-PCSSC 300 mg SC administration twice at Day 1 and Day 90 Receives: Drug: ALN-PCSSC |
| Normal Saline (quarterly dosing) | Placebo comparator | Saline SC administration twice at Day 1 and Day 90 Receives: Drug: Normal Saline |
What is being measured
The primary outcome is the main question the study is designed to answer.
Percentage Change in LDL-C From Baseline to Day 180
Percent Change in LDL-C (beta-quantification) from Baseline to Day 180 in MITT Population
Measured: Baseline to 180 days
Secondary outcomes (9)
Percentage Change in LDL-C From Baseline to Day 90
Percent Change in LDL-C (beta-quantification) from Baseline to Day 90 in MITT Population
Measured: Baseline to 90 days
Percent Change From Baseline In LDL-C Levels At Day 60, Day 120, and Day 210
This outcome measure evaluated the effects of both single- and double-dose inclisiran on LDL-C levels in the mITT population from baseline to Day 60, Day 120, and Day 210.
Measured: Baseline, Day 60, Day 120, and Day 210
Number of Participants With an LDL-C Greater Than 80% of the Baseline Value at Day 180 and Day 210
This outcome measure evaluated the number of participants (single and double dose) in the mITT population with an LDL-C greater than 80% of the baseline value at Day 180 and Day 210.
Measured: Baseline, Day 180, Day 210
Number of Participants With Individual Responsiveness as Measured By LDL-C Levels at Day 90 and Day 180
This outcome measure evaluated the individual responsiveness of participants to inclisiran (single and double dose) in the mITT population as defined by an LDL-C level of <25 mg/deciliter [dL] at Day 90 and Day 180.
Measured: Day 90, Day 180
Number of Participants With Greater Or Equal To 50% LDL-C Reduction From Baseline At Day 180
This outcome measure evaluated the number of participants (single and double dose) in the mITT population with an LDL-C reduction greater than 50% of the baseline value at Day 180.
Measured: Baseline, Day 180
Percentage Change in PCSK9 Levels From Baseline at Day 180
This outcome measure evaluated the percent change in proprotein convertase subtilisin/kexin type 9 (PCSK9) from baseline to Day 180 in participants (single and double dose) in the mITT population.
Measured: Baseline, Day 180
Percentage Change in Other Lipids and Apolipoproteins From Baseline to Day 180
This outcome measure evaluated the percent change from baseline to Day 180 in cholesterol (total, high-density lipoprotein [HDL], non-HDL) and apolipoproteins (B, A1) in participants (single and double dose) in the mITT population.
Measured: Baseline, Day 180
Number of Participants Who Attained Global Lipid Modification Targets for Level of Atherosclerotic Cardiovascular Disease Risk
This outcome measure evaluated the proportion of participants (single and double dose) in the mITT population who attained a global lipid modification target by baseline cardiovascular risk group, looking specifically at LDL-C levels (mg/dL) in the category of cardiovascular disease (CVD).
CVD was defined as a participant who had at least 1 of the following: prior myocardial infarction, prior percutaneous coronary intervention, prior coronary artery bypass graft, prior stroke, prior transient ischemic attack, peripheral artery disease.
Measured: Baseline, Day 180
Percentage Change in Other Lipids and Inflammatory Markers From Baseline to Day 180
This outcome measure evaluated the percent change from baseline to Day 180 in triglycerides, very-low-density lipoprotein (VLDL) cholesterol, lipoprotein(a), and high sensitivity C-reactive protein (hsCRP) in participants (single and double dose) in the mITT population.
Measured: Baseline, Day 180
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted5 Nov 2015 (estimated)
- Study startJan 2016
- Primary completion7 Jun 2017
- Study completion7 Jun 2017
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Posted resultsParticipant flow, outcome measures and adverse events reported by the sponsor.
- Publications (42)Papers the sponsor has linked to this study.
- Other trials for Atherosclerotic Cardiovascular DiseaseStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 2
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind
- Who is masked
- Participant, Investigator
- Enrolment
- 501 participants (actual)
Sponsor and investigators
- Lead sponsor
- The Medicines Company
- Sponsor type
- Industry (pharma, biotech, devices)
- Responsible party
- Sponsor
- Investigators
- Kausik K Ray, MD, Principal investigator, Department of Public Health and Primary Care, Imperial College London, Reynolds Building
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT02597127
- Sponsor's protocol ID
- MDCO-PCS-15-01
- Acronym
- ORION-1
- Status last verified
- Apr 2019
- First submitted
- 3 Nov 2015
- Last updated
- 17 May 2019
- Results posted
- Yes, on ClinicalTrials.gov
- Data monitoring committee
- Yes
Publications
Abifadel M, Varret M, Rabes JP, Allard D, Ouguerram K, Devillers M, Cruaud C, Benjannet S, Wickham L, Erlich D, Derre A, Villeger L, Farnier M, Beucler I, Bruckert E, Chambaz J, Chanu B, Lecerf JM, Luc G, Moulin P, Weissenbach J, Prat A, Krempf M, Junien C, Seidah NG, Boileau C. Mutations in PCSK9 cause autosomal dominant hypercholesterolemia. Nat Genet. 2003 Jun;34(2):154-6. doi: 10.1038/ng1161.
PubMed 12730697Ashwell G, Morell AG. The role of surface carbohydrates in the hepatic recognition and transport of circulating glycoproteins. Adv Enzymol Relat Areas Mol Biol. 1974;41(0):99-128. doi: 10.1002/9780470122860.ch3. No abstract available.
PubMed 4609051Banerjee Y, Shah K, Al-Rasadi K. Effect of a monoclonal antibody to PCSK9 on LDL cholesterol. N Engl J Med. 2012 Jun 21;366(25):2425-6; author reply 2426. doi: 10.1056/NEJMc1204929. No abstract available.
PubMed 22716984Milazzo L, Antinori S. Effect of a monoclonal antibody to PCSK9 on LDL cholesterol. N Engl J Med. 2012 Jun 21;366(25):2425; author reply 2426. doi: 10.1056/NEJMc1204929. No abstract available.
PubMed 22716983Cholesterol Treatment Trialists' (CTT) Collaboration; Baigent C, Blackwell L, Emberson J, Holland LE, Reith C, Bhala N, Peto R, Barnes EH, Keech A, Simes J, Collins R. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet. 2010 Nov 13;376(9753):1670-81. doi: 10.1016/S0140-6736(10)61350-5. Epub 2010 Nov 8.
PubMed 21067804Coelho T, Adams D, Silva A, Lozeron P, Hawkins PN, Mant T, Perez J, Chiesa J, Warrington S, Tranter E, Munisamy M, Falzone R, Harrop J, Cehelsky J, Bettencourt BR, Geissler M, Butler JS, Sehgal A, Meyers RE, Chen Q, Borland T, Hutabarat RM, Clausen VA, Alvarez R, Fitzgerald K, Gamba-Vitalo C, Nochur SV, Vaishnaw AK, Sah DW, Gollob JA, Suhr OB. Safety and efficacy of RNAi therapy for transthyretin amyloidosis. N Engl J Med. 2013 Aug 29;369(9):819-29. doi: 10.1056/NEJMoa1208760.
PubMed 23984729Cohen JC, Boerwinkle E, Mosley TH Jr, Hobbs HH. Sequence variations in PCSK9, low LDL, and protection against coronary heart disease. N Engl J Med. 2006 Mar 23;354(12):1264-72. doi: 10.1056/NEJMoa054013.
PubMed 16554528Davidson MH, Maki KC, Pearson TA, Pasternak RC, Deedwania PC, McKenney JM, Fonarow GC, Maron DJ, Ansell BJ, Clark LT, Ballantyne CM. Results of the National Cholesterol Education (NCEP) Program Evaluation ProjecT Utilizing Novel E-Technology (NEPTUNE) II survey and implications for treatment under the recent NCEP Writing Group recommendations. Am J Cardiol. 2005 Aug 15;96(4):556-63. doi: 10.1016/j.amjcard.2005.04.019.
PubMed 16098311Dias CS, Shaywitz AJ, Wasserman SM, Smith BP, Gao B, Stolman DS, Crispino CP, Smirnakis KV, Emery MG, Colbert A, Gibbs JP, Retter MW, Cooke BP, Uy ST, Matson M, Stein EA. Effects of AMG 145 on low-density lipoprotein cholesterol levels: results from 2 randomized, double-blind, placebo-controlled, ascending-dose phase 1 studies in healthy volunteers and hypercholesterolemic subjects on statins. J Am Coll Cardiol. 2012 Nov 6;60(19):1888-98. doi: 10.1016/j.jacc.2012.08.986. Epub 2012 Oct 17.
PubMed 23083772Elbashir SM, Harborth J, Lendeckel W, Yalcin A, Weber K, Tuschl T. Duplexes of 21-nucleotide RNAs mediate RNA interference in cultured mammalian cells. Nature. 2001 May 24;411(6836):494-8. doi: 10.1038/35078107.
PubMed 11373684Foley KA, Simpson RJ Jr, Crouse JR 3rd, Weiss TW, Markson LE, Alexander CM. Effectiveness of statin titration on low-density lipoprotein cholesterol goal attainment in patients at high risk of atherogenic events. Am J Cardiol. 2003 Jul 1;92(1):79-81. doi: 10.1016/s0002-9149(03)00474-0. No abstract available.
PubMed 12842255Foody JM, Sajjan SG, Hu XH, Ramey DR, Neff DR, Tershakovec AM, Tomassini JE, Wentworth C, Tunceli K. Loss of early gains in low-density lipoprotein cholesterol goal attainment among high-risk patients. J Clin Lipidol. 2010 Mar-Apr;4(2):126-32. doi: 10.1016/j.jacl.2010.01.007. Epub 2010 Feb 6.
PubMed 21122640ALN TTRSC-001; EudraCT 2012 004203 12
ALN-TTRSC-002; EudraCT 2013 002856 33
Geisbert TW, Hensley LE, Kagan E, Yu EZ, Geisbert JB, Daddario-DiCaprio K, Fritz EA, Jahrling PB, McClintock K, Phelps JR, Lee AC, Judge A, Jeffs LB, MacLachlan I. Postexposure protection of guinea pigs against a lethal ebola virus challenge is conferred by RNA interference. J Infect Dis. 2006 Jun 15;193(12):1650-7. doi: 10.1086/504267. Epub 2006 May 10.
PubMed 16703508
Study at a glance
From the registry record, last updated by the sponsor on 17 May 2019. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- A Placebo-controlled, Double-blind, Randomized Trial to Compare the Effect of Different Doses of ALN-PCSSC Given as Single or Multiple Subcutaneous Injections in Subjects With High Cardiovascular Risk and Elevated LDL-C
- ClinicalTrials.gov ID
- NCT02597127
- Acronym / sponsor ID
- ORION-1 / MDCO-PCS-15-01
- Phase
- Phase 2
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 501 participants (actual)
- Lead sponsor
- The Medicines CompanyIndustry (pharma, biotech, devices)
- Study start
- Jan 2016
- Primary completion
- 7 Jun 2017 (actual)
- Study completion
- 7 Jun 2017 (actual)
- First posted
- 5 Nov 2015 (estimated)
- Results
- Posted 17 May 2019
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This study is a Phase II, placebo-controlled, double-blind, randomized trial in 480 participants with atherosclerotic cardiovascular disease (ASCVD) or ASCVD-risk equivalents (for example, diabetes and familial hypercholesterolemia) and elevated LDL-C despite maximum tolerated dose of LDL-C lowering therapies to evaluate the efficacy, safety, and tolerability of ALN-PCSSC injection(s).
Detailed description
Participants will be screened and 480 eligible participants will be randomized: 60 participants per each of six ALN-PCSSC dose groups plus 120 participants total across the placebo groups (20 participants each to match each of the six drug dose groups). Treatment allocation will be stratified by country and by current use of statins or other lipid-modifying therapies. Each participant will receive either one or two injections on Day 1 or a single injection on Day 1 and on Day 90 of blinded ALN-PCSSC or placebo.
Formation of anti-drug antibodies (ADA) will be assessed on Day 1 (prior to and 4 hours after the injection) and on Days 30, 60, 90, 120, 150, 180 (Days 150 and 180 only in participants who receive a second dose of study drug), and 210 or until any ADA response becomes negative within the study duration.
The independent Data Monitoring Committee (DMC) will review safety data beginning after the first 40 participants receive the first injection of ALN-PCSSC or placebo and complete the Day 14 follow-up visit. Thereafter, the DMC will review safety data every 2 months until the end of the trial. A recommendation may be taken to stop or amend the study at any of these reviews.
On Day 1, all eligible participants will be randomized and receive the first subcutaneous (SC) administration of ALN-PCSSC or placebo. After the first study drug administration, the participant will be observed in the clinic for at least 4 hours post injection before being discharged. Participants will return at Day 14 and then at monthly intervals for 6 months. Participants randomized to receive a second dose of study drug will receive the second injection of ALN-PCSSC or placebo at the Day 90 visit.
Efficacy assessments will include the measurement of the effects of ALN-PCSSC on levels of LDL-C lipids and lipoproteins including total cholesterol (TC), triglycerides, high-density lipoprotein cholesterol (HDL-C), non-HDL-C, very low-density lipoprotein (VLDL), apolipoprotein A1 (Apo-AI), apolipoprotein B (Apo-B), lipoprotein (a) [Lp(a)], C-reactive protein (CRP), and proprotein convertase subtilisin/kexin type 9 (PCSK9).
End of study (EOS) evaluations will be conducted at the EOS visit (Day 210). The expected duration of the participants' involvement in the study will be approximately 374 days, which includes screening, study drug administration, the course of single or multiple injections, and the follow-up period to Day 360.
Participants completing the study to Day 210 will be given the opportunity to enroll in a separate long-term extension study. Any participants in whom LDL-C levels have not returned to >80% of baseline values will continue to be followed as part of this study until either this level has been reached or until a maximum of Day 360, at which point they will be given the opportunity to enroll in the long-term extension study. At each visit, LDL-C levels, adverse events, serious adverse events, concomitant medications, and safety laboratory assessments will be collected.
Objectives:
Primary:
To evaluate the effect of ALN-PCSSC treatment on LDL-C levels at Day 180.
Secondary:
To evaluate the effect of ALN-PCSSC on the following:
- LDL-C at Day 90
- LDL-C levels at other time points
- PCSK9 levels over time
- Other lipids, lipoproteins, apolipoproteins
- Proportion of participants achieving pre-specified global lipid guidelines
- Individual responsiveness to different doses
- Duration of lipid-lowering effect of different doses
- Safety and tolerability profile of ALN-PCSSC
Exploratory:
To collect/evaluate the effect of ALN-PCSSC on the following:
- Cardiovascular (CV) events such as CV death, non-fatal myocardial infarction, resuscitated cardiac arrest and non-fatal stroke (ischemic and hemorrhagic)
- Evaluation of ADA for the investigational product
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind (participant, investigator)
- Number of arms
- 8
| Arm | Type | Receives |
|---|---|---|
| ALN-PCSSC 200 mg (bi-annual dosing) | Experimental | Drug: ALN-PCSSCALN-PCSSC 200 milligram (mg) SC administration once at Day 1 |
| ALN-PCSSC 300 mg (bi-annual dosing) | Experimental | Drug: ALN-PCSSCALN-PCSSC 300 mg SC administration once at Day 1 |
| ALN-PCSSC 500 mg (bi-annual dosing) | Experimental | Drug: ALN-PCSSCALN-PCSSC 500 mg SC administration once at Day 1 |
| Normal Saline (bi-annual dosing) | Placebo comparator | Drug: Normal SalineSaline SC administration once at Day 1 |
| ALN-PCSSC 100 mg (quarterly dosing) | Experimental | Drug: ALN-PCSSCALN-PCSSC 100 mg SC administration twice at Day 1 and Day 90 |
| ALN-PCSSC 200 mg (quarterly dosing) | Experimental | Drug: ALN-PCSSCALN-PCSSC 200 mg SC administration twice at Day 1 and Day 90 |
| ALN-PCSSC 300 mg (quarterly dosing) | Experimental | Drug: ALN-PCSSCALN-PCSSC 300 mg SC administration twice at Day 1 and Day 90 |
| Normal Saline (quarterly dosing) | Placebo comparator | Drug: Normal SalineSaline SC administration twice at Day 1 and Day 90 |
Who may qualify
- Ages
- 18 to 99 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (8 listed)
- Male or female participants ≥18 years of age.
- History of ASCVD or ASCVD-risk equivalents (symptomatic atherosclerosis, Type 2 diabetes, familial hypercholesterolemia, including participants whose 10-year risk of a CV event assessed by Framingham Risk Score (Framingham Risk Score >20%) or equivalent has a target LDL-C of <100 mg/deciliter [dL]).
- Serum LDL-C ≥1.8 millimole (mmol)/liter (L) (≥70 mg/dL) for ASCVD participants or ≥2.6 mmol/L (≥100 mg/dL) for ASCVD-risk equivalent participants at screening.
- Fasting triglyceride <4.52 mmol/L (<400 mg/dL) at screening.
- Calculated glomerular filtration rate 30 mL/min or higher by estimated glomerular filtration rate (eGFR) using standardized local clinical methodology.
Key exclusion criteria (23 listed)
- 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 participant at significant risk (according to investigator's [or delegate] judgment) if he/she participates in the clinical study.
- An underlying known disease, or surgical, physical, or medical condition that, in the opinion of the investigator (or delegate), might interfere with interpretation of the clinical study results.
- New York Heart Association (NYHA) class II, III, or IV heart failure or last known left ventricular ejection fraction <30%.
- Cardiac arrhythmia within 3 months prior to randomization that is not controlled by medication or via ablation.
- Any history of hemorrhagic stroke.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| ALN-PCSSCAlso: PCSK9 synthesis inhibitor, InclisiranALN-PCSSC is a small interfering ribonucleic acid (RNA) that inhibits PCSK9 synthesis and is given as SC injections | Drug | ALN-PCSSC 100 mg (quarterly dosing), ALN-PCSSC 200 mg (bi-annual dosing), ALN-PCSSC 200 mg (quarterly dosing), ALN-PCSSC 300 mg (bi-annual dosing), ALN-PCSSC 300 mg (quarterly dosing), ALN-PCSSC 500 mg (bi-annual dosing) |
| Normal SalineSaline (sterile, normal, 0.9%) solution given as SC injections | Drug | Normal Saline (bi-annual dosing), Normal Saline (quarterly dosing) |
Primary outcome
Percentage Change in LDL-C From Baseline to Day 180
Time frame: Baseline to 180 days
Percent Change in LDL-C (beta-quantification) from Baseline to Day 180 in MITT Population
9 secondary outcomes
Percentage Change in LDL-C From Baseline to Day 90
Time frame: Baseline to 90 days
Percent Change From Baseline In LDL-C Levels At Day 60, Day 120, and Day 210
Time frame: Baseline, Day 60, Day 120, and Day 210
Number of Participants With an LDL-C Greater Than 80% of the Baseline Value at Day 180 and Day 210
Time frame: Baseline, Day 180, Day 210
Number of Participants With Individual Responsiveness as Measured By LDL-C Levels at Day 90 and Day 180
Time frame: Day 90, Day 180
Number of Participants With Greater Or Equal To 50% LDL-C Reduction From Baseline At Day 180
Time frame: Baseline, Day 180
Percentage Change in PCSK9 Levels From Baseline at Day 180
Time frame: Baseline, Day 180
Percentage Change in Other Lipids and Apolipoproteins From Baseline to Day 180
Time frame: Baseline, Day 180
Number of Participants Who Attained Global Lipid Modification Targets for Level of Atherosclerotic Cardiovascular Disease Risk
Time frame: Baseline, Day 180
Percentage Change in Other Lipids and Inflammatory Markers From Baseline to Day 180
Time frame: Baseline, Day 180
Results and safety
Loading the posted results from ClinicalTrials.gov…
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 17 May 2019.
- Posted resultsParticipant flow, baseline, all outcome measures and adverse events.
- Background: PubMed 12730697Abifadel M, Varret M, Rabes JP, Allard D, Ouguerram K, Devillers M, Cruaud C, Benjannet S, Wickham L, Erlich D, Derre A, Villeger L, Farnier M, Beucler I, Bruckert E, Chambaz J, Chanu B, Lecerf JM, Luc G, Moulin P, Weissenbach J, Prat A, Krempf M, Junien C, Seidah NG, Boileau C. Mutations in PCSK9 cause autosomal dominant hypercholesterolemia. Nat Genet. 2003 Jun;34(2):154-6. doi: 10.1038/ng1161.
- Background: PubMed 4609051Ashwell G, Morell AG. The role of surface carbohydrates in the hepatic recognition and transport of circulating glycoproteins. Adv Enzymol Relat Areas Mol Biol. 1974;41(0):99-128. doi: 10.1002/9780470122860.ch3. No abstract available.
- Background: PubMed 22716984Banerjee Y, Shah K, Al-Rasadi K. Effect of a monoclonal antibody to PCSK9 on LDL cholesterol. N Engl J Med. 2012 Jun 21;366(25):2425-6; author reply 2426. doi: 10.1056/NEJMc1204929. No abstract available.
- Background: PubMed 22716983Milazzo L, Antinori S. Effect of a monoclonal antibody to PCSK9 on LDL cholesterol. N Engl J Med. 2012 Jun 21;366(25):2425; author reply 2426. doi: 10.1056/NEJMc1204929. No abstract available.
- Background: PubMed 21067804Cholesterol Treatment Trialists' (CTT) Collaboration; Baigent C, Blackwell L, Emberson J, Holland LE, Reith C, Bhala N, Peto R, Barnes EH, Keech A, Simes J, Collins R. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet. 2010 Nov 13;376(9753):1670-81. doi: 10.1016/S0140-6736(10)61350-5. Epub 2010 Nov 8.
- Background: PubMed 23984729Coelho T, Adams D, Silva A, Lozeron P, Hawkins PN, Mant T, Perez J, Chiesa J, Warrington S, Tranter E, Munisamy M, Falzone R, Harrop J, Cehelsky J, Bettencourt BR, Geissler M, Butler JS, Sehgal A, Meyers RE, Chen Q, Borland T, Hutabarat RM, Clausen VA, Alvarez R, Fitzgerald K, Gamba-Vitalo C, Nochur SV, Vaishnaw AK, Sah DW, Gollob JA, Suhr OB. Safety and efficacy of RNAi therapy for transthyretin amyloidosis. N Engl J Med. 2013 Aug 29;369(9):819-29. doi: 10.1056/NEJMoa1208760.
- Background: PubMed 16554528Cohen JC, Boerwinkle E, Mosley TH Jr, Hobbs HH. Sequence variations in PCSK9, low LDL, and protection against coronary heart disease. N Engl J Med. 2006 Mar 23;354(12):1264-72. doi: 10.1056/NEJMoa054013.
- Background: PubMed 16098311Davidson MH, Maki KC, Pearson TA, Pasternak RC, Deedwania PC, McKenney JM, Fonarow GC, Maron DJ, Ansell BJ, Clark LT, Ballantyne CM. Results of the National Cholesterol Education (NCEP) Program Evaluation ProjecT Utilizing Novel E-Technology (NEPTUNE) II survey and implications for treatment under the recent NCEP Writing Group recommendations. Am J Cardiol. 2005 Aug 15;96(4):556-63. doi: 10.1016/j.amjcard.2005.04.019.
- Background: PubMed 23083772Dias CS, Shaywitz AJ, Wasserman SM, Smith BP, Gao B, Stolman DS, Crispino CP, Smirnakis KV, Emery MG, Colbert A, Gibbs JP, Retter MW, Cooke BP, Uy ST, Matson M, Stein EA. Effects of AMG 145 on low-density lipoprotein cholesterol levels: results from 2 randomized, double-blind, placebo-controlled, ascending-dose phase 1 studies in healthy volunteers and hypercholesterolemic subjects on statins. J Am Coll Cardiol. 2012 Nov 6;60(19):1888-98. doi: 10.1016/j.jacc.2012.08.986. Epub 2012 Oct 17.
- Background: PubMed 11373684Elbashir SM, Harborth J, Lendeckel W, Yalcin A, Weber K, Tuschl T. Duplexes of 21-nucleotide RNAs mediate RNA interference in cultured mammalian cells. Nature. 2001 May 24;411(6836):494-8. doi: 10.1038/35078107.
- Background: PubMed 12842255Foley KA, Simpson RJ Jr, Crouse JR 3rd, Weiss TW, Markson LE, Alexander CM. Effectiveness of statin titration on low-density lipoprotein cholesterol goal attainment in patients at high risk of atherogenic events. Am J Cardiol. 2003 Jul 1;92(1):79-81. doi: 10.1016/s0002-9149(03)00474-0. No abstract available.
- Background: PubMed 21122640Foody JM, Sajjan SG, Hu XH, Ramey DR, Neff DR, Tershakovec AM, Tomassini JE, Wentworth C, Tunceli K. Loss of early gains in low-density lipoprotein cholesterol goal attainment among high-risk patients. J Clin Lipidol. 2010 Mar-Apr;4(2):126-32. doi: 10.1016/j.jacl.2010.01.007. Epub 2010 Feb 6.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Kausik K Ray, MD principal investigator
Department of Public Health and Primary Care, Imperial College London, Reynolds Building
54 sites in 5 countries: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 2 study testing ALN-PCSSC and Normal Saline in people with Atherosclerotic Cardiovascular Disease and Familial Hypercholesterolemia, run by The Medicines Company at 54 sites in 5 countries.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 8 inclusion and 23 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 17 May 2019. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 54 sites in Netherlands, United Kingdom, Canada, United States, Germany. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
Yes. Results are posted in the registry (first posted 17 May 2019). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Percentage Change in LDL-C From Baseline to Day 180 (time frame: Baseline to 180 days). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT02597127, which also lists 42 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 17 May 2019.