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Transthyretin Amyloid CardiopathyPhase 2NCT04843020

ION-682884 in Patients With TTR Amyloid Cardiomyopathy

A Phase 2 study testing ION 682884 in people with Transthyretin Amyloid Cardiopathy, run by Brigham and Women's Hospital at 1 site in United States.

Withdrawn

Withdrawn. The study stopped before anyone enrolled.

Official record
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Trial summary

Transthyretin is a protein produced in the liver that transports thyroid hormone and vitamin A. A single substitution of an amino acid in the structure of TTR can result in a relatively unstable protein, the breakdown products of which (predominantly monomers) aggregate abnormally and produce proteinaceous deposits in… Read more about this study

Who is it for?
Ages 65 to 85 years
Conditions the study is for
Transthyretin Amyloid Cardiopathy
What is being tested?
ION 682884
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
0 participants
Where
1 siteUnited States
Study dates
1 Jun 2021to 31 Dec 2025
Phase
Phase 2
Are there results?
None posted in the registry

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 65 to 85 years
  • All sexes
  • No healthy volunteers
  • Older adult

Who may be able to join

  • 1. Only patient who have completed 24 months of therapy in the open label clinical trial of inotersen, "A 24-month open-label study of the tolerability and efficacy of an antisense oligonucleotide (inotersen) in patients with transthyretin (TTR) amyloid cardiomyopathy" (Protocol #:2018-P001436) will be enrolled. All patients in that study had either wild-type transthyretin amyloidosis (ATTRwt) or mutant transthyretin amyloidosis (ATTRm) cardiac amyloidosis, defined by standard criteria. Additional criteria for the current study are as follows:
  • Patients should, in the opinion of the Investigator, be in a stable state in terms of New York Heart Association (NYHA) class. Class I-III patients will be recruited.
  • Age 65-85 years
  • Male, or non-pregnant, non-lactating females. If a male partners with a premenopausal woman, he must be willing to use the following methods of contraception: condoms, oral/hormonal contraception, Intrauterine Device, diaphragm, or abstinence (all patients are either male of post-menopausal) (NB: There will be no premenopausal women in the proposed study)
  • Written informed consent to be obtained prior to study treatment
  • Willingness to return to the treating center for follow-up
  • Willingness and ability to self-administer, or to have spouse administer subcutaneous injections of study drug every 4 weeks.
  • Willingness to take oral Vitamin A supplementation throughout the study and for 3 months thereafter.

Who cannot join

  • 1. Acute coronary syndrome, unstable angina, stroke, transient ischemic attack,, coronary revascularization, cardiac device implantation, cardiac valve repair, or major surgery within 3 emergency room for worsening of HF with discharge date within 4 weeks prior to or during Screening 3. Uncontrolled hypertension (systolic blood pressure [BP] > 160 or diastolic BP > 100 mmHg) 4. Uncontrolled clinically significant cardiac arrhythmia, per Investigator's assessment (e.g., no pacemaker, although indicated) 5. Severe uncorrected cardiac valvular disease 6. Cardiomyopathy not primarily caused by amyloidosis, for example, cardiomyopathy due to hypertension, valvular heart disease, or ischemic heart disease 7. Screening laboratory results as follows, or any other clinically significant abnormalities in Screening laboratory values that would render a patient unsuitable for inclusion
  • Alanine aminotransferase/aspartate aminotransferase (ALT/AST) > 2.0 × upper limit of normal (ULN)
  • Total bilirubin ≥ 1.5 × ULN (patients with total bilirubin ≥ 1.5 × ULN may be allowed on study if indirect bilirubin only is elevated, ALT/AST is not greater than the ULN and known to have Gilbert's disease)
  • Platelets < 125 × 109/L
  • Urine protein creatinine ratio (UPCR) ≥ 750 mg/g. In the event of UPCR above this threshold ineligibility may be confirmed by a repeat random spot UPCR ≥ 750 mg/g
  • Positive test for blood (including trace) on urinalysis that is subsequently confirmed with urine microscopy showing > 5 red blood cells per high power field and is related to glomerulopathies. In women, this exclusion criterion must be assessed outside of menstrual period. If in the opinion of the Investigator the hematuria is not considered related to glomerulopathies the patient may be considered eligible, pending proper follow-up and a discussion with the Medical Monitor. Patients with history of bladder cancer must have been treated with curative intent and have not presented recurrence within the prior 5 years
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  • Estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m2 at Screening. If the eGFR is thought to be underestimated, the CKD-EPI creatinine-cystatin C equation can be used for confirmation.
  • Abnormal thyroid function tests with clinical significance per Investigator judgement
  • Hemoglobin A1c (HbA1c) > 9.5% 8. Monoclonal gammopathy of undetermined significance (MGUS) and/or alterations in immunoglobulin free light chain (FLC) ratio, unless fat, bone marrow, or heart biopsy confirming the absence of light chain and the presence of TTR protein by mass spectrometry or immunoelectron microscopy. For patients with CKD and without presence of monoclonal protein in blood and urine, the acceptable FLC ratio is 0.26-2.25.
  • 9. Active infection requiring systemic antiviral or antimicrobial therapy that will not be completed prior to Study Day 1 10. Known history of or positive test for human immunodeficiency virus (HIV) (as evidenced by positive tests for HIV antibody and HIV RNA), hepatitis C (as evidenced by positive tests for HCV antibody and HCV RNA) or hepatitis B (as evidenced by a positive test for hepatitis B surface antigen) 11. History of bleeding, diathesis or coagulopathy (e.g., liver cirrhosis, hematologic malignancy, antiphospholipid antibody syndrome, congenital disorders such as hemophilia A, B, and Von Willebrand disease) 12. If receiving oral anticoagulants (except vitamin K antagonists), the dose must have been stable for 4 weeks prior to the first dose of Study Drug and regular monitoring must be performed, per clinical practice during the study. If the patient is receiving vitamin K antagonists (e.g., warfarin) INR should be in therapeutic range, as established by the Investigator, for 4 weeks prior to the first dose 13. Malignancy within 5 years, except for basal or squamous cell carcinoma of the skin, melanoma in situ, prostate carcinoma grade group 1, breast ductal carcinoma in situ, or carcinoma in situ of the cervix successfully treated. Patients with a history of other malignancies who have been treated with curative intent and without recurrence within 5 years may also be eligible per Investigator judgment 14. Prior liver or heart transplant, and/or Left Ventricular Assist Device (LVAD) or anticipated liver transplant or LVAD within 1 year after randomization 15. Karnofsky performance status of ≤ 50% 16. Contraindication for immunosuppressive therapy, per Investigator's discretion 17. Known Light chain/Primary Amyloidosis (AL) 18. Known leptomeningeal amyloidos
  • -

Trial locations and contacts

1 site in 1 country.

United States1 site
  • Brigham and Women's Hospital

    Boston, Massachusetts, 02115

Other trials in United States

About this study

Official title: An Open-Label Study of ION-682884 in Patients With TTR Amyloidosis Who Have Completed a 24-Open Label Study of Inotersen for TTR Amyloidosis Cardiomyopathy

Transthyretin is a protein produced in the liver that transports thyroid hormone and vitamin A. A single substitution of an amino acid in the structure of TTR can result in a relatively unstable protein, the breakdown products of which (predominantly monomers) aggregate abnormally and produce proteinaceous deposits in nerves and the heart. These deposits are known as amyloid and produce progressive nerve and heart damage. Amyloidosis due to a mutant TTR is usually an autosomal dominant and hence is a familial condition. Wild-type TTR is also capable of producing amyloid deposits which predominantly involves the heart (rather than the nervous system) resulting in a progressive decrease in cardiac function with increasing signs of heart failure. This study aims to determine whether subcutaneous injection of an antisense oligonucleotide drug, known as ION-682884, that has been specifically designed to reduce production of the protein transthyretin by the liver, can slow or stop the progression of TTR amyloid cardiomyopathy as compared to historical controls, using advanced echocardiography and cardiac MRI. This study drug will only be administered to patients who have completed a 24-month study of a similar drug, inotersen (clinicaltrials.gov identifier NCT037028289).The study also aims to determine the tolerability and safety of this drug when administered over a 36+-month period to patients with TTR amyloid cardiomyopathy. The study duration is open-ended and will continue either until this agent is approved by the FDA, or production is discontinued based on results of ongoing double-blinded studies.

Read the detailed description

The study is limited to those patients who have completed 24 months in our single-center open-label trial of inotersen for amyloid cardiomyopathy (NCT037028289). Patients must have an estimated glomerular filtration rate of greater than 30 and a platelet count greater than 130,000. They will have either wildtype or mutant transthyretin cardiomyopathy. It is anticipated that up to 17 patients will be eligible for the study, age 65-85 years.

Research design:

After completion of the 24 months in the inotersen study, patients will undergo their final visit and assessment. This will include an echocardiogram, lab work, 6-minute walk test, cardiopulmonary exercise testing and, in those without a pacemaker, a cardiac MRI. If the lab work from the end of study confirms eligibility for the new study, patients will be offered the option of continuing with the TTR-lowering drug, ION-682884. After informed consent the patient will be supplied with prefilled syringes containing ION-682884 and the first injection administered. They will return for follow up visits at six weeks, 12 weeks, three months, and six months thereafter. At each six-monthly visit they will undergo the same testing as they had in the inotersen study, namely laboratory measurements, 6-minute walk test, cardiopulmonary exercise testing, echocardiogram and, unless contraindicated, cardiac MRI. The patients will remain in the study for an open-ended period of time until study ending criteria occur (reduction in the glomerular filtration rate to less than 30 or platelet count with a significant fall) or until the drug is FDA-approved or the manufacturer or principal investigator terminates the study.

Because ION-682884 is an antisense oligonucleotide similar to inotersen and because inotersen has been associated with thrombocytopenia and worsening renal function, patients will have weekly lab draws done in their own home for safety monitoring. These bloods will be used to measure platelet function every week, and renal function every other week. This is currently mandated by the Food and Drug administration in the double-blinded study of ION-682884 but the frequency of blood draws may be decreased overtime depending on the interim safety analysis results from that study and FDA evaluation of that data.

Being tested
ION 682884
Keywords
amyloidosis, transthyretin, antisense oligonucleotide, ION682884, cardiomyopathy
Medical subject headings
Amyloidosis, Cardiomyopathies

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • ION 682884Drug

    Subcutaneous injection every month

Study groups in NCT04843020
Study groupRoleWhat they receive
Drug subcutaneous injectionExperimentalMonthly injection of ION 682884, administered subcutaneously at a dose of 45 mg.
Receives: Drug: ION 682884

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Echocardiographic change

    change in echocardiographically-derived left ventricular longitudinal strain (measured as percentage change from end diastole to end systole)

    Measured: 48 months

  2. Change in cardiac MRI

    Change in extracellular volume (measure as a percentage of total of LV mass) between baseline MRI and 48 months

    Measured: 48 months

  3. Change in cardiac MRI

    Change in left ventricular mass, measured by cardiac MRI (gm/m2) , between baseline and 48 months

    Measured: 48 months

  4. change in 6 minute walk

    change in distance walked (measured in meters) between baseline 6 minute walk and walk after 48 months of therapy

    Measured: 48 months

  5. change in cardiopulmonary testing

    change in maximal oxygen consumption (VO2 max measured in ml/kg.min) between baseline cardiopulmonary testing and cardiopulmonary testing at 48 months of therapy

    Measured: 48 months

  6. change in the cardiac biomarker NTproBNP

    change between baseline and after 48 months of therapy of serum NTproBNP (measured in pg/ml)

    Measured: 48 months

  7. change in the cardiac biomarker high-sensitivity troponin

    change between baseline and after 48 months of therapy of serum high-sensitivity troponin T measured in ng/L)

    Measured: 48 months

Secondary outcomes (4)
  1. Response of transthyretin levels to therapy

    Absolute decrease in TTR levels (measured in mg/dl) after initiation of therapy, compared to response, in previous study, to weekly inotersen injections.

    Measured: 3 months

  2. Time frame of response of TTR levels to therapy

    Time frame to nadir of TTR levels (weeks) after initiation of therapy, compared to response, in previous study, to weekly inotersen injections.

    Measured: 3 months

  3. Side-effect profile: renal function

    Effect of therapy on renal function, measured as estimated glomerular filtration rate (mL/min/1.73m2), between baseline measurements and 48 months, measured every 2 weeks

    Measured: 48 months

  4. Side effect profile: platelets

    Effect of therapy on platelet count (normal 150,000 - 450,000/uL), between baseline measurements and 48 months, measured every week

    Measured: 48 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted13 Apr 2021
  2. Study start1 Jun 2021 (estimated)
  3. Primary completion30 May 2025 (estimated)
  4. Study completion31 Dec 2025 (estimated)

Why it stopped: no subjects available

Resources

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
Not applicable
Intervention model
Single group
Model description
open label study of investigational antisense oligonucleotide targeting TTR
Masking
None (open label)
Enrolment
0 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04843020
Sponsor's protocol ID
2021P000784
Status last verified
Feb 2026
First submitted
5 Apr 2021
Last updated
20 Feb 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing ION 682884 in people with Transthyretin Amyloid Cardiopathy, run by Brigham and Women's Hospital at 1 site in United States.

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 11 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: withdrawn, as of the sponsor's last update on 20 Feb 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. 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. 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?

The study was withdrawn before enrolling participants, so there are no results.

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?

Echocardiographic change (time frame: 48 months). The study lists 7 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
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 20 Feb 2026.

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