Lumasiran, an RNAi Therapeutic for Primary Hyperoxaluria Type 1.
Journal
The New England journal of medicine
ISSN: 1533-4406
Titre abrégé: N Engl J Med
Pays: United States
ID NLM: 0255562
Informations de publication
Date de publication:
01 04 2021
01 04 2021
Historique:
entrez:
31
3
2021
pubmed:
1
4
2021
medline:
15
4
2021
Statut:
ppublish
Résumé
Primary hyperoxaluria type 1 (PH1) is a rare genetic disease caused by hepatic overproduction of oxalate that leads to kidney stones, nephrocalcinosis, kidney failure, and systemic oxalosis. Lumasiran, an investigational RNA interference (RNAi) therapeutic agent, reduces hepatic oxalate production by targeting glycolate oxidase. In this double-blind, phase 3 trial, we randomly assigned (in a 2:1 ratio) patients with PH1 who were 6 years of age or older to receive subcutaneous lumasiran or placebo for 6 months (with doses given at baseline and at months 1, 2, 3, and 6). The primary end point was the percent change in 24-hour urinary oxalate excretion from baseline to month 6 (mean percent change across months 3 through 6). Secondary end points included the percent change in the plasma oxalate level from baseline to month 6 (mean percent change across months 3 through 6) and the percentage of patients with 24-hour urinary oxalate excretion no higher than 1.5 times the upper limit of the normal range at month 6. A total of 39 patients underwent randomization; 26 were assigned to the lumasiran group and 13 to the placebo group. The least-squares mean difference in the change in 24-hour urinary oxalate excretion (lumasiran minus placebo) was -53.5 percentage points (P<0.001), with a reduction in the lumasiran group of 65.4% and an effect seen as early as month 1. The between-group differences for all hierarchically tested secondary end points were significant. The difference in the percent change in the plasma oxalate level (lumasiran minus placebo) was -39.5 percentage points (P<0.001). In the lumasiran group, 84% of patients had 24-hour urinary oxalate excretion no higher than 1.5 times the upper limit of the normal range at month 6, as compared with 0% in the placebo group (P<0.001). Mild, transient injection-site reactions were reported in 38% of lumasiran-treated patients. Lumasiran reduced urinary oxalate excretion, the cause of progressive kidney failure in PH1. The majority of patients who received lumasiran had normal or near-normal levels after 6 months of treatment. (Funded by Alnylam Pharmaceuticals; ILLUMINATE-A ClinicalTrials.gov number, NCT03681184.).
Sections du résumé
BACKGROUND
Primary hyperoxaluria type 1 (PH1) is a rare genetic disease caused by hepatic overproduction of oxalate that leads to kidney stones, nephrocalcinosis, kidney failure, and systemic oxalosis. Lumasiran, an investigational RNA interference (RNAi) therapeutic agent, reduces hepatic oxalate production by targeting glycolate oxidase.
METHODS
In this double-blind, phase 3 trial, we randomly assigned (in a 2:1 ratio) patients with PH1 who were 6 years of age or older to receive subcutaneous lumasiran or placebo for 6 months (with doses given at baseline and at months 1, 2, 3, and 6). The primary end point was the percent change in 24-hour urinary oxalate excretion from baseline to month 6 (mean percent change across months 3 through 6). Secondary end points included the percent change in the plasma oxalate level from baseline to month 6 (mean percent change across months 3 through 6) and the percentage of patients with 24-hour urinary oxalate excretion no higher than 1.5 times the upper limit of the normal range at month 6.
RESULTS
A total of 39 patients underwent randomization; 26 were assigned to the lumasiran group and 13 to the placebo group. The least-squares mean difference in the change in 24-hour urinary oxalate excretion (lumasiran minus placebo) was -53.5 percentage points (P<0.001), with a reduction in the lumasiran group of 65.4% and an effect seen as early as month 1. The between-group differences for all hierarchically tested secondary end points were significant. The difference in the percent change in the plasma oxalate level (lumasiran minus placebo) was -39.5 percentage points (P<0.001). In the lumasiran group, 84% of patients had 24-hour urinary oxalate excretion no higher than 1.5 times the upper limit of the normal range at month 6, as compared with 0% in the placebo group (P<0.001). Mild, transient injection-site reactions were reported in 38% of lumasiran-treated patients.
CONCLUSIONS
Lumasiran reduced urinary oxalate excretion, the cause of progressive kidney failure in PH1. The majority of patients who received lumasiran had normal or near-normal levels after 6 months of treatment. (Funded by Alnylam Pharmaceuticals; ILLUMINATE-A ClinicalTrials.gov number, NCT03681184.).
Identifiants
pubmed: 33789010
doi: 10.1056/NEJMoa2021712
doi:
Substances chimiques
Oxalates
0
RNA, Small Interfering
0
Creatinine
AYI8EX34EU
lumasiran
RZT8C352O1
Banques de données
ClinicalTrials.gov
['NCT03681184']
Types de publication
Clinical Trial, Phase III
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1216-1226Investigateurs
Samah Alasrawi
(S)
Spyridon Arampatzis
(S)
Kenneth Aung-Din
(K)
Justine Bacchetta
(J)
Darlene Bartilucci
(D)
Veronique Baudouin
(V)
Corinne Benchimol
(C)
Rachel Becker-Cohen
(R)
Efrat Ben-Shalom
(E)
Stephen Benedict Walsh
(SB)
Maria Berdaguer
(M)
Detlef Bockenhauer
(D)
Troy Borema
(T)
Lili Chan
(L)
Hanh Chu
(H)
Christoph Coch
(C)
Martin Coenen
(M)
Lucy Cooper
(L)
Anne Couderc
(A)
Claire Dossier
(C)
Emilie Doye
(E)
Laurence Dubourg
(L)
Janet Garvey
(J)
Asheeta Gupta
(A)
Mantu Gupta
(M)
Shameer Habeeb
(S)
Wesley Hayes
(W)
Jérôme Harambat
(J)
Maximilian Hohenadel
(M)
Bernd Hoppe
(B)
Hilary Hotchkiss
(H)
Jeffry Jacqmein
(J)
Florentia Kaguelidou
(F)
Theresa Kwon
(T)
Kia Lee
(K)
Sandrine Lemoine
(S)
Brigitte Llanas
(B)
Elizabeth Lorenz
(E)
Anne Maisin
(A)
Bshara Mansour
(B)
Dawn Milliner
(D)
Mordi Muorah
(M)
Michiel Oosterveld
(M)
J Scott Overcash
(JS)
Pallavi Prasad
(P)
Aurelie Portefaix
(A)
Shirley Pollack
(S)
Ziv Paz
(Z)
Alpa Patel
(A)
Bruno Ranchin
(B)
Jessica Reid-Adam
(J)
Choni Rinat
(C)
Mitchell Rothstein
(M)
Indra Schulte
(I)
Anne-Laure Sellier-Leclerc
(AL)
Carolyn Tran
(C)
Shimrit Tzvi Behr
(S)
John Videen
(J)
Bruno Vogt
(B)
Jenny Weinbrand-Goichberg
(J)
Irith Weissman
(I)
Karla Zepeda
(K)
A Greenbaum
(A)
David Goldfarb
(D)
Franz Schaefer
(F)
James E Heubi
(JE)
Gheorghe Doros
(G)
Commentaires et corrections
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