Patisiran, an RNAi Therapeutic, for Hereditary Transthyretin Amyloidosis

By D. Adams, A. González-Duarte, W. O'Riordan, Chih-Chao Yang, M. Ueda, A. Kristen, I. Tournev, H. Schmidt, T. Coelho, J. Berk and 26 more. New England Journal of Medicine, 2018

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BACKGROUND Patisiran, an investigational RNA interference therapeutic agent, specifically inhibits hepatic synthesis of transthyretin. METHODS In this phase 3 trial, we randomly assigned patients with hereditary transthyretin amyloidosis with polyneuropathy, in a 2:1 ratio, to receive intravenous patisiran (0.3 mg per kilogram of body weight) or placebo once every 3 weeks. The primary end point was the change from baseline in the modified Neuropathy Impairment Score+7 (mNIS+7; range, 0 to 304, with higher scores indicating more impairment) at 18 months. Other assessments included the Norfolk Quality of Life–Diabetic Neuropathy (Norfolk QOL‐DN) questionnaire (range, ‐4 to 136, with higher scores indicating worse quality of life), 10‐m walk test (with gait speed measured in meters per second), and modified body‐mass index (modified BMI, defined as [weight in kilograms divided by square of height in meters]×albumin level in grams per liter; lower values indicated worse nutritional status). RESULTS A total of 225 patients underwent randomization (148 to the patisiran group and 77 to the placebo group). The mean (±SD) mNIS+7 at baseline was 80.9±41.5 in the patisiran group and 74.6±37.0 in the placebo group; the least‐squares mean (±SE) change from baseline was ‐6.0±1.7 versus 28.0±2.6 (difference, ‐34.0 points; P<0.001) at 18 months. The mean (±SD) baseline Norfolk QOL‐DN score was 59.6±28.2 in the patisiran group and 55.5±24.3 in the placebo group; the least‐squares mean (±SE) change from baseline was ‐6.7±1.8 versus 14.4±2.7 (difference, ‐21.1 points; P<0.001) at 18 months. Patisiran also showed an effect on gait speed and modified BMI. At 18 months, the least‐squares mean change from baseline in gait speed was 0.08±0.02 m per second with patisiran versus ‐0.24±0.04 m per second with placebo (difference, 0.31 m per second; P<0.001), and the least‐squares mean change from baseline in the modified BMI was ‐3.7±9.6 versus ‐119.4±14.5 (difference, 115.7; P<0.001). Approximately 20% of the patients who received patisiran and 10% of those who received placebo had mild or moderate infusion‐related reactions; the overall incidence and types of adverse events were similar in the two groups. CONCLUSIONS In this trial, patisiran improved multiple clinical manifestations of hereditary transthyretin amyloidosis. (Funded by Alnylam Pharmaceuticals; APOLLO ClinicalTrials.gov number, NCT01960348.)

Subfields: Cell Biology, Molecular Biology, Physiology

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Citations in the corpus

Nanoparticles in the clinic: An update (2019, background): “Moreover, serum transthyretin decreased by over 70% in patients receiving Patisiran/ONPATTRO as compared to less than 20% in patients receiving the placebo.(10) Global net revenues for Patisiran/ONPATTRO were $12.”
Integrin Signaling in Cancer: Mechanotransduction, Stemness, Epithelial Plasticity, and Therapeutic Resistance (2019, background): “Excitingly, the latter finding used the same underlying technology underpinning the recent approval of the first RNAi-based therapy (Adams et al., 2018).”
Delivering the Messenger: Advances in Technologies for Therapeutic mRNA Delivery. (2019, positive): “31 Inspired by the success of LNPs, various groups showed that MC3 can also be used to safely transfect mRNA in order to express therapeutic proteins.”