1. Analysis of autonomic outcomes in APOLLO, a phase III trial of the RNAi therapeutic patisiran in patients with hereditary transthyretin-mediated amyloidosis
- Author
-
Isabel Conceição, Marianne T. Sweetser, Emre Aldinc, Céline Tard, Madeline Merkel, Márcia Waddington-Cruz, Dianna Quan, David Adams, Michael Polydefkis, John L. Berk, Jing Jing Wang, Teresa Coelho, Arnt V. Kristen, Alejandra González-Duarte, Mitsuharu Ueda, Jihong Chen, Cécile Cauquil, Michelle L. Mauermann, and Hartmut Schmidt
- Subjects
Adult ,Male ,medicine.medical_specialty ,Hereditary transthyretin-mediated amyloidosis ,Neurology ,Orthostatic intolerance ,Placebo ,Transthyretin ,Polyneuropathies ,Double-Blind Method ,Quality of life ,Polyneuropathy ,Internal medicine ,medicine ,Humans ,RNA, Small Interfering ,Small interfering ribonucleic acid (siRNA) ,Amyloid Neuropathies, Familial ,Original Communication ,business.industry ,Amyloidosis ,Correction ,Autonomic nervous system diseases ,Middle Aged ,medicine.disease ,RNAi Therapeutics ,Blood pressure ,Quality of Life ,Patisiran ,Female ,Neurology (clinical) ,business ,Body mass index - Abstract
Hereditary transthyretin-mediated (hATTR) amyloidosis is a progressive, debilitating disease often resulting in early-onset, life-impacting autonomic dysfunction. The effect of the RNAi therapeutic, patisiran, on autonomic neuropathy manifestations in patients with hATTR amyloidosis with polyneuropathy in the phase III APOLLO study is reported. Patients received patisiran 0.3 mg/kg intravenously (n = 148) or placebo (n = 77) once every 3 weeks for 18 months. Patisiran halted or reversed polyneuropathy and improved quality of life from baseline in the majority of patients. At baseline, patients in APOLLO had notable autonomic impairment, as demonstrated by the Composite Autonomic Symptom Score-31 (COMPASS-31) questionnaire and Norfolk Quality of Life-Diabetic Neuropathy (Norfolk QOL-DN) questionnaire autonomic neuropathy domain. At 18 months, patisiran improved autonomic neuropathy symptoms compared with placebo [COMPASS-31, least squares (LS) mean difference, - 7.5; 95% CI: - 11.9, - 3.2; Norfolk QOL-DN autonomic neuropathy domain, LS mean difference, - 1.1; - 1.8, - 0.5], nutritional status (modified body mass index, LS mean difference, 115.7; - 82.4, 149.0), and vasomotor function (postural blood pressure, LS mean difference, - 0.3; - 0.5, - 0.1). Patisiran treatment also led to improvement from baseline at 18 months for COMPASS-31 (LS mean change from baseline, - 5.3; 95% CI: - 7.9, - 2.7) and individual domains, orthostatic intolerance (- 4.6; - 6.3, - 2.9) and gastrointestinal symptoms (- 0.8; - 1.5, - 0.2). Rapid worsening of all study measures was observed with placebo, while patisiran treatment resulted in stable or improved scores compared with baseline. Patisiran demonstrates benefit across a range of burdensome autonomic neuropathy manifestations that deteriorate rapidly without early and continued treatment. The study was funded by Alnylam Pharmaceuticals, Inc. Medical writing services provided by Kristen Brown (PhD) of Adelphi Communications Ltd, Macclesfeld, UK were funded by Alnylam Pharmaceuticals, Inc. in accordance with Good Publication Practice (GPP3) guidelines. We would like to thank Anastasia McManus (Alnylam Pharmaceuticals, Inc.) for her assistance during preparation of this manuscript. info:eu-repo/semantics/publishedVersion
- Published
- 2019
- Full Text
- View/download PDF