Lumasiran for Advanced Primary Hyperoxaluria Type 1: Phase 3 ILLUMINATE-C Trial
Résumé
RATIONALE & OBJECTIVE: Lumasiran reduces urinary and plasma oxalate (POx) in patients with primary hyperoxaluria type 1 (PH1) and relatively preserved kidney function. ILLUMINATE-C evaluates the efficacy, safety, pharmacokinetics, and pharmacodynamics of lumasiran in patients with PH1 and advanced kidney disease. STUDY DESIGN: Phase 3, open-label, single-arm trial. SETTING & PARTICIPANTS: Multinational study; enrolled patients with PH1 of all ages, eGFR ≤45 mL/min/1.73m(2) (if age ≥12 months) or elevated serum creatinine (if age \textless12 months), and POx ≥20 μmol/L at screening, including patients with or without systemic oxalosis. EXPOSURE: Lumasiran administered subcutaneously; 3 monthly doses followed by monthly or quarterly weight-based dosing. OUTCOME: Primary endpoint: percent change in POx from baseline to Month 6 (Cohort A; not receiving hemodialysis at enrollment) and percent change in predialysis POx from baseline to Month 6 (Cohort B; receiving hemodialysis at enrollment). Pharmacodynamic secondary endpoints: percent change in POx area under the curve between dialysis sessions (Cohort B only); absolute change in POx; percent and absolute change in spot urinary oxalate:creatinine ratio, and 24-hour UOx corrected for body surface area. RESULTS: All patients (N=21; 43% female; 76% white) completed the 6-month primary analysis period. Median age at consent: 8 (range, 0-59) years. For the primary endpoint, least-squares mean reduction in POx in Cohort A (N=6) was 33.3% (95% CI, -15.2%, 81.8%) and in Cohort B (N=15) was 42.4% (95% CI, 34.2%, 50.7%). Improvements were also observed in all pharmacodynamic secondary endpoints. Most adverse events were mild or moderate. No patient discontinued treatment or withdrew from the study. The most commonly reported lumasiran-related adverse events were injection-site reactions, all mild and transient. LIMITATIONS: Single-arm study without placebo control. CONCLUSIONS: Lumasiran resulted in substantial reductions in POx with acceptable safety in patients with PH1 who have advanced kidney disease, supporting its efficacy and safety in this patient population.
Mots clés
Lumasiran
RNA interference (RNAi)
adverse events
anti-drug antibodies
cardiac dysfunction
efficacy
glycolate
hemodialysis
kidney disease
nephrocalcinosis
pediatric
pharmacodynamics
pharmacokinetics
phase 3 clinical trial
plasma oxalate (POx)
primary hyperoxaluria type 1 (PH1)
safety
systemic oxalosis
urinary oxalate (UOx)
Domaines
Sciences du Vivant [q-bio]Origine | Publication financée par une institution |
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