Clinical Trials Logo

Clinical 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 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 inotersen, 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. The study also aims to determine the tolerability and safety of this drug when administered over a 24-month period to patients with TTR amyloid cardiomyopathy.


Clinical Trial Description

This is an open-label, single center study of 50 patients with cardiac amyloidosis due to wild-type or mutant TTR. Eligible patients will have evidence of cardiac amyloidosis due to transthyretin. The diagnosis will be made by biopsy of the heart or other affected organ with appropriate staining techniques confirming that the amyloid deposits are derived from transthyretin. Alternatively, recent imaging data have shown that a strongly positive nuclear scan using technetium pyrophosphate in the absence of evidence of a plasma cell dyscrasia and in the presence of a typical echocardiographic or cardiac magnetic resonance appearance of cardiac amyloidosis is indicative of TTR amyloidosis and that a biopsy is not needed. This will be acceptable for study entry. As inotersen has been associated with kidney toxicity in a small number of patients, all subjects in the study will be required to have a glomerular filtration rate greater than 45. Once study criteria have been met, and baseline imaging including echocardiography and (where feasible) cardiac magnetic resonance imaging have been performed, all patients will receive inotersen in a weekly 300 mg dosing. Subsequent visits will occur at 6 weeks, and 3, 6, 12, 18 and 24 months. Every 2 weeks, blood will be monitored for renal function and platelet count and urine will be tested by dipstick for proteinuria. Should kidney function be noted to be deteriorating or should proteinuria be found, a more intense renal workup will be performed in order to detect or rule out potential kidney toxicity. At each visit, in addition to standard laboratory work and pregnancy testing if applicable, (complete blood count, comprehensive metabolic panel, thyroid function tests, and urinalysis), Vitamin A level will be drawn (as TTR is a transport protein for Vitamin A) and TTR (prealbumin) level will be drawn to determine degree of suppression. Disease progression will be measured by serial cardiac biomarkers, 6-minute walk, cardiopulmonary stress testing, advanced "strain" echocardiography and cardiac MRI. Patients will be compared to data derived from a historical control group and from data in the literature to determine whether inotersen slows or stops disease progression. ;


Study Design


Related Conditions & MeSH terms


NCT number NCT03702829
Study type Interventional
Source Brigham and Women's Hospital
Contact
Status Active, not recruiting
Phase Phase 2
Start date February 28, 2019
Completion date March 2022

See also
  Status Clinical Trial Phase
Recruiting NCT04893889 - Substudy (NCT04456582): Noninvasive Assessment of Myocardial Stiffness by 2D-SWE Ultrasound Technique (Two-dimensional Shear Wave Elastography) in Patients With Amyloidosis and Fabry Disease. N/A
Withdrawn NCT04943302 - Isatuximab and Bendamustine in Systemic Light Chain Amyloidosis Phase 2
Active, not recruiting NCT02909036 - Study of Captisol Enabled Melphalan and Pharmacokinetics for Patients With Multiple Myeloma or Light Chain Amyloidosis That Are Receiving an Autologous Transplant. Phase 1
Completed NCT02816476 - Daratumumab Therapy for Patients With Refractory or Relapsed AL Amyloidosis Phase 2
Completed NCT01083316 - Bortezomib and Dexamethasone Followed by High-Dose Melphalan and Stem Cell Transplantation for Primary (AL) Amyloidosis Phase 2
Completed NCT01527032 - Risk-adapted Therapy for Primary Systemic (AL) Amyloidosis Phase 2
Completed NCT02545907 - A Dose Escalation Study of Carfilzomib Taken With Thalidomide and Dexamethasone in Relapsed AL Amyloidosis Phase 1/Phase 2
Recruiting NCT05263817 - A Clinical Study of CD19/BCMA CAR-T Cells in the Treatment of Refractory POEMS Syndrome, Amyloidosis, Autoimmune Hemolytic Anemia, and Vasculitis Early Phase 1
Active, not recruiting NCT03201965 - A Study to Evaluate the Efficacy and Safety of Daratumumab in Combination With Cyclophosphamide, Bortezomib and Dexamethasone (CyBorD) Compared to CyBorD Alone in Newly Diagnosed Systemic Amyloid Light-chain (AL) Amyloidosis Phase 3
Withdrawn NCT02589860 - Analysis of Oral Mucositis in Patient's Undergoing Melphalan Conditioning and Autologous Stem Cell Transplant
Recruiting NCT05635266 - Tissue Repository Providing Annotated Biospecimens for Approved Investigator-directed Biomedical Research Initiatives
Completed NCT02574676 - Quality of Life (QOL) Registry for Patients With AL Amyloidosis
Active, not recruiting NCT02260466 - Prevalence and Post-surgical Outcomes of CARdiac Wild-type TransthyrEtin amyloidoSIs in Elderly Patients With Aortic steNosis Referred for Valvular Replacement. N/A
Withdrawn NCT02462213 - Prospective Identification of Cardiac Amyloidosis by Cardiac Magnetic Resonance Imaging N/A
Recruiting NCT05577819 - Prevalence and Prediction of ATTR in Ambulatory Patients With HFpEF N/A
Completed NCT01406314 - SAP Depleter Dose Assessment Study in Patients Phase 1
Not yet recruiting NCT04985734 - Transthyretin Amyloidosis Cardiomyopathy (ATTR-CM) in Patients With Idiopathic Peripheral Neuropathy N/A
Active, not recruiting NCT03584022 - Clinical Trial to Assess the Safety of a Novel Scaffold Biomaterial N/A
Active, not recruiting NCT05199337 - Phase 1/2 Study of ZN-d5 for the Treatment of Relapsed or Refractory Light Chain (AL) Amyloidosis Phase 1/Phase 2
Active, not recruiting NCT05235269 - A Study to Evaluate Organ Level Uptake Repeatability of 124I AT-01 in Subjects With Systemic Amyloidosis Phase 2