E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
alpha-1 antitrypsin deficiency (AATD)-associated liver disease |
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E.1.1.1 | Medical condition in easily understood language |
alpha-1 antitrypsin deficiency (AATD)-associated liver disease |
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E.1.1.2 | Therapeutic area | Diseases [C] - Digestive System Diseases [C06] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 23.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10001806 |
E.1.2 | Term | Alpha-1 anti-trypsin deficiency |
E.1.2 | System Organ Class | 100000004850 |
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E.1.3 | Condition being studied is a rare disease | Yes |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To select a single dose level for use in later stage development based on a combined evaluation of safety and pharmacodynamic (PD) effects of fazirsiran |
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E.2.2 | Secondary objectives of the trial |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1.Male or non-nursing female patients 18 to 65 years of age, inclusive, at the time of Screening with previous diagnosis of PiZZ genotype alpha-1 antitrypsin deficiency. PiZZ diagnosis from source verifiable medical records is permitted. Otherwise, patients must undergo PiZZ confirmatory testing at Screening. PiMZ or PiSZ genotypes are not permitted. 2.Able and willing to provide written informed consent prior to the performance of any study specific procedures. 3.Liver biopsy indicating a liver fibrosis score less than F4 based on local pathologist read. a.A patient with no fibrosis may participate based on a previous biopsy conducted within one year if a source verifiable medical record specifies no evidence of fibrosis. 4.A 12-lead electrocardiogram (ECG) at Screening that, in the opinion of the Investigator, has no significant abnormalities that compromise the patient’s safety in this study. Significant abnormalities include: a.QTcF > 500 msec (which must be confirmed on repeat) b.Symptomatic resting bradycardia or tachycardia (HR < 60 or >100 beats per minute [bpm]) that is confirmed on repeat ECG with simultaneous symptoms likely due to the abnormal heart rate (HR), such as syncope, presyncope, dizziness or chest pain 5.Non-smoker (defined as does not smoke cigarettes daily for at least 12 months) with current non-smoking status confirmed by urine cotinine at Screening and throughout the study AND any previous smoking history prior to 12 months must be < 15 pack years. Patients may be on nicotine replacement (patch or gum). E-cigarettes (vapor) is not permitted. A positive urine cotinine result due to nicotine replacement is acceptable for enrollment at the discretion of the Investigator. 6.Use highly effective contraception (Appendix 4) during the study and for 3 months following the last dose of fazirsiran. Males must not donate sperm for at least 3 months post last dose of study treatment. Women of childbearing potential (WOCBP) must have a negative urine pregnancy test at Screening and on Day 1 pre-dose. Women not of childbearing potential must be post-menopausal (defined as cessation of regular menstrual periods for at least 12 months without an alternative medical cause), confirmed by follicle-stimulating hormone (FSH) consistent with post-menopausal state based on lab reference ranges. •Using twice the normal protection of birth control by using a condom AND one other form of either birth control pills (The Pill), depot or injectable birth control, intrauterine device (IUD), birth control patch (e.g., Ortho Evra), NuvaRing®, OR Surgical sterilization as a single form of birth control: i.e., tubal ligation, hysterectomy, bilateral oophorectomy, vasectomy or equivalently effective surgical form of birth control, is acceptable. •True abstinence for the duration of the study and 12 weeks after the dose of fazirsiran is acceptable only when in line with the preferred and usual lifestyle of the patient. Periodic abstinence (calendar, symptothermal, post-ovulation methods), withdrawal (coitus interruptus), spermicides only, and lactational amenorrhea methods are not considered “true” abstinence and are not acceptable methods of contraception. *All laboratory tests used as inclusion criteria may be repeated once and the repeat value may be used for inclusion purposes. |
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E.4 | Principal exclusion criteria |
1.INR ≥ 1.2 at Screening (one retest permitted). If based on opinion of Investigator and/or prescribing physician patient is appropriate for anticoagulant holiday, patient may stop taking anticoagulant for an appropriate washout period and if indicated a repeat INR within < 1.2 would be acceptable. Vitamin K may be used for reversal. If INR is not indicated (direct thrombin inhibitors or Xa inhibitors) then appropriate washout period alone may be acceptable. (Note: Anti-platelet agents, aspirin, clopidogrel, or nonsteroidal anti-inflammatory drugs [NSAIDs] are acceptable but must be held 7 days before and 7 days after liver biopsy) 2.Platelet count < 150 x 109/L at Screening (one retest permitted) 3.ALT and AST levels > 250 U/L at Screening (one retest permitted) 4. Estimated glomerular filtration rate (eGFR) < 60ml/min/1.73m2 at Screening (one retest permitted) 5.FEV1 <65% of predicted (preferentially post-bronchodilatory reading) at Screening (one retest permitted) 6.Recent (last 3 months) pneumonia or lower respiratory infection (which must be verifiable from the medical record). Patient reported infection is not sufficient to meet this criterion. 7.Unavoidable exposure to inhaled environmental toxins that in the clinical judgment of the Investigator could impair pulmonary function significantly over the course of the study. 8.Human immunodeficiency virus (HIV) infection, as shown by the presence of anti-HIV antibody (sero-positive) 9.Seropositive for HBV (HBsAg positive at Screening) or HCV (detectable HCV RNA at Screening). Cured HCV (positive antibody test without detectable HCV RNA is acceptable). 10.Uncontrolled hypertension (Systolic BP > 170 and diastolic blood pressure [BP] >100 mmHg at Screening). Patients may rescreen once BP is successfully controlled. 11.A history of torsades de pointes, ventricular rhythm disturbances (e.g., ventricular tachycardia or fibrillation), untreated heart block (excluding first-degree block, being PR interval prolongation only), congenital long QT syndrome or new acute ST segment elevation or depression or new acute Q wave on ECG. Stable atrial dysrhythmias (e.g., stable atrial fibrillation) are acceptable. 12.Symptomatic heart failure (per New York Heart Association guidelines), unstable angina, myocardial infarction, severe cardiovascular disease (ejection fraction < 20%), transient ischemic attack (TIA) or cerebrovascular accident (CVA) within 6 months prior to Screening 13.History of malignancy within the last 1 year except for adequately treated basal cell carcinoma, squamous cell skin cancer, superficial bladder tumors, or in situ cervical cancer. Patients with other curatively treated malignancies who have no evidence of metastatic disease and >1-year disease-free interval may be entered following approval by the Medical Monitor 14.History of major surgery within the prior 1 month prior to Screening 15.Regular use of alcohol within one month prior to the Screening visit (i.e., more than 14 units of alcohol per week [1 unit = 150 mL of wine, 360 mL of beer, or 45 mL of 40% alcohol]) 16.Use of illicit drugs (such as cocaine, phencyclidine [PCP]) within 1 year prior to the Screening visit or positive urine drug screen at Screening (a urine drug screen positive for benzodiazepines, opioids or tetrahydrocannabinol is acceptable for enrollment at the discretion of the Investigator). The patient may still be eligible at discretion of Medical Monitor and Investigator if positive urine drug screen is due to a prescription medication. 17.Use of an investigational agent or device within 30 days (or 5 half-lives of investigational agent, whichever is longer) prior to dosing or current participation in an investigational study involving a therapeutic intervention. Patients receiving AAT augmentation therapy as part of a post-marketing study or other access program for approved therapies are acceptable. 18.Blood donation (≥500 mL) within 7 days prior to study treatment administration. 19.Any concomitant medical or psychiatric condition or social situation that would make it difficult to comply with protocol requirements or put the patient at additional safety risk. Patients with NASH, NAFLD, metabolic syndrome, well controlled diabetes mellitus (even if on insulin) or hemochromatosis are acceptable if disease is stable and does not pose a significant threat to patient participation. Patients enrolled with NASH should have no plans to undergo bariatric surgery or have initiated or plan to initiate pharmaceutical therapy for NASH (such as Vitamin E or pioglitazone) during the course of the study. 20.A history of thromboembolic disease (including deep vein thrombosis or pulmonary embolism), myocardial infarction, stroke within three (3) months of Screening. *Please refer to Protocol for Exclusion criteria #21-23.
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E.5 End points |
E.5.1 | Primary end point(s) |
Primary Objetive: To select a single dose level for use in later stage development based on a combined evaluation of safety and pharmacodynamic (PD) effects of fazirsiran
Primary Endpoint: Percent change from baseline at Week 16 in serum Z-AAT. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
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E.5.2 | Secondary end point(s) |
• Subject incidence of treatment-emergent adverse events (AEs) • Absolute and percent change from baseline in total liver Z-AAT (insoluble + soluble) protein at end post-dose biopsy visit • Absolute and percent change from baseline in liver Z-AAT soluble protein at post-dose biopsy visit • Absolute and percent change from baseline in liver Z-AAT insoluble protein at post-dose biopsy visit • Absolute and percent change from baseline in liver function tests including alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), total bilirubin, direct bilirubin and international normalized ratio (INR) at Week 16 and over time through End of Study (EOS) • Absolute and percent change in serum Z-AAT over time through EOS • Change over time in pharmacokinetik (PK) measurements of fazirsiran at timepoints specified in the Schedule of Assessments (SOA) • Incidence of anti-drug antibodies (ADAs) to fazirsiran • Change from baseline in Metavir fibrosis stage at post-dose biopsy |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
Week 4, Week 16 and then at every 12 weeks (Weeks 28, 40, 52, 64, 76, 88, 100, 112, 124, 136, 148, 160, 172, 184 and 196) through End of Study. |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | No |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | Yes |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | Yes |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | Yes |
E.8.1.7.1 | Other trial design description |
Phase 2 to Phase 3 adaptive design |
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E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | Yes |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 3 |
E.8.3 |
The trial involves single site in the Member State concerned
| Yes |
E.8.4 | The trial involves multiple sites in the Member State concerned | No |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 11 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
Canada |
United States |
Sweden |
Netherlands |
Spain |
Germany |
Italy |
Ireland |
Portugal |
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E.8.7 | Trial has a data monitoring committee | Yes |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 4 |
E.8.9.1 | In the Member State concerned months | 6 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 4 |
E.8.9.2 | In all countries concerned by the trial months | 6 |
E.8.9.2 | In all countries concerned by the trial days | 0 |