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Study of AG10 in Amyloid Cardiomyopathy

Primary Purpose

Familial ATTR-CM (ATTRm-CM, or FAC), Wild-type ATTR-CM (ATTRwt-CM)

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
AG10
Placebo Oral Tablet
Sponsored by
Eidos Therapeutics, a BridgeBio company
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Familial ATTR-CM (ATTRm-CM, or FAC)

Eligibility Criteria

18 Years - 90 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Have the ability to understand and sign a written informed consent form, which must be obtained prior to initiation of study procedures.
  2. Be a male or female ≥18 to ≤90 years of age.
  3. Have an established diagnosis of ATTR-CM with either wild-type transthyretin or a variant transthyretin genotype (assessed by genotyping, with patients with concurrent monoclonal gammopathy of undetermined significance requiring a confirmatory test using mass spectrometry) as defined by either positive endomyocardial biopsy or positive technetium pyrophosphate scan.
  4. Have a history of heart failure evidenced by at least one prior hospitalization for heart failure or clinical evidence of heart failure (without hospitalization) requiring medical management.
  5. Have New York Heart Association (NYHA) Class II-III symptoms.
  6. Male patients and female patients of childbearing potential who engage in heterosexual intercourse must agree to use appropriate method(s) of contraception.
  7. For patients taking cardiovascular medical therapy, with the exception of diuretic dosing, must be on stable doses (defined as no greater than 50% dose adjustment and no categorical changes of medications) for at least 2 weeks prior to Screening.

Exclusion Criteria:

  1. Acute myocardial infarction, acute coronary syndrome or coronary revascularization within 90 days prior to Screening.
  2. Experienced stroke within 90 days prior to Screening.
  3. Has hemodynamic instability at Screening or Randomization that, in the judgment of the Principal Investigator (PI), would pose too great a risk for participation in the study.
  4. Has estimated glomerular filtration rate (GFR) <30 mL/min/1.73 m2 at Screening.
  5. Is likely to undergo heart transplantation within the next year.
  6. Has confirmed diagnosis of light-chain amyloidosis.
  7. Has abnormal liver function tests at Screening, defined as Alanine Aminotransferase (ALT) or Aspartate Aminotransferase (AST) >3 × upper limit of normal (ULN) or total bilirubin >2 × ULN.
  8. Has abnormalities in clinical laboratory tests at Screening or Randomization that, in the judgment of the PI, would pose too great a risk for participation in the study.
  9. Known hypersensitivity to study drug (AG10 or placebo), its metabolites, or formulation excipient
  10. Current treatment with diflunisal, tafamidis, green tea, doxycycline, tauroursodeoxycholic acid (TUDCA)/Ursodiol, Patisiran or Inotersen within 14 days or 5 half-lives of the prior investigational agent (whichever is longer) prior to Screening.
  11. Females who are pregnant or breastfeeding. Lactating females must agree to discontinue nursing before the study drug is administered. A negative serum pregnancy test at Screening and a negative urine pregnancy test at Randomization visit are required for female patients of childbearing potential.
  12. In the judgment of the investigator, has any clinically significant ongoing medical condition that might jeopardize the patient's safety or interfere with the study, including participation in another investigational drug or investigational device study within the 30 days prior to Screening with potential residual effects that might confound the results of this study.
  13. Has any laboratory abnormality or condition that, in the investigator's opinion, could adversely affect the safety of the patient or impair the assessment of study results.
  14. Has any condition that, in the opinion of the investigator, would preclude compliance with the study protocol such as a history of substance abuse, alcoholism or a psychiatric condition.
  15. Has participated in another investigational study within 14 days or 5 half-lives of the prior investigational agent (whichever is longer) prior to screening. Exceptions can be made in the case of observational and/or registry studies upon consultation with the Medical Monitor.
  16. Current treatment with, or chronic use of, a proton pump inhibitor (PPI) or histamine-receptor 2 (H2) antagonist within 14 days or 5 half-lives of the prior agent (whichever is longer) prior to Screening.

Sites / Locations

  • Cedars-Sinai Medical Center
  • Stanford University
  • University of California San Francisco
  • Yale University
  • Northwestern University
  • Brigham and Women's Hospital
  • Boston University
  • Mayo Clinic
  • Columbia University
  • Cleveland Clinic
  • Oregon Health & Science University
  • Medical University of South Carolina
  • University of Utah

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Active Comparator

Active Comparator

Placebo Comparator

Arm Label

AG10 Low Dose

AG10 High Dose

Placebo

Arm Description

AG10 400mg tablets twice daily for 28 days

AG10 800mg tablets twice daily for 28 days

Placebo tablets twice daily for 28 days

Outcomes

Primary Outcome Measures

Change in Diastolic Blood Pressure
Change in Diastolic Blood Pressure from Baseline to Day 28 (Postdose)
Change in Heart Rate
Change in Heart Rate from Baseline to Day 28 (Postdose)
Change in Respiratory Rate
Change in Respiratory Rate from Baseline to Day 28 (Postdose)
Change in Temperature
Change in Temperature from Baseline to Day 28
Change in Systolic Blood Pressure
Change in Systolic Blood Pressure from Baseline to Day 28

Secondary Outcome Measures

Number of Participants With Threshold Levels of Overall % Stabilization >= 95% and >= 99% by Fluorescent Probe Exclusion (FPE)
In specialized lab tests on patient samples that measure the stability of the healthy form of TTR, both doses of AG10 were able to reach near complete stabilization.
Pharmacokinetic (PK): Steady State Trough Concentration of AG10
Non-fluctuating minimal amount of AG10 in blood at Day 14 and Day 28

Full Information

First Posted
February 7, 2018
Last Updated
October 24, 2022
Sponsor
Eidos Therapeutics, a BridgeBio company
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1. Study Identification

Unique Protocol Identification Number
NCT03458130
Brief Title
Study of AG10 in Amyloid Cardiomyopathy
Official Title
A Phase 2, Randomized, Placebo-controlled, Dose-ranging Study of the Safety, Tolerability, Pharmacokinetics and Pharmacodynamics of AG10 in Patients With Symptomatic Transthyretin Amyloid Cardiomyopathy
Study Type
Interventional

2. Study Status

Record Verification Date
October 2022
Overall Recruitment Status
Completed
Study Start Date
April 27, 2018 (Actual)
Primary Completion Date
October 5, 2018 (Actual)
Study Completion Date
October 5, 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Eidos Therapeutics, a BridgeBio company

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This prospective, randomized, multicenter, double-blind, parallel group, placebo-controlled, dose-ranging study will evaluate the safety, tolerability, PK (Pharmacokinetic) and PD (Pharmacodynamic) of AG10 compared to placebo administered on a background of stable heart failure therapy. Screening and randomization will be followed by a 28-day blinded, placebo-controlled treatment period.
Detailed Description
A Phase 2, Randomized, Placebo-controlled, Dose-ranging Study of the Safety, Tolerability, Pharmacokinetics and Pharmacodynamics of AG10 in Patients with Symptomatic Transthyretin Amyloid Cardiomyopathy. The primary objective of this study is to evaluate the safety and tolerability of AG10 administered to adult patients with symptomatic transthyretin amyloid cardiomyopathy (ATTRCM). This study will be a Phase 2, randomized, placebo-controlled, dose-ranging study in 45 male and/or female patients with symptomatic ATTR-CM aged 18 through 90 years. If all doses are well tolerated, the duration of each patient's participation in the study will be 28 days of treatment. In addition, there will be a 28-day screening period before treatment and a 30-day follow-up period before the final Follow-up Visit. This prospective, randomized, multicenter, double-blind, parallel group, placebo-controlled, dose-ranging study will evaluate the safety, tolerability, PK and PD of AG10 compared to placebo administered on a background of stable heart failure therapy. Screening and randomization will be followed by a 28-day blinded, placebo-controlled treatment period. secondary objectives of this study are: to characterize the pharmacokinetics (PK) of AG10 administered orally twice daily in patients with symptomatic ATTRCM, and to describe the pharmacodynamic (PD) properties of AG10 as assessed by established assays of transthyretin (TTR) stabilization, including Fluorescent Probe Exclusion (FPE) assay and Western blot, and to describe the Pharmacokinetic Pharmacodynamic (PKPD) relationship of AG10 in adult patients with symptomatic ATTRCM. Eligible patients will be randomized in a 1:1:1 ratio to placebo or one of two different doses of AG10 administered twice daily. A minimum of 30% of patients enrolled will be mutant ATTR-CM.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Familial ATTR-CM (ATTRm-CM, or FAC), Wild-type ATTR-CM (ATTRwt-CM)

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Model Description
A randomized, doubleblind, placebo-controlled, dose-ranging design is considered to be the most appropriate study design for meeting this objective. On the basis of information gained from previous clinical experience with AG10, the doses used in this study will be selected to determine the dose with the better safety and tolerability profile.
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
49 (Actual)

8. Arms, Groups, and Interventions

Arm Title
AG10 Low Dose
Arm Type
Active Comparator
Arm Description
AG10 400mg tablets twice daily for 28 days
Arm Title
AG10 High Dose
Arm Type
Active Comparator
Arm Description
AG10 800mg tablets twice daily for 28 days
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Placebo tablets twice daily for 28 days
Intervention Type
Drug
Intervention Name(s)
AG10
Intervention Description
TTR stabilizer
Intervention Type
Drug
Intervention Name(s)
Placebo Oral Tablet
Intervention Description
Nonactive control
Primary Outcome Measure Information:
Title
Change in Diastolic Blood Pressure
Description
Change in Diastolic Blood Pressure from Baseline to Day 28 (Postdose)
Time Frame
Baseline to Day 28
Title
Change in Heart Rate
Description
Change in Heart Rate from Baseline to Day 28 (Postdose)
Time Frame
Baseline to Day 28
Title
Change in Respiratory Rate
Description
Change in Respiratory Rate from Baseline to Day 28 (Postdose)
Time Frame
Baseline to Day 28
Title
Change in Temperature
Description
Change in Temperature from Baseline to Day 28
Time Frame
Baseline to Day 28
Title
Change in Systolic Blood Pressure
Description
Change in Systolic Blood Pressure from Baseline to Day 28
Time Frame
Baseline to Day 28
Secondary Outcome Measure Information:
Title
Number of Participants With Threshold Levels of Overall % Stabilization >= 95% and >= 99% by Fluorescent Probe Exclusion (FPE)
Description
In specialized lab tests on patient samples that measure the stability of the healthy form of TTR, both doses of AG10 were able to reach near complete stabilization.
Time Frame
Day 1 to Day 28
Title
Pharmacokinetic (PK): Steady State Trough Concentration of AG10
Description
Non-fluctuating minimal amount of AG10 in blood at Day 14 and Day 28
Time Frame
Day 14 and Day 28

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
90 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Have the ability to understand and sign a written informed consent form, which must be obtained prior to initiation of study procedures. Be a male or female ≥18 to ≤90 years of age. Have an established diagnosis of ATTR-CM with either wild-type transthyretin or a variant transthyretin genotype (assessed by genotyping, with patients with concurrent monoclonal gammopathy of undetermined significance requiring a confirmatory test using mass spectrometry) as defined by either positive endomyocardial biopsy or positive technetium pyrophosphate scan. Have a history of heart failure evidenced by at least one prior hospitalization for heart failure or clinical evidence of heart failure (without hospitalization) requiring medical management. Have New York Heart Association (NYHA) Class II-III symptoms. Male patients and female patients of childbearing potential who engage in heterosexual intercourse must agree to use appropriate method(s) of contraception. For patients taking cardiovascular medical therapy, with the exception of diuretic dosing, must be on stable doses (defined as no greater than 50% dose adjustment and no categorical changes of medications) for at least 2 weeks prior to Screening. Exclusion Criteria: Acute myocardial infarction, acute coronary syndrome or coronary revascularization within 90 days prior to Screening. Experienced stroke within 90 days prior to Screening. Has hemodynamic instability at Screening or Randomization that, in the judgment of the Principal Investigator (PI), would pose too great a risk for participation in the study. Has estimated glomerular filtration rate (GFR) <30 mL/min/1.73 m2 at Screening. Is likely to undergo heart transplantation within the next year. Has confirmed diagnosis of light-chain amyloidosis. Has abnormal liver function tests at Screening, defined as Alanine Aminotransferase (ALT) or Aspartate Aminotransferase (AST) >3 × upper limit of normal (ULN) or total bilirubin >2 × ULN. Has abnormalities in clinical laboratory tests at Screening or Randomization that, in the judgment of the PI, would pose too great a risk for participation in the study. Known hypersensitivity to study drug (AG10 or placebo), its metabolites, or formulation excipient Current treatment with diflunisal, tafamidis, green tea, doxycycline, tauroursodeoxycholic acid (TUDCA)/Ursodiol, Patisiran or Inotersen within 14 days or 5 half-lives of the prior investigational agent (whichever is longer) prior to Screening. Females who are pregnant or breastfeeding. Lactating females must agree to discontinue nursing before the study drug is administered. A negative serum pregnancy test at Screening and a negative urine pregnancy test at Randomization visit are required for female patients of childbearing potential. In the judgment of the investigator, has any clinically significant ongoing medical condition that might jeopardize the patient's safety or interfere with the study, including participation in another investigational drug or investigational device study within the 30 days prior to Screening with potential residual effects that might confound the results of this study. Has any laboratory abnormality or condition that, in the investigator's opinion, could adversely affect the safety of the patient or impair the assessment of study results. Has any condition that, in the opinion of the investigator, would preclude compliance with the study protocol such as a history of substance abuse, alcoholism or a psychiatric condition. Has participated in another investigational study within 14 days or 5 half-lives of the prior investigational agent (whichever is longer) prior to screening. Exceptions can be made in the case of observational and/or registry studies upon consultation with the Medical Monitor. Current treatment with, or chronic use of, a proton pump inhibitor (PPI) or histamine-receptor 2 (H2) antagonist within 14 days or 5 half-lives of the prior agent (whichever is longer) prior to Screening.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
MARK MCGOVERN, RN
Organizational Affiliation
Eidos Therapeutics, a BridgeBio company
Official's Role
Study Director
Facility Information:
Facility Name
Cedars-Sinai Medical Center
City
Beverly Hills
State/Province
California
ZIP/Postal Code
90211
Country
United States
Facility Name
Stanford University
City
Palo Alto
State/Province
California
ZIP/Postal Code
94304
Country
United States
Facility Name
University of California San Francisco
City
San Francisco
State/Province
California
ZIP/Postal Code
94143
Country
United States
Facility Name
Yale University
City
New Haven
State/Province
Connecticut
ZIP/Postal Code
06520
Country
United States
Facility Name
Northwestern University
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60611
Country
United States
Facility Name
Brigham and Women's Hospital
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02115
Country
United States
Facility Name
Boston University
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02127
Country
United States
Facility Name
Mayo Clinic
City
Rochester
State/Province
Minnesota
ZIP/Postal Code
55905
Country
United States
Facility Name
Columbia University
City
New York
State/Province
New York
ZIP/Postal Code
10032
Country
United States
Facility Name
Cleveland Clinic
City
Cleveland
State/Province
Ohio
ZIP/Postal Code
44195
Country
United States
Facility Name
Oregon Health & Science University
City
Portland
State/Province
Oregon
ZIP/Postal Code
97239
Country
United States
Facility Name
Medical University of South Carolina
City
Charleston
State/Province
South Carolina
ZIP/Postal Code
29424
Country
United States
Facility Name
University of Utah
City
Salt Lake City
State/Province
Utah
ZIP/Postal Code
84132
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
30885685
Citation
Judge DP, Heitner SB, Falk RH, Maurer MS, Shah SJ, Witteles RM, Grogan M, Selby VN, Jacoby D, Hanna M, Nativi-Nicolau J, Patel J, Rao S, Sinha U, Turtle CW, Fox JC. Transthyretin Stabilization by AG10 in Symptomatic Transthyretin Amyloid Cardiomyopathy. J Am Coll Cardiol. 2019 Jul 23;74(3):285-295. doi: 10.1016/j.jacc.2019.03.012. Epub 2019 Mar 15.
Results Reference
derived

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Study of AG10 in Amyloid Cardiomyopathy

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