Alnylam Presents Positive Complete Results from ENVISION Phase 3 Study of Givosiran, an Investigational RNAi Therapeutic for the Treatment of Acute Hepatic Porphyria
- Givosiran Achieved a 74 Percent Mean Reduction in Composite Annualized Attack Rate (AAR) Relative to Placebo, with Consistent Reductions Across all Components of Composite Endpoint and Subgroups ?
- Treatment Effect Includes a 90 Percent Median Decrease in Composite AAR Relative to Placebo, with 50 Percent of Givosiran Patients Attack-Free ?
- Ninety-Nine Percent of Patients Enrolled in Open-Label Extension Study ?
- Alnylam to Host Conference Call?Saturday, April 13th?at?8:00 am ET??
CAMBRIDGE, Mass.-, the leading RNAi therapeutics company, announced today positive complete results from the ENVISION Phase 3 study of givosiran, an investigational RNAi therapeutic targeting aminolevulinic acid synthase 1 (ALAS1) in development for the treatment of acute hepatic porphyria (AHP). The clinical data are being presented in an oral presentation at the European Association for the Study of the Liver (EASL) International Liver Congress? being held?April 10-14?in?Vienna, Austria. The full ENVISION results demonstrated a 74 percent mean and 90 percent median reduction in the primary endpoint measure of annualized rate of composite attacks in patients on givosiran relative to placebo during the six-month double-blind period. In addition, givosiran achieved statistically significant positive results for five of nine secondary endpoints, with an overall safety and tolerability profile that the Company believes is encouraging, especially in this high unmet need disease. Adverse events (AEs) were reported in 89.6 percent of givosiran patients and 80.4 percent of placebo patients; serious adverse events (SAEs) were reported in 20.8 percent of givosiran patients and 8.7 percent of placebo patients. Ninety-three of 94 patients, or 99 percent, enrolled in the open-label extension (OLE) period of the study. Based on the ENVISION results, the Company plans to complete its rolling submission of a New Drug Application (NDA) and file a Marketing Authorisation Application (MAA) in mid-2019. ?Given the high unmet need in this disease setting, we are very pleased for the patients and families living with acute hepatic porphyria for whom these results signal hope for a potential new therapeutic option,? said Akshay Vaishnaw, M.D., Ph.D., President of R&D at Alnylam. ?Givosiran substantially reduced the frequency of attacks, providing strong support for a treatment benefit, with a consistent effect across all components of the primary endpoint and all subgroups analyzed. In this disease with high burden and associated comorbidities, we?re encouraged by the overall tolerability profile. We firmly believe givosiran has the potential to be a transformative medicine for patients living with AHP.? ?Currently, there are no approved therapies aimed at preventing the painful, often incapacitating attacks and chronic symptoms associated with AHP,? said?Manisha Balwani, M.D., M.S, Associate Professor of the?Department of Genetics and Genomic Sciences?and?Department of Medicine?at the?Icahn School of Medicine?at?Mount Sinai?and principal investigator of the ENVISION study. ?The results from ENVISION are promising and demonstrate a strong treatment effect for givosiran, with reduction of attacks and improvement in patient-reported measures of overall health status and quality of life. Thus, givosiran represents a novel and targeted treatment approach that has the potential to make a significant impact on the lives of patients who are struggling with the disabling symptoms of this disease.? Efficacy Results Givosiran met the primary efficacy endpoint with a 74 percent mean reduction relative to placebo in the annualized rate of composite porphyria attacks, defined as those requiring hospitalization, urgent healthcare visit, or hemin administration, in patients with acute intermittent porphyria (AIP) over six months (p equal to 6.04x10-9). There was a corresponding 90 percent median reduction in composite annualized attack rate (AAR), with a median AAR of 1.0 in givosiran patients compared with a median AAR of 10.7 in placebo patients. Fifty percent of givosiran-treated patients were attack-free during the six-month treatment period as compared to 16.3 percent of placebo-treated patients. The reductions in attack rates were observed across all components of the primary endpoint. The treatment benefit for givosiran compared to placebo was maintained across all pre-specified patient subgroups, including age, race, geography, historical attack rates, prior hemin prophylaxis status, disease severity, and other baseline characteristics. Givosiran also demonstrated statistically significant differences in five of nine hierarchically tested secondary endpoints relative to placebo. These included mean reductions of:- 91 percent in urinary aminolevulinic acid (ALA) in patients with AIP at three months (p equal to 8.74x10-14).
- 83 percent in urinary ALA in patients with AIP at six months (p equal to 6.24x10-7).
- 73 percent in urinary levels of porphobilinogen (PBG) in patients with AIP at six months (p equal to 8.80x10-7).
- 77 percent in the number of annualized days on hemin in patients with AIP (p equal to 2.35x10-5).
- 73 percent in composite AAR for patients with any AHP (p equal to 1.35x10-8).