Safety and efficacy of a fitusiran antithrombin-based dose regimen in people with hemophilia A or B: the ATLAS-OLE study
Abstract
Abstract Fitusiran, a subcutaneous investigational small interfering RNA therapeutic, lowers antithrombin (AT) to increase thrombin generation and rebalance hemostasis in people with hemophilia. This phase 3 open-label extension study (ATLAS-OLE) evaluated safety and efficacy of an AT-based dose regimen (AT-DR) in males aged ≥12 years with severe hemophilia A/B, with/without inhibitors. The original dose regimen (ODR) of 80 mg monthly was optimized to AT-DR targeting AT activity levels 15% to 35% to mitigate thrombotic risk (starting dose of 50 mg once every 2 months, individually adjusted to 20 mg once every 2 months, or 20/50/80 mg monthly as needed). Primary and secondary end points were safety and efficacy, respectively. Integrated safety analyses assessed safety of AT-DR and ODR across all fitusiran studies and integrated efficacy analyses compared efficacy of AT-DR in ATLAS-OLE with phase 3 parent study control groups. At interim data cutoff, 213 participants were enrolled on AT-DR (78% on regimens of once every 2 months). Integrated safety analyses of participants receiving AT-DR (n = 286) demonstrated that AT-DR was well tolerated. In ATLAS-OLE, median observed annualized bleeding rate (ABR) with AT-DR was 3.7 (interquartile range, 0.0-7.5). Integrated efficacy analyses demonstrated superiority of AT-DR over on-demand clotting factor concentrates (CFCs; 71% mean ABR reduction; P< .0001), and on-demand bypassing agents (BPAs; 73% mean ABR reduction; P = .0006); improvement over BPA prophylaxis (70% mean ABR reduction); and ABR comparable with that observed with CFC prophylaxis. Fitusiran AT-DR was well tolerated and maintained bleed protection with as few as 6 injections per year. This trial was registered at www.ClinicalTrials.gov as #NCT03754790.
Article Details
Authors (319)
Steven W. Pipe
Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor
Laurel A. Menapace
17Sanofi, Cambridge, MA
Chuanwu Zhang
9Sanofi, Waltham, United States
Yuqian Shen
4Sanofi, Morristown, United States
Marja Puurunen
17Sanofi, Cambridge, MA
Marek Demissie
2Sanofi, Cambridge, United States
Teh-Liane Khoo
8Royal Prince Alfred Hospital, Sydney, Australia
Scott Dunkley
Stephanie P'ng
4The Haemophilia and Haemostasis Centre, Fiona Stanley Hospital, Murdoch, Australia
Dominic Pepperell
Stephanie Lam
Elizabeth Steinepreis
Jacques Malherbe
3Farmovs, Bloemfontein, South Africa
Tulene Kendrick
Marcus Lombard
Huyen Tran
8Department of Clinical Haematology, Alfred Hospital, Melbourne, VIC, Australia
Jessie Zhao
Hannah Stevens
Caroline Dix
James McFadyen
Jean St-Louis
Jeannine Kassis
Georges Rivard
Jing Sun
Xiaofang Li
Key Laboratory of Cluster Science of Ministry of Education, Beijing Key Laboratory of Photoelectronic/Electrophotonic Conversion Materials, School of Chemistry and Chemical Engineering, Beijing Institute of Technology, 5 South Zhongguancun Street, Haidian District, Beijing 100081, China
Huiping Li
Jieyu Ye
1Department of Hematology, Nanfang Hospital, Southern medical University, Guangzhou, China
Xuan Zhou
State Key Laboratory of Agricultural and Forestry Biosecurity, Key Laboratory of Ministry of Education for Genetics, Breeding and Multiple Utilization of Crops, Plant Immunity Center, Fujian Agriculture and Forestry University
Dong Du
Xuefeng Wang
Beijing National Laboratory for Condensed Matter Physics
Jing Dai
Quilan Ding
Wenman Wu
Yiyi Lu
Runhui Wu
Guoqing Liu
School of Physics and Astronomy, Shanghai Jiao Tong University
Wanru Yao
Yan Wang
Yunyun Wei
Weiqun Xu
20Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China., Hangzhou, China
Yu Du
Key Laboratory of Material Simulation Methods and Software of Ministry of Education, College of Physics
Liyao Xu
Di Wang
Chan Liao
Hongwei Zhang
Key Laboratory of Development and Application of Rural Renewable Energy
ziqiang Yu
3National Clinical Research Center for Hematologic Disease, The First Affiliated Hospital of Soochow University, Suzhou, China
Hong Tian
Haibo Wang
Jie Yin
School of Psychology, Beijing Sport University
Tienan Zhu
2Peking Union Medical College Hospital, Beijing, China
Huacong Cai
1Chinese Academy of Medical Sciences & Peking Union Medical College, Peking, China
Juan Xiao
Shujie Wang
School of Chemical Engineering and Technology, Key Laboratory for Green Chemical Technology of Ministry of Education, Tianjin University
Shufen Liu
Kaini Shen
Yun Chen
Yali Chang
Tan Sang
1Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Department of Lymphohematology Ward 2, Jinan, China
Jun Zhao
Department of Thoracic Oncology Beijing Cancer Hospital Beijing China
Yawei Zhou
Liya Zhai
Xiadong Qiu
Yulei He
Hui Li
Yi Xia
Min Zhou
Feng Gao
Shipin Feng
Xiaoli Luo
Dan Li
Zhongguang Cui
Chunzhu Zhao
Hong Xu
Institute of Nuclear and New Energy Technology
Lingjie Sun
State Key Laboratory of Advanced Materials for Intelligent Sensing, Key Laboratory of Organic Integrated Circuit, Ministry of Education & Tianjin Key Laboratory of Molecular Optoelectronic Sciences, Department of Chemistry, School of Science & Institute of Molecular Aggregation Science, Tianjin University
Xue Shi
Xiaojing Zeng
Lu Qi
Shandong Provincial Key Laboratory for Science of Material Creation and Energy Conversion, Science Center for Material Creation and Energy Conversion, Institute of Frontier Chemistry, School of Chemistry and Chemical Engineering
Shuyun Cao
ZePing Zhou
1The Second Affiliated Hospital of Kunming Medical University, Department of Hematology, kunming, China
Fuhou Zhang
Lingmei Yin
Hongli Mu
Hui Bi
Shanghai Institute of Ceramics, Chinese Academy of Sciences
Zhengchao Li
Yaping Miu
Yaming Xi
Mingfeng Jia
Long Zhao
Key Laboratory of Evolution and Marine Biodiversity (Ministry of Education) and Institute of Evolution and Marine Biodiversity, Ocean University of China, Qingdao, China.
Xielan Zhao
13Xiangya Hospital Central South University, Changsha, China
Yaochun Li
Jie Peng
Institute of Intelligent Innovation, Henan Academy of Sciences
Chia-Yau Chang
2Taipei Medical University, Division of Pediatric Hematology/Oncology, Department of Pediatrics, Taipei, Taiwan
Yen-Lin Liu
1Division of Pediatric Hematology/Oncology, Department of Pediatrics, Taipei Medical University Hospital, Taiwan, Taipei, Taiwan
Ming-Ching Shen
5Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
Cheng-Wei Huang
Shih-Chung Wang
7Changhua Christian Hospital, Changhua, Taiwan
Hsuan-Yu Lin
Ching-Yeh Lin
Sheng-Chieh Chou
9Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
Ming-Kai Chuang
Szu-Chun Hsu
Jiaan-Der Wang
6Center for Rare Disease and Hemophilia, Taichung Veterans General Hospital, Taichung, Taiwan
Ming-Yang Shih
Liang-Tsai Hsiao
Giun-Yi Hung
Hsiu-ju Yen
11Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan
Po-Shen Ko
1Taipei Veterans General Hospital, Division of Hematology and Oncology, Department of Medicine, Taipei, Taiwan
Hung Chang
20Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan
Shih-Hsaing Chen
Te-Fu Weng
Yu-Hua Chao
Sherig-Wei Zeng
Peter Kampmann
5Rigshospitalet, Department of Hematology, Copenhagen, Denmark
Eva Funding
Yesim Dargaud
1Hospices Civils de Lyon, Service d'Hématologie et d'Hémostase Clinique, Lyon, France
Claude Negrier
Stéphanie Desag
Laurent Frenzel
Guillemette Fouquet
Cécile Bally
Robert Klamroth
14Vivantes Clinic Friedrichshain, Internal Medicine, Berlin, Germany
Ana-Marija Orlovic
Christian Pfrepper
4Division of Hemostaseology, Department of Hematology, Cellular Therapy, Hemostaseology and Infectiology, University of Leipzig Medical Centre, Leipzig, Germany
Michael Metze
Rima Chakaroun
Maria Weise
László Nemes
Agnes Ronatas
Cecil Ross
1St John's Medical College Hospital, Department of Clinical Hematology, Bengaluru, India
Seetharam Anandram
1St John's Medical College Hospital, Department of Clinical Hematology, Bengaluru, India
Vandana Bharadwaj
Sonali Salvi
Sunil Lohande
Alok Srivastava
Hematology Research Unit, St. John’s Research Institute, St. John’s National Academy of Health Sciences, Bengaluru, India
Aby Abraham
3Christian Medical College, Vellore, India
Fouzia Aboobacker
Shailendra Verma
Gaurav Datta
Savita Rangarajan
6University Hospital Southampton NHS Foundation Trust, South Hampton, United Kingdom
Shweta Bansal
Shashikant Apte
Kannan Subramanian
35Sahyadri Speciality Hospital Deccan Gymkhana, Pune, India
Beatrice Nolan
13Children's Health Ireland at Crumlin, Department of Paediatric Haematology, Dublin, Ireland
Saad Ahmed
Niamh O’Connell
James O’Donnell
Kevin Ryan
3National Coagulation Centre, St James’s Hospital, Dublin, Ireland
Michelle Lavin
National Coagulation Centre, St. James's Hospital, Dublin, Ireland
Gili Kenet
1The Amalia Biron Research Institute of Thrombosis & Hemostasis, Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel
Omri Cohen
Mudi Misgav
Assaf Barg
Sarina Levy Mendelovich
Flora Peyvandi
Roberta Gualtierotti
Ezio Zanon
Luca Spiezia
Chiara Simion
Tadashi Matsushita
Department of Transfusion Medicine, Nagoya University Hospital, Nagoya, Japan
Shuichi Okamoto
Nobuaki Suzuki
Takeshi Kanematsu
Naruko Suzuki
Yuka Kawaguchi
4Aichi Cancer Center, Department of Hematology and Cell Therapy, Nagoya, Japan
Satoshi Higasa
14Hyogo College of Medicine, Department of Hematology, Nishinomiya, Japan
Tazuko Tokugawa
Akihiro Sawada
Rie Shirayama
Masaru Kawamura
Hiroshi Asai
Koichi Oshida
Tetsuji Sato
Takuma Ito
Department of Chemistry, Graduate School of Science
Katsuyoshi Koh
23Japan Children’s Cancer Group ALL Committee, Nagoya, Japan
Yoshitaka Mizushima
Takahiro Ishikawa
Hirohito Kubota
Ryota Kaneko
Tomoya Irikura
Mamoru Honda
Katsuaki Taira
Yuki Arakawa
Department of Hematology/Oncology, Saitama Children’s Medical Center
Makiko Mori
6Saitama Children's Medical Center, Saitama, Japan
Kohei Fukoka
Koichi Oshima
Yuichi Mitani
Yoshiaki Ogawa
24Tokai University of School of Medicine, Kanagawa, Japan
Kiyoshi Ando
Rikio Suzuki
Ryujiro Hara
Yasuyuki Aoyama
Masako Toyosaki
Daisuke Ogiya
9Tokai University School of Medicine, Department of Hematology and Oncology, Kanagawa, Japan
Shinichiro Machida
11Tokai University School of Medicine, Department of Hematology and Oncology, Kanagawa, Japan
Hiroshi Kawada
Yukari Shirasugi
Makoto Onizuka
Ken Omachi
Kagehiro Amano
Tomoko Yamaguchi
Ei Kinai
Takeshi Hagiwara
Mihoko Yotsumoto
Ryoko Sekiya
Masato Bingo
Yushi Chikasawa
Akito Ichiki
Yoshiko Kamikubo
Ryui Miyashita
Takashi Muramatsu
Ho-jin Shin
Pusan National University Hospital, Busan, Korea, Republic of
Doyoung Kim
Chur-Woo You
2Department of Pediatrics, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Republic of Korea
Ju Young Kim
Seung Min Hahn
Chuhl Joo Lyu
Department of Pediatrics, Yonsei University Severance Hospital, Seoul, South Korea
Jung Woo Han
1Yonsei University College of Medicine, Department of Pediatrics, Seoul, Korea
Young Shil Park
Ja Hyang Cho
Azizan Shariq
Soo Min Lim
7Sultanah Aminah Hospital, Johor Bahru, Malaysia
Lily Wong
Heng Chang Choo
Gilbert Wilfred
Mohd Tarmizi Ahmad Zakhi
Yin Man Lim
Khaiteri Raghunathan
Jameela Sathar
Syazarin Fidhora Nasution
Yee Yee Yap
Veena Selvaratnam
Daniel Malan
Zelda Erika Punt
Ali Bulent Antmen
Ilgen Sasmaz
Utku Aygunes
29Konya City Hospital, Hematology, Konya, Türkiye
Kaan Kavakli
3Ege University Faculty of Medicine Children's Hospital, Department of Pediatric Hematology and Oncology, Izmir, Türkiye
Nihal Karadas
Deniz Karapinar
Alphan Kupesiz
2Akdeniz University School of Medicine, Pediatric Hematology and Oncology, Antalya, Türkiye
Mine Erkan
Kupesiz Funda Tayfun
Elif Guler
Bulent Zulfikar
2Department of Pediatric Hematology-Oncology, Istanbul University, Oncology Institute, Istanbul, Türkiye
Basak Koc
Vahap Okan
Sahin Handan Haydaroglu
Canan Albayrak
Ibrahim Kartal
Ebru Yilmaz
Musa Karakükcü
24Erciyes University, Faculty of Medicine, Kayseri, Turkey, Kayseri, Türkiye
Ekrem Unal
Alper Ozcan
8Erciyes University School of Medicine, Pediatric Hematology and Oncology, Kayseri, Türkiye
Fahri Sahin
Betul Tuzun
Güray Saydam
9Ege University Medical Faculty Hospital, Department of Internal Diseases, Division of Hematology, Izmir, Türkiye
Ievgenii Averianov
Oksana Kovtunenko
Oleksandra Stasyshyn
Maksym Semerak
Orest Tushnytskyy
Kateryna Vilchevska
Iryna Bakhchyvandzhy
Nataliya Romanyuk
Stanislav Nikulin
Alina Kobets
Jayanthi Alamelu MRCPCH
Samah Babiker
Catherine Bagot
18Glasgow Royal Infirmary, Glasgow, United Kingdom
James Tyan Rodgers
Lisa Boggio
4Rush Hemophilia and Thrombophilia Center, Chicago, United States
Mindy Simpson
1Rush University Medical Center, Rush Hemophilia and Thrombophilia Center, Chicago, United States
Erin Cockrell
11St. Joseph's Hospitals Center for Bleeding and Clotting Disorders, Tampa, United States
Candance DeBerry
Dana Obzut
John Fargo
1Ann & Robert H. Lurie Children's Hospital, Chicago, United States
Jeffrey Hord
Stephanie Savelli
Joseph Lasky
Jennifer Buitrago
Waseem Alhushki
Cynthia Gauger
Darren Klawinski
Eric Sandler
Scott Bradfield
Paul Pitel
Michael Joyce
20Department of Pediatrics, Nemours Children’s Health, Jacksonville, FL
Howard Katzenstein
Manisha Bansal
Allison Bechtel
Christine Knoll
Esteban Gomez
Shanna White
1Phoenix Children's Hospital, Phoenix, United States
Sanjay Shah
1Phoenix Children's Hospital, Phoenix, United States
Joanna Gendreau
3Johnson & Johnson, Global Medical Organization, Horsham, United States
Lori Wagner
Maa-Ohui Quarmyne
1Phoenix Children's Hospital, Phoenix, United States
Larissa Bornikova
Colleen Cleary CNP
Pamela G. Hodges
Division of Hematology–Oncology, Massachusetts General Hospital, Harvard Medical School, Boston
Alexandra Mossali
Rachel Rosovsky
Victoria Turbini
Valerie Wood
Hanny Al-Samkari
Department of Medicine, Massachusetts General Hospital, Boston
Steven Pipe
4University of Michigan, Departments of Pediatrics and Pathology, Ann Arbor, United States
Angela Weyand
4Department of Pediatrics, University of Michigan Medical School, Ann Arbor, United States
Jordan Shavit
1University of Michigan, Department of Pediatrics, Ann Arbor, United States
Amit Soni
Diane Nugent
13Children's Hospital of Orange County, Orange, United States
Nina Hwang
2Center for Inherited Blood Disorders, Orange, United States
Vanessa Salinas
Guy Young
Children’s Hospital Los Angeles
Tom Hofstra
Jennifer Donkin
Jacquelyn Keegan
Zaheer Sibgha
Wendy Leung
Julie Jaffray
1Department of Pediatrics, University of California, San Diego, San Diego, CA