familial hypercholesterolaemia
Conditions
Interventions
AAV8.TBG.hLDLR will be administered via a peripheral vein by infusion.
Sponsors
REGENXBIO Inc
Eligibility
Age
18 Years to 99 Years
Inclusion criteria
Inclusion criteria: 1. Male or female * 18 years of age. 2. Untreated and/or treated LDL-C levels and clinical presentation consistent with the diagnosis of homozygous FH 3. Molecularly defined LDLR mutations at both LDLR alleles. 4. Concurrent allowed lipid lowering medication must be stable for * 4 weeks before the baseline visit and must remain stable until 18 weeks after vector administration (or 4 weeks post steroid termination). These include but are not limited to: statins, ezetimibe, bile acid sequestrants, PCSK9 inhibitors, and LDL and/or plasma apheresis. Subjects on other lipid-lowering medications are eligible for the study but must wash out of these medications for the pre-specified time period. 5. Females of childbearing potential must have a negative pregnancy test at screening and baseline visits and be willing to have additional pregnancy tests during the study. 6. Sexually active subjects (both female and male) must be willing to use a medically accepted method of contraception from screening visit until 6 months after vector administration 7. A baseline serum AAV8 NAb titer * 1:10.
Exclusion criteria
Exclusion criteria: 1. Unwilling to wash out of the following lipid lowering therapies for the pre-specified time period: a. niacin > 250 mg/day: within 6 weeks of baseline b. fibrates: within 4 weeks of baseline c. lomitapide: within 8 weeks of baseline d. mipomersen: within 24 weeks of baseline 2. Heart failure defined by the NYHA classification as functional Class III with history of hospitalization(s) within 12 weeks of the baseline visit or functional Class IV. 3. History within 12 weeks of the baseline visit of a myocardial infarction (MI), unstable angina leading to hospitalization, coronary artery bypass graft surgery (CABG), percutaneous coronary intervention (PCI), uncontrolled cardiac arrhythmia, carotid surgeryor stenting, stroke, transient ischemic attack, carotid revascularization, endovascular procedure or surgical intervention. 4. Uncontrolled hypertension defined as: systolic blood pressure > 180 mmHg, diastolic blood pressure > 95 mmHg. 5. Uncontrolled diabetes defined as HbA1c > 8.5% or an average fasting glucose * 160 mg/dl. 6. Known hypersensitivity to prednisone 7. History of cirrhosis or chronic liver disease based on documented histological evaluation or non-invasive imaging or testing. 8. Documented diagnosis of any of the following liver diseases: a. Nonalcoholic steatohepatitis (biopsy-proven) b. Alcoholic liver disease c. Autoimmune hepatitis d. Liver cancer e. Primary biliary cirrhosis f. Primary sclerosing cholangitis g. Wilson*s disease h. Hemochromatosis i. *1 anti-trypsin deficiency 9. Abnormal liver function tests (LFTs) at screening (AST or ALT > 2 × upper limit of normal (ULN) and/or Total Bilirubin of * 1.5 × ULN unless patient has unconjugated hyperbilirubinemia due to Gilbert*s syndrome). 10. Hepatitis B as defined by positive for HepB SAg, or Hep B Core Ab, and/or viral DNA 11. Chronic active Hepatitis C as defined by positive for HCV Ab and viral RNA. 12. History of chronic alcohol abuse within 52 weeks of the screening visit. 13. Certain prohibited medications known to be potentially hepatotoxic, especially those that can induce microvesicular or macrovesicular steatosis. These include but are not limited to: Accutane (isotretinoin), amiodarone, HAART medications, heavy acetaminophen use (2 g/day more than 3 times a week), isoniazid, methotrexate, tetracyclines, tamoxifen, or valproate. 14. Active tuberculosis, systemic fungal disease, or other chronic infection. 15. History of immunodeficiency diseases, including a positive HIV test result. 16. Chronic renal insufficiency defined as estimated GFR < 30 mL/min/1.73m2. 17. History of cancer within the past 5 years, except for adequately treated basal cell skin cancer, squamous cell skin cancer, or in situ cervical cancer. 18. Previous organ transplantation. 19. Administration of an investigational drug within 12 weeks or 5 half-lives of the drug (whichever is longer) prior to the screening visit and until 52 weeks after receivingAAV8.TBG.hLDLR. Subjects are not prohibited from receiving investigational drugs after 52 weeks. 20. Any major surgical procedure occurring less than 3 months prior to the screening visit, or any planned future surgical procedure within 3 months of baseline. 21. Serious or unstable medical or psychological conditions that, in the opinion of th
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Primary Objectives To determine the safety of AAV8.TBG.hLDLR administration in patients with homozygous familial hypercholesterolemia (HoFH) as assessed by the number of reported adverse events, changes noted on physical examinations, and clinical laboratory parameters assessed up to 24 weeks post vector administration. | — |
Secondary
| Measure | Time frame |
|---|---|
| 2.2. Secondary Objectives -* To assess the LDL-C reduction achieved with AAV8.TBG.hLDLR administration as defined by percent change in LDL-C at 12 weeks (Cohort 1 only) or 18 weeks after vector administration (or 4 weeks after steroid termination or prior to changing lipid lowering therapies) compared to baseline. -* To assess changes in other lipid parameters at 12 weeks (Cohort 1 only) or 18 weeks after vector administration (or 4 weeks after steroid termination or prior to changing lipid lowering therapies) compared to baseline values, specifically percent change in total cholesterol (TC), non-high density lipoprotein cholesterol (non-HDL-C), HDL-C, fasting triglycerides (TG), very low density lipoprotein cholesterol (VLDL-C), lipoprotein(a) (Lp(a)), apolipoprotein B (apoB), and apolipoprotein A-I (apoA-I). -* To determine the safety of AAV8.TBG.hLDLR administration as assessed by the number of reported adverse events, changes noted on physical examinations and clinical laboratory parameters assessed at multiple time points up to 104 weeks post vector administration. -* To assess vector shedding in plasma and urine. 2.3. Exploratory Objectives -* To assess the immune response to the vector administration. -* To assess the metabolic mechanism by which LDL-C is reduced by performing LDL kinetic studies prior to vector administration and again 12 weeks (Cohort 1 only) or 18 weeks after vector administration (or 4 weeks after steroid termination or prior to changing lipid lowering therapies). The primary parameter to be evaluated is the fractional catabolic rate (FCR) of LDL apoB. -* To assess the percentage of subjects achieving various LDL-C thresholds (e.g., LDL-C | — |
Countries
Netherlands
Outcome results
None listed