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Fazirsiran for Liver Disease Associated with Alpha1-Antitrypsin Deficiency
Pavel Strnad1, Mattias Mandorfer1, Gourab Choudhury1
1From the Department of Internal Medicine III, University Hospital, RWTH (Rheinisch-Westfälische Technische Hochschule) Aachen, Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN RARE-LIVER), Aachen, Germany (P.S., C.T.); the Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, ERN RARE-LIVER, Vienna (M.M.); the Department of Respiratory Medicine, Royal Infirmary of Edinburgh University Hospital, University of Edinburgh, Edinburgh (G.C.), and the Department of Hepatology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge (W.G.) - both in the United Kingdom; the Division of Gastroenterology, University of California San Diego School of Medicine, La Jolla (R.L.), and Arrowhead Pharmaceuticals, Pasadena (T.S., T.C., M.Y., B.D.G., J.C.H., J.S.M.) - both in California; and the Departments of Pediatrics and Biochemistry and Molecular Biology, Saint Louis University School of Medicine, St. Louis (J.H.T.).
Fazirsiran significantly reduced Z-alpha-1-antitrypsin (Z-AAT) protein accumulation in the liver for patients with AAT deficiency liver disease. This RNA interference therapy also improved liver enzymes and showed potential for fibrosis regression.
Area of Science:
- Hepatology
- Genetics
- Pharmacology
Background:
- Alpha-1-antitrypsin (AAT) deficiency, caused by the SERPINA1 Z mutation, leads to Z-AAT protein buildup in hepatocytes.
- This accumulation can cause progressive liver disease, fibrosis, and potentially liver failure.
- Current treatments are limited, highlighting the need for novel therapeutic strategies.
Purpose of the Study:
- To evaluate the safety and efficacy of fazirsiran, an RNA interference (RNAi) therapeutic.
- To assess fazirsiran's impact on Z-AAT protein levels in the liver and serum.
- To investigate changes in liver enzymes and fibrosis in patients with AAT deficiency liver disease.
Main Methods:
- An open-label, phase 2 clinical trial involving adult patients with PI ZZ genotype and liver fibrosis.
- Patients received subcutaneous fazirsiran at doses of 100 mg or 200 mg.
- Primary endpoint was the change in liver Z-AAT concentrations measured by liquid chromatography-mass spectrometry at weeks 24 or 48.
Main Results:
- Significant reduction in liver Z-AAT accumulation (median 83%) and serum Z-AAT (nadir ~90%).
- Reduced histologic globule burden (mean score decreased from 7.4 to 2.3).
- Improvements in liver enzyme concentrations and observed fibrosis regression in 7 of 15 patients.
Conclusions:
- Fazirsiran demonstrated potent reduction of Z-AAT concentrations in liver and serum.
- The treatment was associated with concurrent improvements in liver enzyme levels.
- Fazirsiran shows promise as a therapeutic agent for liver disease associated with AAT deficiency.
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