アポリプロテインを標的にするアンチセンセスオリゴヌクレオチド (a) 増加したリポプロテインを標的にするアンチセンセスオリゴヌクレオチド (a) 増加したリポプロテインを標的にするアンチセンセスオリゴヌクレオチド (b)
Nicholas J Viney1, Julian C van Capelleveen2, Richard S Geary1
1Ionis Pharmaceuticals, Carlsbad, CA, USA.
Lancet (London, England)
|September 26, 2016
まとめ
IONIS-APO (a) RxとIONIS-APO (a) -LRxという2つの新しいアンチセンセスのオリゴヌクレオチドは,臨床試験で,リポプロテイン (a) (Lp (a)) のレベルを著しく低下させた. これらの治療は,高Lp (a) と関連した心血管疾患のリスクを軽減する見込みを示しています.
科学分野:
- 心血管医学
- 薬理学について
- 遺伝学
背景:
- リポプロテイン (Lp[a]) の上昇は,心血管疾患と動脈弁狭窄の有病的な遺伝的危険因子である.
- 人口の約20%がLp (a) を上昇させていますが,それを低下させるための特定の治療法は承認されていません.
- アンチセンセスオリゴヌクレオチドは,Lp (a) 濃度をターゲットにする潜在的な治療戦略を提供します.
研究 の 目的:
- IONIS-APO(a) RxとIONIS-APO(a) -LRxという2つの新しい抗意味オリゴヌクレオチドの有効性,安全性,耐受性を評価する.
- 増加したLp (a) を有する参加者の投与量によるLp (a) 値の低下を評価する.
- Lp (a) 媒介性心血管疾患のリスクを軽減するこれらの治療法の可能性を決定する.
主な方法:
- 2つのランダム化,ダブルブラインド,プラセボ対照試験が行われました.
- ステージ2試験では,Lp (a) が上昇した被験者にIONIS- APO (a) Rxを,エスカレートする皮膚下投与量で評価した.
- ステージ1/ 2a試験では,IONIS- APO (a) - LRxを健康なボランティアで,単回および複数の上昇する皮膚下投与量で評価した.
主要な成果:
- IONIS- APO (a) Rxは2つのコホート (p< 0. 0001) で,それぞれ66. 8%と71. 6%の有意なLp (a) 減少を示した.
- IONIS- APO (a) - LRxは投与量依存のLp (a) 減少を示し,40 mg群では92%まで増加した (p=0. 07).
- 両方のオリゴヌクレオチドは安全で耐受性があり,治療に関連した有害事象は最小でした.
結論:
- IONIS- APO (a) - LRxは,Lp (a) 濃度を下げる新しい,許容可能で強力な治療法です.
- これらのアンチセンセスのオリゴヌクレオチドは,Lp (a) の上昇に伴う心血管疾患のリスクを軽減する可能性があります.
- 既存の心血管疾患やカルシフ性大動脈弁の狭窄症および上昇したLp (a) の患者については,さらなる開発が必要である.
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