A Trial to Learn if Receiving ALN-PNP siRNA is Safe and Well Tolerated, and How it Works in Adult Participants With Nonalcoholic Fatty Liver Disease (NAFLD) and a Genetic Risk Factor

• ClinicalTrials.gov Identifier: NCT06024408
• Recruitment Status: Not yet recruiting
• First Posted: September 6, 2023
• Last Update Posted: January 25, 2024
• Sponsor: Regeneron Pharmaceuticals
• Information provided by (Responsible Party): Regeneron Pharmaceuticals

Study Description

Brief Summary:

This study is researching an experimental drug called ALN-PNP. This study is focused on participants who are known to have nonalcoholic fatty liver disease (NAFLD), and a specific variant of the patatin-like phospholipase domain containing 3 (PNPLA3) gene.

The aim of this study is to see how safe, tolerable, and effective the study drug is.

This study is looking at several other research questions, including:

• What side effects may happen from taking the study drug
• How the study drug works to change liver fat content in NAFLD
• How much study drug and study drug metabolites (byproduct of the body breaking down the study drug) are in your blood at different times
• Whether the body makes antibodies against the study drug (which could make the drug less effective or could lead to side effects)
• Better understanding of the study drug and NAFLD

Condition or disease	Intervention/treatment	Phase
Nonalcoholic Fatty Liver Disease (NAFLD); Nonalcoholic Steatohepatitis (NASH); Genetic Risk Factor	Drug: ALN-PNP; Drug: Placebo	Phase 1

Study Design

• Study Type: Interventional (Clinical Trial)
• Estimated Enrollment: 104 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
• Primary Purpose: Treatment
• Official Title: A Three-Part, Phase 1, Randomized, Double-Blind, Placebo-Controlled, Single and Multiple Dose Study of the Safety, Tolerability, Pharmacokinetics, and Pharmacodynamics of ALN-PNP siRNA in Participants With Nonalcoholic Fatty Liver Disease (NAFLD) and a PNPLA3 Genetic Risk Factor
• Estimated Study Start Date: April 15, 2024
• Estimated Primary Completion Date: May 30, 2026
• Estimated Study Completion Date: December 30, 2026

Arms and Interventions

Arm	Intervention/treatment
Placebo Comparator: Part A: Placebo; Participants who are homozygous for the PNPLA3 rs738409:G risk allele will be randomized 1:1:1:1	Drug: Placebo; Part A: Administered as single SC injection on day 1 Part B and Part C: Administered SC every 12 weeks (Q12W x2)
Experimental: Part A: Low Dose; Participants who are homozygous for the PNPLA3 rs738409:G risk allele will be randomized 1:1:1:1	Drug: ALN-PNP; Part A: Administered as single subcutaneous (SC) injection on day 1 Part B and Part C: Administered SC every 12 weeks (Q12W x2)
Experimental: Part A: Mid Dose; Participants who are homozygous for the PNPLA3 rs738409:G risk allele will be randomized 1:1:1:1	Drug: ALN-PNP; Part A: Administered as single subcutaneous (SC) injection on day 1 Part B and Part C: Administered SC every 12 weeks (Q12W x2)
Experimental: Part A: High Dose; Participants who are homozygous for the PNPLA3 rs738409:G risk allele will be randomized 1:1:1:1	Drug: ALN-PNP; Part A: Administered as single subcutaneous (SC) injection on day 1 Part B and Part C: Administered SC every 12 weeks (Q12W x2)
Placebo Comparator: Part B: Placebo; Participants who are homozygous for the PNPLA3 rs738409:G risk allele will be randomized 1:1:1:1	Drug: Placebo; Part A: Administered as single SC injection on day 1 Part B and Part C: Administered SC every 12 weeks (Q12W x2)
Experimental: Part B : Low Dose; Participants who are homozygous for the PNPLA3 rs738409:G risk allele will be randomized 1:1:1:1	Drug: ALN-PNP; Part A: Administered as single subcutaneous (SC) injection on day 1 Part B and Part C: Administered SC every 12 weeks (Q12W x2)
Experimental: Part B: Mid Dose; Participants who are homozygous for the PNPLA3 rs738409:G risk allele will be randomized 1:1:1:1	Drug: ALN-PNP; Part A: Administered as single subcutaneous (SC) injection on day 1 Part B and Part C: Administered SC every 12 weeks (Q12W x2)
Experimental: Part B: High Dose; Participants who are homozygous for the PNPLA3 rs738409:G risk allele will be randomized 1:1:1:1	Drug: ALN-PNP; Part A: Administered as single subcutaneous (SC) injection on day 1 Part B and Part C: Administered SC every 12 weeks (Q12W x2)
Placebo Comparator: Part C: Placebo (Optional); Sponsor may elect to enroll participants who are heterozygous for the PNPLA3 rs738409:G risk allele and may be randomized 1:1	Drug: Placebo; Part A: Administered as single SC injection on day 1 Part B and Part C: Administered SC every 12 weeks (Q12W x2)
Experimental: Part C: High Dose (Optional); Sponsor may elect to enroll participants who are heterozygous for the PNPLA3 rs738409:G risk allele and may be randomized 1:1	Drug: ALN-PNP; Part A: Administered as single subcutaneous (SC) injection on day 1 Part B and Part C: Administered SC every 12 weeks (Q12W x2)

Outcome Measures

Primary Outcome Measures :

1. Incidence of treatment-emergent adverse events (TEAEs) [ Time Frame: Up to 253 days ]
2. Severity of TEAEs [ Time Frame: Up to 253 days ]

Secondary Outcome Measures :

1. Change in liver fat fraction by magnetic resonance imaging proton density fat fraction (MRI-PDFF) in participants with NAFLD [ Time Frame: Baseline up to 253 days ]
2. Change in low-density lipoprotein cholesterol (LDL-C) in participants with NAFLD [ Time Frame: Baseline up to 253 days ]
3. Change in high-density lipoprotein cholesterol (HDL-C) in participants with NAFLD [ Time Frame: Baseline up to 253 days ]
4. Change in triglycerides (TG) in participants with NAFLD [ Time Frame: Baseline up to 253 days ]
5. Change in lipoprotein a (Lp(a)) in participants with NAFLD [ Time Frame: Baseline up to 253 days ]
6. Change in apolipoprotein A1 (ApoA1) in participants with NAFLD [ Time Frame: Baseline up to 253 days ]
7. Change in apolipoprotein B (ApoB) in participants with NAFLD [ Time Frame: Baseline up to 253 days ]
8. Concentration of ALN-PNP and potential major metabolite(s) in plasma over time [ Time Frame: Up to 253 days ]
9. Incidence of anti-drug antibodies (ADAs) to ALN-PNP [ Time Frame: Up to 253 days ]
10. Titer of anti-drug antibodies (ADAs) to ALN-PNP [ Time Frame: Up to 253 days ]

Eligibility Criteria

• Ages Eligible for Study: 18 Years to 65 Years (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Key Inclusion Criteria:

1. Participants from 18 (or country's legal age of adulthood) to 65 years of age, inclusive, at screening visit 1
2. Body mass index (BMI) from 23.0 kg/m^2 to 40.0 kg/m^2, inclusive, for East Asians (including but not limited to South Koreans, Chinese, Taiwanese, and Japanese) and BMI from 27.0 kg/m^2 to 40.0 kg/m^2, inclusive, for any other ethnicity at screening visit 1
3. Meets genotype criteria for the rs738409:G PNPLA3 risk allele: homozygotes (for Part A and Part B) or heterozygotes (optional Part C); p.I148M variant (PNPLA3 rs738409:G [p.I148M]) at screening visit 1
4. Liver fat content ≥8.5% as measured by MRI-PDFF at screening visit 3
5. Generally stable diet (based on participant's recall) for at least 3 months prior to the screening visit

Key Exclusion Criteria:

1. Evidence of other forms of known chronic liver disease, as defined in the protocol
2. Has a contraindication to MRI examinations, such as persons with cardiac pacemaker and implants made out of metal (for example, cochlear implant, nerve stimulators, magnetic vascular clips, and metallic heart valve), severe claustrophobia, or other contraindications for MRI
3. Is taking a medication to treat a co-morbid condition that is not permitted during the study
4. Has any laboratory parameter assessments at screening, as defined in the protocol
5. History of Type 1 diabetes
6. Bariatric surgery within approximately 5 years prior or planned during the study period
7. Has lost or gained more than 4.0% body weight over the 3 months prior to or during the screening period
8. Has known human immunodeficiency virus (HIV) infection, evidence of current or chronic hepatitis B virus (HBV) infection, or current or chronic hepatitis C virus (HCV) infection, as defined in the protocol
9. Was hospitalized (ie, >24 hours) for any reason within 30 days of the screening visit

Note: Other protocol defined Inclusion/Exclusion Criteria apply

Contacts and Locations

Contacts

Contact: Clinical Trials Administrator; 844-734-6643; clinicaltrials@regeneron.com

Sponsors and Collaborators

Regeneron Pharmaceuticals

Investigators

• Study Director: Clinical Trial Management; Regeneron Pharmaceuticals

More Information

• Responsible Party: Regeneron Pharmaceuticals
• ClinicalTrials.gov Identifier: NCT06024408
• Other Study ID Numbers: ALN-PNP-NASH-2255
• First Posted: September 6, 2023
• Last Update Posted: January 25, 2024
• Last Verified: January 2024

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: Yes
• Plan Description: All Individual Patient Data (IPD) that underlie publicly available results will be considered for sharing.
• Supporting Materials: Study Protocol; Statistical Analysis Plan (SAP); Informed Consent Form (ICF); Clinical Study Report (CSR); Analytic Code
• Time Frame: When Regeneron has received marketing authorization from major health authorities (e.g., FDA, European Medicines Agency (EMA), Pharmaceuticals and Medical Devices Agency (PMDA), etc.) for the product and indication, has made results publicly available (e.g., scientific publication, scientific conference, clinical trial registry), has the legal authority to share the data, and has ensured the ability to protect participant privacy.
• Access Criteria: Qualified researchers can submit a proposal for access to individual patient or aggregate level data from a Regeneron-sponsored clinical trial through Vivli. Regeneron's Independent Research Request Evaluation Criteria can be found at: https://www.regeneron.com/sites/default/files/Regeneron-External-Data-Sharing-Policy-and-Independent-Research-Request-Evaluation-Criteria.pdf
• URL: https://vivli.org/

• Studies a U.S. FDA-regulated Drug Product: Yes
• Studies a U.S. FDA-regulated Device Product: No
• Product Manufactured in and Exported from the U.S.: Yes

Keywords provided by Regeneron Pharmaceuticals:

Homozygous; Heterozygous

Additional relevant MeSH terms:

Liver Diseases; Fatty Liver; Non-alcoholic Fatty Liver Disease; Digestive System Diseases