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J Am Coll Cardiol. 2019 Jul 23;74(3):285-295. doi: 10.1016/j.jacc.2019.03.012. Epub 2019 Mar 15.

Transthyretin Stabilization by AG10 in Symptomatic Transthyretin Amyloid Cardiomyopathy.

Author information

1
Department of Medicine, Medical University of South Carolina, Charleston, South Carolina.
2
Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon. Electronic address: heitner@ohsu.edu.
3
Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
4
Columbia University Irving Medical Center, New York, New York.
5
Northwestern University Feinberg School of Medicine, Chicago, Illinois.
6
Stanford University Medical Center, Stanford, California.
7
Mayo Clinic, Rochester, Minnesota.
8
University of California, San Francisco, San Francisco, California.
9
Yale University Medical Center, New Haven, Connecticut.
10
Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio.
11
University of Utah Health, Salt Lake City, Utah.
12
Cedars-Sinai Medical Center, Los Angeles, California.
13
Eidos Therapeutics, Inc., San Francisco, California.

Abstract

BACKGROUND:

Transthyretin (TTR) amyloidosis is an underdiagnosed disease caused by destabilization of TTR due to pathogenic mutations or aging. Both pathogenic and protective mutations illuminate mechanisms of disease and potential interventions. AG10 is a selective, oral TTR stabilizer under development for transthyretin amyloidosis cardiomyopathy (ATTR-CM) that mimics a protective TTR mutation.

OBJECTIVES:

This randomized, double-blind, placebo-controlled study evaluated safety, tolerability, pharmacokinetics, and pharmacodynamics of AG10 in ATTR-CM patients with symptomatic, chronic heart failure.

METHODS:

ATTR-CM, New York Heart Association functional class II to III subjects (n = 49, mutant or wild-type) were randomized 1:1:1 to AG10 400 mg, AG10 800 mg, or placebo twice daily for 28 days. Safety and tolerability were assessed by clinical and laboratory criteria. AG10 plasma levels were measured. TTR stability was assessed by changes in serum TTR, and 2 established ex vivo assays (fluorescent probe exclusion and Western blot).

RESULTS:

AG10 treatment was well-tolerated, achieved target plasma concentrations and demonstrated near-complete stabilization of TTR. TTR stabilization was more complete and less variable at the higher dose with stabilization by fluorescent probe exclusion of 92 ± 10% (mean ± SD) at trough and 96 ± 9% at peak (both p < 10-12 vs. placebo). Average serum TTR increased by 36 ± 21% and 51 ± 38% at 400 and 800 mg, respectively (both p < 0.0001 vs. placebo). Baseline serum TTR in treated subjects was below normal in 80% of mutant and 33% of wild-type subjects. AG10 treatment restored serum TTR to the normal range in all subjects.

CONCLUSIONS:

AG10 has the potential to be a safe and effective treatment for patients with ATTR-CM. A phase 3 trial is ongoing. (Study of AG10 in Amyloid Cardiomyopathy; NCT03458130).

KEYWORDS:

AG10; ATTR-CM; amyloidosis; cardiomyopathy; heart failure; transthyretin

PMID:
30885685
DOI:
10.1016/j.jacc.2019.03.012
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