Study to Evaluate the Efficacy, Safety, Tolerability, Pharmacokinetics, and Pharmacodynamics of Sapablursen (Formerly ISIS 702843, IONIS-TMPRSS6-LRx)

The purpose was to evaluate the efficacy, safety, tolerability, pharmacokinetics and pharmacodynamics of sapablursen administered subcutaneously to participants with non-transfusion dependent β-Thalassemia Intermedia.

This was a multi-center, randomized, open-label study in up to 29 participants. The duration of participation for each subject in the study was approximately 29 months and included an approximately 2-month screening period, a 24-month treatment period, and a 3-month post-treatment period.

Eligibility Criteria:
Inclusion Criteria:

* Willingness to comply with study procedures
* Clinical diagnosis of Beta-Thalassemia Intermedia with genotypic confirmation
* Non-transfusion dependent, as defined by: no more than 6 transfusions in the past 12-month period, and no transfusions in the 8-week period prior to Day 1
* Mean Hb within the range of 6.0-10.0 g/dL, inclusive at Screening
* LIC within the range of 3.0-20.0 mg Fe/g dry weight, inclusive
* If using chelators, must be on a stable dose for at least 3 months with liver iron concentration (LIC) \> 5.0 mg iron (Fe) per gram of dry weight of liver (Fe/g) dry weight and serum ferritin \> 300 nanograms per milliliter (ng/mL)
* Females must be non-pregnant and non-lactating, and either surgically sterile or postmenopausal
* Males must be surgically sterile, abstinent or using an acceptable contraceptive method

Exclusion Criteria:

* Clinically significant abnormalities in lab values, medical history, or physical examination
* α-globin gene triplication
* Symptomatic splenomegaly
* Platelet count \< lower limit of normal (LLN) or \> 1,000 x 10\^9/L
* Significant concurrent/recent coagulopathy, history of non-traumatic significant bleeding; history of immune thrombocytopenic purpura (ITP); current use of SC anti-coagulants; history of thrombotic events, including stroke or DVT
* Clinically significant renal, liver or cardiac dysfunction
* Uncontrolled hypertension (\> 140 mm Hg systolic or \> 90 mm Hg diastolic)
* Fasting blood glucose \> 2.0 × upper limit of normal (ULN)
* Inability to have a magnetic resonance imaging (MRI) scan
* Known history or positive test for human immunodeficiency virus (HIV), hepatitis C (HCV), or hepatitis B (HBV)
* Active infection requiring systemic antiviral or antimicrobial therapy
* Regular excessive use of alcohol
* Recent start of hydroxyurea (6 months prior to Day 1)
* Treatment with or recent exposure to another investigational drug, biological agent, antisense oligonucleotide (ASO), small interfering ribonucleic acid (siRNA), or device within 1 month of Screening, or 5 half-lives of investigational agent, whichever is longer; or treatment with or exposure to:

  * sotatercept (ACE-011), luspatercept (ACE-536), or ruxolitinib within 4 months of Screening
  * hematopoietic stimulating agents or any hypoxia-inducible factor prolyl hydroxylase inhibitors within 8 weeks of Day 1
  * prior bone marrow transplant, stem cell transplant, or gene therapy
* Surgery associated with significant blood loss within 4 months of Screening, splenectomy within 12 months of Screening, or splenectomy scheduled during treatment