A Study Investigate the Safety, Tolerability, Pharmacokinetic, and Pharmacodynamic Response of SLN124 in Adults With Alpha/Beta-thalassaemia and Very Low- and Low-risk Myelodysplastic Syndrome

Study Overview
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Brief Summary
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This study will investigate the safety and tolerability of SLN124 in patients with Thalassaemia or patients with Very Low- and Low-risk Myelodysplastic Syndrome (MDS) after single ascending s.c. doses and multiple doses in healthy male and female subjects. Up to 7 cohorts of 56 patients with Thalassaemia and up to 7 cohorts of 56 patients with MDS will be enrolled. Each subject will receive single or multiple doses of SLN124 or placebo given by subcutaneous (s.c) injection.

Official Title
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A Randomised, Single-blind, Placebo-controlled, Phase 1, Single-ascending and Multiple-dose Study in Adult Subjects With Alpha/Beta-thalassaemia and Very Low- and Low-risk Myelodysplastic Syndrome to Investigate the Safety, Tolerability, Pharmacokinetic, and Pharmacodynamic Response of SLN124.

Conditions
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Non-transfusion-dependent Thalassemia, Low Risk Myelodysplastic Syndrome, Very-Low Risk Myelodysplastic Syndrome

Intervention / Treatment
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* Drug: SLN124
* Drug: Placebo


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult with alpha- or beta-thalassaemia or compound heterozygous haemoglobin E/beta-thalassaemia or adult with very low- or low-risk MDS according to the 2016 revision to the World Health Organisation classification. All subjects must agree to adhere to appropriate contraception requirements. Subjects must provide written informed consent and be able to comply with all study requirements. Body mass index ≥18 kg/m2 and ≤35 kg/m2 at screening. At least one of: a) Mean ferritin >250 μg/L based on a minimum of 2 measurements ≥1 week apart within 20 days before the planned dosing day, in the absence of active significant infection; b) Mean TSAT >40% measured on a minimum of 2 occasions ≥1 week apart within 20 days before the planned dosing day; c) Liver iron >3 mg Fe/g dry weight, measured according to local procedures. Mean baseline haemoglobin concentration ≥5 g/dL and ≤11 g/dL, based on a minimum of 2 measurements ≥1 week apart, within 20 days before the planned dosing day. Exclusion criteria Adult with haemoglobin S/alpha-thalassaemia or haemoglobin S/beta-thalassaemia or adult with secondary MDS, i.e., MDS that is known to have arisen because of chemical injury or treatment with chemotherapy and/or radiation for another disease. History of multiple drug allergies or history of allergic reaction to an oligonucleotide or GalNAc, or intolerance to s.c. injections. Known infection with HIV, or active infectious hepatitis A, B, or C virus. Any conditions which, in the opinion of the Investigator, would make the subject unsuitable for enrolment in the study or could interfere with the subject's participation in, or completion of the study. History or clinical evidence of alcohol or illegal drug misuse within 2 years before screening. Currently using ESA, or plan to use ESA at any point during the study. Require daily treatment with 1 or more non-steroidal anti-inflammatory drugs during the study period. Paracetamol will be permitted for use as an antipyretic and/or analgesic. Treatment, or change in treatment with prohibited medications as specified in the protocol Treatment with ICT where the subject has not been on a stable dose for at least 8 weeks before screening or it is planned to initiate ICT therapy during the study. Clinically significant cardiac disease Clinically significant pulmonary disease For subjects with thalassaemia: Treatment, or change in treatment with prohibited medications as specified in the protocol currently and anticipated to receiving more than 5 units of RBCs during the 24 weeks to 6 weeks period before first dose of study drug. For subjects with very low / low-risk MDS: Previous allogeneic or autologous stem cell transplantation. Currently or planned to receive treatment with a corticosteroid for MDS within 8 weeks before screening. Currently or planned to receive treatment with haematopoietic growth factors (e.g., eltrombopag, romiplostim) within 8 weeks before screening.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: 1.0mg/kg - Thalassaemia<br> | Drug: SLN124<br>* SLN124 for subcutaneous (s.c.) injection<br>|
| Experimental: 3.0mg/kg - Thalassaemia<br> | Drug: SLN124<br>* SLN124 for subcutaneous (s.c.) injection<br>|
| Experimental: 6.0mg/kg - Thalassaemia<br> | Drug: SLN124<br>* SLN124 for subcutaneous (s.c.) injection<br>|
| Placebo Comparator: Placebo - Thalassaemia<br> | Drug: Placebo<br>* Sodium chloride for s.c. injection<br>|
| Experimental: Xmg/kg - Thalassaemia<br> | Drug: SLN124<br>* SLN124 for subcutaneous (s.c.) injection<br>|
| Experimental: 1.0mg/kg - Myelodysplastic Syndrome<br> | Drug: SLN124<br>* SLN124 for subcutaneous (s.c.) injection<br>|
| Experimental: 3.0mg/kg - Myelodysplastic Syndrome<br> | Drug: SLN124<br>* SLN124 for subcutaneous (s.c.) injection<br>|
| Experimental: 10.0mg/kg - Myelodysplastic Syndrome<br> | Drug: SLN124<br>* SLN124 for subcutaneous (s.c.) injection<br>|
| Experimental: Xmg/kg - Myelodysplastic Syndrome<br> | Drug: SLN124<br>* SLN124 for subcutaneous (s.c.) injection<br>|
| Experimental: 3.0mg/kg - Thalassaemia multi dose<br> | Drug: SLN124<br>* SLN124 for subcutaneous (s.c.) injection<br>|
| Experimental: 10.0mg/kg - Thalassaemia multi dose<br> | Drug: SLN124<br>* SLN124 for subcutaneous (s.c.) injection<br>|
| Experimental: Xmg/kg - Thalassaemia multi dose<br> | Drug: SLN124<br>* SLN124 for subcutaneous (s.c.) injection<br>|
| Experimental: 3.0mg/kg - Myelodysplastic Syndrome multi dose<br> | Drug: SLN124<br>* SLN124 for subcutaneous (s.c.) injection<br>|
| Experimental: 10.0mg/kg - Myelodysplastic Syndrome multi dose<br> | Drug: SLN124<br>* SLN124 for subcutaneous (s.c.) injection<br>|
| Experimental: Xmg/kg - Myelodysplastic Syndrome multi dose<br> | Drug: SLN124<br>* SLN124 for subcutaneous (s.c.) injection<br>|
| Placebo Comparator: Placebo - Thalassaemia multi dose<br> | Drug: Placebo<br>* Sodium chloride for s.c. injection<br>|
| Placebo Comparator: Placebo - Myelodysplastic Syndrome<br> | Drug: Placebo<br>* Sodium chloride for s.c. injection<br>|
| Placebo Comparator: Placebo - Myelodysplastic Syndrome multi dose<br> | Drug: Placebo<br>* Sodium chloride for s.c. injection<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Incidence of treatment-emergent adverse events | safety and tolerability will be reported separately following single-dose administration. | Day 84 | 
| Incidence of treatment-emergent adverse events | safety and tolerability will be reported separately following multi-dose administration. | Day 140 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pharmacokinetic: peak plasma concentration (Cmax) | Will be reported separately following single-dose and multiple-dose administration. | Day 84 and Day 140 | 
| Pharmacokinetic: area under the plasma concentration (AUC) | Will be reported separately following single-dose and multiple-dose administration. | Day 84 and Day 140 | 
| Pharmacokinetic: apparent total clearance from plasma after s.c injection (CL/F) | Will be reported separately following single-dose and multiple-dose administration. | Day 84 and Day 140 | 
| Pharmacodynamic biomarkers: Change in TSAT after s.c injection. | safety and tolerability will be reported separately following single-dose and multiple-dose administration. | Day 84 and Day 140 | 
| Pharmacodynamic biomarkers: Change in hepcidin after s.c injection. | safety and tolerability will be reported separately following single-dose and multiple-dose administration. | Day 84 and Day 140 | 
| Pharmacodynamic biomarkers: Change in serum iron after s.c injection. | safety and tolerability will be reported separately following single-dose and multiple-dose administration. | Day 84 and Day 140 | 
| Pharmacodynamic biomarkers: Change in haemoglobin after s.c injection. | safety and tolerability will be reported separately following single-dose and multiple-dose administration. | Day 84 and Day 140 |