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Givosiran

Phase 3

Acute Hepatic Porphyria | Small molecule | Rare Disease |Alnylam Pharmaceuticals, Inc.|Last Updated: Apr 22, 2024

Success Probability

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Trial Design

RandomizedDouble-BlindPLACEBO_CONTROLLEDDMC
Total Trials1
Total Enrollment94

FDA Designations

No designations recorded

Clinical trial landscape

Givosiran · 4 trials · 9 indications

Phase 3 1Phase 1 3
NCT03338816ENVISION: A Study to Evaluate the Efficacy and Safety of Givosiran (ALN-AS1) in Patients With Acute Hepatic Porphyrias (AHP)Acute Hepatic Porphyria
COMPLETED94 Analytics
PHASE3COMPLETED
ENVISION: A Study to Evaluate the Efficacy and Safety of Givosiran (ALN-AS1) in Patients With Acute Hepatic Porphyrias (AHP)
Acute Hepatic PorphyriaUnlock trial analytics

Study Endpoints

Primary Endpoints

Annualized Rate of Porphyria Attacks in Participants With Acute Intermittent Porphyria (AIP)
6 months

Porphyria attacks were defined as meeting all of the following criteria: an acute episode of neurovisceral pain in the abdomen, back, chest, extremities and/or limbs, no other medically determined cause, and required treatment with intravenous (IV) dextrose or hemin, carbohydrates, or analgesics, or other medications such as antiemetics at a dose or frequency beyond the participant's usual daily porphyria management. The annualized rate of porphyria attacks is a composite endpoint which included porphyria attacks requiring hospitalization, urgent healthcare visit, or IV hemin administration at home.

Profile of Pharmacokinetics (PK) of Cytochrome P450 (CYP) probe cocktail
Days 1 and 36

Area under the concentration-time curve (AUC)

Percentage of Participants With Adverse Events (AEs)
Through Month 49

An AE is any untoward medical occurrence in a participant or clinical investigational patient administered a pharmaceutical product and which does not necessarily have a causal relationship with this treatment.

The safety of givosiran evaluated by the proportion of subjects experiencing adverse events (AEs), serious adverse events (SAEs), and AEs leading to study drug discontinuation
Part A (SAD phase): through day 42; Part B (MAD) phase: through Day 70; Part C (MD) phase: through Day 168

Secondary Endpoints

The Pharmacodynamic (PD) Effect of Givosiran on Urine Levels of Delta-aminolevulinic Acid (ALA) in Participants With AIP
3 and 6 months
The PD Effect of Givosiran on Urine Levels of Porphobilinogen (PBG) in Participants With AIP
6 months
Annualized Rate of Hemin Administration in Participants With AIP
6 months
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Study Design & Arms

AllocationRANDOMIZED
MaskingQUADRUPLE
ModelPARALLEL
PurposeTREATMENT

Treatment Arms

ArmTypeDescription
Givosiran/GivosiranEXPERIMENTALGivosiran 2.5 mg/kg administered subcutaneously (SC), monthly (QM), for 6 months during the 6-Month Double-blind (DB) Period, followed by givosiran 2.5 mg/kg or 1.25 mg/kg SC, QM for 29 months during the Open-label Extension (OLE) Period.
Placebo/GivosiranPLACEBO_COMPARATORMatching placebo (normal saline \[0.9% NaCl\]) was administered SC, QM, for 6 months during the 6-Month DB Period, followed by givosiran 2.5 mg/kg or 1.25 mg/kg SC, QM for 29 months during the OLE period.
Givosiran with 5-probe cocktailEXPERIMENTAL -
GivosiranEXPERIMENTALAt the beginning of this study, participants received either givosiran 2.5 mg/kg subcutaneous (SC) injection once monthly(QM), givosiran 5.0 mg/kg SC injection QM, or givosiran 5.0 mg/kg SC injection once every 3 months (Q3M). Within a year, all participants were transitioned to givosiran 2.5 mg/kg SC injection QM.
givosiran (ALN-AS1)ACTIVE_COMPARATOR -
Sterile Normal Saline (0.9% NaCl)PLACEBO_COMPARATOR -

Interventions

NameTypeDescription
GivosiranDRUGGivosiran by SC
PlaceboDRUGMatching placebo (normal saline \[0.9% NaCl\]) by SC
5-probe cocktailDRUGincludes midazolam, caffeine, losartan, omeprazole, and dextromethorphan
givosiran (ALN-AS1)DRUGSingle or multiple doses of ALN-AS1 by subcutaneous (sc) injection
Sterile Normal Saline (0.9% NaCl)DRUGcalculated volume to match active comparator
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Eligibility Criteria

Age Range12 Years to N/A
SexALL
Healthy VolunteersNo
Study Sites36

Inclusion Criteria: * ≥ 12 years of age * Diagnosed with Acute Hepatic Porphyria (Acute Intermittent Porphyria, Hereditary Corproporhyria, Variegate Porphyria, aminolevulinic acid (ALA) dehydratase deficient porphyria) * Elevated urinary or plasma porphobilinogen (PBG) or ALA values within the past...

Countries:United StatesAustraliaBulgariaCanadaDenmarkFinlandFranceGermanyItalyJapanMexicoNetherlandsPolandSouth KoreaSpainSwedenTaiwanUnited Kingdom
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Frequently asked questions about Givosiran

What is Givosiran used for?

Givosiran is an investigational small molecule being developed for the treatment of acute hepatic porphyria, including acute intermittent porphyria. It is designed to address the underlying enzyme deficiency that leads to the accumulation of toxic precursors in the liver, which cause the symptoms of these rare genetic disorders.

What does Givosiran target?

Givosiran targets aminolevulinate synthase 1 (ALAS1), an enzyme involved in heme biosynthesis. By reducing ALAS1 activity, givosiran aims to lower the levels of porphobilinogen and aminolevulinic acid, which are precursors that accumulate and trigger acute porphyria attacks.

Who makes Givosiran?

Givosiran is being developed by Alnylam Pharmaceuticals, Inc., a biopharmaceutical company focused on RNA interference therapeutics. Alnylam is publicly traded on the Nasdaq under the ticker symbol ALNY.

What phase is Givosiran in?

Givosiran is in Phase 3 clinical development for acute hepatic porphyria. It has completed Phase 1 and Phase 3 trials, including the ENVISION study, which evaluated its efficacy and safety in patients with acute hepatic porphyrias. It remains investigational and has not yet been approved by regulatory authorities.

What clinical trials is Givosiran in?

Givosiran has been studied in several clinical trials, including NCT02452372, a Phase 1 study in patients with acute intermittent porphyria; NCT02949830, a long-term safety study; NCT03338816, the Phase 3 ENVISION trial in acute hepatic porphyrias; and NCT03505853, a drug interaction study. All trials listed are completed.

Is Givosiran the same as ALN-AS1?

Yes, Givosiran is also known as ALN-AS1. In clinical trial records, it is referred to by both names. For example, the Phase 1 study NCT02452372 is titled 'A Phase 1 Study of Givosiran (ALN-AS1) in Patients With Acute Intermittent Porphyria (AIP).'