Prevention & lipids

Plozasiran (ARO-APOC3) for Severe Hypertriglyceridemia: The SHASTA-2 Randomized Clinical Trial

JAMA CardiolPublished Randomised controlled trial

Primary result · % change in TGResult — go to the resultPlacebo-adjusted LS-mean reduction −57 % 95% CI −71.9% to −42.1%

Authors' conclusion

In this randomized clinical trial of patients with sHTG, plozasiran decreased triglyceride levels, which fell below the 500 mg/dL threshold of acute pancreatitis risk in most participants.

Study context

Population
Adults with severe hypertriglyceridemia (fasting TG 500–4000 mg/dL) on stable lipid-lowering treatment226 in primary analysis
Participants
229 adults
Comparison
Plozasiran vs placebo
Primary endpoint
Placebo-subtracted difference in mean % TG change
Follow-up
Week 24
Methodological detailsphase 2b, placebo-controlled, double-blind, dose-ranging, 74 centres, Follow-up through week 48, 74 centers in US, Europe, New Zealand, Australia, Canada; May 31, 2021 to August 31, 2023
  • Phase 2b
  • Placebo-controlled
  • Double-blind
  • Dose-ranging
  • 74 centres
  • Follow-up through week 48
  • 74 centers in US, Europe, New Zealand, Australia, Canada; May 31, 2021 to August 31, 2023

Primary result

% change in TG

Placebo-adjusted least squares (LS)-mean reduction

−57 %

95% CI −71.9% to −42.1%

P < 0.001

Plozasiran 50 mgvs Placebo
placebo-adjusted LS-mean reduction −57 % (95% CI −71.9% to −42.1%); P < 0.001

As reported in the abstract

Further findings

OutcomeValuesEstimateP value
APOC3, placebo-adjusted LS-mean % change (highest dose) · week 24Plozasiranvs PlaceboHighest doseplacebo-adjusted LS-mean reduction −77 % (95% CI −89.1% to −65.8%)P < 0.001
LDL-C, placebo-adjusted LS-mean % change (highest dose)Plozasiranvs PlaceboHighest dose; dose-dependent increasesplacebo-adjusted LS-mean increase 60 % (95% CI 31%–89%)P < 0.001
OutcomeValues
TG <500 mg/dLPlozasiran 90.6%
  • TG <500 mg/dL: 144 of 159 plozasiran-treated patients

Apolipoprotein B (ApoB) and non-HDL-C

Non-HDL-C decreased significantly at all doses; placebo-adjusted change at highest dose
−20%
ApoB did not increase

Remnant cholesterol, ApoB48, HDL-C · through week 48

Significant durable reductions in remnant cholesterol and ApoB48 and increases in HDL-C

Safety

Adverse events

Serious AEs mild to moderate, not treatment related; none led to discontinuation or death
0
AE rates similar with plozasiran vs placebo

Original publication

Plozasiran (ARO-APOC3) for Severe Hypertriglyceridemia: The SHASTA-2 Randomized Clinical Trial. JAMA Cardiol. Published 1 July 2024. doi:10.1001/jamacardio.2024.0959

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