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RHAPSODY: Rationale for and design of a pivotal Phase 3 trial to assess efficacy and safety of rilonacept, an interleukin-1? and interleukin-1? trap, in patients with recurrent pericarditis - 17/09/20

Doi : 10.1016/j.ahj.2020.07.004 
Allan L. Klein a, , 1 , Massimo Imazio b, 1, Antonio Brucato c, Paul Cremer a, Martin LeWinter d, Antonio Abbate e, David Lin f, Alberto Martini g, Anna Beutler h, Steven Chang i, Fang Fang j, Anais Gervais j, Randy Perrin j, John F. Paolini j
a Department of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH 
b University Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino, Turin, Italy 
c Department of Biomedical and Clinical Science, University of Milano, Fatebenefratelli Hospital, Milan, Italy 
d Cardiology Unit, The University of Vermont Medical Center, The University of Vermont, Burlington, VT 
e VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA 
f Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN 
g University of Genoa and G. Gaslini Institute, Genoa, Italy 
h Kiniksa Pharmaceuticals Ltd., Hamilton, Bermuda 
i NJS Associates, Bridgewater, NJ 
j Kiniksa Pharmaceuticals Corp., Lexington, MA 

Reprint requests: Allan L. Klein, MD, Section of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Desk J1-5, 9500 Euclid Ave, Cleveland, OH 44195.Section of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial DiseasesHeart and Vascular Institute, Cleveland Clinic, Desk J1-59500 Euclid AvClevelandOH44195

Abstract

Recurrent pericarditis (RP) occurs in 15% to 30% of patients following a first episode, despite standard treatment with nonsteroidal anti-inflammatory drugs, colchicine, and corticosteroids; many patients become dependent on corticosteroids. Rilonacept (KPL-914), an interleukin-1α and β inhibitor, is in development for the treatment of RP. RHAPSODY, a double-blind, placebo-controlled, randomized-withdrawal (RW) pivotal Phase 3 trial (NCT03737110), enrolls patients 12 years or older presenting with at least a third pericarditis episode, pericarditis pain score ≥4 (11-point numeric rating scale [NRS]), and C-reactive protein ≥1 mg/dL at screening. After a subcutaneous loading dose (adults, 320 mg; children, 4.4 mg/kg), all patients receive blinded weekly subcutaneous rilonacept (adults, 160 mg; children, 2.2 mg/kg) during the run-in period. Patients must taper and discontinue concomitant pericarditis medications during the blinded run-in period and achieve clinical response (C-reactive protein ≤0.5 mg/dL and weekly average NRS ≤2.0 during the 7 days prior to and including the day of randomization) by end of the run-in (while on rilonacept monotherapy) to be randomized to either continued rilonacept or placebo in the RW period. Primary efficacy end point was time to adjudicated pericarditis recurrence during the RW period; secondary efficacy end points were proportion of patients maintaining clinical response, percentage of days with NRS ≤2, and percentage of patients with no-to-minimal pericarditis symptoms at week 16 of the RW period. Safety evaluations include adverse event monitoring, physical examinations, and laboratory tests. The RHAPSODY trial will evaluate the efficacy and safety of rilonacept in the treatment of RP to improve outcomes and patient health-related quality of life.

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 Declaration of interest: M. Imazio: scientific advisory board Kiniksa Pharmaceuticals, Ltd; advisory board Swedish Orphan Biovitrum AB. A. Klein: research grant, scientific advisory board Kiniksa Pharmaceuticals, Ltd; advisory board Swedish Orphan Biovitrum AB; advisory board Pfizer, Inc. Brucato: unrestricted research grants from ACARPIA and Swedish Orphan Biovitrum AB. P. Cremer: advisory board Swedish Orphan Biovitrum AB; advisory board Kiniksa Pharmaceuticals, Ltd. M. LeWinter: 1 seminar for Kiniksa Pharmaceuticals, Ltd. A. Abbate: research grants from Kiniksa Pharmaceuticals, Ltd, Swedish Orphan Biovitrum AB, Olatec Therapeutics LLC, Serpin Pharma, LLC; consultant fees: Kiniksa Pharmaceuticals, Ltd, Olatec Therapeutics LLC, Serpin Pharma, LLC, Merck & Co, Inc. D. Lin: none. A. Martini: honoraria for consultancy or speaker's bureaus from Eli-Lilly, EMD Serono, Janssen, Novartis, Pfizer, and AbbVie. A. Beutler: Kiniksa Pharmaceuticals, Ltd, consultant. F. Fang: Kiniksa Pharmaceuticals Corp employee. A. Gervais: Kiniksa Pharmaceuticals Corp employee. R. Perrin: Kiniksa Pharmaceuticals Corp employee. J. F. Paolini: Kiniksa Pharmaceuticals Corp employee. Medical writing assistance was provided in part by Peloton Advantage, LLC, an OPEN Health company, and Emmanuelle Hugentobler and Emily Plummer, Kiniksa Pharmaceuticals Corp employees. Funding disclosure: This study is sponsored by Kiniksa Pharmaceuticals, Ltd.
 Registration: ClinicalTrials.gov NCT03737110.


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Vol 228

P. 81-90 - octobre 2020 Retour au numéro
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