Plasma reduction of apolipoprotein C-III with olezarsen leads to significant reductions in postprandial triglyceride levels: results from a randomized trial

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BACKGROUND: Hypertriglyceridemia is an established risk factor for cardiovascular disease and acute pancreatitis with postprandial elevations as an important contributor. Olezarsen, an investigational antisense oligonucleotide targeting plasma apolipoprotein C-III (apoC-III), markedly reduces fasting triglyceride levels, though its effect on postprandial triglyceride levels remains to be established. DESIGN: In a double-blind, placebo-controlled trial, 28 patients with fasting triglycerides ≥4 mmol/L received either 2 doses 80mg olezarsen (19 patients) or placebo (9 patients) every 4 weeks.Triglyceride levels were measured in the fasting state and postprandially both at baseline and 7 weeks into treatment. Postprandial triglyceride levels were assessed by calculating the area under the curve (AUC). RESULTS: The mean (±SD) age was 58.6±9.4 years, 82.1% (23) were male and the median [IQR] baseline fasting triglyceride levels were 5.9 [4.5, 9.2] mmol/L. At 7 weeks of olezarsen treatment led to a placebo adjusted triglyceride reduction of 59.3% (-77.3 to -41.2%, p<0.0001). The mean (95% CI) postprandial placebo-adjusted triglyceride AUC was reduced by 50.1% (-68.3 to -31.8%, p<0.0001). Mean (95% CI) incremental AUC (iAUC) was reduced by 30.3% (-56.2 to -4.3%, p=0.026) in the olezarsen versus baseline group; the placebo-adjusted iAUC remained unchanged. The proportion of patients reaching any triglyceride levels ≥10 mmol/L, indicative of increased risk estimation of acute pancreatitis, decreased from 47% to 5% after olezarsen treatment, a 96.6% (p<0.0001) reduction. CONCLUSION: Olezarsen significantly reduces both fasting and postprandial triglyceride levels, these findings highlight olezarsen as a promising intervention to managing hypertriglyceridemia and reducing the risk of hypertriglyceridemia induced acute pancreatitis.

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