Zilebesiran as Add-on Therapy in Patients With Hypertension Not Adequately Controlled by a Standard of Care Antihypertensive Medication (KARDIA-2)

NCT ID: NCT05103332

Last Updated: 2025-11-03

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE2

Total Enrollment

663 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-11-05

Study Completion Date

2024-09-13

Brief Summary

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The purpose of this study is to evaluate the effect of zilebesiran on systolic and diastolic blood pressure and to characterize the pharmacodynamic (PD) effects and safety of zilebesiran as add-on therapy.

Detailed Description

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Conditions

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Hypertension

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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Placebo (Add-on to Indapamide)

Following a 4-week run-in treatment on indapamide, 2.5 milligrams (mg), orally, once daily (QD), eligible participants were randomized to receive placebo matched to zilebesiran as a subcutaneous (SC) injection on Day 1 of 6-month double-blind (DB) treatment period as add-on therapy to indapamide. Participants received protocol-assigned background medication for 6 months, after which it was discontinued. Thereafter, participants will receive zilebesiran once every 6 months (Q6M) during the open-label extension (OLE) period. Upon implementation of Amendment 3, the OLE period was closed.

Group Type PLACEBO_COMPARATOR

Indapamide

Intervention Type DRUG

Indapamide administered orally

Placebo

Intervention Type DRUG

Placebo administered by SC injection

Zilebesiran

Intervention Type DRUG

Zilebesiran administered by SC injection

Zilebesiran (Add-on to Indapamide)

Following a 4-week run-in treatment on indapamide, 2.5 mg, orally, QD, eligible participants were randomized to receive zilebesiran 600 mg, as a SC injection on Day 1 of 6-month DB treatment period as add-on therapy to indapamide. Participants received protocol-assigned background medication for 6 months, after which it was discontinued. Thereafter, participants will receive zilebesiran, Q6M during the OLE period. Upon implementation of Amendment 3, the OLE period was closed.

Group Type EXPERIMENTAL

Indapamide

Intervention Type DRUG

Indapamide administered orally

Zilebesiran

Intervention Type DRUG

Zilebesiran administered by SC injection

Placebo (Add-on to Amlodipine)

Following a 4-week run-in treatment on amlodipine, 5 mg, orally, QD, eligible participants were randomized to receive placebo matched to zilebesiran as a SC injection on Day 1 of 6-month DB treatment period as add-on therapy to amlodipine. Participants received protocol-assigned background medication for 6 months, after which it was discontinued. Thereafter, participants will receive zilebesiran Q6M during the OLE period. Upon implementation of Amendment 3, the OLE period was closed.

Group Type PLACEBO_COMPARATOR

Amlodipine

Intervention Type DRUG

Amlodipine administered orally

Placebo

Intervention Type DRUG

Placebo administered by SC injection

Zilebesiran

Intervention Type DRUG

Zilebesiran administered by SC injection

Zilebesiran (Add-on to Amlodipine)

Following a 4-week run-in treatment on amlodipine, 5 mg, orally, QD, eligible participants were randomized to receive zilebesiran 600 mg, as a SC injection on Day 1 of 6-month DB treatment period as add-on therapy to amlodipine. Participants received protocol-assigned background medication for 6 months, after which it was discontinued. Thereafter, participants will receive zilebesiran, Q6M during the OLE period. Upon implementation of Amendment 3, the OLE period was closed.

Group Type EXPERIMENTAL

Amlodipine

Intervention Type DRUG

Amlodipine administered orally

Zilebesiran

Intervention Type DRUG

Zilebesiran administered by SC injection

Placebo (Add-on to Olmesartan)

Following a 4-week run-in treatment on olmesartan, 40 mg, orally, QD, (or 20 mg, orally, QD for participants with creatinine clearance ≤60 milliliters per minute \[mL/min\] at screening enrolled at sites outside of the United States \[US\] consistent with local labeling), eligible participants were randomized to receive placebo matched to zilebesiran as a SC injection on Day 1 of 6-month DB treatment period as add-on therapy to olmesartan. Participants received protocol-assigned background medication for 6 months, after which it was discontinued. Thereafter, participants will receive zilebesiran Q6M during the OLE period. Upon implementation of Amendment 3, the OLE period was closed.

Group Type PLACEBO_COMPARATOR

Olmesartan

Intervention Type DRUG

Olmesartan administered orally

Placebo

Intervention Type DRUG

Placebo administered by SC injection

Zilebesiran

Intervention Type DRUG

Zilebesiran administered by SC injection

Zilebesiran (Add-on to Olmesartan)

Following a 4-week run-in treatment on olmesartan, 40 mg, orally, QD, (or 20 mg, orally, QD for participants with creatinine clearance ≤60 mL/min at screening enrolled at sites outside of the US consistent with local labeling), eligible participants were randomized to receive zilebesiran 600 mg, as a SC injection on Day 1 of 6-month DB treatment period as add-on therapy to olmesartan. Participants received protocol-assigned background medication for 6 months, after which it was discontinued. Thereafter, participants will receive zilebesiran, Q6M during the OLE period. Upon implementation of Amendment 3, the OLE period was closed.

Group Type EXPERIMENTAL

Olmesartan

Intervention Type DRUG

Olmesartan administered orally

Zilebesiran

Intervention Type DRUG

Zilebesiran administered by SC injection

Interventions

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Indapamide

Indapamide administered orally

Intervention Type DRUG

Amlodipine

Amlodipine administered orally

Intervention Type DRUG

Olmesartan

Olmesartan administered orally

Intervention Type DRUG

Placebo

Placebo administered by SC injection

Intervention Type DRUG

Zilebesiran

Zilebesiran administered by SC injection

Intervention Type DRUG

Other Intervention Names

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ALN-AGT01

Eligibility Criteria

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Inclusion Criteria

* Office SBP at Screening as follows:

1. ≥155 mmHg and ≤180 mmHg for patients with untreated hypertension
2. ≥145 mmHg and ≤180 mmHg for patients on antihypertensive medications
* 24-hour mean SBP ≥130 mmHg and ≤160 mmHg by ABPM after at least 4 weeks of run-in

Exclusion Criteria

* Secondary hypertension, orthostatic hypotension
* Elevated potassium \<lower limit of normal (LLN) range or \>5 milliequivalents per liter (mEq/L)
* Estimated glomerular filtration rate (eGFR) of \<30 mL/min/1.73m\^2
* Received an investigational agent within the last 30 days
* Type 1 diabetes mellitus, poorly controlled Type 2 diabetes mellitus, or laboratory evidence of diabetes during screening without known diagnosis of diabetes
* History of any cardiovascular event within 6 months prior to randomization
* History of intolerance to SC injection(s)
Minimum Eligible Age

18 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Alnylam Pharmaceuticals

INDUSTRY

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Medical Director

Role: STUDY_DIRECTOR

Alnylam Pharmaceuticals

Locations

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Clinical Trial Site

Riga, , Latvia

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Mesa, Arizona, United States

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Tempe, Arizona, United States

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Tempe, Arizona, United States

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Bell Gardens, California, United States

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Beverly Hills, California, United States

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Canoga Park, California, United States

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Carlsbad, California, United States

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Encinitas, California, United States

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Garden Grove, California, United States

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Hollywood, California, United States

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Huntington Beach, California, United States

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Irvine, California, United States

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Long Beach, California, United States

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Los Angeles, California, United States

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Mission Hills, California, United States

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Oceanside, California, United States

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Panorama City, California, United States

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San Diego, California, United States

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Santa Clarita, California, United States

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South Gate, California, United States

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Tustin, California, United States

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Upland, California, United States

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Washington D.C., District of Columbia, United States

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Clearwater, Florida, United States

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Coconut Creek, Florida, United States

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Coral Gables, Florida, United States

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Hollywood, Florida, United States

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Hollywood, Florida, United States

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Inverness, Florida, United States

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Jacksonville, Florida, United States

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Miami, Florida, United States

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Miami, Florida, United States

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Miami, Florida, United States

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Miami, Florida, United States

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Miami, Florida, United States

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Naples, Florida, United States

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Orlando, Florida, United States

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Orlando, Florida, United States

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Pembroke Pines, Florida, United States

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Tampa, Florida, United States

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Winter Haven, Florida, United States

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Winter Park, Florida, United States

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Acworth, Georgia, United States

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Canton, Georgia, United States

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Columbus, Georgia, United States

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Savannah, Georgia, United States

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Louisville, Kentucky, United States

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New Orleans, Louisiana, United States

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Southgate, Michigan, United States

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Jackson, Mississippi, United States

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Hazelwood, Missouri, United States

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Jefferson City, Missouri, United States

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New York, New York, United States

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Greensboro, North Carolina, United States

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Greensboro, North Carolina, United States

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Monroe, North Carolina, United States

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Winston-Salem, North Carolina, United States

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Norman, Oklahoma, United States

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Little River, South Carolina, United States

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Memphis, Tennessee, United States

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Amarillo, Texas, United States

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Coppell, Texas, United States

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Dallas, Texas, United States

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Houston, Texas, United States

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Houston, Texas, United States

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Lake Jackson, Texas, United States

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Plano, Texas, United States

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Sherman, Texas, United States

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Splendora, Texas, United States

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Stephenville, Texas, United States

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Tomball, Texas, United States

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Waco, Texas, United States

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Burke, Virginia, United States

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Kenosha, Wisconsin, United States

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Brampton, Ontario, Canada

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Concord, Ontario, Canada

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London, Ontario, Canada

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Toronto, Ontario, Canada

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Winnipeg, Ontario, Canada

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Chicoutimi, Quebec, Canada

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Lévis, Quebec, Canada

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Pointe-Claire, Quebec, Canada

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Québec, Quebec, Canada

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Sherbrooke, Quebec, Canada

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Trois-Rivières, Quebec, Canada

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Québec, , Canada

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Tartu, , Estonia

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Frankfurt, , Germany

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Kaunas, , Lithuania

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Vilnius, , Lithuania

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Częstochowa, , Poland

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Gdansk, , Poland

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Katowice, , Poland

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Staszów, , Poland

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Warsaw, , Poland

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Wroclaw, , Poland

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Bellshill, Lanarkshire, United Kingdom

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Carshalton, , United Kingdom

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Edinburgh, , United Kingdom

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Fowey, , United Kingdom

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Glasgow, , United Kingdom

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Lancashire Preston, , United Kingdom

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Liskeard, , United Kingdom

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London, , United Kingdom

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Manchester, , United Kingdom

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Newquay, , United Kingdom

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Plymouth, , United Kingdom

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Sheffield, , United Kingdom

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Torpoint, , United Kingdom

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Countries

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United States Canada Estonia Germany Latvia Lithuania Poland United Kingdom

References

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Desai AS, Karns AD, Badariene J, Aswad A, Neutel JM, Kazi F, Park W, Stiglitz D, Makarova N, Havasi A, Zappe DH, Saxena M; KARDIA-2 Study Group. Add-On Treatment With Zilebesiran for Inadequately Controlled Hypertension: The KARDIA-2 Randomized Clinical Trial. JAMA. 2025 Jul 1;334(1):46-55. doi: 10.1001/jama.2025.6681.

Reference Type DERIVED
PMID: 40434761 (View on PubMed)

Provided Documents

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Document Type: Study Protocol

View Document

Document Type: Statistical Analysis Plan

View Document

Other Identifiers

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2021-003776-13

Identifier Type: EUDRACT_NUMBER

Identifier Source: secondary_id

ALN-AGT01-003

Identifier Type: -

Identifier Source: org_study_id

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