Faculty experts from the Duke Clinical Research Institute (DCRI) shared results from late-breaking trials, debated optimal treatment strategies, and led crucial discussions on navigating cardiovascular challenges during the European Society of Cardiology Congress (ESC), held Aug. 29—Sept.1 in Madrid, Spain.
Highlights for the DCRI included two late-breaking “Hot Line” presentations from DCRI faculty cardiologists Neha Pagidipati, MD, MPH, and Renato Lopes, MD, PhD. In total, seven faculty members participated in 20 sessions covering topics including atrial fibrillation, arrhythmias, cardio-oncology, digital health, heart failure, hypertension, and pharmacotherapy.
DCRI Highlights from ESC
Zilebesiran Demonstrates Reductions in Office Systolic Blood Pressure in Patients with Uncontrolled Hypertension and High Cardiovascular Risk in KARDIA-3 Results
The investigational RNAi therapeutic zilebesiran demonstrated clinically meaningful office systolic blood pressure (SBP) reductions in patients with uncontrolled hypertension and high cardiovascular risk at the three-month primary endpoint, with continuous control through six months, according to results from the KARDIA-3 trial presented during a late-breaking ESC session on Aug. 30.
KARDIA-3 — which evaluated the efficacy and safety of zilebesiran in patients with uncontrolled hypertension and high cardiovascular risk, on two or more background hypertensives—showed that a single 300 mg dose of zilebesiran resulted in clinically meaningful systolic blood pressure reductions at three months, with sustained benefits to six months. When controlled for multiplicity, the study did not meet the pre-specified definition for statistical significance.
Zilebesiran also demonstrated encouraging safety in patients with comorbidities on multiple background therapies – over 90% of whom were receiving treatment with an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. These findings support zilebesiran's potential to be combined with any standard of care antihypertensive.
Zilebesiran reduces blood pressure by targeting angiotensinogen, which plays a key role in blood pressure regulation and impacts cardiovascular and renal health.
The results, presented by Neha Pagidipati, MD, MPH, associate professor of medicine in the Duke School of Medicine, DCRI faculty member, and KARDIA-3 lead investigator, add to the growing body of evidence from the KARDIA Phase 2 program, underscoring zilebesiran’s potential to address an area of significant unmet need.
“Patients with uncontrolled hypertension, despite the use of multiple background therapies, are at the highest risk of major adverse cardiovascular events. It is well known that reductions in systolic blood pressure of five mmHg or more can result in a reduction in cardiovascular risk,” Pagidipati said. “Therefore, I’m excited by the KARDIA-3 results, which, together with the additional Phase 2 data from the KARDIA program, support zilebesiran’s potential to achieve clinically meaningful, sustained blood pressure reductions in high-risk patients. This, in turn, may lead to more consistent long-term blood pressure control and improve cardiovascular outcomes. Zilebesiran’s emerging profile, now including the KARDIA-3 findings, underscores its ability to address the well-known challenges of managing patients with hypertension and warrants further exploration in a multi-year Phase 3 cardiovascular outcomes trial.”
Informed by the comprehensive KARDIA Phase 2 program and the late-breaking KARDIA-3 results, Alnylam Pharmaceuticals, Inc. announced plans to initiate the Phase 3 cardiovascular outcomes trial to evaluate the potential of zilebesiran to reduce the risk of major adverse cardiovascular events. Clinical trial applications for the ZENITH Phase 3 trial have been submitted to global regulators. Alnylam and its partner Roche expect the trial to initiate by the end of 2025.
PARACHUTE-HF Results Demonstrate Sacubitril-valsartan to be Superior to Enalapril in HFrEF Patients with Chagas Disease
A new study exploring treatments in patients with Chagas disease and heart failure with reduced ejection fraction (HFrEF) revealed sacubitril-valsartan is more effective than enalapril at reducing deaths from heart-related causes, reducing hospitalizations caused by heart failure, and lowering levels of a key heart failure marker.
Renato Lopes, MD, PhD, DCRI faculty member and Duke School of Medicine professor of cardiology, presented the results during a late-breaking session at ESC on Sept. 1. These results shed new light on the efficacy of commonly recommended therapies for HFrEF in patients with Chagas disease.
“Heart failure (HF) caused by Chagas disease has unique clinical features with worse prognosis than other causes of HF despite the fact that patients are often younger and have fewer comorbidities,” Lopes said. “There have been no prospective randomised trials testing the effects of standard treatments in patients with Chagas disease and HF. In the general population, the angiotensin receptor–neprilysin inhibitor, sacubitril-valsartan, improved HF outcomes versus the angiotensin-converting enzyme inhibitor, enalapril, and we compared these two agents in the largest trial in patients with Chagas disease and HF conducted to date.”
Chagas disease is a condition caused by a parasitic infection spread by triatomine bugs, contaminated food, blood transfusion, organ transplantation, laboratory accidents, and congenitally. It is common in Latin America and increasingly prevalent in the United States, where more than 200,000 people are estimated to be affected. The most common complication is cardiomyopathy, which occurs in 20 to 30% of those with the disease.
The PARACHUTE-HF study is the first randomized clinical trial to test a heart failure treatment in patients with HFrEF due to Chagas cardiomyopathy and the largest trial ever conducted in this population, with more than 900 patients from Brazil, Argentina, Colombia, and Mexico.
Patients were randomly assigned to receive either sacubitril-valsartan or enalapril, in addition to their usual therapy. Over a median follow-up of 25 months, sacubitril-valsartan was more effective than enalapril in reducing levels of the heart failure marker NT-proBNP by more than 30 percent compared to 5 percent with enalapril. Sacubitril-valsartan also showed a 52% higher frequency of better outcomes compared to enalapril.
“PARACHUTE-HF shows that much needed studies to better characterise chronic Chagas cardiomyopathy and trials to define the benefit and risk of new therapies in this condition are possible, and provides a successful model for international collaborations – in this field among cardiologists and infectious disease physicians − with the shared goal of evaluating the impact of new therapies on cardiovascular outcomes in patients with neglected diseases,” Lopes said.