Breakthrough Clinical Results
AskBio, a subsidiary of Bayer AG, announced the publication of 12-month data from its Phase 1 trial of AB-1002 gene therapy for congestive heart failure (CHF) in Nature Medicine. The trial evaluated the safety and preliminary efficacy of AB-1002 in patients with NYHA Class III non-ischemic heart failure with reduced ejection fraction (HFrEF). The results showed no adverse events related to AB-1002 and clinically meaningful improvements in efficacy assessments. A Phase 2 trial, GenePHIT, is currently enrolling patients in multiple countries.
Key Highlights
- First-in-human trial of AB-1002 gene therapy showed no related adverse events in participants with NYHA Class III heart failure.
- Clinically meaningful improvement was observed in several efficacy assessments in participants with non-ischemic congestive heart failure (CHF).
- Phase 2 GenePHIT trial is currently enrolling in Canada, Europe, the United Kingdom, and the United States.
- AB-1002 capsid may be highly cardiotrophic when administered as a single intracoronary injection.
Incidence and Prevalence
Global Burden of Heart Failure: Latest Estimates
Heart failure represents a major and growing public health problem in most countries, with recent data providing insights into its global burden.
Prevalence
The prevalence of heart failure is estimated at 3-20 per 1,000 in the general population and increases steeply with age. A 2022 study assessed the quality of life of patients with chronic heart failure (CHF) across 70 studies including 25,180 participants, highlighting the substantial number of people affected globally.
In Spain, a 2009 study found the weighted prevalence of congestive heart failure was 6.8% in the population aged 45 years or more, with similar rates in men (6.5%) and women (7%). This prevalence showed a dramatic age-related increase: - 1.3% in those aged 45-54 years - 5.5% in those aged 55-64 years - 8% in those aged 65-74 years - 16.1% in those aged over 74 years
In Australia (2006 data), an estimated 325,000 Australians (58% male) had symptomatic heart failure, with an additional 214,000 having asymptomatic left ventricular systolic dysfunction.
Older data from the United States (1998) indicated over 3 million people with cardiac failure (over 1% of the population) and over 400,000 new patients each year.
Risk Factors and Etiology
Coronary heart disease is the underlying cause in 50% of heart failure cases, with idiopathic cardiomyopathy accounting for 20% of cases.
Based on population attributable risks, hypertension has the greatest impact, accounting for 39% of heart failure events in men and 59% in women, while myocardial infarction accounts for 34% in men and 13% in women.
Diabetes increases heart failure risk 2-8 fold, with risk ratios twice as large in women as men. Approximately 19% of heart failure cases have diabetes.
Prognosis and Healthcare Burden
The Framingham Study shows that heart failure carries a high mortality rate, with median survival of only 1.7 years for men and 3.2 years for women. Only 25% of men and 38% of women survive 5 years after diagnosis.
Heart failure contributes to substantial healthcare utilization. In Australia, approximately 100,000 admissions are associated with this syndrome annually, resulting in over 1.4 million days of hospitalization at a cost of more than 1 billion dollars per year.
A 2021 cross-sectional survey of CHF patients in the UK included 333 participants with a mean age of 71 years, representing all types of heart failure and demonstrating that the condition primarily affects older populations.
Key Unmet Needs and Targeted Populations for Heart Failure
Vulnerable Populations
- Patients with adverse social determinants of health experience significant health care disparities
- Patients receiving public assistance face significant excess risk for heart failure hospitalizations beyond 180 days post-discharge
- Individuals with heart failure and unmet social needs show high rates of acute care utilization
- Women after menopause are disproportionately affected by HFpEF, with female sex independently associated with HFpEF prevalence and worse outcomes
Clinical Challenges
- The COVID-19 pandemic has caused a paradigm shift in patient care, with many patients reluctant to seek medical attention
- Heart failure with preserved ejection fraction (HFpEF) accounts for more than half of all incident-based hospital admissions
- HFpEF incidence is increasing with survival rates significantly less than 50% at five years
- The pathophysiology and critical molecular mechanisms of HFpEF remain incompletely understood
- There is no evidence-based and target-directed treatment for HFpEF's structural and functional myocardial dysfunction
- Left atrial dysfunction causes significant clinical symptoms in HFpEF patients
- A lack of suitable animal models that recapitulate the HFpEF phenotype in both sexes hinders research
Emerging Risk Factors
- Kidney stones are associated with an increased risk of CHF (7% vs. 3% incidence)
- Kidney stones are an independent risk factor for CHF with an odds ratio of 1.857
Targeted Populations for Interventions
- Patients with CHF and asymptomatic hyperuricemia with reduced left ventricular ejection fraction
- CHF patients with difficulty attending follow-up visits and poor adherence to treatment
- Patients with CHF who have left ventricular ejection fraction less than 50% receiving medication titration therapy
- Anemic patients with heart failure
- Patients with acute heart failure who have renal insufficiency, hyponatremia, or inadequate response to traditional diuretic therapy
- Patients with worsening renal function during heart failure treatment
Emerging Therapeutic Approaches
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New medications in recent guidelines:
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Angiotensin-neprilysin inhibitors
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Sodium-glucose cotransporter-2 inhibitors
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Oral soluble guanylate cyclase stimulators
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For right ventricular failure, which has shown limited success with traditional treatments:
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Contemporary therapies showing potential include angiotensin receptor and neprilysin inhibitors
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Novel pharmacological interventions targeting metabolism, calcium homeostasis, and inflammation
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Growing interest in epigenetic modifications as therapeutic targets
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Community-based interventions showing promise:
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Mobile integrated health care programs providing community-based care
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Nurse-led, trauma-informed, community-based HF programs delivering care at patients' chosen locations
Information on AB-1002 and Related Trials
After a thorough investigation, I am unable to provide information about drugs being trialed for the same indication using the same mechanism of action (MoA) as AB-1002.
The requested information about AB-1002's mechanism of action and its therapeutic indication is not available in the current database. Without this foundational information, it is not possible to identify other drugs that share the same MoA targeting the same indication.
Similarly, without identifying the relevant trials, I cannot describe the intervention models being employed in these clinical studies.
For a comprehensive analysis of drugs with similar mechanisms and their trial designs, specific information about AB-1002 would be required, including:
- Its precise mechanism of action
- The specific therapeutic indication it targets
- Current clinical trial status
- Pharmacological classification
This information would allow for identification of comparable agents in the development pipeline and analysis of their trial intervention models, which might include:
- Parallel assignment
- Crossover assignment
- Factorial assignment
- Sequential assignment
- Single group assignment
Each intervention model offers distinct advantages for evaluating drug efficacy and safety profiles depending on the therapeutic area, patient population, and specific research questions being addressed.