RNA interference therapy targeting coagulation factor XI: a first-in-human trial of RBD4059 (vortosiran)

Clinical Snapshot

Key Findings

• P Value: Not reported in abstract

• Effect Size: Dose-dependent FXI activity suppression exceeding 90%

• Primary Outcome: Safety and tolerability - no apparent safety concerns identified up to day 169

• Nnt Or Sensitivity: Not applicable for phase 1 safety study

• Confidence Interval: Not reported in abstract

Clinical Application

Subcutaneous administration with 3-6 month dosing intervals could improve compliance compared to daily oral anticoagulants Would require TGA approval through clinical trial pathway; potential PBS listing would depend on phase 2/3 efficacy and safety data compared to existing anticoagulants like DOACs Currently limited to research setting; potential future application in patients requiring anticoagulation who are inadequately treated or contraindicated for current therapies

Abstract

Inhibiting coagulation factor XI (FXI) activity has emerged as a promising strategy to prevent intravascular thrombosis. Here, we describe the first-in-human trial with an N-acetylgalactosamine-conjugated small interfering RNA (siRNA), RBD4059, targeting FXI. In this phase 1 single ascending dose study (NCT05653037), healthy volunteers were randomized to receive either active drug or placebo (6 + 2), administered subcutaneously, in 4 consecutive dose cohorts ranging from 50 mg to 600 mg. The primary end point was safety and tolerability up to day 169 after dose. Secondary end points included pharmacokinetic and pharmacodynamic (PD) parameters. Single ascending doses of RBD4059 were well tolerated, and no apparent safety concerns were identified. RBD4059 was associated with a dose-dependent and durable suppression of FXI activity up to >90%. Modeling of the available PD data supports clinical dosing schemes of 3 to 6 months to achieve a robust antithrombotic effect. Altogether, these observations support further clinical development of RBD4059 to provide an siRNA-based therapeutic option targeting FXI for patients inadequately treated with or contraindicated for current available thrombosis prophylaxis. This trial was registered at www.clinicaltrials.gov as #NCT05653037.

References

1. 1.Gabrielsen, A., Ueckert, S., Nilsson, C., Egnell, A.-C., Fu, J., Wikström, J., Svedlund, S., Friend, R., Zhang, H., Liang, Z., Gao, S., & Gan, L.-M. (2026). RNA interference therapy targeting coagulation factor XI: a first-in-human trial of RBD4059 (vortosiran). Blood Advances. https://doi.org/10.1182/bloodadvances.2025018348