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Liver DiseaseJune 2020Summary reviewed June 2026

A Monthly Injection Cut Severe Liver Disease Attacks by 74% in Patients

Researchers tested givosiran, a monthly injection that blocks a liver enzyme, in people with acute intermittent porphyria who were having repeated attacks. Patients who got givosiran had 74% fewer porphyria attacks over six months compared to those who got a placebo.

What the trial was testing

The ENVISION enrolled 94 patients with liver disease. The study was sponsored by Alnylam Pharmaceuticals and tracked outcomes across the full group of patients who matched the trial's eligibility profile.

It was a large trial designed to confirm whether the treatment works well enough for wider use. Trials at this stage are designed to produce evidence regulators and physicians can act on — not just observations to follow up later.

What the results showed

Patients taking givosiran had 74% fewer porphyria attacks than those on placebo.

The New England journal of medicine · 2020 · NCT03338816

These findings — that people taking givosiran had three-quarters fewer porphyria attacks than those on placebo — were published in the The New England journal of medicine and represent the headline result of the study.

Researchers tracked outcomes across 94 patients enrolled in the trial. The result was consistent enough across the group that the team felt confident reporting it.

What this means for patients

For patients with liver disease, this result changes the calculus on what to ask their care team about. Whether it changes day-to-day care depends on factors like disease subtype, prior treatments, and where the patient is in their care journey.

What you can do now

Givosiran is FDA-approved for acute hepatic porphyria and is given as a monthly injection under the skin. It significantly reduces attacks but can cause liver enzyme changes and kidney function changes that need monitoring. Talk to your doctor about whether givosiran is right for you, especially if you're having frequent attacks.

Eligibility for the treatments mentioned above depends on specific test results and clinical history. Bring this summary, the trial name, and your most recent labs or pathology report to your next visit.