Sarepta Therapeutics Announces Significant Clinical Benefit With Eteplirsen After 36 Weeks in Phase IIb Study for the Treatment of Duchenne Muscular Dystrophy

by Admin 7/24/2012 10:46:00 AM

Jul 24, 2012 (Marketwire via COMTEX) --Sarepta Therapeutics (NASDAQ: SRPT), a developer of innovative RNA-based therapeutics, today announced that treatment with its exon-skipping compound, eteplirsen, achieved a significant clinical benefit on the primary clinical outcome, the 6-minute walk test (6MWT), over a placebo/delayed treatment cohort in a Phase IIb trial in Duchenne muscular dystrophy (DMD) patients. Eteplirsen administered once weekly at 50mg/kg over 36 weeks resulted in a 69.4 meter benefit compared to patients who received placebo for 24 weeks followed by 12 weeks of treatment with eteplirsen in the open-label extension. In the predefined prospective analysis of the study's intent-to-treat (ITT) population on the primary clinical outcome measure, the change in 6MWT distance from baseline, eteplirsen-treated patients who received 50mg/kg of the drug weekly (n=4) demonstrated a decline of 8.7 meters in distance walked from baseline (mean=396.0 meters), while patients who received placebo/delayed-eteplirsen treatment for 36 weeks (n=4) showed a decline of 78.0 meters from baseline (mean=394.5 meters), for a statistically significant treatment benefit of 69.4 meters over 36 weeks (p≤0.019).

"The magnitude of this clinical benefit is an unprecedented treatment effect in DMD. This result represents a major advance in the pursuit of a disease modifying treatment for this severe, progressive and life-threatening disease," said Jerry Mendell, M.D., Director of the Centers for Gene Therapy and Muscular Dystrophy at Nationwide Children's Hospital and principal investigator of the Phase IIb study. Dr. Mendell added, "The 6-minute walk test results with eteplirsen, combined with its safety profile to date, make eteplirsen the most promising advance to treat the underlying cause of muscular dystrophy I've seen in my more than 30 years in the field."

The clinical benefit observed in the 50mg/kg treatment cohort compared to placebo was also significant at week 32 with a benefit of 59.9 meters (p≤0.045). The safety profile of eteplirsen was evaluated across all subjects through 36 weeks and there were no treatment-related adverse events, no serious adverse events and no discontinuations. Furthermore, no treatment related changes were detected on any safety laboratory parameters, including several biomarkers for renal function.

"These data suggest that the previously reported levels of dystrophin we observed in muscle biopsies after 24 weeks of treatment are translating to a clinical benefit on the standard measure of ambulation in DMD patients," said Chris Garabedian, President and CEO of Sarepta Therapeutics. "The magnitude of this 69.4-meter difference after 36 weeks of treatment and the robustness of the statistical analysis is encouraging, especially given the average benefit in the 6-minute walk test for several approved drugs in other diseases has been 30 to 40 meters." 

There was no statistically significant difference between the cohort of patients who received 30mg/kg weekly of eteplirsen and the placebo/delayed treatment cohort.

Modified Intent-to-Treat and Subgroup Analyses

A modified intent-to-treat (mITT) population was evaluated that excluded two patients who were randomized to the 30mg/kg weekly eteplirsen cohort who showed signs of rapid disease progression within weeks after enrollment and were unable to perform measures of ambulation beyond 24 weeks. This mITT population consisting of 10 patients (4 eteplirsen-treated patients receiving 50mg/kg weekly, 2 eteplirsen-treated patients receiving 30mg/kg weekly, and 4 placebo/delayed-treatment patients) was further analyzed.

Summary of 6MWT: Eteplirsen versus Placebo/Delayed-treatment through Week 36*

Treatment Arm   Mean 6MWT Change from Baseline (meters)   Estimated Treatment Effect (Eteplirsen minus Placebo/Delayed-Tx)   p-value
Placebo/Delayed-Tx (n=4)   -70.9        
Eteplirsen 50 mg/kg (n=4)   -5.2   65.8 meters   0.0002
Eteplirsen Both Doses (n=6)   -14.6   56.2 meters   0.0004
Eteplirsen 30 mg/kg (n=2)   -33.3   37.6 meters   ns

*Note: Analysis based on Mixed Model Repeated Measures test

Summary of Additional Sub-Group Analyses at Week 36**

Subset   Mean 6MWT Change from Baseline (meters)   Estimated Treatment Benefit (Eteplirsen minus Placebo/delayed-Tx)   p-value
             
Placebo/delayed Tx:
 < 9.5 yrs at baseline
(n=2; mean=7.6 yrs)
  -60.6   63.6 meters   0.0040
Eteplirsen: 
 < 9.5 yrs at baseline
(n=3; mean=8.4 yrs)
  +3.1        
Placebo/delayed Tx:
≥9.5 yrs at baseline
(n=2; mean=10.1 yrs)
  -73.4    36.0  meters   ns
Eteplirsen: 
≥9.5 yrs at baseline
(n=3; mean=10.4 yrs)
  -37.4        
Placebo/delayed Tx:
Higher 6MWT baseline
(n=2; mean=422m)
  -75.5   82.5  meters   0.0001
Eteplirsen:
Higher 6MWT baseline
(n=3; mean=424m)
  +7.0        
Placebo/delayed Tx: Lower 6MWT baseline
(n=2; mean=367m)
  -72.1   39.9 meters   ns
Eteplirsen:
Lower 6MWT baseline
(n=3; mean=375m)
  -32.3        
Placebo/delayed Tx:
Genotype 49-50 deletion (n=3; age mean=9.2 yrs, 6MWT BL mean=397m)
  -67.6   68.5 meters   0.0001
Eteplirsen:
Genotype 49-50 deletion
(n=2; age mean=9.1 yrs, 6MWT BL mean=383m)
  +0.9        

 ** Note: Analysis based on Mixed Model Repeated Measures test

About Study 201 and Study 202 (Phase IIb Eteplirsen Study)

Study 4658-US-201 was conducted at Nationwide Children's Hospital in Columbus, Ohio. Twelve boys meeting the inclusion criteria being between 7 and 13 years of age with appropriate deletions of the dystrophin gene that confirm eligibility for treatment with an exon-51 skipping drug, received double-blind IV infusions of placebo (n=4), 30 mg/kg of eteplirsen (n=4), or 50 mg/kg of eteplirsen once weekly for 24 weeks (n=4). Muscle biopsies for evaluation of dystrophin were obtained at baseline for all subjects, and after 12 weeks for patients in the 50 mg/kg cohort and after 24 weeks for patients in the 30 mg/kg cohort. Two placebo patients were randomized to the 30 mg/kg cohort and two placebo patients were randomized to the 50 mg/kg cohort. This study design allowed Sarepta to investigate the relationship of dose and duration of eteplirsen treatment on the production of dystrophin over the course of the 24-week study.

Study 4658-US-202 is the extension study to 201 and continues to assess the long-term safety and efficacy of open-label eteplirsen. The four placebo patients were rolled over to open-label eteplirsen at week 24, with six patients on 30 mgs/kg, and six patients on 50 mgs/kg. Third biopsies will occur at 48 weeks in the original study 201 treated patients, and at 24 weeks, the same time point, in the original placebo patients. 6MWT was performed at 32 weeks and 36 weeks, and will continue to be performed every 12 weeks going forward.



Currently rated 1.5 by 54 people

  • Currently 1.537036/5 Stars.
  • 1
  • 2
  • 3
  • 4
  • 5

Tags: , , , , , ,

Research

Ataluren Update July 2012

by Admin 7/24/2012 10:39:00 AM

Summary of trial results

The pivotal Phase 2b trial of ataluren, an investigational new drug being studied in nonsense mutation Duchenne/Becker muscular dystrophy (DBMD), was completed in late 2009. It had enrolled 174 patients at 37 trial sites in 11 countries on four continents. As PTC and statistics experts have analyzed the complex data from this trial using various statistical methods, the company has come to understand that the results are very promising.

Efficacy

  • The trial had low-dose ataluren and high-dose ataluren arms as well as a placebo arm. The main criterion, or endpoint, used to determine differences in performance among the three arms was the Six Minute Walk Test, which measured, every six weeks, the distance that participants could walk in 6 minutes (6MWD).

  • Participants receiving low-dose ataluren (10, 10, 20 mg/kg) showed a clinically meaningful difference (approximately 30 meters) in the change in their 6MWD results when compared to the placebo arm.

  • The FDA requires that trial sponsors specify in advance which statistical models will be used to analyze data at the end of a study. The data was first analyzed using the pre-specified statistical method. The unexpected complexity of the ataluren data could not be fully addressed using this method, so it was necessary to use a different (ie, post hoc) statistical model to fully understand the results.

o A post hoc statistical analysis, using a model suggested by independent statistics experts, showed an average difference between low-dose ataluren and placebo of 31.3 meters (103 feet) in the 6MWD. The p-value for this result is 0.0561. A p-value is a test of statistical significance that measures how likely it is that a result is due to an actual effect rather than to chance. In this case, the post hoc corrected p value of 0.0561 indicates that there is only about a 5% possibility that the results could have been obtained if ataluren was no different than placebo.

o A second measure used to compare the effects of ataluren at the two different doses and against placebo was the time it took for the 6MWD to worsen by 10% and remain so. This was defined as “time to persistent 10% worsening.” This analysis indicated that patients receiving low-dose ataluren experienced slower disease progression than patients receiving placebo. By the end of the trial, 26% of the low-dose patients were persistently 10% worse in 6MWD than when they started, compared to 48% in the high-dose arm and 44% in the placebo arm (post hoc p=0.0652 for low-dose ataluren vs placebo).

The 6MWD results from the high-dose (20, 20, 40 mg/kg) arm were similar to the placebo arm. At the completion of the preliminary data analysis, all patients in three ongoing DBMD clinical trials (Phase 2a and 2b extension studies and a non-ambulatory study) were receiving the high dose. Although an independent data monitoring committee agreed that ataluren was well tolerated by patients, the committee recommended that the trials be suspended because all patients in ongoing trials were on the high dose.

Safety

Safety results showed that ataluren was generally well tolerated:
o Adverse events were similar across all three arms of the study: high-dose, low-dose and

placebo.
o No patients discontinued treatment due to an adverse event.
o Serious adverse events were infrequent and none was considered to be related to ataluren.

Current status

Extension Studies

  • In the US, PTC is providing access to ataluren to 106 previous trial participants through an open- label study in which all patients receive ataluren (10, 10, 20 mg/kg). Safety data is being collected. Enrollment in this trial is complete and patients have been receiving ataluren for at least six months.

  • In Canada and nine other countries that had Phase 2b trial sites, PTC has initiated an open-label study, collecting safety and efficacy data. Several patients have already been enrolled and are now receiving drug. Many sites are in various stages of obtaining national and local regulatory permission and completing paperwork to enroll patients over the next several months.

    Regulatory Path

    • PTC remains committed to the development and commercialization of ataluren and is engaged in discussions with regulatory authorities in the US and Europe regarding the path forward for ataluren in nonsense mutation Duchenne/Becker muscular dystrophy.

    • The FDA feedback is that the efficacy data from the single Phase 2b trial is not adequate to support approval at this time.

o When the FDA is presented with data from a single pivotal trial, even for a rare disease, the

data has to meet a particularly high standard. Discussions with the FDA regarding ataluren and

the path forward are still ongoing.
o The FDA considers a p-value of 0.05 to be the standard criterion for statistical significance.

This means that there is no more than a 5% chance that the trial results were due to chance and not to an actual drug effect. The corrected post-hoc analysis showed a p-value of 0.0561 for the comparison of low-dose ataluren vs. placebo in the 6MWD.

o The ataluren Phase 2b study was the first registration-directed trial ever conducted in DBMD and it was not known what the clinical endpoints, some of which had never been used before, would show when measuring the impact of a disease-modifying therapy.

o Several other factors contributed to the difficulty of obtaining more robust evidence of efficacy in this trial, including the variability in the natural history of DBMD, the requirement to pre- specify the statistical analysis in the absence of a previous trial that could act as a model, and the limitations of doing trials in rare diseases.

o The most likely outcome of our FDA discussions is that a pre-approval confirmatory study will be necessary.

The company is simultaneously in discussions with the European Medicines Agency (EMA) concerning the path forward in Europe. It is possible that we will be able to file in the European Union under the mechanism of conditional approval, in which approval is granted with the requirement to conduct a confirmatory study.

o PTC is engaged in the formal scientific advice process of presenting data from the trial to selected regulatory officials for their input. The precise timing of the filing, however, will depend on the outcome of our upcoming meetings. We are encouraged by discussions with the EMA thus far.

Confirmatory study

Whether in the context of conditional approval in Europe, or to meet additional requirements in the US, PTC is currently planning to conduct an additional confirmatory study of low dose ataluren (10, 10, 20 mg/kg) vs. placebo.

  • This study design will be based on the Phase 2b trial results and the goal is to confirm the previous findings in the low-dose patient group.

  • PTC is in discussions with clinical investigators and regulatory agencies about the specific design and endpoints for this trial and will update the community when a protocol is finalized.

  • It is important to realize that a confirmatory study is often more restrictive in its inclusion/exclusion criteria than the original trial, as it is intended to confirm specific results. The goal of the clinical trial is to secure approval of ataluren so all patients who might benefit from ataluren may have access. 



Currently rated 1.7 by 15 people

  • Currently 1.733333/5 Stars.
  • 1
  • 2
  • 3
  • 4
  • 5

Tags: ,

Research

Powered by BlogEngine.NET 1.3.0.0
Theme by Mads Kristensen

Sign in

Recent Duchenne Posts

Recent Duchene Post Responses

Don't show

Tags

Calendar

<<  July 2012  >>
MoTuWeThFrSaSu
2526272829301
2345678
9101112131415
16171819202122
23242526272829
303112345

View posts in large calendar

Disclaimer

The opinions expressed herein are individual bloggers own personal opinions and do not represent Duchenne Ireland's view in anyway.

© Copyright Duchenne Ireland 2013

Sign in

Locations of visitors to this page