Oct 03, 2012 (Marketwire via COMTEX) --Sarepta Therapeutics (NASDAQ: SRPT), a developer of innovative RNA-based therapeutics, today announced that treatment with its lead exon-skipping compound, eteplirsen, met the primary efficacy endpoint, increase in novel dystrophin, and achieved a significant clinical benefit on the primary clinical outcome, the 6-minute walk test (6MWT) over the placebo/delayed treatment cohort in a Phase IIb extension trial in Duchenne muscular dystrophy (DMD) patients.
Eteplirsen administered once weekly at either 30 mg/kg or 50 mg/kg for 48 weeks (n=8) resulted in a statistically significant increase (p≤0.001) in dystrophin-positive fibers to 47.0% of normal. The placebo/delayed treatment cohort, which had received 24 weeks of eteplirsen at either 30 mg/kg or 50 mg/kg following 24 weeks of placebo (n=4), also showed a statistically significant increase in dystrophin-positive fibers to 38.3% of normal (p≤0.009).
"These data represent a significant milestone and a defining moment of progress and hope for patients with DMD and their families, as well as for those of us in the scientific community who have been pursuing potential treatments for this devastating and deadly disease for decades," 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, "By addressing the underlying cause of DMD, eteplirsen has demonstrated unparalleled effects on enabling dystrophin production and slowing the progression of the disease as measured by the 6-minute walk test, with no treatment associated adverse events. While eteplirsen is targeted to DMD patients with a specific genetic mutation, I think the implications for all DMD patients with related genetic mutations are clearly evident."
Eteplirsen administered once weekly at 50 mg/kg over 48 weeks resulted in an 89.4 meter benefit compared to patients who received placebo for 24 weeks followed by 24 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 50 mg/kg of the drug weekly (n=4) demonstrated an increase of 21.0 meters in distance walked from baseline (mean=396.0 meters), while patients who received placebo/delayed-eteplirsen treatment (n=4) showed a decline of 68.4 meters from baseline (mean=394.5 meters), for a statistically significant treatment benefit of 89.4 meters over 48 weeks (p=0.016, using ANCOVA for ranked data). There was no statistically significant difference between the cohort of patients who received 30 mg/kg weekly of eteplirsen and the placebo/delayed treatment cohort.
"We are extremely excited about these data, as they demonstrate that longer-term treatment with eteplirsen is translating to continued and unprecedented increases in both dystrophin production and clinical benefit across various subgroups of DMD patients involved in this study," said Chris Garabedian, President and CEO of Sarepta Therapeutics. "On a broader scale, these results signify the promise and tremendous potential of our RNA-based technology to impact and modulate disease at the genetic level, which may lead to first-ever opportunities to target serious and life-threatening rare conditions at the origin of disease."
The safety profile of eteplirsen was evaluated across all subjects through 48 weeks and there were no treatment-related adverse events, no serious adverse events, and no discontinuations. Furthermore, no clinically significant treatment-related changes were detected on any safety laboratory parameters, including several biomarkers for renal function.
Summary of Dystrophin: Eteplirsen-Treated Patients in All Dose Groups through Week 48*
| |
|
|
|
|
| Treatment Arm |
|
Mean Change from Baseline in % Dystrophin-Positive Fibers |
|
p-value |
| Eterplirsen (both doses): 48 wks of Tx (n=8) |
|
47.0 |
|
≤0.001 |
| |
Eteplirsen 50 mg/kg (n=4) |
|
41.7 |
|
≤0.008 |
| |
Eteplirsen 30 mg/kg (n=4) |
|
52.1 |
|
≤0.001 |
| Placebo/Delayed Tx: 24 wks of Tx (n=4) |
|
38.3 |
|
≤0.009 |
| |
Placebo/50 mg/kg Delayed-Tx (n=2) |
|
42.9 |
|
ns |
| |
Placebo/30 mg/kg Delayed-Tx (n=2) |
|
34.2 |
|
ns |
| |
|
|
|
|
| |
|
|
|
|
* Values based on Immunofluorescence using anti-dystrophin antibody MANDYS106
Modified Intent-to-Treat (mITT)
The 6MWT results were further analyzed using the mITT population which excluded two patients who were randomized to the 30 mg/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 consisted of 10 patients (4 eteplirsen-treated patients receiving 50 mg/kg weekly, 2 eteplirsen-treated patients receiving 30 mg/kg weekly, and 4 placebo/delayed-treatment patients).
Summary of 6MWT: Eteplirsen versus Placebo/Delayed-Treatment to Week 48*
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|
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|
|
|
|
| Treatment Arm |
|
Mean Change from Baseline in 6MWT (meters) |
|
Estimated Treatment Effect (Eteplirsen minus Placebo/Delayed-Tx) |
|
p-value |
| Placebo/Delayed-Tx (n=4) |
|
-60.3 |
|
|
|
|
| Eteplirsen 50 mg/kg (n=4) |
|
+27.1 |
|
87.4 m |
|
≤0.001 |
| Eteplirsen Both Doses (n=6) |
|
+7.3 |
|
67.3 m |
|
≤0.001 |
| Eteplirsen 30 mg/kg (n=2) |
|
-31.5 |
|
28.8 m |
|
ns |
| |
|
|
|
|
|
|
*Note: Analysis based on Mixed Model Repeated Measures test
Summary of Additional Sub-Group Analyses at Week 48*
| |
|
|
|
|
|
|
| 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) |
|
-42.3 |
|
58.9 m |
|
≤0.038 |
Eteplirsen:
< 9.5 yrs at baseline
(n=3; mean=8.4 yrs) |
|
+16.5 |
|
Placebo/delayed Tx:
≥9.5 yrs at baseline
(n=2; mean=10.1 yrs) |
|
-63.5 |
|
52.1 m |
|
ns |
Eteplirsen:
≥9.5 yrs at baseline
(n=3; mean=10.4 yrs) |
|
-11.3 |
|
Placebo/delayed Tx:
Higher 6MWT baseline
(n=2; mean=422m) |
|
-53.5 |
|
93.8 m |
|
≤0.001 |
Eteplirsen:
Higher 6MWT baseline
(n=3; mean=424m) |
|
+40.3 |
|
Placebo/delayed Tx:
Lower 6MWT baseline
(n=2; mean=367m) |
|
-65.8 |
|
39.6 m |
|
ns |
Eteplirsen:
Lower 6MWT baseline
(n=3; mean=375m) |
|
-26.2 |
|
Placebo/delayed Tx:
Genotype 49-50 deletion
(n=3; age mean=9.2 yrs,
6MWT BL mean=397m) |
|
-69.0 |
|
83.4 m |
|
≤0.001 |
Eteplirsen:
Genotype 49-50 deletion
(n=2; age mean=9.1 yrs,
6MWT BL mean=383m) |
|
+14.4 |
|
| |
|
|
|
|
|
|
* Note: Analysis based on Mixed Model Repeated Measures test
An abstract describing the results from this Phase IIb extension study has been accepted as part of the World Muscle Society (WMS) Congress's Late-Breaking Science program in Perth, Australia during October 9 to October 13, 2012. Principal investigator, Jerry R. Mendell, M.D. of Nationwide Children's Hospital, will present the data via an oral presentation of the abstract titled, "Results at 48 Weeks of a Phase IIb Extension Study of the Exon-Skipping Drug Eteplirsen in Patients with Duchenne muscular dystrophy (DMD)." Dr. Mendell will present on October 13 at 4:00 p.m. WST UTC +8 hours/4:00 a.m. EDT. Dr. Mendell's presentation will be posted on the Sarepta website in the "Events & Presentations" section after the session is completed. In addition, Sarepta is sponsoring an educational symposium at WMS chaired by Professor Steve Wilton, PhD, Head of the Molecular Genetic Therapy Group and Director of Translational Research and Development, Australian Neuromuscular Research Institute at the University of Western Australia. Professor Wilton is a long-time collaborator of Sarepta's whose groundbreaking research has extended the use of antisense oligomers to DMD.
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 occurred 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, 36 weeks, 48 weeks and will continue to be performed every 12 weeks going forward.