Secukinumab in Ankylosing Spondylitis (AS)
George Vratsanos, MD, Executive Global Program Head, Immunology & Dermatology, Novartis, discusses Ph. III results for secukinumab in ankylosing spondylitis
Living with AS: A Patient Perspective
Stuart, from the UK, is living with ankylosing spondylitis.
Ankylosing Spondylitis Patient
A young man with severe ankylosing spondylitis, showing outward curvature of the spine due to fusion of the vertebrae
Hand of Patient with Ankylosing Spondylitis
A patient’s hand affected with ankylosing spondylitis
Spondyloarthritis (SpA) Infographic
See below for PDF version
IL-17A in SpA Infographic
See below for PDF version
Nov 15, 2014 10:45 PM RST
Novartis presents ground-breaking Phase III results showing AIN457 (secukinumab) significant efficacy in ankylosing spondylitis patients
· More than 60% of secukinumab 150 mg patients achieved significant improvements in AS symptoms, seen as early as Week 1 and sustained through one year of treatment1,2
· Secukinumab is the first selective IL-17A inhibitor to significantly improve signs and symptoms of ankylosing spondylitis (AS) versus placebo in Phase III studies1,2
· Up to 40% of AS patients have inadequate or no response to standard of care anti-TNF (tumor-necrosis-factor) medicines3; secukinumab is the first non anti-TNF biologic to show significant efficacy in AS patients1,2
· Joint regulatory filings of secukinumab in AS and psoriatic arthritis are planned for 2015
Basel, November 15, 2014 – Novartis announced today results from the MEASURE 1 and MEASURE 2 pivotal Phase III studies of AIN457 (secukinumab) in ankylosing spondylitis (AS). In the studies, secukinumab met the primary endpoint demonstrating rapid and statistically significant improvements versus placebo in the signs and symptoms of AS. More than 60% of secukinumab 150 mg patients achieved an ASAS20 response, a standard tool used to assess clinical improvement in AS, in MEASURE 1 (p<0.0001) and MEASURE 2 (p<0.001)1.2. This is in comparison to 28.7% and 28.4% of placebo patients who achieved ASAS20 in MEASURE 1 and MEASURE 2, respectively. Detailed study results will be presented during a plenary session (MEASURE 1) and in a late breaker poster presentation (MEASURE 2) at the American College of Rheumatology (ACR) Congress in Boston, USA.
AS is a common type of spondyloarthritis (SpA), a family of long-term, inflammatory diseases impacting joints4, which affects up to 1% of the general population5. Caused by spine inflammation, AS is a painful and progressively debilitating condition that can result in irreversible spinal damage reducing patients’ mobility and quality of life6.
“Ankylosing spondylitis is a debilitating condition that severely impacts patients’ mobility, ability to work and overall quality of life,” said Vasant Narasimhan, Global Head of Development, Novartis Pharmaceuticals. “As part of our commitment to addressing the significant unmet patient needs, we are proud to present positive Phase III results of secukinumab in ankylosing spondylitis, which marks a potential new treatment option for these patients. These ground-breaking data are expected to form the basis of joint regulatory submissions planned for 2015, which also includes results from the FUTURE 1 and FUTURE 2 psoriatic arthritis studies.”
About the data at ACR
Statistically significant improvements in signs and symptoms of AS were achieved with secukinumab versus placebo at Week 16, as measured by at least 20% improvement in the Assessment of Spondyloarthritis International Society criterion (ASAS20)1,2. Improvements in secukinumab 150 mg treated patients were seen as early as Week 1 in both studies (ASAS20; p<0.01, MEASURE 1; p<0.05, MEASURE 2) and were sustained through 52 weeks of treatment, according to data from MEASURE 11,2. There are few therapeutic options available to people with AS and there is a significant unmet need for alternative treatment options3. Up to 40% of patients have an inadequate or no response to the current standard of care, anti-tumor-necrosis-factor (anti-TNF) medicines3. Importantly, clinical benefits with secukinumab were not only observed in patients who had not been previously treated with anti-TNF therapies (anti-TNF naïve), but also in patients who had an inadequate response or intolerance to anti-TNFs1,2. Specifically, over twice as many secukinumab 150 mg patients (more than 45%) who had an inadequate response or intolerance to anti-TNFs achieved an ASAS20 response in MEASURE 1 and MEASURE 2 (p<0.05, MEASURE 1; p<0.05, MEASURE 2) compared to placebo patients (under 25%) in both studies1,2.
Up to 70% of patients with severe AS can develop spinal fusion (bones grow together), significantly reducing mobility and quality of life4,7,8. Patients with AS can become progressively disabled and unable to work, which may add to their reduced quality of life4. In both studies, treatment with secukinumab 150 mg resulted in rapid improvements in physical function and quality of life at Week 16 versus placebo as measured by the SF-36 Physical Component Summary (p<0.0001, MEASURE 1; p<0.001, MEASURE 2), with improvements sustained through 52 weeks of treatment1,2.
Secukinumab was well tolerated in both studies, with a safety profile consistent with that observed in the psoriasis clinical trial program involving nearly 4,000 patients1,2,9. The most common adverse events (AEs) were upper respiratory tract infection and headache1,2.
About Phase III secukinumab AS studies at ACR1,2
MEASURE 1 and MEASURE 2 are multi-center, randomized, placebo-controlled Phase III studies to evaluate the efficacy of secukinumab in IL-17A inhibition in AS compared to placebo, and to assess the safety, tolerability and effectiveness in patients with AS. Both MEASURE 1 and MEASURE 2 evaluated secukinumab 75 mg and 150 mg versus placebo. In the MEASURE 1 study patients received an intravenous loading dose of 10 mg/kg every two weeks for the first four weeks of treatment followed by monthly subcutaneous doses that aimed to provide high exposure for induction of response in order to confirm the clinical benefit observed in an initial proof-of-concept study. MEASURE 2 evaluated subcutaneous loading regimens. Regimens based solely on subcutaneous secukinumab therapy might be more convenient for patients, and have shown strong efficacy in other therapy areas. Both studies met their primary endpoint of ASAS20 Assessment of Spondyloarthritis International Society criteria response) and the results were consistent for the 150 mg dose:
· MEASURE 1, 60.8% and 59.7% for secukinumab 150 mg and 75 mg, respectively, versus 28.7% for placebo; p<0.00011,2
· MEASURE 2, 61.1% and 41.1% for secukinumab 150 mg and 75 mg, respectively, versus 28.4% for placebo; p<0.001 for 150 mg, p=0.0967 for 75 mg1,2
Full results of secondary endpoints will be presented at ACR. Secondary endpoints at Week 16 for MEASURE 1 and MEASURE 2 included1,2:
· ASAS40 response (a ≥40% improvement of at least two units in each of three domains, with no worsening in the fourth domain)
· High sensitivity C-reactive protein (hs-CRP)
· ASAS 5/6 responses (≥20% improvement in five of six domains, adding spinal mobility and C-reactive protein [CRP], with no worsening in the sixth domain)
· Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), ASAS partial remission (a score of <2 units in each domain)
· BASDAI, quality of life assessed using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and the AS QoL, and ASAS partial remission
About ankylosing spondylitis (AS)
Ankylosing spondylitis (AS) is a common type of spondyloarthritis (SpA), a family of long-term diseases of joints (inflammatory disease), which also includes psoriatic arthritis (PsA)4. AS is a painful, progressively debilitating condition caused by inflammation of the spine. AS occurs in up to 1% of the general population and typically affects young men and women aged 25 or older5,10. Certain genetic factors increase a person’s risk of developing AS by more than 50%11.
About secukinumab (AIN457) and interleukin-17A (IL-17A)
Secukinumab (AIN457) is a human monoclonal antibody that selectively neutralizes IL-17A12. Secukinumab is the first IL-17A inhibitor with positive Phase III results for the treatment of AS. Research shows IL-17A plays an important role in driving the body’s immune response in psoriasis and other inflammatory arthritic diseases, including AS13.
In addition to AS, secukinumab is also in clinical trials for the treatment of psoriatic arthritis (PsA) and rheumatoid arthritis (RA). Global regulatory applications for secukinumab in AS and PsA are planned for 2015. This follows the secukinumab global regulatory applications for moderate-to-severe plaque psoriasis which were filed in October 2013 with approvals anticipated in late 2014 or early 2015.
Full Press Release
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