Clinical Trials

Date: 2015-05-18

Type of information: Presentation of results at a congress

phase: 2b

Announcement: presentation of results at the American Thoracic Society 2015 International Conference

Company: Sanofi (France) Regeneron Pharmaceuticals (USA - NY)

Product: dupilumab

Action mechanism:

• monoclonal antibody. Dupilumab, a fully-human monoclonal antibody, is directed against the shared IL-4 receptor alpha subunit, which blocks signaling from both IL-4 and IL-13. IL-4 and IL-13 are key cytokines that are required for the initiation and maintenance of the Th2 (Type 2 helper T-cell) immune response, which is believed to be a critical pathway in allergic inflammation.
• Dupilumab was created using Regeneron's pioneering VelocImmune® technology and is being co-developed with Sanofi in asthma, atopic dermatitis and chronic sinusitis with nasal polyposis.

Disease: uncontrolled moderate-to-severe asthma

Therapeutic area: Allergic diseases - Inflammatory diseases - Respiratory diseases

Country: USA, Argentina, Australia, Chile, France, Italy, Japan, Korea, Mexico, New Zealand, Poland, Russia, South Africa, Spain, Turkey, Ukraine

Trial details:

• The double-blind, placebo-controlled, 24-week, dose-ranging study enrolled 776 adult patients with moderate-to-severe uncontrolled asthma, as defined by the Global Initiative for Asthma 2014 Guidelines. Trial participants were randomized to receive one of four doses of dupilumab (300 mg every other week, 200 mg every other week, 300 mg monthly, 200 mg monthly) or placebo. Approximately 40 percent of patients had high eosinophils across the dose groups. During the treatment period, patients continue their stable medium- or high-dose inhaled corticosteroid and long-acting beta agonist (ICS/LABA) combination product. Patients can administer inhaled rescue medication as needed during the study. A severe exacerbation event during the study is defined as a deterioration of asthma requiring the use of systemic corticosteroids for three or more days, or hospitalization or an emergency room visit. Approximately 77 percent of randomized patients have a history of atopic disease, which includes atopic dermatitis, allergic conjunctivitis, allergic rhinitis, chronic rhinosinusitis, nasal polypsis, food allergy and/or hives history.(NCT01854047)

Latest news:

• • On May 18, 2015, Regeneron Pharmaceuticals and Sanofi shared positive results from an interim analysis of a pivotal Phase 2b study of dupilumab in adult patients with moderate-to-severe asthma, who are uncontrolled despite treatment with inhaled corticosteroids and long-acting beta agonists (ICS/LABA).
• The study met its primary endpoint of improving lung function in asthma patients with high blood eosinophil counts (HEos, greater than or equal to 300 eosinophilic cells/microliter). Such high counts are thought to be a marker for patients more likely to have "atopic" or "allergic" asthma.
• New data presented on secondary endpoints at the American Thoracic Society 2015 International Conference included positive results in study patients with low blood eosinophil counts (LEos, less than 300 eosinophilic cells/microliter), who are thought to be less likely to suffer from "allergic" asthma and thus less likely to respond to TH2 targeted therapies.
• Based on discussions with the FDA, this Phase 2b study may be considered one of two pivotal efficacy studies required for a potential dupilumab biologics license application (BLA) in asthma.
• The new results focused on LEos asthma patients. In this population, patients treated with either 200 mg or 300 mg Q2W doses of dupilumab showed a greater than 8 percent improvement in forced expiratory volume over one second (FEV1, a standard measure of lung function) at Week 12 (p less than 0.001), in comparison to placebo, both in combination with ICS/LABA. Additionally, the 200 mg and 300 mg Q2W doses of dupilumab in combination with ICS/LABA showed 68 percent and 62 percent reductions, respectively, in adjusted annualized rate of severe exacerbations in the LEos population (p less than 0.01 and p less than 0.05), in comparison to placebo in combination with ICS/LABA.
• These results are consistent with previously reported positive results in HEos asthma patients and the overall patient population, in which the two Q2W doses (200 mg and 300 mg) of dupilumab in combination with ICS/LABA demonstrated a statistically significant 12 to 15 percent improvement in FEV1 over placebo at Week 12 and a 64 to 75 percent improvement in annualized rate of severe exacerbations over placebo.
• Dupilumab also significantly reduced mean fractional exhaled nitric oxide (FeNO) across both Q2W doses tested (200 and 300 mg) and the three patient populations (overall, LEos and HEos), in a roughly dose-dependent manner. FeNO is recommended by the American Thoracic Society clinical practice guidelines to assess airway inflammation, since higher than normal levels of nitric oxide may be released when a patient has a chronic airway disease, such as asthma.
• The most common adverse event was injection site reaction, which was more frequent in the dupilumab dose groups (13 to 25 percent) compared to placebo (12 percent). Other common adverse events in the study included upper respiratory tract infection (10 to 13 percent dupilumab; 13 percent placebo), headache (5 to 10 percent dupilumab; 8 percent placebo), nasopharyngitis (3 to 10 percent dupilumab; 6 percent placebo) and bronchitis (5 to 8 percent dupilumab; 8 percent placebo). The incidence of infections was balanced across treatment groups (42 to 45 percent dupilumab; 46 percent placebo), as was the incidence of serious adverse events (3 to 7 percent dupilumab; 5 percent placebo).
• • On November 11, 2014, Regeneron Pharmaceuticals and Sanofi announced positive results from the interim analysis of a dose-ranging Phase 2b study of dupilumab in adult patients with uncontrolled moderate-to-severe asthma. In the study, the three highest doses of dupilumab in combination with standard-of-care therapy met the primary endpoint of a statistically significant improvement from baseline in forced expiratory volume over one second (FEV1, a standard measure of lung function) at Week 12 in patients with high blood eosinophils (greater than or equal to 300 cells/microliter), as compared to placebo in combination with standard-of-care therapy. In addition, two doses of dupilumab (200 mg every other week and 300 mg every other week) showed a statistically significant improvement in mean percent change in FEV1, as well as a reduction in severe exacerbations, in both the high eosinophils and overall study population.
• Key results included:
• In the high eosinophils patient group: Mean improvements from baseline in FEV1 (and mean percent change in FEV1) at 12 weeks, the primary (and a secondary) endpoint of the study were: 390ml (26 percent) dupilumab 300 mg every other week (Q2W); 430 ml (26 percent) dupilumab 200 mg Q2W; 180 ml (10 percent) placebo. (p less than 0.01)
• In the overall population: Mean improvements from baseline in FEV1 at 12 weeks (and mean percent change in FEV1) were: 280 ml (18 percent) dupilumab 300 mg Q2W; 310 ml (18 percent) dupilumab 200 mg Q2W; 120 ml (6 percent) placebo. (p less than 0.001)
• In both the high eosinophils patient group and overall patient group: Dupilumab showed a reduction in adjusted annualized rate of severe exacerbations compared to placebo (64 to 75 percent reduction, p less than 0.05 for high eosinophils group and p less than 0.01 for the overall population).
• These results were based on a pre-specified interim analysis, which occurred when all patients had reached Week 12 of the 24-week treatment period; the average treatment duration at the time of the analysis was 21.5 weeks. The final analyses on exacerbations and safety will occur at 24 weeks.

Is general: Yes