Biogen Idec and Swedish Orphan Biovitrum (Sobi, an international healthcare company, have reported positive results from A-LONG, a clinical study that evaluated a new long-lasting clotting factor candidate in people with hemophilia A. Hemophilia A is a rare inherited disorder that impairs blood coagulation.
Top-line results from A-LONG, a global, multi-centre, phase III clinical study of the companies’ long-lasting recombinant Factor VIII Fc fusion protein (rFVIIIFc), showed that rFVIIIFc was effective in the control and prevention of bleeding, routine prophylaxis and perioperative management. Recombinant FVIIIFc was generally well-tolerated. Additional analyses of the A-LONG study are ongoing, and the companies anticipate presenting detailed results at a future scientific meeting.
Biogen Idec plans to submit a Biologics License Application (BLA) to the US Food and Drug Administration (FDA) in the first half of 2013. Consistent with guidelines published by the European Medicines Agency (EMA) that require a study in children less than 12 years of age prior to filing, Biogen Idec and Sobi expect to file a Marketing Authorization Application with the EMA upon completion of the ongoing Kids A-LONG study.
“These top-line results demonstrated that rFVIIIFc has the potential to enhance the care of people living with hemophilia A by offering protection from bleeding with reduced treatment burden,” said Glenn Pierce, MD, PhD., senior vice president of Global Medical Affairs and chief medical officer of Biogen Idec’s hemophilia therapeutic area. “We share the enthusiasm of the hemophilia community including the study participants and clinical investigators who supported the rapid enrollment of the A-LONG study. We are diligently working to prepare our regulatory submission with the goal of providing rFVIIIFc to people with hemophilia A as soon as possible.”
“We are very encouraged by the positive A-LONG study results, which support the application of Fc fusion technology in hemophilia A to prolong factor activity and potentially offer extended protection from bleeding,” said Geoffrey McDonough, MD, chief executive officer of Sobi. “The A-LONG findings, coupled with recently announced results from the B-LONG study of our companies’ long-lasting recombinant Factor IX Fc fusion product candidate for hemophilia B, represent a major step forward for the hemophilia community.”
In the A-LONG study, 165 male patients aged 12 years and older were enrolled. The A-LONG study had three treatment arms: individualized prophylaxis, weekly prophylaxis and episodic (on-demand) treatment (Arms 1, 2 and 3, respectively). In a subgroup of patients across treatment arms, rFVIIIFc was evaluated in the perioperative management of patients who required a major surgical procedure during the study.
Overall, 93 per cent of patients completed the study. Recombinant FVIIIFc was generally well-tolerated. No inhibitors to rFVIIIFc were detected and no cases of anaphylaxis were reported in any patients, all of whom switched from commercially-available Factor VIII products. No serious adverse events were assessed to be related to drug by the investigator. The most common adverse events (incidence of =5 percent) occurring outside of the perioperative management period were nasopharyngitis, arthralgia, headache and upper respiratory tract infection.
The median annualized bleeding rates (ABR), including spontaneous and traumatic bleeds, were 1.6 in the individualized prophylaxis arm, 3.6 in the weekly prophylaxis arm and 33.6 in the episodic treatment arm. In the individualized prophylaxis arm, the median dosing interval was 3.5 days. During the last three months on study, 30 per cent of patients in the individualized prophylaxis arm achieved a mean dosing interval of five days.
Control of bleeding was assessed in all patients who experienced a bleeding episode during the study. Overall, 98 per cent of bleeding episodes were controlled by one or two injections of rFVIIIFc.
In addition, rFVIIIFc was assessed in the perioperative management of nine patients undergoing nine major surgical procedures. The treating physicians rated the hemostatic efficacy of rFVIIIFc as excellent or good in 100 per cent of these surgeries.
A-LONG included pharmacokinetic (PK) analysis of rFVIIIFc in all patients in the study. In a protocol-defined subset of patients with extensive PK sampling, the approximate terminal half-life of rFVIIIFc was 19.0 hours compared to 12.4 hours for Advate [antihemophilic factor (recombinant), plasma/albumin-free method], consistent with the results obtained in the phase I/IIa study of rFVIIIFc.
Recombinant FVIIIFc is a clotting factor developed using Biogen Idec's novel and proprietary monomeric Fc fusion technology, which makes use of a natural pathway to recycle rFVIIIFc in circulation and enable it to remain in the body longer. With this technology, rFVIIIFc is designed to provide long-lasting protection from bleeding and reduce the treatment burden associated with hemophilia A, which currently requires up to 180 injections annually for prophylaxis with commercially-available Factor VIII products. Fc fusion technology is used in seven FDA-approved products for the long-term treatment of chronic diseases including rheumatoid arthritis, psoriasis and platelet disorders.
Using the same Fc fusion technology, Biogen Idec and Sobi are also developing a long-lasting recombinant Factor IX Fc fusion protein (rFIXFc) for the control and prevention of bleeding episodes and routine prophylaxis in hemophilia B. On September 26, the companies announced top-line results from B-LONG, a global pivotal phase III clinical study of rFIXFc in patients with hemophilia B.
Biogen Idec and Sobi are partners in the development and commercialization of rFIXFc and rFVIIIFc. Biogen Idec leads development, has manufacturing rights, and has commercialization rights in North America and all other regions excluding the Sobi territory. Sobi has the right to opt in to assume final development and commercialization in Europe, Russia, the Middle East and Northern Africa.
Biogen Idec discovers, develops and delivers to patients worldwide innovative therapies for the treatment of neurodegenerative diseases, hemophilia and autoimmune disorders. Founded in 1978, Biogen Idec is the world's oldest independent biotechnology company.
Sobi is an international healthcare company dedicated to bringing innovative therapies and services to improve the lives of rare disease patients.