Biogen announced that the new research collected from more than 16,000 multiple sclerosis (MS) patients across Europe, in the largest study to capture the widespread impact of the disease, along with updated clinical findings from the company's broad portfolio of MS therapies will be presented at the 32nd congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) in London, 14-17 September 2016.
The Biogen-sponsored MS Cost of Illness (COI) study further builds on the highly influential and frequently cited 2005 European COI study, which examined the burden of MS on patients and their caregivers in Europe. Gisela Kobelt, PhD, president, European Health Economics, the author of both the 2005 research and the new study, will present the data during the congress and share insights in a workshop attended by patient groups and the study’s clinical advisors.
“We look forward to hearing from the patient community in our upcoming ECTRIMS workshop on the burden of illness in MS. We encourage an open discussion about how the community can apply the main findings of the study to engage and educate researchers, governments, and policy makers around the issues most critical to patients, and, ultimately, identify new ways to improve outcomes in the treatment of MS,” said Ralph Kern, M.D., senior vice president, Worldwide Medical, Biogen.
Additional data to be presented at ECTRIMS will highlight Biogen’s industry-leading portfolio including Tecfidera (dimethyl fumarate), the world’s most-prescribed oral MS treatment, and Zinbryta (daclizumab), a new once-monthly, self-administered, subcutaneous treatment recently approved in the United States and the European Union: Real-world data and new clinical evidence that demonstrate Tecfidera consistently delivers strong, sustained efficacy in reducing disease activity among newly diagnosed and previously treated patients with relapsing-remitting multiple sclerosis (RRMS). Additional data affirm Tecfidera’s well-characterized safety profile in patients who have had up to nine years of treatment; A new analysis from the pivotal DECIDE study that further supports the positive impact of Zinbryta on no evidence of disease activity (NEDA), and the first interim results from the ongoing EXTEND study, providing up to five years of efficacy and safety data; Detailed results evaluating opicinumab (anti-LINGO-1) in people with relapsing forms of MS from the phase 2 SYNERGY study, the largest study investigating remyelination conducted to date.
Tecfidera is an oral therapy for relapsing forms of MS, including relapsing-remitting MS, the most common form of MS. Tecfidera is currently approved in 24 countries including United States, the European Union, Canada, Australia and Switzerland. Through a robust clinical trial programme and commercial launches starting with the United States in March 2013, more than 215,000 patients have been treated with Tecfidera worldwide.
Tecfidera has been proven to reduce the rate of MS relapses, slow the progression of disability, and the number of MS brain lesions, while demonstrating a favorable benefit-risk profile in a broad range of patients with relapsing forms of MS. In clinical trials, the most common adverse events associated with Tecfidera were flushing and gastrointestinal (GI) events. Other side effects included a decrease in mean lymphocyte counts during the first year of treatment, which then plateaued. Tecfidera is contraindicated in patients with a known hypersensitivity to dimethyl fumarate or any of the excipients of Tecfidera. Rare cases of PML have been seen with Tecfidera patients in the setting of prolonged moderate to severe lymphopenia.
The efficacy and safety of Tecfidera have been studied in a large, global clinical programme, which includes an ongoing long-term extension study. It is believed that Tecfidera treats MS by activating the Nrf2 pathway, although its exact mechanism of action is unknown. This pathway provides a way for cells in the body to defend themselves against inflammation and oxidative stress caused by conditions like MS.
Tysabri is a disease modifying therapy (DMT) approved in more than 80 countries including the United States, the European Union, Canada, Australia and Switzerland. In the United States, Tysabri is indicated as monotherapy for the treatment of patients with relapsing forms of multiple sclerosis (MS). In the European Union, it is indicated as a single DMT in highly active relapsing-remitting MS (RRMS) for adult patients who have high disease activity despite treatment with a beta interferon or glatiramer acetate or patients with rapidly evolving severe RRMS. Tysabri is proven effective, with 10 years of experience in treating RRMS, and more than 149,000 people treated worldwide and 475,000 patient-years of experience.
Tysabri is a monoclonal antibody that selectively binds to a4-integrin and is thought to interrupt the activity of inflammatory cells in MS patients by blocking the interaction between a4ß1-integrin and vascular cell adhesion molecule-1. Disruption of these molecular interactions prevents transmigration of leukocytes across the endothelium into inflamed parenchymal tissue. The specific mechanism(s) by which Tysabri exerts its effects in MS have not been fully defined.
Tysabri has advanced the treatment of MS patients with its proven ability to slow the progression of disability, reduce relapse rates, and impact the number of MRI brain lesions with a well-characterized safety profile. Data from the phase 3 AFFIRM trial, which was published in the New England Journal of Medicine, showed that at two years, Tysabri treatment led to a 68 percent relative reduction (p<0.001) in the annualized relapse rate when compared with placebo and reduced the relative risk of disability progression by 42 to 54 per cent (12-24-week sustained respectively, both p<0.001).
Tysabri increases the risk of progressive multifocal leukoencephalopathy (PML), a rare opportunistic viral infection of the brain which has been associated with death or severe disability. Risk factors that increase the risk of PML are presence of anti-JCV antibodies, prior immunosuppressant use, and longer Tysabri treatment duration. Patients who have all three risk factors have the highest risk of developing PML. Tysabri increases the risk of developing encephalitis and meningitis caused by herpes simplex and varicella zoster viruses and clinically significant liver injury has also been reported in the post-marketing setting. Serious, life-threatening, and sometimes fatal cases have been reported in the postmarketing setting in MS patients receiving Tysabri. Other serious adverse events that have occurred in Tysabri-treated patients include hypersensitivity reactions (e.g., anaphylaxis) and infections, including opportunistic and other atypical infections. Clinically significant liver injury has also been reported in the post-marketing setting.
Plegridy is a subcutaneous pegylated interferon dosed once every two weeks for relapsing forms of MS, including relapsing-remitting MS, the most common form of MS. Plegridy is currently approved in the United States, the European Union, Canada, Australia, and Switzerland. Biogen continues to work toward making Plegridy available in additional countries across the globe.
The efficacy and safety of Plegridy is supported by one of the largest pivotal studies with interferons conducted in people living with RRMS. In clinical studies, Plegridy has been proven to significantly reduce the rate of MS relapses, slow the progression of disability, and reduce the number of MS brain lesions while demonstrating a favorable safety profile for patients with relapsing forms of MS. In clinical trials, the most common adverse events associated with Plegridy were injection site reactions and flu-like symptoms. Other side effects reported include liver problems, including liver failure and increases in liver enzymes; depression or suicidal thoughts; serious allergic reactions; cardiac problems, including congestive heart failure; autoimmune disorders; decreases in white blood cell or platelet counts; and seizures. A list of adverse events can be found in the full Plegridy product labeling for each country where it is approved.
It is believed that Plegridy modulates immune responses that are thought to play a role in MS although its exact mechanism of action is unknown.
Zinbryta is approved for the treatment of relapsing forms of multiple sclerosis (RMS) in the United States and the European Union. The recommended dosage of Zinbryta is 150 mg, self-administered subcutaneously on a monthly basis. Zinbryta is currently under regulatory review in Switzerland, Canada and Australia.
In clinical trials, Zinbryta demonstrated superior efficacy in reducing relapses and MRI lesions, compared to Avonex (interferon beta-1a) intramuscular injection and placebo.
Zinbryta is a humanized IgG1 monoclonal antibody that selectively binds to the high-affinity interleukin-2 (IL-2) receptor subunit (CD25). CD25 is expressed at high levels on T-cells that become activated in people with MS.
Zinbryta increases the risk of severe hepatic (liver) injury. It also increases the risk of immune-mediated events including lymphadenopathy (enlargement of the lymph nodes), cutaneous (skin) reactions and non-infectious colitis, acute hypersensitivity (allergic reactions), infections, depression and decreased lymphocyte (type of white blood cell) counts.
The most common adverse reactions that occurred in Zinbryta-treated patients were nasopharyngitis (inflammation of the nose and a part of the throat), upper respiratory tract infection, rash, influenza, dermatitis, oropharyngeal (part of the throat) pain, bronchitis, eczema, lymphadenopathy, pharyngitis (inflammation of part of the throat) and increased alanine aminotransferase (ALT; a type of liver enzyme).
Zinbryta is only available through a Risk Evaluation and Mitigation Strategy (REMS) Program in the US, and is under a Risk Management Plan (RMP) in the EU.
AbbVie and Biogen are co-promoting Zinbryta in the US. Biogen is responsible for commercialization in Canada, the EU and the rest of the world.
Fampyra is a prolonged-release (sustained release) tablet formulation of the drug fampridine (4-aminopyridine, 4-AP or dalfampridine). Fampyra is indicated in the European Union for the improvement of walking in adult patients with multiple sclerosis (MS) with walking disability (EDSS 4-7). In clinical trials, the highest incidence of adverse reactions identified with Fampyra given at the recommended dose was urinary tract infection, although infection was often not proven by culture. Other adverse drug reactions identified were mainly divided between neurological disorders, such as insomnia, balance disorder, dizziness, paraesthesia, headache and gastrointestinal disorders including nausea, dyspepsia and constipation. In post-marketing experience, there have been reports of seizure. Confounding factors may have contributed to the occurrence of seizure in some patients. This prolonged-release formulation was developed and is being commercialized in the United States by Acorda Therapeutics, Inc. under the trade name Ampyra (dalfampridine) Extended Release Tablets, 10 mg. Biogen licensed rights from Acorda to develop and commercialize fampridine in all markets outside the United States.
Opicinumab (anti-LINGO-1) is a fully human monoclonal antibody being investigated as a potential neuroreparative therapy in people with relapsing forms of multiple sclerosis (RMS). Opicinumab targets LINGO-1, a protein expressed selectively in the central nervous system (CNS) that is known to play a central role in regulating axonal myelination and regeneration.
Two global Phase 2 trials, RENEW and SYNERGY, were designed to assess the biological activity and clinical potential of opicinumab in acute optic neuritis (AON) and relapsing forms of MS, respectively. In RENEW, opicinumab was evaluated in patients following a first episode of AON. Opicinumab demonstrated an improvement in recovery of optic nerve latency (time for a signal to travel from the retina to the visual cortex) relative to placebo. RENEW was the first clinical study to provide evidence of biological repair in the CNS by facilitating remyelination following an acute inflammatory injury.
SYNERGY was a separate phase 2 study aiming to measure the impact of opicinumab in combination with an anti-inflammatory therapy on improving and slowing disease progression among participants with relapsing forms of MS (both relapsing-remitting MS and secondary-progressive MS). In the study, opicinumab missed the primary endpoint, a multicomponent measure evaluating improvement of physical function, cognitive function, and disability. Further study of the inverted U-shaped response seen in SYNERGY suggested a clinical effect of opicinumab.