Otsuka Pharmaceutical Co., Ltd.,a global healthcare company, announced that the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA) has recommended Jinarc (tolvaptan) for approval. This treatment has been recommended to slow the progression of cyst development and renal insufficiency of autosomal dominant polycystic kidney disease (ADPKD) in adults with chronic kidney disease (CKD) stage 1 to 3 at initiation of treatment with evidence of rapidly progressing disease.
Tolvaptan was developed over a period of 26 years through the persevering efforts of researchers in Otsuka’s Japanese pharmaceutical research centre. Upon discovering a cell signaling pathway that causes renal cysts to proliferate and enlarge, Otsuka launched an effort in 2004 to develop a drug for the disease in conjunction with the world’s leading ADPKD medical specialists.
The CHMP recommendation is based on data from the largest clinical study conducted in ADPKD to date – the pivotal Phase III randomised, double-blind and placebo-controlled TEMPO 3:4 trial. In the three-year trial, tolvaptan achieved its primary endpoint, demonstrating a statistically significant reduction of almost half (49%) in the annual increase in total kidney volume versus placebo (p<0.001). Furthermore, the study showed tolvaptan significantly reduced the decline in kidney function by 30% versus placebo (p<0.001). The overall incidence of side effects observed in ADPKD patients administered tolvaptan in the TEMPO 3:4 trial was comparable with those administered a placebo.
On 5 August 2013, tolvaptan was granted orphan drug designation for the treatment of ADPKD by the European Commission.2 Tolvaptan’s orphan designation highlights the EMA’s recognition of ADPKD as a rare, life-threatening and chronically debilitating condition for which there is currently no specific treatment.
“This recommendation brings us one step closer to providing to patients in Europe the first-in-the-world, disease-modifying treatment for ADPKD, a progressive and chronic genetic disease,” said Ole Vahlgren, CEO & President, Otsuka Europe. “Otsuka strives to develop medicines that address genuine unmet medical need and we look forward to the final decision of the European Commission.”
ADPKD is the most common inherited kidney disease and is primarily characterised by the development and expansion of multiple fluid-filled cysts in the kidney. Cyst growth and expansion in both kidneys leads to slow deterioration of kidney function, and approximately half of patients reach end-stage renal disease (ESRD) and require renal replacement therapy in the form of dialysis or a kidney transplant by age 54. ADPKD is the fourth leading cause of ESRD in adults and accounts for around 10% of patients with ESRD requiring renal replacement therapy.
The European Commission (EC) reviews the recommendations of the CHMP but is not obliged to grant marketing authorisation following a recommendation for approval. A final EC decision is expected during the second quarter of 2015.
The TEMPO 3:4 trial (Tolvaptan Efficacy and Safety in Management of Autosomal Dominant Polycystic Kidney Disease and its Outcomes) enrolled patients across 129 sites worldwide. In this trial a total of 1,445 adult patients (age 18-50 years) with evidence of rapidly-progressing early ADPKD were enrolled between January 2007 and January 2009 and administered tolvaptan or a placebo for up to three years.
In the TEMPO 3:4 trial the risk of liver injury was identified in patients with ADPKD taking tolvaptan. Whilst this risk is small (4% in the trial), patients taking tolvaptan will have to undergo monthly blood tests for the first 18 months of treatment with tolvaptan and 3-monthly thereafter to mitigate this risk.