Regeneron Pharmaceuticals, Inc. and Sanofi announced that the Ministry of Health, Labor and Welfare (MHLW) in Japan has granted marketing and manufacturing authorization for Praluent (alirocumab) for the treatment of uncontrolled low-density lipoprotein (LDL) cholesterol, in certain adult patients with hypercholesterolemia at high cardiovascular risk.

Praluent is a human monoclonal antibody targeting PCSK9 (proprotein convertase subtilisin/kexin type 9). In Japan, Praluent is indicated for the treatment of patients with hypercholesterolemia and familial hypercholesterolemia (FH) who are at high cardiovascular risk and in whom treatment with statins (HMG-CoA reductase inhibitors) is not sufficient. Praluent 75 mg and 150 mg will be available in Japan as a single-dose pre-filled pen and syringe.

"Hypercholesterolemia is a significant concern in Japan, and many patients are not able to achieve their LDL cholesterol treatment goals despite current lipid-lowering therapy," said Jay Edelberg, MD, Ph.D., head of cardiovascular development, Sanofi. "For these patients, Praluent could be an important treatment option to help address their needs."

Data from the global phase 3 ODYSSEY trials showed consistent, robust reductions in LDL cholesterol for Praluent compared to placebo, when added to current standard-of-care, which included maximally-tolerated statins. The phase 3 ODYSSEY JAPAN trial evaluated the safety and efficacy of Praluent 75 mg starting dose every two weeks, in comparison with placebo in 216 Japanese patients with primary hypercholesterolemia and LDL cholesterol of at least 100 milligrams/deciliter (mg/dL) (at least 2.59 millimoles per liter [mmol/L]). All study patients were on ongoing statin treatment with or without other lipid-lowering therapies. Average baseline LDL cholesterol levels in the randomized population were similar between the Praluent (141 mg/dL / 3.6 mmol/L) and placebo groups (142 mg/dL / 3.7 mmol/L).  Patients in the Praluent group who did not achieve their pre-specified LDL cholesterol goals with Praluent 75 mg at week 8 (2 out of 140 patients who continued treatment beyond week 12) were increased to Praluent 150 mg every two weeks at week 12.

In the ODYSSEY JAPAN trial, Praluent reduced LDL cholesterol by 63 per cent at week 24 on top of stable background statin therapy, compared to a 2 per cent increase in the placebo group (p less than 0.0001, ITT analysis). Patients treated with Praluent maintained their LDL cholesterol reductions for the duration of the trial. By week 52, patients in the Praluent group achieved an average LDL cholesterol of 53.4 mg/dL (1.38 mmol/L) compared to an average LDL cholesterol of 135.6 mg/dL (3.51 mmol/L) in the placebo group (ITT population).

In the trial, Praluent was generally well-tolerated with an acceptable safety profile. Frequently reported adverse events included nasopharyngitis (46 per cent Praluent versus 36 per cent placebo); back pain (13 per cent Praluent versus 6 per cent placebo); and injection site reaction (13 per cent Praluent versus 4 per cent placebo).

"Results from the Japanese phase 3 trial were consistent with the findings from our global ODYSSEY programme that evaluated the efficacy and safety of Praluent in patients who required further reduction of their LDL cholesterol," said Bill Sasiela, Ph.D., VP, programme direction, Regeneron. "Notably, in the ODYSSEY JAPAN trial, 99 per cent of patients were able to effectively reach their LDL cholesterol goals as defined by the Japan Atherosclerosis Society with Praluent 75 mg Q2W and maintain these reductions for the duration of their therapy, up to 52 weeks."

In ODYSSEY JAPAN, LDL cholesterol goals were defined according to the "Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases 2012" published by the Japan Atherosclerosis Society (JAS) in which goals are set according to patients' risk of cardiovascular events. The JAS guidelines define the risk of cardiovascular events as high when the patient has a history of coronary artery disease, a history of ischemic stroke (other than cardiogenic cerebral infarction), peripheral artery disease, diabetes mellitus, and chronic kidney disease, or in the presence of several risk factors for atherosclerosis.

In Japanese phase 2 and 3 clinical trials, adverse events were observed in 17 per cent (33 of 193) of patients on Praluent 75 mg or 150 mg. The most common adverse event was injection site reactions in 22 cases (11.4 per cent).

Praluent is also approved in the United States, European Union, Canada and Mexico. The effect of Praluent on cardiovascular morbidity and mortality has not yet been determined.

Praluent inhibits the binding of PCSK9 to the LDL receptor and thereby increases the number of available LDL receptors on the surface of liver cells, which results in lower LDL cholesterol (so-called "bad" cholesterol) levels in the blood.

In July 2015, the companies announced that Praluent was approved for use in the US as adjunct to diet and maximally tolerated statin therapy for the treatment of adults with HeFH or clinical atherosclerotic cardiovascular disease, who require additional lowering of LDL cholesterol.

In September 2015, the European Commission approved the marketing authorization for Praluent. In the EU, Praluent is approved for the treatment of adult patients with primary hypercholesterolemia (HeFH and non-familial) or mixed dyslipidemia as an adjunct to diet: a) in combination with a statin, or statin with other lipid-lowering therapies in patients unable to reach their LDL cholesterol goals with the maximally-tolerated statin or b) alone or in combination with other lipid-lowering therapies for patients who are statin intolerant, or for whom a statin is contraindicated.

This medicinal product is subject to additional monitoring. This will allow quick identification of new safety information. Healthcare professionals are asked to report any suspected adverse reactions.