Novartis announced positive results of two pivotal phase III trials in patients with severe gouty arthritis, showing that ACZ885 (canakinumab) provided superior pain relief and reduced the risk of new attacks by up to 68% compared to an injectable steroid (triamcinolone acetonide, TA) used to treat gouty arthritis attacks. ACZ885 is an investigational, fully human monoclonal antibody.

The studies involved more than 450 gouty arthritis patients for whom the standard anti-inflammatory therapies, Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) or colchicine, were inadequate or inappropriate. Results will be presented for the first time at the 2011 European League Against Rheumatism (EULAR) Congress in London.

“These findings show that ACZ885 may represent an important advance in the treatment of gouty arthritis in sufferers whose disease cannot be appropriately managed with currently available treatments,” said Professor Alexander So, Rheumatology Department, CHUV, Lausanne, Switzerland, and one of the studies' investigators. “Scientists only recently learned that the root cause of the pain in gouty arthritis is interleukin-1 beta. Through specifically targeting interleukin-1 beta, these studies show ACZ885 can effectively treat painful attacks while extending the time to new attacks.”

Both trials used an internationally recognized pain scale to measure differences in pain 72 hours after treatment, and found ACZ885 reduced pain by an additional -11.4 millimeters (mm) (p=0.0005) in one study and -9.8 mm in the other (p=0.0018), compared to TA. ACZ885 also significantly reduced the risk of suffering a new gouty arthritis attack within three months, by 55% in one study (p=0.0014) and 68% in the other (p<0.0001), compared to TA.

Gouty arthritis, commonly referred to as gout, is a serious, chronic and progressive inflammatory disease that affects 1-4% of adults. In the UK, an estimated 1.4% of the population suffers from gouty arthritis, while in the US, 3.9% of the population has the condition. Gouty arthritis is the most common form of inflammatory arthritis in adults, with a prevalence comparatively higher than rheumatoid arthritis, which is estimated to affect 0.5-1% of adults.

“We are very excited about these results, which indicate that ACZ885 may become a significant new alternative for gouty arthritis patients where many standard anti-inflammatory treatments are inadequate or inappropriate,” said David Epstein, Head of the Pharmaceuticals Division of Novartis. “Novartis is committed to meeting this unmet medical need and to further investigating the potential of ACZ885 in a number of other conditions where interleukin-1 beta may play a role.”

Gouty arthritis attacks occur when the body has a strong inflammatory response to uric acid crystals forming in the affected joint, typically of the toe, foot, ankle or knee. This intense inflammatory response causes the severe pain associated with gouty arthritis attacks, which can last for a week or more. Gouty arthritis may also result in chronic disability and joint destruction.

Treatments currently available to manage the pain and inflammation of gouty arthritis attacks, such as NSAIDs or colchicine, may be inadequate or inappropriate in patients who have coexisting medical problems. This poses a significant unmet treatment need in gouty arthritis. New data presented at EULAR today indicates nearly 90% of gouty arthritis patients in the EU and the US have at least one coexisting disease, a portion of whom may be unable to take these standard anti-inflammatory therapies.

Regulatory filings for the use of ACZ885 in gouty arthritis patients with limited treatment options were submitted in the EU in 2010 and in the US, Canada and Switzerland in the first quarter of 2011.

The two studies were phase III, 12-week, randomized, multi-centre, double-blind, double dummy, active-controlled studies involving 228 and 226 patients who met the American College of Rheumatology (ACR) criteria for acute gouty arthritis. Patients had suffered from three or more gouty arthritis attacks in the previous 12 months and were either unresponsive or intolerant to common therapies such as NSAIDs or colchicine, or these treatments were contraindicated. Patients were randomized to receive a single dose of ACZ885 150 milligrams (mg) via subcutaneous (s.c.) injection or TA 40 mg via intramuscular (i.m.) injection. In the case of a new attack, patients received a new dose of the same treatment they were randomized to at baseline.

Both studies had the same two primary endpoints: pain intensity at 72 hours post-dose; and time to the first new gouty arthritis attack. Pain in the affected joint was measured according to an internationally recognized pain scale, the Visual Analogue Scale (VAS).

In one study, patients treated with ACZ885 had significantly lower mean pain scores from baseline compared to TA, pain intensity at 72 hrs was 28.1 mm for ACZ885 and 39.5 mm for TA (p=0.0005). Similarly, patients in the other study receiving ACZ885 had significantly lower mean pain scores from baseline compared to TA, pain intensity at 72 hrs was 22.1 mm for ACZ885 and 31.9 mm for TA (p=0.0018). In both studies, the respective decreases of 46 and 53 mm from baseline with ACZ885 exceeded those of 35 and 43 mm seen with TA.

The number of patients with new attacks across both studies was also significantly reduced with ACZ885 compared to TA. In the first study, nearly twice as many patients experienced a new gouty arthritis attack in the TA group compared to ACZ885 (40 vs. 21 patients respectively [p=0.0061]). In addition, in the second study nearly three times as many patients in the TA group experienced a new attack compared to ACZ885 (42 vs. 15 patients respectively [p=0.0001]). In the previous year, patients in both studies suffered an average of at least six attacks (6.5 for ACZ885 and seven for TA in study one; and 6.5 and 5.9 respectively in study two).

ACZ885 was generally well tolerated in the two studies. In one study, 55.8% of patients had Adverse Events (AEs) with ACZ885 vs. 38.3% with TA. In the other study, 54.5% of patients had AEs with ACZ885 vs. 50.9% with TA[22]. Serious Adverse Events (SAEs), 10 for ACZ885 vs. five for TA in one study and three for ACZ885 vs. one for TA in the other study, were not considered to be related to study medication by the investigators.

ACZ885 is a fully human monoclonal antibody that provides selective inhibition of interleukin-1 beta (IL-1 beta), which is part of the body's immune system defenses. Excessive production of IL-1 beta plays a major role in many inflammatory diseases, including gouty arthritis. ACZ885 works by neutralizing IL-1 beta for a sustained period of time, therefore inhibiting inflammation.

Under the brand name Ilaris, ACZ885 is approved in more than 45 countries, including the EU, US and Switzerland for the treatment of adults and children as young as four with Cryopyrin-Associated Periodic Syndromes (CAPS), a rare, lifelong, inflammatory disorder with debilitating symptoms. ACZ885 is also being studied in other diseases in which IL-1 beta plays a key role in causing inflammation, such as Systemic Juvenile Idiopathic Arthritis (SJIA), cardiovascular disease and diabetes. Not all potential patients with these diseases would be eligible for treatment with ACZ885, if approved.

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