Novartis will soon be submitting a revised filing package, including new data analyses, for re-examination for conditional approval of RLX030 (serelaxin) for acute heart failure (AHF) from the Committee for Medicinal Products for Human Use (CHMP) following a negative opinion issued recently. In accordance with CHMP process a revised opinion could be granted in Q2 2014.

The file for regulatory approval is continuing review by the Food and Drug Administration (FDA) in the United States where RLX030 was granted Breakthrough Therapy designation status in June 2013. Reviews are also underway with health authorities in 16 countries around the world.

"With the results from RELAX-AHF showing significant mortality  benefits with RLX030 in patients with AHF and recognizing that there had been no treatment breakthroughs in this area for 20 years, Novartis took a decision to file for regulatory approval," said David Epstein, division head of Novartis Pharmaceuticals. "It has become apparent through the review process and in accordance with advice we've received that the current evidence package may be more compatible with an application for conditional approval in the EU. We look forward to providing a revised package for review to the CHMP shortly."

In September 2013 the second phase III study RELAX-AHF-2 started recruitment of the over 6000 patients who are expected to be enrolled. The goal is to replicate the key findings of RELAX-AHF and the study will assess cardiovascular mortality as the primary endpoint. This would be one of the largest and most robust programmes undertaken by a company for an AHF drug.

RLX030, a relaxin receptor agonist, is a form of a naturally occurring hormone (human relaxin 2) present in both men and women which rises in women during pregnancy to help the body cope with the additional cardiovascular demands. RLX030 is thought to have multiple effects including relaxing the blood vessels, reducing fluid buildup and protecting the heart and vital organs from the cascade of damage that occurs during an AHF episode. More than 1.5 million AHF episodes happen every year in Europe alone, with one in five patients not surviving a year afterwards.

RLX030 was studied in the phase III RELAX-AHF trial, which showed it had both short and longer-term effects, relieving symptoms and reducing the rate of heart failure worsening. In the trial patients who received RLX030 also had a 37 per cent reduction in mortality at six months after an AHF episode compared to those who received conventional treatment. Data from clinical trials has shown that RLX030 was generally well tolerated.

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