New analysis shows Novartis drug Gilenya® significantly reduced rate of brain volume loss across three large Phase III studies

New data presented at the 65th annual meeting of the American Academy of Neurology (AAN) show Gilenya® (fingolimod), the first oral disease modifying therapy approved to treat relapsing forms of multiple sclerosis (MS), significantly and consistently reduced the rate of brain volume loss. Results also showed that Gilenya reduced annualized relapse rates across important subgroups; and additional data reinforce Gilenya’s safety profile in patients treated up to four years.

“Loss of brain volume is a consequence of multiple sclerosis and is a key MRI correlate of disease progression,” said Dr. Timothy Wright, Global Head Development, Novartis Pharmaceuticals AG. “The findings reported show the effect of Gilenya across a variety of important disease measures and support evidence for initiating early use of this highly effective treatment in patients with relapsing MS.”

Data shows consistent reduction in rate of brain volume loss

In a new analysis of over 3,600 patients from three large Phase III studies (TRANSFORMS, FREEDOMS, and FREEDOMS II) Gilenya showed a significant reduction in the rate of brain volume loss vs. a comparator – consistent with previously reported results[1]. In the TRANSFORMS study over one year, Gilenya reduced the rate of brain volume loss by -32% (p<0.001) compared to Avonex® (interferon beta-1a IM), a commonly prescribed injectable treatment[1]. Over two years, Gilenya reduced the rate of brain volume loss compared to placebo by 35% (p<0.001) in the FREEDOMS study, and by 33% (p<0.001) in the FREEDOMS II study, respectively[1].

The data also showed that brain volume, at baseline, consistently correlated with the level of disease severity and disability. Lower brain volume was linked with more severe disease and disability, while higher brain volume correlated with less severe levels. In addition, traditional markers of disease activity (such as MRI lesion counts) at baseline were predictive of the rate of brain volume loss over two years.

New results highlight consistent efficacy and long-term safety profile

Separately, a recent subgroup analysis (n=1083) of FREEDOMS II, the third large Phase III Gilenya study, supports the known efficacy of Gilenya treatment. Specifically, results show Gilenya consistently reduced annualized relapse rates (ARR) compared to placebo in patients with relapsing-remitting MS, across gender, age, prior treatment, and baseline disease activity[2].

New extension data from FREEDOMS II (n=632) reinforce the known safety profile of Gilenya in patients treated up to four years[3]. More than eight out of ten patients (83%) completed the extension study, which identified no unexpected safety concerns[3].

Gilenya was approved based on the largest Phase III program in relapsing-remitting MS at the time of submission. With up to seven years of clinical trial experience (Phase II and III) and over two years of real-world use, there is increasing experience of Gilenya’s long-term effectiveness and safety profile in more than -56,000 patients worldwide[4].

About Gilenya

Gilenya is the first oral therapy approved to treat relapsing forms of MS and the first in a new class of compounds called sphingosine 1-phosphate receptor modulators[5],[6]. Gilenya is thought to act on inflammatory processes implicated in the MS disease process[5],[6].

Data has shown significant efficacy with Gilenya in reducing relapses and significant slowing of six-month disability progression sustained at four years[7]. Nearly half of Gilenya patients were disease-free after one year of treatment[8] and in the pivotal FREEDOMS study eight out of ten patients remained on treatment at two years[9]. Gilenya is the only treatment shown to consistently decrease brain volume loss, the best characterized magnetic resonance imaging (MRI) predictor of long-term disability.

Gilenya has demonstrated superior efficacy compared to Avonex® (interferon beta-1a IM), a commonly prescribed treatment, showing a 52% relative reduction in annualized relapse rate (primary endpoint) at one year in a pivotal head-to-head trial in patients with relapsing-remitting multiple sclerosis[10]. In a post hoc sub-group analysis, Gilenya showed a 61% relative reduction in annualized relapse rate compared to interferon-beta-1a (IM) at one year in subgroups of patients with highly active relapsing-remitting MS not responding to interferon treatment[11].

In clinical trials, Gilenya was generally well-tolerated with a manageable safety profile. The most common side effects were headache, liver enzyme elevations, influenza, diarrhea, back pain, and cough. Other Gilenya-related side effects included transient, generally asymptomatic, heart rate reduction and atrioventricular block upon treatment initiation, mild blood pressure increase, macular edema and mild bronchoconstriction[9],[10]. The rates of infections overall, including serious infections, were comparable among treatment groups, although a slight increase in lower respiratory tract infections (primarily bronchitis) was seen in patients treated with Gilenya. The number of malignancies reported across the clinical trial program was small, with comparable rates between the Gilenya and control groups[9],[10].

Gilenya is licensed from Mitsubishi Tanabe Pharma Corporation.

References:

1. Cohen J. et al. Fingolimod-effect on brain atrophy and clinical/MRI correlations in Three Phase 3 studies – TRANSFORMS, FREEDOMS and FREEDOMS II. Abstract Presented at AAN, San Diego, March 2013.
2. Goodin D. et al. Fingolimod reduces annualized relapse rates in patients with relapsing-remitting multiple sclerosis: FREEDOMS II study subgroup analysis. Abstract Presented at AAN, San Diego, March 2013.
3. Vollmer T. et al. Long-term safety of fingolimod in patients with relapsing-remitting multiple sclerosis: Results from phase 3 FREEDOMS extension study. Abstract Presented at AAN, San Diego, March 2013.
4. Novartis data on file.
5. Brinkmann V. FTY720 (fingolimod) in multiple sclerosis: therapeutic effects in the immune and the central nervous system. Br J Pharmacol 2009;158(5):1173-1182.
6. Chun J, Hartung HP. Mechanism of Action of Oral Fingolimod (FTY720) in Multiple Sclerosis. Clin Neuropharmacol. 2010 March-April;33(2):91-101.
7. Kappos L. et al. Phase 3 FREEDOMS study extension: fingolimod (FTY720) efficacy in patients with relapsing-remitting multiple sclerosis receiving continuous or placebo-fingolimod switched therapy for up to 4 years. Poster presented at: 28th Congress of the European Committee for Treatment and Research in Multiple Sclerosis; October 10-13, 2012: Lyon, France. Poster P979.
8. Khatri B. et al. Fingolimod treatment increases the proportion of patients who are free from disease activity in multiple sclerosis compared to interferon beta-1a: results from a phase 3 active controlled study (TRANSFORMS). Abstract presented at: 64th AAN Annual Meeting; April 21-28, 2012; New Orleans, LA. Abstract PD5:006.
9. Kappos L. et al; for FREEDOMS Study Group. A placebo-controlled trial of oral fingolimod in relapsing multiple sclerosis. N Engl J Med. 2010;362(5):387-401.
10. Cohen JA, Barkhof F, Comi G, et al; for TRANSFORMS Study Group. Oral fingolimod or intramuscular interferon for relapsing multiple sclerosis. N Engl J Med. 2010;362(5):402-415.
11. Havrdová E, et al. Clinical outcomes in subgroups of patients with highly active relapsing-remitting multiple sclerosis treated with Fingolimod (FTY720): Results from the FREEDOMS and TRANSFORMS phase III studies. Poster presented at ECTRIMS, Amsterdam, October 2011.

Avonex® is a registered trademark of Biogen Idec.