New Data Reinforce Improved and Durable Clinical Responses of Orencia in Moderate-to-Severe Early Rheumatoid Arthritis Patients with Autoantibodies Linked to More Severe Disease
Findings from open-label switch period of Early AMPLE study show that high efficacy responses observed at week 24 with Orencia were sustained through week 48 in early rheumatoid arthritis patients testing positive (seropositive) for certain autoantibodies
Seropositive patients switching from adalimumab to Orencia showed trend toward higher efficacy at week 48
Early AMPLE poster presentation is one of 27
The Early AMPLE study included early (≤ 12 months from symptom onset) moderate-to-severe RA patients who had never been treated with a biologic medication and who were seropositive for autoantibodies called anti-citrullinated protein antibody (ACPA) and rheumatoid factor (RF). These patients are considered to have more highly active, progressive RA and a poor disease prognosis.
Findings showed that among the 76 seropositive RA patients who entered the open-label switch period:
- The efficacy responses observed at 24 weeks with Orencia were sustained at week 48 in the patients who continued on Orencia. At week 48, ACR 20/50/70 responses with Orencia in the non-switch arm were 78, 63 and 50, respectively. At week 24, ACR 20/50/70 responses with Orencia were 83, 73 and 50, respectively; ACR 20/50/70 scores for adalimumab at week 24 were 63, 45 and 30, respectively.
- In the patients who switched from adalimumab to Orencia, while the trial was not powered to show superiority or non-inferiority, the efficacy responses generally increased over the open-label period through week 48. ACR 20/50/70 scores for patients who switched from adalimumab to Orencia were 75, 63 and 38, respectively, at week 48.
- Overall, patients with a well-known genetic marker of RA prognosis, called the “Shared Epitope” (SE), who continued on Orencia achieved numerically higher responses than the broader seropositive patient population at week 48, indicating the potential importance of SE as a predictor of response to Orencia. ACR 20/50/70 responses were 77, 67 and 53, respectively, for SE+ patients continuing on Orencia.
- The overall safety profile of Orencia was consistent with prior studies, with no new safety signals identified.
The HLA-DRB1 allele, which codes for the Shared Epitope, provides instructions for making a protein that plays a key role in helping the immune system distinguish one’s own proteins from those of harmful invaders, such as bacteria and viruses. Shared Epitope has been shown to be strongly associated with RA, and is thought to be involved with the overactivation of immune cells, called T cells, that characterizes RA. Shared Epitope is present in 70-80 percent of RA patients positive for ACPA.
“We know that RA patients who are seropositive for anti-citrullinated protein antibodies and/or carry the Shared Epitope genotype are likely to have a more severe disease course and experience worse outcomes,” said
Following the encouraging results of this study,
“These data further support Orencia as a first-line treatment option for patients with key biomarkers of RA, showing that the high levels of response achieved by patients with a more severe disease course may be maintained over a long-term period,” said Dr.
About the Early AMPLE Study
Early AMPLE, a Phase IV randomized, head-to-head, single-blinded study of 24 weeks duration with multiple exploratory endpoints (changes to autoantibody levels, changes to cytokines, changes to percentages of immune cell subsets and changes to activation states of immune cell subsets), compared the efficacy of the subcutaneous (SC) formulation of Orencia versus adalimumab on a background of methotrexate (MTX) in adult, biologic-naïve patients with moderate-to-severe RA.
In this prospective analysis, adults with early (≤ 12 months from symptom onset), moderate-to-severe RA (ACR/
Eighty patients were treated through 24 weeks: 40 Orencia (9 SE−, 30 SE+, 1 SE unknown) and 40 adalimumab (9 SE−, 31 SE+). All 40 Orencia-treated patients and 36/40 adalimumab-treated patients entered the open-label Orencia period. Three patients (2 lost to follow up and 1 for “other” reason) and one patient, respectively, discontinued from the two arms during the open-label period. Baseline characteristics were balanced. Mean (SD) RA duration was 5.5 (2.6) months.
About Rheumatoid Arthritis
Rheumatoid arthritis (RA) is a destructive immune-mediated disease characterized by inflammation in the lining of joints (or synovium), causing joint damage with chronic pain, stiffness and swelling. RA causes limited range of motion and decreased joint function. The condition is more common in women than in men, who account for 75 percent of patients diagnosed with RA.
ORENCIA® is an immunomodulator that disrupts the continuous cycle of T-cell activation that characterizes RA.
Indication and Usage
Adult Rheumatoid Arthritis (RA): ORENCIA® (abatacept) is indicated for reducing signs and symptoms, inducing major clinical response, inhibiting the progression of structural damage, and improving physical function in adult patients with moderately to severely active RA. ORENCIA may be used as monotherapy or concomitantly with disease-modifying, anti-rheumatic drugs (DMARDs) other than tumor necrosis factor (TNF) antagonists.
Juvenile Idiopathic Arthritis (JIA): ORENCIA® (abatacept) is indicated for reducing signs and symptoms in patients 2 years of age and older with moderately to severely active polyarticular JIA. ORENCIA may be used as monotherapy or concomitantly with methotrexate (MTX).
Adult Psoriatic Arthritis (PsA): ORENCIA® (abatacept) is indicated for the treatment of adult patients with active PsA.
Important Limitations of Use: ORENCIA should not be administered concomitantly with TNF antagonists, and is not recommended for use concomitantly with other biologic RA therapy, such as anakinra.
Important Safety Information for ORENCIA® (abatacept)
Concomitant Use with TNF Antagonists: Concurrent therapy with ORENCIA and a TNF antagonist is not recommended. In controlled clinical trials, adult RA patients receiving concomitant intravenous ORENCIA and TNF antagonist therapy experienced more infections (63%) and serious infections (4.4%) compared to patients treated with only TNF antagonists (43% and 0.8%, respectively), without an important enhancement of efficacy.
Hypersensitivity: Anaphylaxis or anaphylactoid reactions can occur during or after an infusion and can be life-threatening. There were 2 cases (<0.1%; n=2688) of anaphylaxis or anaphylactoid reactions in clinical trials with adult RA patients treated with intravenous ORENCIA. Other reactions potentially associated with drug hypersensitivity, such as hypotension, urticaria, and dyspnea, each occurred in <0.9% of patients. There was one case of a hypersensitivity reaction with ORENCIA in JIA clinical trials (0.5%; n=190). In postmarketing experience, a case of fatal anaphylaxis following the first infusion of ORENCIA was reported. Appropriate medical support measures for treating hypersensitivity reactions should be available for immediate use. If an anaphylactic or other serious allergic reaction occurs, administration of ORENCIA should be stopped immediately and permanently discontinued, with appropriate therapy instituted.
Infections: Serious infections, including sepsis and pneumonia, have been reported in patients receiving ORENCIA. Some of these infections have been fatal. Many of the serious infections have occurred in patients on concomitant immunosuppressive therapy which, in addition to their underlying disease, could further predispose them to infection. Caution should be exercised in patients with a history of infection or underlying conditions which may predispose them to infections. Treatment with ORENCIA should be discontinued if a patient develops a serious infection. Patients should be screened for tuberculosis and viral hepatitis in accordance with published guidelines, and if positive, treated according to standard medical practice prior to therapy with ORENCIA.
Immunizations: Live vaccines should not be given concurrently with ORENCIA or within 3 months of its discontinuation. The efficacy of vaccination in patients receiving ORENCIA is not known. ORENCIA may blunt the effectiveness of some immunizations. It is recommended that JIA patients be brought up to date with all immunizations in agreement with current immunization guidelines prior to initiating therapy with ORENCIA.
Use in Patients with Chronic Obstructive Pulmonary Disease (COPD): Adult COPD patients treated with ORENCIA developed adverse events more frequently than those treated with placebo, including COPD exacerbations, cough, rhonchi, and dyspnea. In adult RA studies, 97% of COPD patients treated with ORENCIA developed adverse reactions versus 88% treated with placebo and respiratory disorders occurred more frequently in patients treated with ORENCIA compared to those on placebo (43% vs 24%, respectively), including COPD exacerbation, cough, rhonchi, and dyspnea. A greater percentage of adult RA patients treated with ORENCIA developed a serious adverse event compared to those on placebo (27% vs 6%), including COPD exacerbation [3 of 37 patients (8%)] and pneumonia [1 of 37 patients (3%)]. Use of ORENCIA in patients with RA and COPD should be undertaken with caution, and such patients monitored for worsening of their respiratory status.
Blood Glucose Testing: ORENCIA for intravenous administration contains maltose, which may result in falsely elevated blood glucose readings on the day of infusion when using blood glucose monitors with test strips utilizing glucose dehydrogenase pyrroloquinoline quinone (GDH-PQQ). Consider using monitors and advising patients to use monitors that do not react with maltose, such as those based on glucose dehydrogenase nicotine adenine dinucleotide (GDH-NAD), glucose oxidase or glucose hexokinase test methods. ORENCIA for subcutaneous (SC) administration does not contain maltose; therefore, patients do not need to alter their glucose monitoring.
Pregnancy: There are no adequate and well-controlled studies of ORENCIA use in pregnant women and the data with ORENCIA use in pregnant women are insufficient to inform on drug-associated risk. A pregnancy registry has been established to monitor pregnancy outcomes in women exposed to ORENCIA during pregnancy. Healthcare professionals are encouraged to register patients by calling 1-877-311-8972.
Lactation: There is no information regarding the presence of abatacept in human milk, the effects on the breastfed infant, or the effects on milk production. However, abatacept was present in the milk of lactating rats dosed with abatacept.
Most Serious Adverse Reactions: Serious infections (3% ORENCIA vs 1.9% placebo) and malignancies (1.3% ORENCIA vs 1.1% placebo).
Malignancies: The overall frequency of malignancies was similar between adult RA patients treated with ORENCIA or placebo. However, more cases of lung cancer were observed in RA patients treated with ORENCIA (0.2%) than those on placebo (0%). A higher rate of lymphoma was seen compared to the general population; however, patients with RA, particularly those with highly active disease, are at a higher risk for the development of lymphoma. The potential role of ORENCIA in the development of malignancies in humans is unknown.
Most Frequent Adverse Events (≥10%): Headache, upper respiratory tract infection, nasopharyngitis, and nausea were the most commonly reported adverse events in the adult RA clinical studies. Other events reported in ≥5% of JIA patients were diarrhea, cough, pyrexia, and abdominal pain. In general, the adverse events in JIA and adult PsA patients were similar in frequency and type to those seen in adult RA patients.
Note concerning ORENCIA administration options: Intravenous dosing has not been studied in patients younger than 6 years of age. The safety and efficacy of ORENCIA ClickJect™ Autoinjector for subcutaneous injection has not been studied in patients under 18 years of age.
Please see Full Prescribing Information at http://packageinserts.bms.com/pi/pi_orencia.pdf. ORENCIA® (abatacept) is a registered trademark of
Cautionary Statement Regarding Forward-Looking Statements
This press release contains “forward-looking statements” within the meaning of the Private Securities Litigation Reform Act of 1995 regarding, among other things, the research, development and commercialization of pharmaceutical products. All statements that are not statements of historical facts are, or may be deemed to be, forward-looking statements. Such forward-looking statements are based on historical performance and current expectations and projections about our future financial results, goals, plans and objectives and involve inherent risks, assumptions and uncertainties, including internal or external factors that could delay, divert or change any of them in the next several years, that are difficult to predict, may be beyond our control and could cause our future financial results, goals, plans and objectives to differ materially from those expressed in, or implied by, the statements. These risks, assumptions, uncertainties and other factors include, among others, that future study results will be consistent with the results to date, that Orencia may not achieve its primary study endpoints or receive regulatory approval for the additional indication described in this release and, if approved, whether such product candidate for such additional indication described in this release will be commercially successful. No forward-looking statement can be guaranteed. Forward-looking statements in this press release should be evaluated together with the many risks and uncertainties that affect Bristol Myers Squibb’s business and market, particularly those identified in the cautionary statement and risk factors discussion in Bristol Myers Squibb’s Annual Report on Form 10-K for the year ended
Bristol Myers Squibb