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Background Certolizumab pegol is a pegylated humanised Fab’ fragment of a monoclonal antibody with high specificity for human TNF α Phase II studies have demonstrated the efficacy and tolerability of sc certolizumab pegol 400mg 4-weekly (Q4W) in patients with moderate to severe Crohn’s disease (CD) PRECiSE 1 and 2 are large well controlled studies demonstrating the safety and efficacy of certolizumab pegol in inducing and maintaining response and remission in patients with moderate to severe CD
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UCB vision To build a global biopharmaceutical leader, based on unique blending of innovation, entrepreneurship and proven experience, bringing to specialists new medicines to heal patients suffering from severe diseases
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UCB: a biopharmaceutical leader Amgen Schering AG Novo Nordisk Genentech UCB Altana Serono Genzyme Chiron Lundbeck Biogen IDEC 1.8 1.4 1.3 1.8 8.5 4.9 3.9 3.7 2.1 Revenues 2004 (€ billion)
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World pharmaceutical market: $500 billion (+ 8%) Pharmaceuticals – Top 15 in 2003 Global sales range$ 2.5 – 9.2 billion Annual growth 16% Biologicals – Top 15 in 2003 Global sales range$ 0.8 – 4.0 billion Annual growth 46%
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UCB key strengths Leader in fields of epilepsy, allergy, and monoclonal antibody research Proven productivity in research with an exciting pipeline Global presence in over 40 countries Strong partnerships and experienced management
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Crohn’s disease Chronic inflammatory disease of the gastrointestinal tract considerable unmet need Prevalence: over 1 million patients worldwide Only around 15% and around 8% of Crohn’s patients are currently treated with anti-TNFs in US and Europe respectively Remicade ® (infliximab), administered by infusion, the only anti- TNF biologic currently approved
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Certolizumab Pegol (CIMZIA TM ), a humanised anti-TNF PEGylated Fab' fragment, is safe and effective in the maintenance of response and remission following induction in active Crohn’s disease: a Phase III study (PRECiSE 2) Stefan Schreiber, 1 Munaa Khaliq-Kareemi, 2 Ian Lawrance, 3 Stephen Hanauer, 4 Juliet McColm, 5 Ralph Bloomfield, 5 William Sandborn 6 1 Christian-Albrechts-Univ., Kiel, Germany; 2 Dalhousie Univ., Halifax, Canada; 3 Univ. of Western Australia, Fremantle Hosp, Australia; 4 Univ. of Chicago Medical Center, Chicago, USA; 5 UCB, Slough, UK; 6 Mayo Clinic, Rochester, USA
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Background Certolizumab pegol is a pegylated humanised Fab’ fragment of a monoclonal antibody with high specificity for human TNF α Phase II studies have demonstrated the efficacy and tolerability of sc certolizumab pegol 400mg 4-weekly (Q4W) in patients with moderate to severe Crohn’s disease (CD) PRECiSE 1 and 2 are large well controlled studies demonstrating the safety and efficacy of certolizumab pegol in inducing and maintaining response and remission in patients with moderate to severe CD
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Aim Determine the efficacy and safety of certolizumab pegol maintenance treatment compared to three doses of certolizumab followed by placebo in patients with moderate to severe Crohn’s disease
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PRECiSE 2 study design CDAI score 220–450 points inclusive Stratified for: – CRP <10 mg/L or ≥10 mg/L – baseline steroids and immunosuppressants Responders a Nonresponders Discontinue Certolizumab Q4W Placebo Q4W Primary endpoint a Defined as patients with ≥100-point fall from Week 0 CDAI score Doses Weeks 024626816122024 Identify Responders, a Randomise 1:1 Randomised, double-blind maintenance phase Certolizumab open-label induction phase
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Efficacy Measures Primary efficacy: Clinical Response (≥ 100 point decrease from Baseline CDAI) at Week 26 in patients with baseline CRP 10 mg/L Secondary efficacy (selected): Clinical Response (≥100 points) irrespective of baseline CRP Clinical Remission (CDAI≤150 points) in overall population and in patients with CRP ≥ 10 mg/L Patients with change in IBDQ ≥ 16 points
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Patient Disposition Responders Randomized N=428 Placebo n=212 (102,110) Certolizumab n=216 (113,103) ITT n=215 (112,103) ITT n=210 (101,109) Completed 26 weeks n=109 (51.9%) (46 ;45.5%, 63; 57.8%) Completed 26 weeks n=150 (69.8%) (77; 68.8%, 73; 70.9%) Entered Induction N=668 “n” for CRP ≥ 10 /< 10
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Demographic & Baseline Characteristics (ITT) 3 inj. + Placebo (N=210) Certolizumab (N=215) Age (years)Mean (SD)37.6 (12.07)37.5 (11.21) Range 18-6918-67 GenderMale109 (51.9%)92 (42.8%) Female101 (48.1%)123 (57.2%) Duration of DiseaseMean7.38.6 (years)Median4.56.7 Range<1-43<1-33 Resection Performed Previous Infliximab Yes 73 (34.8%) 51 (24.3%) 64 (29.8%) 52 (24.2%)
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Concurrent Use of Crohn’s Treatment at Baseline* (ITT) 3 inj. + Placebo (N=210) Certolizumab (N=215) Corticosteroids (CS)78 (37.1%)75 (34.9%) Mesalazine82 (39.0%)86 (40.0%) Sulfasalazine35 (16.7%)32 (14.9%) Immunosuppressants (IS)86 (41.0%)87 (40.5%) AZA62 (29.5%)73 (34.0%) MTX9 (4.3%)9 (4.2%) 6-MP16 (7.6%)6 (2.8%) CS and IS34 (16.2%)28 (13.0%) * Patients could be on multiple therapies
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Clinical Response at Week 6, Open Label (All Patients, N=668)
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Clinical Response at Week 26 (ITT) N=210N=215n=101n=112 p < 0.001
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Clinical Response over Time CRP 10 (ITT) p < 0.001 † Non overlapping confidence interval † † †
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Clinical Response over Time All (ITT) p < 0.001 † Non overlapping confidence interval † † † †
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Clinical Remission at Week 26 (ITT) N=210N=215n=101n=112 p<0.01
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Clinical Remission over Time CRP 10 (ITT) p < 0.01 † Non overlapping confidence interval †
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Clinical Remission over Time All (ITT) p < 0.001 † Non overlapping confidence interval † †
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Clinical Response at Week 26 by Use of Immunosuppressants (CRP≥10 mg/L, ITT) n= 41 n=45 n=60 n=67 p = 0.002p = 0.014
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Clinical Response at Week 26 by prior Anti-TNF Use All (ITT) n=159n=163n=51n=52 *
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Patients with Increase in IBDQ ≥16 Points at Week 26 (ITT) p<0.05p<0.001 N=210N=214n=101n=112
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Safety Profile – Open Label Any AE Intensity Mild Moderate Severe Related SAE AE leading to withdrawal AE leading to death Certolizumab (N=668) 1094 (392, 58.7%) 675 (290, 43.4%) 348 (193, 28.9%) 71 (54, 8.1%) 336 (161, 24.1%) 56 (47, 7.0%) 65 (51, 7.6%) 1 (1, 0.1%) Number of AEs (number of patients, % of patients)
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Safety Any AE Intensity Mild Moderate Severe Related SAE AE leading to withdrawal Certolizumab (N=216) 411 (140, 64.8%) 254 (105, 48.6%) 135 (70, 32.4%) 22 (16, 7.4%) 87 (49, 22.7%) 19 (12, 5.6%) 25 (18, 8.3%) Number of AEs (number of patients, % of patients) 3 inj. + Placebo (N=212) 394 (143, 67.5%) 211 (97, 45.8%) 154 (84, 39.6%) 29 (19, 9.0%) 120 (58, 27.4%) 19 (14, 6.6%) 34 (28, 13.2%) Greater incidence of injections site reactions with placebo 1 case of TB Low incidence of antibodies to certolizumab (8%)
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Conclusions Treatment with certolizumab pegol 400 mg Q4W was superior in maintaining response and remission in patients with CD compared to three injections of certolizumab followed by placebo (p<0.001) Efficacy (Response & Remission) statistically significantly different between maintenance with certolizumab and three injections of certolizumab followed by placebo, irrespective of baseline CRP Significant difference achieved in patients previously exposed to infliximab Certolizumab pegol was well tolerated and its safety profile did not identify any signals of concern
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