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STUDY 303 A Phase III, Randomized, Multi-Center, Open-Label, 12 to 14 Month Extension Study to Evaluate the Safety and Tolerability of Mesalamine Given Once Daily Vs. Twice Daily for the Maintenance of Ulcerative Colitis in Remission
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Study 303: Objectives Study design Patient disposition Definitions Safety of 8-week acute extension Efficacy of 8-week acute extension Safety of 12-month long-term extension Efficacy of 12-month long-term extension Summary
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Study Design of 303 Open-label, multicenter, phase III study 12–14-month extension of the Lichtenstein et al. and Kamm et al. studies (parent studies) Two phases 8-week acute extension phase Patients not in remission at the end of the parent studies Mesalamine 4.8 g/day (given b.i.d.) 12-month long-term extension phase Patients in remission at the end of the parent studies or the end of the 8-week acute extension phase Mesalamine 2.4 g/day (given q.d. or 1.2 g b.i.d.) Adapted from Kamm et al. Gut 2008;57(7):893-902.
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Study 303 End Points 1 Primary objective: to assess the long term safety and tolerability of Mesalamine 2.4 g/day over 12 months Efficacy was not a primary endpoint of Study 303 Secondary objectives included: Safety in acute extension phase Time to relapse in long-term extension phase Patients in remission at 12 months Patient satisfaction Adapted from Kamm et al. Poster presented at BSG 2007 1.
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Mild (Score = 1) Moderate (Score = 2) Severe (Score = 3) Rectal bleeding Streaks of blood Obvious blood Mostly blood Stool frequency 1-2/day > normal 3-4/day > normal > 4/day > normal Mucosal appearance Erythema Decreased vascular pattern Minimal granularity Friability * Marked erythema Friability * Granularity Absent vascular pattern Bleeding minimal trauma No ulcerations Ulceration Spontaneous bleeding PGA (Physician’s Global Assessment) Mild Moderate Severe * Friability moved from Score of 1 to 2 Adapted from Kamm et al. Gastroenterology 2007;132:66–75. Modified* Ulcerative Colitis-Disease Activity Index
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End Point Definitions Relapse: Withdrawal from the study due to a requirement for alternative treatment (including a dose increase or surgery) for an exacerbation of UC Remission: Modified UC-DAI score 1, calculated as a score of 0 for rectal bleeding and for stool frequency, a combined Physician’s Global Assessment (PGA) and sigmoidoscopy score of 1, no mucosal friability, and a sigmoidoscopy score reduction of 1 point or more from baseline Adapted from Kamm et al. 2008;57(7):893-902.
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623 (Parent Studies) 558 (89.6%) (Rolled over into 303) 312 (56%) (Acute Extension Phase) 246 (44%) (Long-term Extension Phase) 213 225 (q.d. Group) 234 (b.i.d. Group) 459 (Safety population) (Long-term Extension Phase) (68%) Adapted from: 1 Kamm et al. Poster presented at BSG 2007. 2 Kamm et al. Gut 2008;57(7):893-902. Patient Disposition 1,2
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Efficacy Results: 8-Week Acute Extension Phase
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8-Week Acute Extension Phase: Efficacy Results Remission 59.5% of patients in the efficacy population (n=304) achieved remission Modified UC-DAI score Mean reduction of 3.9 ± 2.8 points from week 0* to end point Mean reduction of 5.0 ± 2.7 from parent study baseline to end point Symptom improvement 65.1% of patients had a score of 0 for stool frequency at end point compared to 7.9% at week 0 80.6% of patients had a score of 0 for rectal bleeding at end point compared to 27.3% at week 0 *Week 0=First study visit of the acute extension phase Adapted from Lichtenstein GR, et al. Poster presented at ACG, 2007.
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(n = 107) (n = 78) (n = 41) Prior treatment Up to 8 weeks’ active treatment Up to 16 weeks’ active treatment Patients in Remission After Eight Weeks’ Extension Therapy
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Number of patients (%) Adapted from Lichtenstein et al. Poster presented at ACG 2007. *Week 0=First study visit of the acute extension phase 8-Week Acute Extension Phase: Sigmoidoscopy Scores
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STUDY 303 Acute Extension Phase Conclusions 1,2 Mesalamine 4.8 g/day (2.4 g dosed b.i.d.) was well- tolerated in the 8-week acute extension phase Safety profile similar to that of the parent studies (Lichtenstein et al. and Kamm et al.) Mesalamine 4.8 g/day for up to 4 months was well- tolerated Approximately 60% of patients achieved remission, using stringent clinical and endoscopic criteria Adapted from: 1 Lichtenstein et al. Poster presented at APhA 2007. 2 Lichtenstein et al. Poster presented at ACG 2007.
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