Mesoblast Limited (ASX:MSB) (Nasdaq:MESO) today announced that
results from the randomized, placebo-controlled Phase 2 trial of
its proprietary allogeneic mesenchymal precursor cells (MPCs) over
52 weeks in patients with biologic refractory rheumatoid arthritis
(RA) were presented at the 2017 American College of Rheumatology
(ACR) Annual Meeting held this week in San Diego, CA.
The abstract was submitted for peer review by the trial’s lead
investigators, Dr. Suzanne Kafaja, Assistant Clinical Professor,
and Dr. Daniel E. Furst, Professor of Medicine in the Division of
Rheumatology, Department of Medicine, at the University of
California at Los Angeles (UCLA). The ACR Annual Meeting is
attended by approximately 16,000 delegates from more than 100
countries.
Dr. Kafaja said: “The clinical responses in this Phase 2 trial,
together with the safety profile, position MPC-300-IV to become an
early treatment option in rheumatoid arthritis patients who are
resistant to or intolerant of anti-TNF or other biologic
agents.”
The Phase 2 trial recruited a total of 48 patients with active
RA who were on a stable regimen of methotrexate and had an
inadequate prior response to at least one anti-TNF agent. Of the 48
patients, 30 (63%) had previously received 1-2 biologic agents.
Patients were randomized to a single intravenous infusion of 1
million MPCs/kg (1M/kg, n=16), 2 million MPCs/kg (2M/kg, n=16) or
placebo (n=16).
The primary objective of the study was to evaluate safety and
tolerability of a single intravenous MPC infusion in these biologic
refractory RA patients through a 12-week primary endpoint.
Additional objectives were to evaluate clinical efficacy at the
12-week endpoint and to assess the durability of effects and safety
profile through the full 52-week study.
Pre-specified efficacy endpoints included the following: ACR
composite clinical response, which is an endpoint used in RA
clinical trials to measure improvement in signs and symptoms of the
disease in terms of 20%, 50% or 70% improvement from baseline;
ACR-N which measures the mean or median magnitude of benefit using
an ACR composite for a typical patient; the health assessment
questionnaire-disability index (HAQ-DI), a standardized measure of
functional status; the short-form health survey (SF-36), an
assessment of health-related quality-of-life; and the measure of
disease activity in 28 joints (DAS28) composite measurement of
disease activity; no adjustment for multiplicity was performed as
these efficacy endpoints were exploratory and the trial was not
powered for efficacy.
Additionally, continuous variables ACR-N, HAQ-DI and DAS-28 were
evaluated in a pre-specified manner since the use of endpoints
sensitive to change provide better discriminatory power for
dose-response assessment, in line with the FDA Guidance For
Industry Rheumatoid Arthritis: Developing Drug Products For
Treatment, May 2013.
Analyses were performed for the whole study population and for
the pre-specified exploratory subgroups based on whether the
subjects had previously received 1-2 biologic agents or more than 2
biologic agents.
Key findings:
• Infusions were well-tolerated and there were no
treatment-related serious adverse events reported during the
52-week period, with the safety profile over 52 weeks comparable
among the placebo and two MPC treatment groups.
• A single intravenous MPC infusion in biologic refractory
RA patients resulted in dose-related improvements in clinical
symptoms, function, disease activity and patient-reported outcomes.
Efficacy signals were observed for each of ACR 20/50/70, ACR-N,
HAQ-DI, SF-36 and DAS-28 disease activity score.
• The 2 million MPC/kg dose showed the greatest overall
treatment responses. Onset of treatment responses occurred as early
as 4 weeks, peaked at 12 weeks, were maintained through 39 weeks,
and waned by 52 weeks.
• Greatest benefits over 52 weeks were seen in patients who
had failed less than 3 biologics (1-2 biologic sub-group) prior to
MPC treatment, identifying this as a potentially optimal target
population.
• The following statistically significant outcomes were
observed over the 52-week study period:
- At 4 weeks:- the MPC 2M/kg group had significantly better
outcomes than placebo for improvement in pain, as measured by the
ACR domain for subjective assessment of pain (p=0.04) and the SF-36
domain for bodily pain (p=0.014)- the MPC 2M/kg group had
significantly better outcomes than placebo for improvement in
physical function, as measured by the SF-36 physical component
summary score (p=0.015) and physical function score (p=0.002), as
well as the HAQ-DI mean change from baseline (p=0.043)
- At 12 weeks:- the MPC 2M/kg group had significantly
better outcomes than placebo for both the composite ACR70 response
(p=0.043) and the overall ACR-N Area Under the Curve, AUC
(p=0.05)- the MPC 2M/kg group had significantly better
outcomes than placebo for the ACR domains of subject’s assessment
of pain (p=0.039) and subject’s assessment of disease activity
(p=0.04)- the MPC 2M/kg group had significantly better
outcomes than placebo for proportion of patients achieving
minimally important improvement in HAQ-DI function score (p=0.003)
as well as the HAQ-DI mean change from baseline (p=0.018)-
the MPC 2M/kg group had significantly better outcomes than placebo
for several domains of the SF-36 composite score, including
physical component summary score (p=0.018), bodily pain (p=0.03),
and role physical (p=0.014)
- At 12, 39 and 52 weeks:- the MPC 2M/kg group
significantly outperformed placebo at every time point for ACR-N
Area Under the Curve (AUC) (p=0.05 at 12 weeks, p=0.004 at 39
weeks, and p=0.008 at 52 weeks), indicating a robust, durable and
consistent clinical effect of this MPC dose.
Mesoblast Chief Medical Officer Dr. Donna Skerrett said: “We are
very pleased with the results of this Phase 2 trial, which
identified a dose-related treatment effect, the earliest onset of
the effect, and the durability from a single dose. Given the
excellent safety profile, we intend to evaluate whether higher MPC
doses can achieve even greater rates of low disease activity or
remission within the first 12 weeks and beyond. We also plan
to evaluate whether the observed durable treatment responses can be
maintained for the longer term using repeat dose therapy.”
About Rheumatoid ArthritisRA is a chronic
autoimmune disease of unknown etiology, affecting approximately one
percent of the global population. The disease is attributed to
chronic inflammation affecting the synovial membrane of multiple
joints, which eventually leads to cartilage and bone destruction.
The health-related quality of life in patients with RA is
significantly impaired by pain, fatigue, and decline in
musculoskeletal function. RA is associated with an increased risk
of cardiovascular disease and mortality.
Major advances in the treatment of RA using biologic agents have
resulted in a $19 billion global market in 2016, the majority of
which is due to use of anti-TNF agents. The RA population resistant
to anti-TNF agents, which constitutes about one-third of patients
treated with anti-TNF agents, is the fastest growing branded market
segment within the global RA biologics market, and is set to grow
further as multiple anti-TNF biosimilars become available. There
are approximately 6 million prevalent cases in the United States,
Japan, and EU5, with 2.9 million in the United States alone in
2016.1,2
Standard criteria established by the American College of
Rheumatology (ACR) and the European League Against Rheumatism
(EULAR) are used to assess the effectiveness of RA treatments. The
ACR20/50/70 response is a composite measure based on achieving
20%/50%/70% improvement in tender joint counts (TJC) or swollen
joint counts (SJC) plus improvement in three of the following:
• Patient global assessment • Physician global assessment •
Patient pain assessment • Physical function/disability
questionnaire (HAQ-DI) • Acute phase reactant (sedimentation rate
or high-sensitivity C-reactive protein)
The patient and physician global assessments and pain assessment
are measured using a visual analogue scale on a scale of 0-100. The
ACR-N provides a single number that characterizes the percentage of
improvement or deterioration from baseline that a patient has
experienced in analogy to ACR20, ACR50, and ACR70 responses. The
ACR-N is defined operationally as the lowest of 3 values (the
percent change in the SJC, the percent change in the TJC, and the
median of the other 5 measures in the ACR core data set). The ACR-N
can be used to measure improvement at specific time points in a
landmark analysis and expressed as the mean or median ACR-N
achieved, or to compare the area under the curve (AUC) by patient
over time. This approach may substantially increase the power to
detect small differences between treatment arms.
The HAQ-DI assesses physical function in performing a variety of
activities of daily living and yields a score ranging from 0-3
(lower is better). A reduction in the HAQ-DI score of -0.22 is the
minimal clinically important difference. The DAS28 is another
validated RA disease activity index based on a 28 joint count. The
derived DAS28 scores are comprised of tender joint count; swollen
joint count; acute phase reactant (hsCRP or ESR) and the subject’s
global assessment of disease but do not include measures of pain or
physical function. High disease activity is defined as DAS28 score
>5.1; moderate disease activity is defined as DAS28 scores
between 5.1-3.2; low disease activity and remission are defined as
DAS28 scores of ≤3.2 and <2.6, respectively.
In line with the FDA Guidance For Industry Rheumatoid Arthritis:
Developing Drug Products for Treatment, May 2013, for dose-ranging
studies the use of endpoints sensitive to change provide better
discriminatory power for dose-response assessment. A clinical
endpoint such as the ACR20 response criteria may not be optimal for
this purpose, because it is a dichotomous endpoint, and using the
proportion of responders in a small group of patients could be
unreliable. Continuous variables such as DAS28, HAQ-DI, and ACR-N
may be more sensitive to change and provide a more suitable
alternative to ACR responder index. For continuous variables where
changes from baseline are reported, the Least Squares of the Mean
(ANCOVA) is utilized in order to adjust for baseline differences
between groups.
1 GlobalData©: Rheumatoid Arthritis Global Forecast 2015-2025 0-
January 20172 Decision Resources Rheumatoid Arthritis Dec 2015
About Mesoblast Mesoblast Limited (ASX:MSB)
(Nasdaq:MESO) is a global leader in developing innovative
cell-based medicines. The Company has leveraged its proprietary
technology platform, which is based on specialized cells known as
mesenchymal lineage adult stem cells, to establish a broad
portfolio of late-stage product candidates. Mesoblast’s allogeneic,
‘off-the-shelf’ cell product candidates target advanced stages of
diseases with high, unmet medical needs including cardiovascular
conditions, orthopedic disorders, immunologic and inflammatory
disorders and oncologic/hematologic conditions.
Forward-Looking Statements This announcement
includes forward-looking statements that relate to future events or
our future financial performance and involve known and unknown
risks, uncertainties and other factors that may cause our actual
results, levels of activity, performance or achievements to differ
materially from any future results, levels of activity, performance
or achievements expressed or implied by these forward-looking
statements. We make such forward-looking statements pursuant to the
safe harbor provisions of the Private Securities Litigation Reform
Act of 1995 and other federal securities laws. Forward-looking
statements should not be read as a guarantee of future performance
or results, and actual results may differ from the results
anticipated in these forward-looking statements, and the
differences may be material and adverse. Forward- looking
statements include, but are not limited to, statements about: the
initiation, timing, progress and results of Mesoblast’s preclinical
and clinical studies, and Mesoblast’s research and development
programs; Mesoblast’s ability to advance product candidates into,
enroll and successfully complete, clinical studies, including
multi-national clinical trials; Mesoblast’s ability to advance its
manufacturing capabilities; the timing or likelihood of regulatory
filings and approvals, manufacturing activities and product
marketing activities, if any; the commercialization of Mesoblast’s
product candidates, if approved; regulatory or public perceptions
and market acceptance surrounding the use of stem-cell based
therapies; the potential for Mesoblast’s product candidates, if any
are approved, to be withdrawn from the market due to patient
adverse events or deaths; the potential benefits of strategic
collaboration agreements and Mesoblast’s ability to enter into and
maintain established strategic collaborations; Mesoblast’s ability
to establish and maintain intellectual property on its product
candidates and Mesoblast’s ability to successfully defend these in
cases of alleged infringement; the scope of protection Mesoblast is
able to establish and maintain for intellectual property rights
covering its product candidates and technology; estimates of
Mesoblast’s expenses, future revenues, capital requirements and its
needs for additional financing; Mesoblast’s financial performance;
developments relating to Mesoblast’s competitors and industry; and
the pricing and reimbursement of Mesoblast’s product candidates, if
approved. You should read this press release together with our risk
factors, in our most recently filed reports with the SEC or on our
website. Uncertainties and risks that may cause Mesoblast’s actual
results, performance or achievements to be materially different
from those which may be expressed or implied by such statements,
and accordingly, you should not place undue reliance on these
forward-looking statements. We do not undertake any obligations to
publicly update or revise any forward-looking statements, whether
as a result of new information, future developments or
otherwise.
For further information, please contact:
Julie Meldrum Corporate Communications T: +61 3 9639 6036E:
julie.meldrum@mesoblast.com
Schond Greenway Investor Relations T: +1 212 880 2060 E:
schond.greenway@mesoblast
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