Long-term Extension Study Research Articles

Long-term all-cause and cardiovascular-related mortality in patients with ATTR-CM treated with continuous tafamidis vs placebo to tafamidis by NAC stage at baseline

Abstract Background The National Amyloidosis Centre (NAC) staging system is used to stratify patients with transthyretin amyloid cardiomyopathy (ATTR-CM) into prognostic categories.[1] Purpose This post hoc analysis evaluated all-cause and cardiovascular (CV)-related mortality in patients receiving tafamidis 80 mg or placebo by NAC stage at baseline in the phase 3 Tafamidis in Transthyretin Cardiomyopathy Clinical Trial (ATTR-ACT) and its long-term extension (LTE) study.[2,3] Methods Patients in ATTR-ACT were randomised to tafamidis meglumine 80 mg, 20 mg, or placebo for 30 months, stratified by transthyretin (TTR) genotype (wild-type or variant) and NYHA class (I or II/III). Patients with an NT-proBNP <600 ng/l or eGFR <25 ml/min/1.73m² were excluded. After completing ATTR-ACT, patients could receive tafamidis 61 mg up to 60 months in the open-label LTE study. Heart transplant and cardiac mechanical assist device implantation were treated as death in the mortality assessments. Secondary analyses were change from baseline in Kansas City Cardiomyopathy Questionnaire (KCCQ) clinical and overall summary (CS, OS) scores and frequency of all-cause and CV-related hospitalisations. Results Of 350 patients, 42%, 38% and 20% had NAC stage I, II and III at baseline, respectively. Patients at stage III tended to be older, more likely female, and with a variant TTR genotype vs those at a lower stage (Table). At the end of follow-up, all-cause mortality was consistently lower in patients continuously treated with tafamidis vs those who initially received placebo across NAC stages (I: 36% vs 61%; : 55% vs 74%; III: 69% vs 88%). The hazard ratio (HR [95% CI]) for all-cause mortality with continuous tafamidis treatment vs placebo to tafamidis was 0.43 (0.26-0.70; P<0.001), 0.51 (0.33-0.80; P=0.003) and 0.75 (0.44-1.29; P=0.298), for patients at stage I, II and III, respectively. Similar trends were observed in CV-related mortality at the end of follow-up, where HR (95% CI) for continuous tafamidis-treated patients at stage I, II and III was 0.39 (0.22-0.70; P=0.001), 0.51 (0.31-0.85; P=0.009) and 0.75 (0.42-1.33; P=0.320). The separation of survival curves was seen in the first few months of tafamidis treatment in patients at NAC stage I (Figure A). Such early separation was not seen in those at stage II or III. Starting from Month 18, statistically smaller declines in KCCQ-OS and CS scores were frequently observed in the continuous tafamidis vs placebo to tafamidis groups at stages I and II. Across NAC stages, all-cause and CV-related hospitalisations were lower in the continuous tafamidis vs placebo to tafamidis group (Figure B). Conclusions Continuous tafamidis treatment reduced mortality and hospitalisations (both all-cause and CV-related) across all NAC stages. These reductions were larger and occurred earlier in patients with NAC stage I, emphasising the importance of early disease-modifying treatment in patients with ATTR-CM.[3] NCT01994889, NCT02791230.

Tafamidis treatment for transthyretin amyloid cardiomyopathy: results from an open-label, early-access, long-term study extension in an all-comers population

Abstract Background In the pivotal Tafamidis in Transthyretin Cardiomyopathy Clinical Trial (ATTR-ACT NCT01994889), tafamidis significantly reduced mortality and cardiovascular hospitalization in patients with transthyretin amyloid cardiomyopathy (ATTR-CM). Given the high clinical unmet need and the favorable benefit-to-risk profile of tafamidis, there was a justification to provide patients with an option for early access to treatment as part of the ATTR-ACT long-term extension study (LTE; NCT02791230). Purpose To assess long-term safety in an all-comers population receiving early access to tafamidis. Methods Following protocol amendment (20 July 2018), patients with ATTR-CM, not previously enrolled in ATTR-ACT, and without commercial access to tafamidis, were enrolled in the LTE early-access study arm in 13 countries. Patients received open-label, once-daily tafamidis free acid 61 mg for up to 60 months, until they gained product access by prescription or study discontinuation by the sponsor. All-cause and cardiovascular (CV)-related mortality, CV-related hospitalization, and treatment-emergent adverse events (TEAEs) were assessed. Results Of 1481 patients enrolled in the early-access cohort, 1476 received at least one dose of tafamidis and were included in the analysis. Mean (SD) age at enrollment was 76.5 (7.8) years old, 37.5% were ≥80 years old, and 88.8% were male. Most patients (85.6%) had wild-type ATTR-CM, and 14.9%, 52.9%, 30.8%, and 1.3% were in New York Heart Association (NYHA) Class I, II, III, and IV, respectively. Over a mean (SD) follow-up period of 17.7 (13.8) months, all-cause and CV-related mortality rates were 23.4% and 13.8%, respectively (Table). Mean frequency of CV-related hospitalization per year was 0.28 (0.60). Serious TEAEs and TEAEs leading to discontinuation of the study were observed in 0.6% of patients (both); no new safety signals were identified. Conclusions Findings from the early-access cohort of the ATTR-ACT LTE highlight the safety of tafamidis treatment in an all-comers ATTR-CM patient population.

Long-term safety and efficacy of MBA-P01 for the treatment of glabellar lines: results from a multicenter, repeated-dose, open-label extension study

Purpose Following the introduction of new type of botulinum toxin (MBA-P01), a recent phase 3 study demonstrated that MBA-P01 showed comparable efficacy and safety to onabotulinumtoxin A for reducing glabellar lines. The primary objective of this study was to evaluate the long-term safety of repeated MBA-P01 administration for the treatment of glabellar lines. Materials and methods This multicenter, single-group, repeated-dose, long-term open-label extension study evaluated repeated treatment with MBA-P01 (20 U, five treatments over 16 months), with posttreatment evaluation performed up to 52 weeks. Results Based on the safety assessment results, no specific irreversible adverse reactions were associated with the safety profile of MBA-P01. Repeated treatment with MBA-P01 was effective for a treatment duration of 3–5 months. Conclusion In conclusion, multiple cycles of treatment of glabellar lines with MBA-P01 at a dose of 20 U were well tolerated. Clinical trial registration information: This study is registered in ClincalTrials.gov (NCT05321979).

Review article: Novel therapies in inflammatory bowel disease - An update for clinicians.

Several new treatments including small molecules and biologics have been approved for the treatment of inflammatory bowel diseases in recent years. Clinicians and patients now have a wide variety of therapeutic options to choose from and these novel therapies provide several advantages including oral administration, lower immunogenicity, better selectivity and arguably better safety profiles. An increase in treatment options has increased the complexity of decision-making. Both patients and clinicians have had to become rapidly familiar with efficacy of new medications balanced against a range of pre-initiation requirements, dosing schedules and adverse event profiles. To provide a simple guide to practising clinicians on recently approved and emerging therapies and address key challenges around treatment strategies such as optimal sequencing and timing of treatment. We comprehensively searched the published literature and major conference abstracts to identify phase III placebo-controlled and active comparator trials for Crohn's disease and ulcerative colitis. Data for recently approved therapies including selective Janus kinase inhibitors, sphingosine-1 receptor modulators and p19 interleukin (IL)-23 inhibitors have demonstrated improved patient outcomes in both Crohn's disease and ulcerative colitis. Further comparative head-to-head studies have improved our understanding of when and how to optimally use newer therapies, specifically for IL-23 inhibitors. Data for emerging treatment options and novel treatment strategies such as early effective treatment, combinations of treatments and implications for sequencing are continuing to transform IBD care continually. Recently approved novel therapies have expanded the range of medical options available to treat IBD. However, further data from long-term extension studies, real-world studies and head-to-head trials are warranted to better inform the long-term safety and optimal sequencing of treatments for patients living with IBD.

Efficacy and safety of filgotinib in patients with rheumatoid arthritis: week 156 interim results from a long-term extension study

BackgroundJanus kinase inhibitors are an effective option for achieving sustained remission or low disease activity in patients with rheumatoid arthritis (RA) following inadequate response to conventional synthetic disease-modifying anti-rheumatic drugs....

Long-Term Safety and Efficacy of Pegcetacoplan in Patients with C3 Glomerulopathy or Primary Immune-Complex Membranoproliferative Glomerulonephritis: The Long-Term VALE Extension Study

Long-Term Safety and Efficacy of Pegcetacoplan in Patients with C3 Glomerulopathy or Primary Immune-Complex Membranoproliferative Glomerulonephritis: The Long-Term VALE Extension Study

S1080 Corticosteroid-Free Remission Through 3 Years of Upadacitinib Therapy in Patients With Moderately to Severely Active Ulcerative Colitis: Data From the Phase 3 Long-Term Extension Study U-ACTIVATE

S1080 Corticosteroid-Free Remission Through 3 Years of Upadacitinib Therapy in Patients With Moderately to Severely Active Ulcerative Colitis: Data From the Phase 3 Long-Term Extension Study U-ACTIVATE

S1050 Efficacy and Safety of Upadacitinib Maintenance Treatment in Patients With Moderately to Severely Active Crohn’s Disease: Two Year Results From the U-ENDURE Long-Term Extension Study

S1050 Efficacy and Safety of Upadacitinib Maintenance Treatment in Patients With Moderately to Severely Active Crohn’s Disease: Two Year Results From the U-ENDURE Long-Term Extension Study

The effect of long-term tafamidis treatment on quality of life in people with transthyretin amyloid cardiomyopathy (ATTR-CM): A plain language summary.

This summary explains some results of a study called ATTR-ACT and its ongoing long-term extension study that were published in the European Journal of Heart Failure. The purpose of ATTR-ACT was to find out if a drug called tafamidis is an effective treatment for people with a heart condition called transthyretin amyloid cardiomyopathy (ATTR-CM). People took tafamidis or placebo for up to 2.5years in ATTR-ACT (the initial study). A placebo looks like the study medicine but does not contain any active ingredients. After people completed the initial study, they could take part in the extension study. An extension study allows people to continue receiving treatment after the original clinical study ends and helps researchers understand how well a treatment works over a longer time period. This extension study allows people to receive tafamidis for up to an additional 5years. People who took placebo in the initial study now receive tafamidis. People who took tafamidis in the initial study continue tafamidis treatment. Researchers looked at changes in peoples' ability to enjoy life ('quality of life') and heart failure symptoms since they started ATTR-ACT. Results are available for the first 2.5years of the extension study. During the initial study, there was less worsening of quality of life and heart failure symptoms in people who took tafamidis compared to people who took placebo. In the extension study, quality of life and heart failure symptoms were maintained or nearly maintained in people who took tafamidis in the initial study. In people who started tafamidis in the extension study, quality of life and heart failure symptoms continued to worsen, but the worsening slowed down. Tafamidis slows the worsening of quality of life and heart failure symptoms in people with ATTR-CM. People with ATTR-CM should start treatment early to receive the most benefit.Clinical Trial Registration: NCT01994889 (ATTR-ACT) (ClinicalTrials.gov).

51876 Impact of Long-Term Abrocitinib Treatment on Patient-Reported Outcomes and Quality of Life for Approximately 2 Years in Patients With Moderate-to-Severe Atopic Dermatitis: An Interim Analysis of JADE EXTEND, a Long-Term Extension Study

51876 Impact of Long-Term Abrocitinib Treatment on Patient-Reported Outcomes and Quality of Life for Approximately 2 Years in Patients With Moderate-to-Severe Atopic Dermatitis: An Interim Analysis of JADE EXTEND, a Long-Term Extension Study

50342 Serum Protein Biomarkers May Reveal Clues to Early Immune Activity Upon Ruxolitinib Cream Withdrawal in the TRuE-V Long-Term Extension Study

50342 Serum Protein Biomarkers May Reveal Clues to Early Immune Activity Upon Ruxolitinib Cream Withdrawal in the TRuE-V Long-Term Extension Study

Long-term safety and efficacy of filgotinib for the treatment of moderately to severely active ulcerative colitis: Interim analysis from up to 4 years of follow-up in the SELECTION open-label long-term extension study.

Filgotinib, an oral, once-daily, Janus kinase 1 preferential inhibitor, is an approved treatment for moderately to severely active ulcerative colitis. The aim of this study is to assess the safety and efficacy of continued filgotinib therapy over ~4 years in the long-term extension of the phase 2b/3 SELECTION trial (SELECTIONLTE; NCT02914535). In this interim analysis of SELECTIONLTE, SELECTION completers (week 10 responders to filgotinib who completed the maintenance study) continued their assigned treatment (double-blind filgotinib 200 mg [FIL200] or filgotinib 100 mg) and SELECTION week 10 non-responders received open-label FIL200. We assessed safety by adverse events (AEs), and efficacy by partial Mayo Clinic Score (pMCS), inflammatory biomarkers and health-related quality of life (HRQoL). We compared safety and efficacy between achievers and non-achievers of a multi-component endpoint, comprehensive disease control (CDC), comprising symptomatic, endoscopic, inflammatory biomarker and HRQoL improvements. Data for completers (n = 250) and non-responders (n = 372) were reported for ≤202 weeks. AE occurrences were low and consistent with previous analyses. The as-observed proportion of FIL200-treated patients in pMCS, biomarker and HRQoL remission during SELECTIONLTE remained high among completers (week 144: 80.0%, 86.4% and 86.0%, respectively) and increased among non-responders (week 192: 62.1%, 76.7% and 59.3%, respectively). Significantly higher proportions of CDC achievers at SELECTION week 58 achieved pMCS, IBDQ and corticosteroid-free pMCS remission than non-achievers, up to LTE week 96. Filgotinib induced and maintained symptomatic remission and improved HRQoL over 4 years. Safety results showed a proven long-term benefit-risk profile. FIL200-treated CDC achievers had better long-term outcomes than non-achievers.

P-308 Relugolix combination therapy vs relugolix monotherapy with transition to relugolix combination therapy for the treatment of endometriosis-associated pain: implications for cumulative benefit/risk profile

Abstract Study question How does the benefit/risk profile compare in women with endometriosis-associated pain who initiated relugolix combination therapy (Relugolix-CT) vs relugolix monotherapy with transition to Relugolix-CT? Summary answer Initiation with Relugolix-CT showed a more favourable benefit/risk profile than relugolix monotherapy: similar efficacy, lower rate of vasomotor symptoms and clinically significant bone loss. What is known already Treatment of endometriosis with a gonadotropin-releasing hormone antagonist monotherapy may be associated with vasomotor symptoms (e.g. hot flushes) and bone mineral density (BMD) loss. Relugolix-CT (relugolix 40 mg, estradiol 1 mg, norethisterone acetate 0.5 mg) was developed to minimise these hypoestrogenic adverse effects. In the pivotal SPIRIT 1 and 2 studies and long-term extension (LTE), once-daily Relugolix-CT demonstrated improved dysmenorrhoea early in treatment that was sustained for the duration of therapy over 104 weeks, with BMD loss <1%. This analysis evaluates the benefit of initiation with Relugolix-CT vs relugolix monotherapy and transition to Relugolix-CT on the 104-week benefit/risk profile. Study design, size, duration In the 24-week SPIRIT 1 and 2 studies, premenopausal women with endometriosis and moderate-to-severe pain at baseline were randomised 1:1:1 to placebo, Relugolix-CT, or delayed Relugolix-CT (relugolix 40 mg monotherapy then Relugolix-CT; 12 weeks each). Study completers were eligible to enrol in the open-label, 80-week LTE study where all women received once-daily Relugolix-CT. Efficacy and safety data over 104 weeks from the SPIRIT studies were assessed in this ad hoc analysis. Participants/materials, setting, methods Efficacy and safety were analysed as cumulative proportions, evaluating time to benefit and time to harm. Time to benefit was defined as median time to minimal-to-no dysmenorrhoea (Numerical Rating Scale score ≤1), time to harm as time to first vasomotor symptoms (hyperhidrosis, feeling hot, hot flush, night sweats and flushing), and time to lumbar spine BMD loss from baseline to > 3% among those meeting protocol-specified BMD criteria. Median time was not estimable for safety. Main results and the role of chance In total, 1251 women were treated in the SPIRIT 1 and 2 studies. Of 418 and 417 women in the Relugolix-CT and delayed Relugolix-CT groups, time to minimal-to-no dysmenorrhoea was 8 weeks in 56.3% and 75.7% of women, respectively, increasing to 82.5% and 86.4% at Week 24, 94.5% and 95.9% at Week 52, and 95.3% and 95.9% at Week 104. In both groups, median time to minimal/no dysmenorrhea-associated pain occurred within two menstrual cycles. Cumulative proportion of patients with first vasomotor symptoms in the Relugolix-CT and delayed Relugolix-CT groups was 4.1% and 16.8%, respectively, at Week 4, 13.5% and 35.3% at Week 24, 16.4% and 38.3% at Week 52, and 16.8% and 38.8% at Week 104. Cumulative proportion of patients with first BMD loss >3% in the Relugolix-CT and delayed Relugolix-CT groups was 1.1% and 5.9%, respectively, at Week 12, 10.2% and 23.5% at Week 24, 15.5% and 29.4% at Week 52, and 21.5% and 32.1% at Week 104. Given similar time to pain improvement with higher risk of vasomotor symptoms or clinically significant BMD loss with delayed Relugolix-CT treatment, these findings support the benefit of initiation of Relugolix-CT to mitigate hypoestrogenic adverse events. Limitations, reasons for caution The 80-week, open-label SPIRIT LTE did not have a control group. This evaluation was an ad hoc investigation of SPIRIT data and was not part of the prespecified statistical analysis plan. Comparisons between groups were qualitative, and no statistical inferences were generated. Wider implications of the findings Although Relugolix-CT and relugolix monotherapy showed similar efficacy benefit, monotherapy was associated with a higher risk of vasomotor symptoms and clinically significant BMD loss. The more favourable Relugolix-CT benefit/risk profile vs monotherapy helps fulfil an unmet need for long-term, effective, and well-tolerated hormonal treatment of symptoms of endometriosis. Trial registration number SPIRIT 1 (ClinicalTrials.gov: NCT03204318; EudraCT: 2017–001588–19); SPIRIT 2 (NCT03204331; 2017–001632–19); SPIRIT LTE (NCT03654274; 2017-004066-10)

Long-term tafamidis efficacy in patients with transthyretin amyloid cardiomyopathy by baseline left ventricular ejection fraction.

Patients with transthyretin amyloid cardiomyopathy (ATTR-CM) present with diverse left ventricular ejection fraction (LVEF). This study assessed tafamidis efficacy by baseline LVEF in the phase 3 Tafamidis in Transthyretin Cardiomyopathy Clinical Trial (ATTR-ACT) and its long-term extension (LTE) study. Patients were randomized to 30 months of tafamidis or placebo treatment in ATTR-ACT. On completion, patients could join an LTE study to receive tafamidis. All-cause mortality (death, heart transplant, or cardiac mechanical assist device implantation) from baseline to the end of follow-up was assessed in patients continuously treated with tafamidis (80 mg meglumine or 61 mg free acid) or delayed tafamidis treatment (placebo in ATTR-ACT; tafamidis in the LTE study) according to baseline LVEF (<50% or ≥50%). Supportive outcomes were evaluated over a shorter follow-up. Patients with baseline LVEF <50% (n = 177: 88 tafamidis- and 89 placebo-treated) had signs of more severe heart failure, a higher proportion were Black, and had variant ATTR-CM than those with LVEF ≥50% (n = 171: 85 tafamidis- and 86 placebo-treated). At the end of follow-up (median 60-64 months), all-cause mortality was numerically higher in patients with baseline LVEF <50%; however, consistent with supportive findings, continuous tafamidis treatment was associated with a 47% reduction in mortality risk compared with delayed tafamidis treatment in patients with LVEF <50% and ≥50% (hazard ratio 0.53 [95% confidence interval 0.367-0.758]; p < 0.001, and 0.53 [0.344-0.818]; p < 0.01, respectively). Early initiation of tafamidis is associated with reduced mortality in patients with ATTR-CM, irrespective of initial LVEF value. ClinicalTrials.gov NCT01994889, NCT02791230.

Impact of relugolix combination therapy on functioning and quality of life in women with endometriosis-associated pain

To evaluate the effect of relugolix combination therapy (relugolix CT; 40 mg relugolix, 1 mg estradiol, and 0.5 mg norethisterone acetate) for up to 2 years in the SPIRIT long-term extension study on functioning and health-related quality of life (QoL), using the Endometriosis Health Profile (EHP)-30 questionnaire, and assess how changes in QoL domains correlated with improvements in dysmenorrhea as well as nonmenstrual pelvic pain (NMPP). Long-term extension study of the SPIRIT phase 3 trials. Clinics and University Hospitals. Premenopausal women with moderate-to-severe endometriosis pain who previously completed the randomized SPIRIT trials were eligible to enroll in an 80-week long-term extension where all women received relugolix CT. Relugolix CT (relugolix 40 mg, estradiol 1 mg, and norethindrone acetate 0.5 mg). Least squares (LS) mean changes in the EHP-30 domain and total scores from baseline (pivotal) were analyzed using a mixed-effects model. Results up to 104 weeks are reported by a pivotal trial treatment group with a focus on the relugolix CT group (i.e., relugolix CT or placebo for 24 weeks, or delayed relugolix CT [relugolix 40 mg monotherapy for 12 weeks, followed by relugolix CT for 12 weeks]). In addition, the relationships between changes in dysmenorrhea and NMPP as well as changes in EHP-30 scores were assessed. In the 277 women treated with relugolix CT, LS mean EHP-30 pain domain scores improved by 57.8% (LS mean change: -32.8; 95% CI: -35.5, -30.1), 66.4% (LS mean change: -37.7; 95% CI: -40.3, -35.0), and 72.2% (LS mean change: -41.3; 95% CI: -43.9, -38.7) at weeks 24, 52, and 104, respectively. The proportions of women with clinically meaningful improvement in the EHP-30 pain domain were 75.9%, 83.6%, and 88.6% at weeks 24, 52, and 104, respectively. Non-pain EHP-30 domain and total scores likewise improved. A positive correlation between changes in dysmenorrhea/NMPP and all EHP-30 domain scores was observed. Results were similar for the delayed relugolix CT and placebo → relugolix CT groups. Sustained reduction of endometriosis-associated pain with relugolix CT observed up to 104 weeks was accompanied by improvements in functioning and health-related QoL. These findings complement the results of the pivotal SPIRIT trials, which showed that relugolix combination therapy significantly reduced dysmenorrhea, NMPP, and dyspareunia vs. placebo in premenopausal women with endometriosis-associated pain. Registration/clinicaltrials.gov identifier: SPIRIT Extension Study (NCT03654274).

Faricimab for neovascular age-related macular degeneration and diabetic macular edema: from preclinical studies to phase 3 outcomes

AbstractIntravitreal anti–vascular endothelial growth factor (VEGF) therapy is the standard of care for diabetic macular edema (DME) and neovascular age-related macular degeneration (nAMD); however, vision gains and anatomical improvements are not sustained over longer periods of treatment, suggesting other relevant targets may be needed to optimize treatments. Additionally, frequent intravitreal injections can prove a burden for patients and caregivers. Angiopoietin-2 (Ang-2) has been explored as an additional therapeutic target, due to the involvement of Ang-2 in DME and nAMD pathogenesis. Recent evidence supports the hypothesis that targeting both VEGF and Ang-2 may improve clinical outcomes in DME and nAMD compared with targeting VEGF alone by enhancing vascular stability, resulting in reduced macular leakage, prevention of neovascularization, and diminished inflammation. Faricimab, a novel bispecific antibody that targets VEGF-A and Ang-2, has been evaluated in clinical trials for DME (YOSEMITE/RHINE) and nAMD (TENAYA/LUCERNE). These trials evaluated faricimab against the anti-VEGFA/B and anti–placental growth factor fusion protein aflibercept, both administered by intravitreal injection. In addition to faricimab efficacy, safety, and pharmacokinetics, durability was evaluated during the trials using a treat-and-extend regimen. At 1 year, faricimab demonstrated non-inferior vision gains versus aflibercept across YOSEMITE/RHINE and TENAYA/LUCERNE. In YOSEMITE/RHINE, faricimab improved anatomic parameters versus aflibercept. Reduction of central subfield thickness (CST), and absence of both DME and intraretinal fluid were greater in faricimab- versus aflibercept-treated eyes. In TENAYA/LUCERNE, CST reductions were greater for faricimab than aflibercept at the end of the head-to-head phase (0–12 weeks), and were comparable with aflibercept at year 1, but with less frequent dosing. CST and vision gains were maintained during year 2 of both YOSEMITE/RHINE and TENAYA/LUCERNE. These findings suggest that dual Ang-2/VEGF-A pathway inhibition may result in greater disease control versus anti-VEGF alone, potentially addressing the unmet needs and reducing treatment burden, and improving real-world outcomes and compliance in retinal vascular diseases. Long-term extension studies (RHONE-X, AVONELLE-X) are ongoing. Current evidence suggests that dual inhibition with faricimab heralds the beginning of multitargeted treatment strategies inhibiting multiple, independent components of retinal pathology, with faricimab providing opportunities to reduce treatment burden and improve outcomes compared with anti-VEGF monotherapy.

Safety and efficacy of tofacitinib for the treatment of patients with juvenile idiopathic arthritis: preliminary results of an open-label, long-term extension study

ObjectivesWe report the safety, tolerability and efficacy of tofacitinib in patients with juvenile idiopathic arthritis (JIA) in an ongoing long-term extension (LTE) study.MethodsPatients (2–<18 years) with JIA who completed phase...

Analysis of tofacitinib safety in ulcerative colitis from the completed global clinical developmental program up to 9.2years of drug exposure.

Tofacitinib is an oral Janus kinase inhibitor for the treatment of ulcerative colitis (UC). We report an integrated summary of tofacitinib safety from the completed global UC clinical program (9.2years maximum tofacitinib exposure). This analysis included patients receiving tofacitinib 5 or 10mg twice daily (b.i.d.) from completed phase 2/3 placebo-controlled studies, an open-label, long-term extension study and a randomized phase 3b/4 study. Proportions and incidence rates (IRs; unique patients with events/100 patient-years [PY] of exposure) were evaluated for deaths and adverse events (AEs) of special interest (AESI). Overall, 1157 patients received ≥1 dose of tofacitinib 5 or 10mg b.i.d.; 938(81.1%) were in the predominant dose tofacitinib 10mgb.i.d. group; 552 (47.7%) received tofacitinib for ≥2years; total exposure: 3202.0 PY; 994 (85.9%) experienced AEs; 254 (22.0%) experienced serious AEs. Median treatment duration: 1.7 (range 0.0-9.2) years. IRs (95% CI) for combined tofacitinib doses: deaths 0.24 (0.10-0.48); serious infections (SIs) 1.80 (1.37-2.32); herpes zoster (HZ; non-serious and serious) 3.24 (2.63-3.94); serious HZ 0.24 (0.10-0.48); opportunistic infections 0.96 (0.65-1.36); malignancies (excluding non-melanoma skin cancer [NMSC]) 0.88 (0.59-1.26); NMSC 0.71 (0.45-1.07); major adverse cardiovascular events 0.27 (0.12-0.52); deep vein thrombosis 0.06 (0.01-0.22); pulmonary embolism 0.18 (0.07-0.40); and gastrointestinal perforations 0.09 (0.02-0.27). Except for HZ and SIs, IRs for AESI were <1 case/100 PY. Safety was consistent with previous analyses of shorter exposure and tofacitinib's known safety profile, including real-world data. GOV: NCT00787202; NCT01465763; NCT01458951; NCT01458574; NCT01470612; NCT03281304.

Determinants of tofacitinib discontinuation in adult patients with rheumatoid arthritis during long-term extension studies up to 9.5 years

Abstract Objectives To examine determinants of tofacitinib discontinuation due to voluntary (ie patient-driven) or involuntary reasons (ie protocol-mandated) in long-term extension (LTE) studies of patients with rheumatoid arthritis (RA) to inform clinical practice, clinical study execution/data capture. Methods This post hoc analysis used pooled data from patients receiving tofacitinib 5 or 10 mg twice daily (BID) in LTE studies. Outcomes included time to voluntary/involuntary discontinuation (and baseline predictors), including by geographical region. Exposure-adjusted event rates (EAERs) were calculated for adverse events (AEs), serious AEs (SAEs) and discontinuations due to AEs/SAEs. Results Of 4967 patients, 2463 (49.6%) discontinued (1552/4967 [31.2%] voluntarily, 911/4967 [18.3%] involuntarily) and 55 (1.1%) died over the course of 9.5 years. When involuntary discontinuation was present as a competing risk for voluntary discontinuation, patients who stayed on combination therapy, and with higher patient-assessed pain were significantly more likely to discontinue for voluntary reasons (p &amp;lt; 0.05). Older patients, those enrolled in Asia/Europe/Latin America (vs US/Canada) or with rheumatoid factor+/anti-cyclic citrullinated antibody+ status, were significantly less likely to discontinue for voluntary reasons (p &amp;lt; 0.05). Small numeric differences in disease activity were observed between geographical regions in patients who discontinued or completed the studies. EAERs were generally higher for tofacitinib 10 vs 5 mg BID, irrespective of discontinuation reason. Conclusion The factors associated with voluntary/involuntary discontinuation of tofacitinib suggest that treatment persistence in RA studies is partly predictable, which may be reflected in clinical practice. Applying these learnings may improve understanding of attrition and inform future study design/execution.

MELTEMI and COLUMBA: 5-Year Comparative Safety Analysis of Benralizumab and Mepolizumab

Benralizumab and mepolizumab are interleukin (IL)-5Rα/interleukin-5-targeted monoclonal antibodies indicated as add-on treatments for patients with uncontrolled severe eosinophilic asthma (SEA). To evaluate and compare the safety of benralizumab and mepolizumab among patients with SEA treated in MELTEMI and COLUMBA open-label, long-term extension studies, respectively. MELTEMI was an extension study of benralizumab every 4 weeks (q4w) or every 8 weeks (q8w) for adults (aged 18-75 y) with SEA. MELTEMI participants transitioned from the BORA extension, preceded by participation in 1 of 3 placebo-controlled studies (SIROCCO, CALIMA, or ZONDA). COLUMBA was an extension study of mepolizumab for patients (aged ≥ 12 y) with SEA who transitioned from the dose-ranging DREAM study. Safety endpoints were presented as drug exposure patient-years (MELTEMI, q4w 784.28, q8w 797.03; COLUMBA 1,201) for nonserious adverse events, serious adverse events, and infections; malignancies were counted numerically. This analysis included 446 MELTEMI patients (benralizumab q4w 220; benralizumab q8w 226) and 347 COLUMBA patients (mepolizumab q4w). Viral upper respiratory tract infection was the most common nonserious adverse event in both studies (MELTEMI q8w 46.5%; q4w 47.3%; COLUMBA, 48.7%). Asthma-related events were the most common serious adverse events in both studies: MELTEMI 8.0% (q8w) and 8.6% (q4w) and COLUMBA 9.5%. Serious infections included pneumonia (MELTEMI q8w, 2 [0.9%]; COLUMBA, 6 [1.7%]); cellulitis (MELTEMI q8w, 1 [0.4%]; COLUMBA, 2 [0.6%]); and respiratory tract infections (COLUMBA, 2 [0.6%]). COLUMBA reported 6 malignancies and MELTEMI reported 4 malignancies in each group. This analysis demonstrated generally similar safety events between mepolizumab and benralizumab in patients with SEA.