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FDA Accepts Biologic License Application of Infliximab for Inhibiting Progression of Structural Damage in Psoriatic Arthritis
"Findings from IMPACT 2 show that early intervention with Remicade therapy can significantly inhibit the progression of joint damage, which is an important factor in the long-term prognosis of patients with psoriatic arthritis," said Jerome A. Boscia, MD, Senior Vice President, Clinical Research and Development, Centocor, Inc. "We are encouraged by these data and are pleased that the FDA has accepted the file for review."
One-year radiographic analyses from IMPACT 2 showed that treatment with Remicade resulted in significantly greater inhibition of the progression of structural damage, compared with placebo (as measured by the change from baseline in van der Heijde-Sharp [vdH-S] score modified for PsA by adding measurement for distal interphalangeal joints of the hands). In this method a higher change in score indicates greater structural damage, while lower change in score indicates less structural damage. At as early as 24 weeks of treatment, Remicade-treated patients experienced a mean change (+/- standard deviation) in vdH-S score of -0.70 (+/- 2.53) from baseline, compared with an average change of 0.82 (+/- 2.62) in the placebo group (P Remicade-treated patients demonstrated significant improvement in physical function as measured by the Health Assessment Questionnaire (HAQ). The HAQ assesses the difficulty a patient has accomplishing tasks in eight functional areas (dressing, arising, eating, walking, hygiene, reaching, gripping and other activities of daily living). As early as week 14, patients in the Remicade group experienced a median improvement of 43 percent, compared with zero percent in the placebo group (P Additionally, in May 2006, the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency gave a positive opinion for the use of Remicade for treatment of active and progressive psoriatic arthritis in patients who have responded inadequately to DMARDs to be used in combination with methotrexate or alone in patients who show intolerance to methotrexate or in whom methotrexate is contraindicated. Acceptance of the sBLA filing by the FDA does not mean that a license has been issued for this indication nor does it represent any evaluation of the adequacy of the data submitted in the sBLA.
About IMPACT/IMPACT 2
The Infliximab Multinational Psoriatic Arthritis Controlled Trial (IMPACT) was a Phase 2b, randomized, double-blind, placebo-controlled study that involved 104 patients with active psoriatic arthritis (defined as affecting at least five joints) who failed at least one DMARD. Patients received either Remicade (5 mg/kg) or placebo, administered at weeks 0, 2, 6 and 14. The Remicade group continued on maintenance treatments every eight weeks through week 94. Beginning at week 16, patients randomized to the placebo group received an induction regimen of Remicade followed by maintenance treatment every eight weeks through week 94. Hands and feet radiographs were taken at screening and at weeks 50 and 98. Physical function was measured at multiple visits including screening and at weeks 16, 22, 50 and 94.
Remicade was generally well tolerated in this study, with one Remicade and one placebo patient experiencing serious adverse events (AEs) in the placebo- controlled portion of the study through week 16. Fourteen patients out of 104 experienced serious AEs from week 16 through 50 in placebo/Remicade crossover and Remicade groups together. In the second year of IMPACT, seven patients out of 78 treated with Remicade were reported with serious AEs. No deaths, cases of tuberculosis or other opportunistic infections were reported and serious infections were uncommon. There were no serious infusion reactions. One patient had a serious AE relating to malignancy: a ductal adenocarcinoma of the pancreas three months after week 98.
The Induction and Maintenance of Psoriatic Arthritis Clinical Trial 2 (IMPACT 2) was a Phase 3, randomized, double-blind, placebo-controlled study of 200 patients with active psoriatic arthritis (defined as affecting at least five joints). The study evaluated the safety and efficacy of Remicade in patients who had an inadequate response to DMARDs or nonsteroidal anti- inflammatory drugs (NSAIDs). Patients received Remicade (5 mg/kg) at weeks 0, 2, 6 and every 8 weeks until week 46 or placebo at weeks 0, 2, 6, 14 and 22. Placebo patients with less than 10 percent improvement in both swollen and tender joints entered early escape and received Remicade at weeks 16, 18 and 22 (n=47). At week 24, placebo patients who did not qualify for early escape received Remicade at week 24, 26, 30, 38 and 46. Patients randomized to Remicade who had less than 20 percent improvement in combined swollen and tender joint count received Remicade 10 mg/kg at weeks 38 and 46 (n=15). Patients were allowed concomitant methotrexate use at a stable dose. Hand and foot radiographs were taken at week 0, 24 and 54. Physical function was measured at multiple visits including weeks 0, 14, 24 and 54.
Through 54 weeks, 12 percent of patients in combined Remicade treatment groups experienced serious AEs (during average follow-up of 42.8 weeks) as compared to 6 percent of placebo patients (average follow-up 20.2 weeks). No deaths, cases of tuberculosis or other opportunistic infections or serious infusion reactions were reported; serious infections were uncommon. There were two patients who were reported an AE of malignancy: one case of basal cell carcinoma in the placebo group and one case of stage I Hodgkin lymphoma in the Remicade group. The only laboratory abnormalities that occurred more frequently with Remicade compared with placebo were asymptomatic liver enzyme test elevations. See "Important Safety Information" below.
About Psoriatic Arthritis
Psoriatic arthritis is a chronic inflammatory arthropathy manifesting with joint pain and swelling that can lead to joint destruction and debilitation. It is frequently associated with inflamed, scaly, red patches of skin psoriasis. Symptoms may include stiffness and tenderness of the joints and surrounding tissue, reduced range of motion, nail changes and redness and pain of the eye (uveitis). Joints of the hands, wrists, knees, ankles, feet, lower back and neck are commonly affected. Psoriasis affects an estimated two to three percent of the world's population, and approximately one out of three patients affected by psoriasis may develop psoriatic arthritis. Both men and women are equally affected by psoriatic arthritis, most commonly between the ages 30 and 50, in the peak of their productive years.
Remicade is the global market leader among anti-tumor necrosis factor alpha (TNF-alpha) therapies and has demonstrated broad clinical utility in rheumatoid arthritis (RA), Crohn's disease (CD), psoriatic arthritis (PsA), ulcerative colitis (UC), ankylosing spondylitis (AS) and pediatric Crohn's disease (PCD). The safety and efficacy of Remicade have been well established in clinical trials over the past 14 years and through commercial experience with more than 770,000 patients treated worldwide.
In the U.S., Remicade, in combination with methotrexate, is indicated for reducing signs and symptoms, inhibiting the progression of structural damage and improving physical function in patients with moderately to severely active RA. Remicade is the only biologic indicated for reducing signs and symptoms and inducing and maintaining clinical remission in adult and pediatric patients with moderately to severely active CD who have had an inadequate response to conventional therapy. Remicade is also indicated for reducing the number of draining enterocutaneous and rectovaginal fistulas and maintaining fistula closure in patients with fistulizing CD. In December 2004, Remicade was approved for reducing signs and symptoms in patients with active AS. In May 2005, Remicade was approved for reducing signs and symptoms of active arthritis in patients with PsA. Additionally, in September 2005, Remicade was approved for reducing signs and symptoms, achieving clinical remission and mucosal healing, and eliminating corticosteroid use in patients with moderately to severely active UC who have had an inadequate response to conventional therapy. This approval makes Remicade the first and only biologic approved for the treatment of moderate to severe UC. In addition, on May 19, 2006, Remicade was approved for reducing signs and symptoms and inducing and maintaining clinical remission in pediatric patients with moderately to severely active Crohn's disease who have had an inadequate response to conventional therapy. This approval establishes Remicade as the first and only biologic therapy approved for the treatment of PCD. Remicade is unique among available anti-TNF biologic therapies. Unlike self-administered therapies that require patients to inject themselves frequently, Remicade is the only anti-TNF biologic administered directly by caregivers in the clinic or office setting. In RA (3 mg/kg), CD (5 mg/kg), PsA (5 mg/kg), UC (5 mg/kg), and PCD (5 mg/kg), Remicade is a two-hour infusion administered every 8 weeks, following a standard induction regimen that requires treatment at weeks 0, 2 and 6. As a result, Remicade patients may require as few as six treatments each year. In AS (5 mg/kg), Remicade is a two-hour infusion administered every 6 weeks, following a standard induction regimen that requires treatment at weeks 0, 2 and 6.