1
|
Boyko AN, Alifirova VM, Lukashevich IG, Goncharova ZA, Greshnova IV, Zaslavsky LG, Kotov SV, Malkova NA, Mishin GN, Parshina EV, Poverennova IY, Prakhova LN, Sivertseva SA, Smagina IV, Totolyan NA, Trinitatsky YV, Trushnikova TN, Khabirov FA, Chefranova JY, Shchur SG, Dudin VA, Pokhabov DV, Artemeva AV, Eremeeva AV, Linkova YN, Zinkina-Orikhan AV. [Long-term efficacy and safety of divozilimab during 2-year treatment of multiple sclerosis patients in randomized double-blind placebo-controlled clinical trial BCD-132-4/MIRANTIBUS]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:86-96. [PMID: 38676683 DOI: 10.17116/jnevro202412404186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2024]
Abstract
OBJECTIVE To evaluate the efficacy and safety of the anti-CD20 monoclonal antibody divozilimab (DIV) used as an intravenous infusion at a dose of 500 mg every 24 weeks during 100 weeks for the treatment of patients with multiple sclerosis (MS), including relapsing-remitting multiple sclerosis (RRMS) and secondary progressive MS (SPMS) with relapses. MATERIAL AND METHODS The multicenter, randomized, double-blind and double-masked phase III clinical trial (CT) BCD-132-4/MIRANTIBUS (NCT05385744) included 338 adult patients with MS distributed in a 1:1 ratio into two groups: DIV 500 mg and teriflunomide (TRF) 14 mg. After screening, subjects were included in the main CT period, which consisted of two cycles of therapy over 48 weeks, then entered an additional period from weeks 49 to 100, which included three cycles of therapy. The efficacy was assessed based on the results of brain MRI and registration of data on relapses. RESULTS 308 subjects completed 5 therapy cycles according to the study protocol. An analysis of the effectiveness of DIV therapy over 2 years showed a persistent suppression of MRI and clinical activity of the disease in comparison with TRF, which was confirmed by all the studied MRI indicators (including CUA; total number of gadolinium-enhancing (GdE) lesions on T1-weighted scans ; number of new or enlarged lesions on T2-weighted scans; lesions volume change on T2-weighted scans; change in the volume of hypointense lesions on T1-weighted scans). The use of DIV was associated with a statistically significant decrease in ARR compared to TRF (p=0.0001). The ARR in the DIV group was 0.057, in the TRF group - 0.164 with 95% confidential interval for the frequency ratio [0.202; 0.593]. The incidence of GdE lesions on T1-weighted scans in the DIV group was significantly lower than in the TRF group. The average number of such lesions was 0.0±0.08 and 1.0±4.46 in the DIV and TRF groups, respectively (p<0.0001). Progression of EDSS was detected in 18 (10.7%) and 36 (21.3%) patients in the DIV and TRF groups, respectively (p=0.0075). The proportion of patients with relapses was 11.2% (n=19) in the DIV group and 23.1% (n=39) in the TRF group (p=0.0039). In the subpopulation of patients with SPMS, no cases of increase in EDSS were detected, and not a single case of exacerbation was recorded over 2 years of using DIV. Also, DIV has shown a favorable safety profile. Among the adverse reactions (AR), infusion reactions and laboratory abnormalities, such as a decrease in the number of leukocytes, neutrophils, and lymphocytes, were most often recorded. Identified AR were expected, had mild to moderate severity, and resolved without any negative consequences. CONCLUSION The results of the BCD-132-4/MIRANTIBUS CT indicate a high sustained efficacy and safety of long-term use of DIV in comparison with TRF during 2 years of therapy.
Collapse
Affiliation(s)
- A N Boyko
- Pirogov Russian National Research Medical University, Moscow, Russia
- Federal Center of Brain and Neurotechnologies, Moscow, Russia
| | | | | | | | - I V Greshnova
- Ulyanovsk Regional Clinical Hospital, Ulyanovsk, Russia
| | - L G Zaslavsky
- Leningrad Regional Clinical Hospital, St. Petersburg, Russia
| | - S V Kotov
- Vladimirsky Moscow Regional Research Clinical Institute, Moscow, Russia
| | - N A Malkova
- State Novosibirsk Regional Clinical Hospital, Novosibirsk, Russia
| | - G N Mishin
- Pyatigorsk City Clinical Hospital No. 2, Pyatigorsk, Russia
| | - E V Parshina
- Semashko Nizhny Novgorod Regional Clinical Hospital, Nizhny Novgorod, Russia
| | | | - L N Prakhova
- N. Bechtereva Institute of the Human Brain, St. Petersburg, Russia
| | | | | | - N A Totolyan
- Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia
| | | | | | - F A Khabirov
- Republican Clinical Nerological Center, Kazan, Russia
| | - J Yu Chefranova
- Belgorod Regional Clinical Hospital of St. Joasaph, Belgorod, Russia
| | - S G Shchur
- Municipal Filatov Clinical Hospital No. 15, Moscow, Russia
| | - V A Dudin
- Center for Cardiology and Neurology, Kirov, Russia
| | - D V Pokhabov
- Federal Siberian Scientific and Clinical Center, Krasnoyarsk, Russia
| | | | | | | | | |
Collapse
|
2
|
Boyko AN, Smirnova NF, Shchukin IA, Guseva ME, Volkov AI. [Ofatumumab - a new drug for the treatment of multiple sclerosis]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:37-43. [PMID: 34387444 DOI: 10.17116/jnevro202112107237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Recently anti-B-cell therapy has been increasingly integrated into the treatment of multiple sclerosis (MS). This review is devoted to ofatumumab, a new drug of this line. Ofatumumab, an all-human monoclonal antibody used to treat chronic leukemia, binds to a different region than the binding site of other CD20 antibodies, including both a small and large loop in the CD20 receptor structure. This monoclonal antibody provides favorable results for MS by reducing the frequency of exacerbations and the risk of disability progression, significantly more pronounced when compared with teriflunomide. The drug can be used in patients with active relapsing MS and SPMS with exacerbations, with the ineffectiveness of first-line drugs as one of the options for second-line therapy, in patients with highly active MS, especially with a high risk of PML (transfer from natalizumab), as well as if there are difficulties in organizing intravenous courses in day hospitals (produced as outpatient injections).
Collapse
Affiliation(s)
- A N Boyko
- Pirogov Russian National Research Medical University, Moscow, Russia.,Federal Center for Brain and Neurotechnology of the FMBA, Moscow, Russia
| | - N F Smirnova
- Pirogov Russian National Research Medical University, Moscow, Russia.,Federal Center for Brain and Neurotechnology of the FMBA, Moscow, Russia
| | - I A Shchukin
- Pirogov Russian National Research Medical University, Moscow, Russia.,Federal Center for Brain and Neurotechnology of the FMBA, Moscow, Russia
| | - M E Guseva
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - A I Volkov
- Federal Center for Brain and Neurotechnology of the FMBA, Moscow, Russia
| |
Collapse
|