Effect of bimekizumab on symptoms and impact of disease in patients with psoriatic arthritis over 3 years: results from BE ACTIVE

OBJECTIVES

Evaluate effects of long-term bimekizumab treatment on patient-reported outcome (PRO) measures, symptoms and the impact of PsA on patients.

METHODS

Patients with active PsA were enrolled into BE ACTIVE, a 48-week randomised controlled trial (NCT02969525). After Week 48, patients could enter a 104-week open-label extension (NCT03347110), receiving bimekizumab 160 mg every four weeks. PRO measures assessed included arthritis pain visual analogue scale (VAS), PsA Impact of Disease (PsAID)-9, 36-Item Short Form Survey (SF-36) and HAQ-Disability Index (HAQ-DI). Results were analysed as mean (S.E.M.) changes from baseline (CfB) from Week 0 to the end of the open-label extension (3 years) and as percentage of patients reaching patient-acceptable symptom state (PASS) for global impact (PsAID-9 total score ≤4) and normal function (HAQ-DI total score <0.5). Non-responder imputation was applied to missing binary outcomes.

RESULTS

In 206 patients (mean age 49.3 years, 51.0% male), completion rate was high; 161 (78.2%) patients completed Week 152. Bimekizumab treatment was associated with long-term sustained improvements in pain [arthritis pain VAS CfB; Week 48: -29.9 (1.9); Week 152: -32.0 (1.9)] and fatigue [PsAID-9 fatigue CfB; -2.4 (0.2); -2.7 (0.2)]. High percentages of patients achieved acceptable symptom state (PsAID-9 PASS: 75.2%; 65.0%) and normalised function (HAQ-DI <0.5: 49.0%; 46.1%). Improvements in patient global assessment and SF-36 Physical Component Summary were also sustained.

CONCLUSIONS

Bimekizumab treatment was associated with long-term sustained improvements in pain and fatigue, reducing overall impact of PsA on patients. Physical function and quality of life improved up to 3 years.

TRIAL REGISTRATION

ClinicalTrials.gov, https://clinicaltrials.gov, NCT02969525, NCT03347110.

Bimekizumab in patients with psoriatic arthritis, naive to biologic treatment: a randomised, double-blind, placebo-controlled, phase 3 trial (BE OPTIMAL)

BACKGROUND

Bimekizumab is a monoclonal IgG1 antibody that selectively inhibits interleukin (IL)-17A and IL-17F. We assessed the efficacy and safety of bimekizumab in patients with active psoriatic arthritis who were naive to biologic disease-modifying antirheumatic drugs (DMARDs).

METHODS

BE OPTIMAL was a 52-week, phase 3, multicentre, randomised, double-blind, placebo-controlled, active reference (adalimumab) trial done at 135 sites (hospitals, clinics, doctors' offices, and research centres) in 14 countries. Eligible patients were 18 years or older with a documented diagnosis of adult-onset psoriatic arthritis that met the Classification Criteria for Psoriatic Arthritis for at least 6 months before screening. Participants were randomly assigned with an interactive-voice and web-response system on the basis of a predetermined randomisation schedule (3:2:1, stratified by region and bone erosion number at baseline) to bimekizumab 160 mg every 4 weeks, placebo every 2 weeks, or the reference group (adalimumab 40 mg every 2 weeks), all administered subcutaneously. At week 16, patients randomly assigned to placebo switched to bimekizumab 160 mg every 4 weeks. The primary endpoint was the proportion of patients reaching 50% or greater improvement in American College of Rheumatology criteria (ACR50) at week 16 (non-responder imputation). Efficacy analyses included all patients who were randomly assigned (intention-to-treat population); the safety analysis set comprised patients who received one or more doses of treatment. Data are presented to week 24 (preplanned analysis). This trial is registered at ClinicalTrials.gov, NCT03895203.

FINDINGS

Between April 3, 2019, and Oct 25, 2021, 1163 patients were screened and 852 were randomly assigned to bimekizumab (n=431), placebo (n=281), and reference (adalimumab; n=140) groups. At week 16, significantly more patients receiving bimekizumab (189 [44%] of 431) reached ACR50 response versus placebo (28 [10%] of 281; odds ratio 7·1 [95% CI 4·6-10·9], p<0·0001; adalimumab 64 [46%] of 140). All secondary hierarchical endpoints were met. Treatment-emergent adverse events up to week 16 were reported in 258 [60%] of 431 patients receiving bimekizumab, 139 [49%] of 281 patients receiving placebo, and 83 [59%] of 140 patients receiving adalimumab. No deaths occurred.

INTERPRETATION

Bimekizumab treatment had superior improvements in joint, skin, and radiographic efficacy outcomes at week 16 compared with placebo in patients with psoriatic arthritis who were naive to biologic DMARDs. The safety profile of bimekizumab, including the occurrence of fungal infections, was consistent with previous phase 3 studies in patients with plaque psoriasis, and with IL-17A inhibitors.

FUNDING

UCB Pharma.

Bimekizumab in patients with active psoriatic arthritis and previous inadequate response or intolerance to tumour necrosis factor-α inhibitors: a randomised, double-blind, placebo-controlled, phase 3 trial (BE COMPLETE)

BACKGROUND

Bimekizumab is a monoclonal IgG1 antibody that selectively inhibits interleukin (IL)-17F and IL-17A. This study compared the efficacy and safety of bimekizumab with placebo over 16 weeks in patients with active psoriatic arthritis and previous inadequate response or intolerance to tumour necrosis factor-α (TNFα) inhibitors.

METHODS

BE COMPLETE was a phase 3, multicentre, randomised, double-blind, placebo-controlled trial conducted across 92 sites (including hospitals, clinics, and research centres) in 11 countries (Australia, Canada, Czech Republic, Germany, Hungary, Italy, Japan, Poland, Russia, the UK, and the USA). Eligible patients were aged 18 years or older with adult-onset psoriatic arthritis (meeting the Classification Criteria for Psoriatic Arthritis for at least 6 months before screening) with a history of inadequate response or intolerance to treatment with one or two TNFα inhibitors for either psoriatic arthritis or psoriasis. We stratified patients with active psoriatic arthritis by region and previous TNFα inhibitor use. Patients were randomly assigned (2:1) to receive subcutaneous bimekizumab 160 mg every 4 weeks or placebo by an interactive-voice and web-response system on the basis of a predetermined randomisation schedule. The primary endpoint was the proportion of patients with 50% or greater improvement in American College of Rheumatology criteria (ACR50) at week 16 (non-responder imputation). Efficacy analyses were done in the randomised population. The safety analysis set comprised patients who received one or more doses of study treatment. This trial was registered at ClinicalTrials.gov, NCT03896581, and is completed.

FINDINGS

Between March 28, 2019, and Feb 14, 2022, 556 patients were screened and 400 patients were randomly assigned to bimekizumab 160 mg every 4 weeks (n=267) or placebo (n=133). The primary and all hierarchical secondary endpoints were met at week 16. 116 (43%) of 267 patients receiving bimekizumab reached ACR50, compared with nine (7%) of 133 patients receiving placebo (adjusted odds ratio [OR] 11·1 [95% CI 5·4-23·0], p<0·0001). 121 (69%) of 176 patients with psoriasis affecting at least 3% body surface area at baseline who received bimekizumab reached 90% or greater improvement in the Psoriasis Area and Severity Index (PASI90), compared with six (7%) of 88 patients who received placebo (adjusted OR 30·2 [12·4-73·9], p<0·0001). Treatment-emergent adverse events up to week 16 were reported in 108 (40%) of 267 patients receiving bimekizumab and 44 (33%) of 132 patients receiving placebo. There were no new safety signals and no deaths.

INTERPRETATION

Bimekizumab treatment led to superior improvements in joint and skin efficacy outcomes at week 16 compared with placebo in patients with psoriatic arthritis and inadequate response or intolerance to TNFα inhibitors. The safety profile of bimekizumab was consistent with previous phase 3 studies in patients with plaque psoriasis, and studies of IL-17A inhibitors.

FUNDING

UCB Pharma.

Safety and Efficacy of Bimekizumab in Patients with Active Psoriatic Arthritis: 3-Year Results from a Phase 2b Randomized Controlled Trial and its Open-Label Extension Study

OBJECTIVE

To assess long-term safety, tolerability, and efficacy of bimekizumab in active psoriatic arthritis (PsA).

METHODS

Adult patients with active PsA completing the double- and dose-blind periods of the BE ACTIVE randomized controlled trial could enroll in the open-label extension (OLE) at Week 48, after which patients received bimekizumab 160 mg every four weeks. Safety and efficacy results are presented through 152 weeks.

RESULTS

At Week 152, 161/206 patients (78.2%) remained in the study. From Weeks 0-152, 184/206 patients (126.4/100 patient-years) had ≥1 treatment-emergent adverse event. Most frequent were nasopharyngitis (7.6), upper respiratory tract infection (6.8), bronchitis (3.5), and oral candidiasis (3.5). 47/206 patients (9.7) had fungal infections; 24/206 (4.6) had Candida infections and 19/206 (3.5) had oral candidiasis. All fungal infections were mild to moderate and localized. Four patients (0.7) had serious infections; there were no reported cases of active tuberculosis, adjudicated major adverse cardiac events, or deaths. Efficacy demonstrated at Week 48 was sustained in the OLE. At Week 152, non-responder imputation (observed case) analysis showed 52.9% (69.4%) of patients achieved American College of Rheumatology criteria 50% response, 57.7% (73.8%) achieved 100% skin clearance per the Psoriasis Area and Severity Index, and 51.5% (67.5%) achieved minimal disease activity. Patients also maintained improvements in pain, physical function, and health-related quality of life.

CONCLUSIONS

The safety profile of bimekizumab was consistent with previous reports, with no new safety signals identified. Sustained joint and efficacy responses were observed over three years.

LB0001 BIMEKIZUMAB IN BDMARD-NAIVE PATIENTS WITH PSORIATIC ARTHRITIS: 24-WEEK EFFICACY & SAFETY FROM BE OPTIMAL, A PHASE 3, MULTICENTRE, RANDOMISED, PLACEBO-CONTROLLED, ACTIVE REFERENCE STUDY

Background

Bimekizumab (BKZ) is a monoclonal IgG1 antibody that selectively inhibits IL-17F in addition to IL-17A.

Objectives

Assess BKZ efficacy and safety vs PBO in bDMARD-naïve pts with active PsA to Wk 24 of BE OPTIMAL.

Methods

BE OPTIMAL (NCT03895203) comprises 16 wks double-blind PBO-controlled and 36 wks treatment-blind. Pts were ≥18 yrs, bDMARD-naïve, with adult-onset, active PsA, ≥3 tender and ≥3 swollen joints. Pts randomised 3:2:1, subcutaneous BKZ 160 mg Q4W:PBO:adalimumab (ADA; reference arm) 40 mg Q2W. From Wk 16, PBO pts received BKZ 160 mg Q4W. Primary endpoint: ACR50 at Wk 16.

Results

821/852 (96.4%) pts completed Wk 16 and 806 (94.6%) Wk 24. Mean age 48.7 yrs, BMI 29.2 kg/m2; since diagnosis: 5.9 yrs; 46.8% male. BL characteristics comparable across arms. Primary endpoint met (Wk 16 ACR50: 43.9% BKZ vs 10.0% PBO, p<0.001; ADA: 45.7%; Figure 1). All ranked secondary endpoints met at Wk 16 (Table 1). As early as Wk 2, ACR20 was higher in BKZ vs PBO (27.1% vs 7.8%, nominal p<0.001; ADA: 33.6%). Outcomes continued to improve at Wk 24 (Table 1). To Wk 16, pts with ≥1 TEAE, BKZ: 59.9%; PBO: 49.5%; ADA: 59.3%. SAE rate low (1.6%; 1.1%; 1.4%). Most frequent (≥5%) AEs for all arms: nasopharyngitis (9.3%; 4.6%; 5.0%), URTI (4.9%; 6.4%; 2.1%), increased ALT (0.7%; 0.7%; 5.0%). Candida infections: 2.6%, 0.7%, 0%; no systemic candidiasis. 2 malignancies (BKZ: basal cell carcinoma; PBO: breast cancer stage 1); no MACE, uveitis, IBD or deaths.

Table 1.

Wk 16 and 24 efficacy

BLWk 16Wk 24PBO N=281BKZ 160 mg Q4W N=431ADA 40 mg Q2W N=140†PBO N=281BKZ 160 mg Q4W N=431ADA 40 mg Q2W N=140†p value (BKZ vs PBO)PBO→ BKZ 160 mg Q4WaN=281BKZ 160 mg Q4W N=431ADA 40 mg Q2W N=140†Ranked endpointsbACR50 [NRI],–––28189 (43.9)64<0.00110119666n (%)-10-45.7(35.9)(45.5)-47.1HAQ-DI CfB [MI],0.890.820.86−0.09 (0.03)−0.26 (0.02)−0.33<0.001c−0.28−0.30−0.34mean (SE)-0.04-0.03-0.05(0.04)(0.03)(0.02)(0.05)PASI90d [NRI],–––4133 (61.3)f28<0.00186 (61.4)e158 (72.8)f32n (%)(2.9)e(41.2)g(47.1)gSF-36 PCS CfB [MI],36.938.137.62.36.36.8<0.001c6.27.37.3mean (SE)-0.6-0.5-0.7-0.5-0.4-0.8-0.5-0.4-0.8MDA [NRI],51413719463<0.00110620967n (%)-1.8-3.2-0.7-13.2(45.0)-45(37.7)(48.5)-47.9vdHmTSS CfB (subgroup)h [MI], mean (SE)15.67 (1.80)i15.56 (1.69)j17.39 (2.89)k0.36 (0.10)i−0.01 (0.04)j−0.06 (0.08)k<0.001c–––vdHmTSS CfB [MI],mean (SE)13.31 (1.56)l13.44 (1.47)m14.55 (2.44)n0.31 (0.09)l0(0.04)m−0.03 (0.07)n0.001c–––Other endpointsACR20 [NRI],–––6726896<0.001o17528299n (%)-23.8(62.2)-68.6(62.3)(65.4)-70.7ACR70 [NRI],–––1210539<0.001o5312642n (%)-4.3(24.4)-27.9-18.9(29.2)-30PASI100d [NRI],–––3103f14<0.001o6012226n (%)(2.1)e(47.5)(20.6)g(42.9)e (56.2)f(38.2)gTJC CfB [MI],17.116.817.5−3.2−10.0−10.9<0.001o−9.4−11.5−11.8mean (SE)-0.7-0.6-1.1(0.7) (0.5)-1(0.7)(0.5)-0.9SJC CfB [MI],9.599.6−3.0 (0.5)−6.6 (0.3)−7.5<0.001o−6.8 (0.4)−7.2 (0.3)−7.9mean (SE)-0.4-0.3-0.6-0.6-0.6

Randomised set. Interim results.

†Reference arm; study not powered for statistical comparisons of ADA to BKZ or PBO.

aPBO→BKZ pts received PBO to Wk 16, switched to BKZ 160 mg Q4W through Wk 24 (8 wks BKZ);

bResolution of enthesitis/dactylitis in pts with LEI>0/LDI>0 at BL pooled with BE COMPLETE (Wk 16 LEI=0 BKZ: 124/249 [49.8%], PBO: 37/106 [34.9%], p=0.008; LDI=0 BKZ: 68/90 [75.6%], PBO: 24/47 [51.1%], p=0.002);

cContinuous outcome p values calculated with RBMI data;

dPts with PSO and ≥3% BSA at BL;

en=140;

fn=217;

gn=68;

hPts with hs-CRP ≥6 mg/L and/or bone erosion at BL;

in=221;

jn=357;

kn=108;

ln=261;

mn=416;

nn=131;

oNominal, not powered for multiplicity.

Conclusion

Dual inhibition of IL-17A and IL-17F with BKZ in bDMARD-naïve pts with active PsA resulted in rapid, clinically relevant improvements in musculoskeletal and skin outcomes vs PBO. No new safety signals observed.1,2

References

[1]Ritchlin CT Lancet 2020;395(10222):427–40; 2. Coates LC Ann Rheum Dis 2021;80:779–80(POS1022).

Disclosure of Interests

Iain McInnes Consultant of: AbbVie, BMS, Boehringer Ingelheim, Celgene, Eli Lilly, Janssen, Novartis, and UCB Pharma, Grant/research support from: BMS, Boehringer Ingelheim, Celgene, Janssen, UCB Pharma, Laura Coates Consultant of: AbbVie, Amgen, Boehringer Ingelheim, BMS, Celgene, Domain, Eli Lilly, Gilead, Galapagos, Janssen, Moonlake, Novartis, Pfizer, and UCB Pharma, Speakers bureau: AbbVie, Amgen, Biogen, Celgene, Eli Lilly, Galapagos, Gilead, GSK, Janssen, Medac, Novartis, Pfizer, and UCB Pharma, Grant/research support from: AbbVie, Amgen, Celgene, Eli Lilly, Gilead, Janssen, Novartis, Pfizer, and UCB Pharma, Robert B.M. Landewé Consultant of: Abbott, Ablynx, Amgen, AstraZeneca, BMS, Centocor, GSK, Novartis, Merck, Pfizer, Roche, Schering-Plough, UCB Pharma, and Wyeth, Speakers bureau: Abbott, Amgen, BMS, Centocor, Merck, Pfizer, Roche, Schering-Plough, UCB Pharma, and Wyeth, Grant/research support from: Abbott, Amgen, Centocor, Novartis, Pfizer, Roche, Schering-Plough, UCB Pharma, and Wyeth, Philip J Mease Consultant of: AbbVie, Amgen, BMS, Boehringer Ingelheim, Eli Lilly, Galapagos, Gilead, GSK, Janssen, Novartis, Pfizer, Sun Pharma and UCB Pharma, Speakers bureau: AbbVie, Amgen, Eli Lilly, Janssen, Novartis, Pfizer and UCB Pharma, Grant/research support from: AbbVie, Amgen, BMS, Eli Lilly, Gilead, Janssen, Novartis, Pfizer, Sun Pharma and UCB Pharma, Christopher T. Ritchlin Consultant of: AbbVie, Amgen, Eli Lilly, Gilead, Janssen, Novartis, Pfizer and UCB Pharma, Grant/research support from: AbbVie, Amgen and UCB Pharma, Yoshiya Tanaka Consultant of: AbbVie, Ayumi, Daiichi-Sankyo, Eli Lilly, GSK, Sanofi, and Taisho, Speakers bureau: AbbVie, Amgen, Astellas, AstraZeneca, BMS, Boehringer-Ingelheim, Chugai, Eisai, Eli Lilly, Gilead, Mitsubishi-Tanabe, and YL Biologics, Grant/research support from: AbbVie, Asahi-Kasei, Boehringer-Ingelheim, Chugai, Corrona, Daiichi-Sankyo, Eisai, Kowa, Mitsubishi-Tanabe, and Takeda, Akihiko Asahina Grant/research support from: AbbVie, Amgen, Eisai, Eli Lilly, Janssen, Kyowa Kirin, LEO Pharma, Maruho, Mitsubishi Tanabe Pharma, Pfizer, Sun Pharma, Taiho Pharma, Torii Pharmaceutical, and UCB Pharma, Laure Gossec Consultant of: AbbVie, Amgen, BMS, Celltrion, Galapagos, Gilead, GSK, Janssen, Lilly, Novartis, Pfizer and UCB Pharma, Grant/research support from: Amgen, Galapagos, Lilly, Pfizer, Sandoz and UCB Pharma, Alice B Gottlieb Consultant of: Amgen, AnaptsysBio, Avotres Therapeutics, Boehringer Ingelheim, BMS, Dermavant, Eli Lilly, Incyte, Janssen, Novartis, Pfizer, Sanofi, Sun Pharma, UCB Pharma, and XBiotech, Grant/research support from: Boehringer Ingelheim, Janssen, Novartis, Sun Pharma, UCB Pharma, and XBiotech: all funds go to Mount Sinai Medical School, Richard B. Warren Consultant of: AbbVie, Almirall, Amgen, Arena, Astellas, Avillion, Biogen, BMS, Boehringer Ingelheim, Celgene, Eli Lilly, GSK, Janssen, LEO Pharma, Novartis, Pfizer, Sanofi, and UCB Pharma, Paid instructor for: Astellas, DiCE, GSK, and Union, Grant/research support from: AbbVie, Almirall, Janssen, LEO Pharma, Novartis, and UCB Pharma, Barbara Ink Shareholder of: GSK, UCB Pharma, Employee of: UCB Pharma, Deepak Assudani Shareholder of: UCB Pharma, Employee of: UCB Pharma, Jason Coarse Shareholder of: UCB Pharma, Employee of: UCB Pharma, Rajan Bajracharya Shareholder of: UCB Pharma, Employee of: UCB Pharma, Joseph F. Merola Consultant of: AbbVie, Amgen, Biogen, BMS, Dermavant, Eli Lilly, Janssen, Leo Pharma, Novartis, Pfizer, Regeneron, Sanofi, Sun Pharma, and UCB Pharma, Paid instructor for: Amgen, Abbvie, Biogen, BMS, Dermavant, Eli Lilly, Janssen, Leo Pharma, Novartis, Pfizer, Regeneron, Sanofi, Sun Pharma, and UCB Pharma

OP0255 BIMEKIZUMAB IN PATIENTS WITH ACTIVE PSORIATIC ARTHRITIS AND AN INADEQUATE RESPONSE TO TUMOUR NECROSIS FACTOR INHIBITORS: 16-WEEK EFFICACY & SAFETY FROM BE COMPLETE, A PHASE 3, MULTICENTRE, RANDOMISED PLACEBO-CONTROLLED STUDY

Background

Bimekizumab (BKZ) is a monoclonal IgG1 antibody that selectively inhibits IL-17F in addition to IL-17A. BKZ has shown sustained efficacy and tolerability up to 152 wks in a phase 2b study in patients (pts) with active psoriatic arthritis (PsA).1,2

Objectives

To assess efficacy and safety of BKZ vs placebo (PBO) in pts with active PsA and prior inadequate tumour necrosis factor inhibitor (TNFi) response in the 16-wk pivotal phase 3 study, BE COMPLETE.

Methods

BE COMPLETE (NCT03896581) comprises a 16-wk double-blind, PBO-controlled period. Pts were aged ≥18 yrs, had a diagnosis of adult-onset, active PsA with ≥3 tender joints and ≥3 swollen joints, and inadequate response or intolerance to treatment with 1 or 2 TNFi. Pts were randomised 2:1 to BKZ 160 mg Q4W or PBO. From Wk 16, pts were eligible to enter an open-label extension, receiving BKZ 160 mg Q4W. The primary endpoint was a ≥50% improvement in American College of Rheumatology response criteria (ACR50) at Wk 16. Primary and ranked secondary efficacy endpoints were assessed at Wk 16.

Results

Of 400 randomised pts (BKZ: 267; PBO: 133), 388 (97.0%) completed Wk 16 (BKZ: 263 [98.5%]; PBO: 125 [94.0%]). Baseline characteristics were comparable between groups: mean age 50.5 yrs, weight 86.0 kg, BMI 29.8 kg/m2, time since diagnosis 9.5 yrs; 47.5% pts were male.

At Wk 16, the primary endpoint (ACR50: 43.4% BKZ vs 6.8% PBO; p<0.001; Figure 1) and all ranked secondary endpoints (HAQ-DI CfB, PASI90, SF-36 PCS CfB and MDA response) were met (all p<0.001; Table 1). The ACR50 response was rapid with separation from PBO observed from Wk 4 (nominal p<0.001). Additional outcomes, including ACR20/70, TJC and SJC CfB, and PASI75/100, demonstrated numerical improvement with BKZ compared to PBO at Wk 16 (all nominal p<0.001; Table 1).

Table 1.

Disease characteristics at baseline and efficacy at Wk 16

PBO N=133BKZ 160 mg Q4W N=267p valueBaseline characteristicsTJCmean (SD)19.3 (14.2)18.4 (13.5)-SJCmean (SD)10.3 (8.2)9.7 (7.5)-PtGA-PsAmean (SD)63.0 (22.0)60.5 (22.5)-PtAAPmean (SD)61.7 (24.6)58.3 (24.2)-Psoriasis BSAn (%)<3%45 (33.8)91 (34.1)-≥3 to ≤10%63 (47.4)109 (40.8)->10%25 (18.8)67 (25.1)-PASIamean (SD)8.5 (6.6)b10.1 (9.1)c-Prior TNFin (%)Inadequate response to 1 TNFi103 (77.4)204 (76.4)-Inadequate response to 2 TNFi15 (11.3)29 (10.9)-Intolerance to TNFi15 (11.3)34 (12.7)-Current cDMARDsn (%)63 (47.4)139 (52.1)-Ranked endpoints in hierarchical orderACR50* [NRI] n (%)9 (6.8)116 (43.4)<0.001HAQ-DI CfB† [RBMI] mean (SE)–0.1 (0.0)–0.4 (0.0)<0.001PASI90†a [NRI]n (%)6 (6.8)b121 (68.8)c<0.001SF-36 PCS CfB† [RBMI]mean (SE)1.4 (0.7)7.3 (0.5)<0.001MDA Response† [NRI]n (%)8 (6.0)118 (44.2)<0.001Other endpointsACR20† [NRI]n (%)21 (15.8)179 (67.0)<0.001‡ACR70† [NRI] n (%)1 (0.8)71 (26.6)<0.001‡TJC CfB [MI] mean (SE)–2.4 (0.9)–10.9 (0.8)<0.001‡SJC CfB [MI] mean (SE)–2.0 (0.5)–7.0 (0.4)<0.001‡PASI75a [NRI]n (%)9 (10.2)b145 (82.4)c<0.001‡PASI100a [NRI]n (%)4 (4.5)b103 (58.5)c<0.001‡

Randomised set (N=400). *Primary endpoint; †Secondary endpoint; ‡Nominal p value. aIn patients with ≥3% BSA with PSO at BL; bn=88; cn=176.

Over 16 wks, 107/267 (40.1%) pts on BKZ had ≥1 TEAE vs 44/132 (33.3%) pts on PBO; the three most frequent TEAEs on BKZ were nasopharyngitis (BKZ: 3.7%; PBO: 0.8%), oral candidiasis (BKZ: 2.6%; PBO: 0%) and upper respiratory tract infection (BKZ: 2.2%; PBO: 1.5%). Incidence of SAEs was low (BKZ: 1.9%; PBO: 0%); none led to discontinuation. 2 pts on BKZ discontinued due to a TEAE (BKZ: 0.7%; PBO: 0%). No systemic candidiasis, cases of IBD, MACE, uveitis, VTE or deaths were reported.

Conclusion

Dual inhibition of IL-17A and IL-17F with BKZ in pts with active PsA and prior inadequate TNFi response resulted in rapid, clinically relevant and statistically significant improvements in efficacy outcomes vs PBO. No new safety signals were observed.1,2

References

[1]Ritchlin C.T. Lancet 2020;395(10222):427–40; 2. Coates L.C. Ann Rheum Dis 2021;80:779–80(POS1022).

Acknowledgements

This study was funded by UCB Pharma. Editorial services were provided by Costello Medical.

Disclosure of Interests

Joseph F. Merola Paid instructor for: Amgen, Abbvie, Biogen, BMS, Dermavant, Eli Lilly, Janssen, Leo Pharma, Novartis, Pfizer, Regeneron, Sanofi, Sun Pharma and UCB Pharma, Consultant of: Amgen, Abbvie, Biogen, BMS, Dermavant, Eli Lilly, Janssen, Leo Pharma, Novartis, Pfizer, Regeneron, Sanofi, Sun Pharma and UCB Pharma, Iain McInnes Consultant of: AbbVie, BMS, Boehringer Ingelheim, Celgene, Eli Lilly, Janssen, Novartis, and UCB Pharma, Grant/research support from: BMS, Boehringer Ingelheim, Celgene, Janssen, UCB Pharma, Christopher T. Ritchlin Consultant of: Amgen, AbbVie, Eli Lilly, Gilead, Janssen, Novartis, Pfizer and UCB Pharma, Grant/research support from: AbbVie, Amgen and UCB Pharma, Philip J Mease Speakers bureau: AbbVie, Amgen, Eli Lilly, Janssen, Novartis, Pfizer and UCB Pharma, Consultant of: AbbVie, Amgen, BMS, Boehringer Ingelheim, Eli Lilly, Galapagos, Gilead, GSK, Janssen, Novartis, Pfizer, Sun Pharma and UCB Pharma, Grant/research support from: AbbVie, Amgen, BMS, Eli Lilly, Gilead, Janssen, Novartis, Pfizer, Sun Pharma and UCB Pharma, Robert B.M. Landewé Speakers bureau: Abbott, Amgen, BMS, Centocor, Merck, Pfizer, Roche, Schering-Plough, UCB Pharma, and Wyeth, Consultant of: Abbott, Ablynx, Amgen, AstraZeneca, BMS, Centocor, GSK, Novartis, Merck, Pfizer, Roche, Schering-Plough, UCB Pharma, and Wyeth, Grant/research support from: Abbott, Amgen, Centocor, Novartis, Pfizer, Roche, Schering-Plough, UCB Pharma, and Wyeth, Akihiko Asahina Grant/research support from: AbbVie, Amgen, Eisai, Eli Lilly, Janssen, Kyowa Kirin, LEO Pharma, Maruho, Mitsubishi Tanabe Pharma, Pfizer, Sun Pharma, Taiho Pharma, Torii Pharmaceutical, and UCB Pharma, Yoshiya Tanaka Speakers bureau: AbbVie, Amgen, Astellas, AstraZeneca, BMS, Boehringer-Ingelheim, Chugai, Eisai, Eli Lilly, Gilead, Mitsubishi-Tanabe, and YL Biologics, Consultant of: AbbVie, Ayumi, Daiichi-Sankyo, Eli Lilly, GSK, Sanofi, and Taisho, Grant/research support from: Asahi-Kasei, AbbVie, Boehringer-Ingelheim, Chugai, Corrona, Daiichi-Sankyo, Eisai, Kowa, Mitsubishi-Tanabe, and Takeda, Richard B. Warren Paid instructor for: Astellas, DiCE, GSK, and Union, Consultant of: AbbVie, Almirall, Amgen, Arena, Astellas, Avillion, Biogen, BMS, Boehringer Ingelheim, Celgene, Eli Lilly, GSK, Janssen, LEO Pharma, Novartis, Pfizer, Sanofi, and UCB Pharma, Grant/research support from: AbbVie, Almirall, Janssen, LEO Pharma, Novartis, and UCB Pharma, Laure Gossec Consultant of: AbbVie, Amgen, BMS, Galapagos, Gilead, GSK, Janssen, Lilly, Novartis, Pfizer, Samsung Bioepis, Sanofi-Aventis, and UCB Pharma, Grant/research support from: Amgen, Galapagos, Lilly, Pfizer, and Sandoz, Dafna D Gladman Consultant of: AbbVie, Amgen, BMS, Eli Lilly, Galapagos, Gilead, Janssen, Novartis, Pfizer, and UCB Pharma, Grant/research support from: AbbVie, Amgen, Eli Lilly, Janssen, Novartis, Pfizer, and UCB Pharma, Frank Behrens Consultant of: AbbVie, Boehringer Ingelheim, Celgene, Chugai, Eli Lilly, Genzyme, Janssen, MSD, Novartis, Pfizer, Roche, and Sanofi, Barbara Ink Shareholder of: GSK, UCB Pharma, Employee of: UCB Pharma, Deepak Assudani Shareholder of: UCB Pharma, Employee of: UCB Pharma, Rajan Bajracharya Shareholder of: UCB Pharma, Employee of: UCB Pharma, Jason Coarse Shareholder of: UCB Pharma, Employee of: UCB Pharma, Laura Coates Speakers bureau: AbbVie, Amgen, Biogen, Celgene, Eli Lilly, Galapagos, Gilead, GSK, Janssen, Medac, Novartis, Pfizer, and UCB Pharma, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, BMS, Celgene, Eli Lilly, Gilead, Galapagos, Janssen, Moonlake, Novartis, Pfizer, and UCB Pharma, Grant/research support from: AbbVie, Amgen, Celgene, Eli Lilly, Janssen, Novartis, Pfizer, and UCB Pharma

OA36 Bimekizumab in patients with psoriatic arthritis: achievement and maintenance of Psoriatic Arthritis Response Criteria responses through 3 years in a phase 2b open-label extension study

Background/Aims

Bimekizumab (BKZ), a monoclonal IgG1 antibody that selectively inhibits interleukin (IL)-17F and IL17A, has demonstrated an acceptable safety profile with improvements in joint and skin outcomes to 3 years in patients with active psoriatic arthritis (PsA). Psoriatic Arthritis Response Criteria (PsARC) response data can help relate clinical trial data to UK clinical practice. We report PsARC response rates to 3 years in patients with active PsA from the phase 2b 48-week (wk) dose-ranging study BE ACTIVE (NCT02969525) and its open-label extension (OLE)(NCT03347110).

Methods

In BE ACTIVE, patients were randomised (1:1:1:1:1) to placebo, BKZ 16mg, BKZ 160mg (with or without 320mg loading dose), or BKZ 320mg, every 4 wks (Q4W). At Wk12, patients assigned to placebo or BKZ 16mg were reassigned (1:1) to dose-blind BKZ 160mg or 320mg Q4W; other patients remained on their original dose. From Wk48 all patients received open-label BKZ 160mg Q4W. We report PsARC to Wk152 and maintenance of response among patients with PsARC response at Wk12, for the full analysis set (FAS). Data are reported as observed and with NRI.

Results

206 patients were randomised at baseline in BE ACTIVE and included in the FAS. 181 patients entered the OLE and 161 completed the OLE. 157 patients had calculable PsARC response at Wk152. At Wk12, PsARC response (NRI) was achieved by 125/206, including placebo: 33.3% (14/42), BKZ 16mg: 56.1% (23/41), 160mg: 73.2% (60/82), 320mg: 68.3% (28/41) (Table). At Wk48 and Wk152, 78.2% (161/206) and 68.0% (140/206) patients were PsARC responders, respectively. Of the 125 PsARC responders at Wk12, 88.8% (111/125) also met PsARC at Wk48 and 74.4% (93/125) were PsARC responders at Wk152 (NRI). Over 152 wks, the exposure-adjusted incidence rate per 100 patient-years was 126.4 for all treatment-emergent adverse events (TEAEs), 4.1 for serious TEAEs, 0.7 for serious infections and 4.6 for Candida infections.

Conclusion

A numerically higher proportion of patients achieved PsARC response in all BKZ-treated groups at Wk12, compared with placebo. The PsARC response rate was sustained through 3 years. Nearly three-quarters of patients who achieved PsARC at Wk12 were also PsARC responders at Wk152. No new safety signals were observed.

Disclosure

W. Tillett: Consultancies; WT has received consulting fees from AbbVie, Amgen, Celgene, Eli Lilly, Janssen, MSD, Novartis, Pfizer and UCB Pharma. Honoraria; WT has received honoraria from AbbVie, Amgen, Celgene, Eli Lilly, Janssen, MSD, Novartis, Pfizer and UCB Pharma. Grants/research support; WT has received research grants from AbbVie, Amgen, Celgene, Eli Lilly, Janssen, MSD, Novartis, Pfizer and UCB Pharma. I.B. McInnes: Consultancies; IBM has received consulting fees from AbbVie, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Novartis, UCB Pharma. Honoraria; IBM has received honoraria from AbbVie, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Novartis, UCB Pharma. Grants/research support; IBM has received research support from Boehringer Ingelheim, BMS, Celgene, Janssen and UCB Pharma. D. McGonagle: Consultancies; DM has received consulting fees from AbbVie, Celgene, Janssen, Merck, Novartis, Pfizer and UCB Pharma. Honoraria; DM has received honoraria from AbbVie, Celgene, Janssen, Merck, Novartis, Pfizer and UCB Pharma. Member of speakers’ bureau; DM has been on speaker’s bureau for AbbVie, Celgene, Janssen, Merck, Novartis, Pfizer and UCB Pharma. Grants/research support; DM has received grants/research support from AbbVie, Celgene, Janssen, Merck, Pfizer and Novartis. D.R. Jadon: Consultancies; DRJ has received consultancy fees from AbbVie, Amgen, Biogen, BMS, Celgene, Celltrion, Eli Lilly, Fresenius Kabi, Galapagos, GSK, Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi and UCB Pharma. Grants/research support; DRJ has received research grants from AbbVie, Amgen, Biogen, BMS, Celgene, Celltrion, Eli Lilly, Fresenius Kabi, Galapagos, GSK, Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB Pharma. B. Ink: Corporate appointments; BI is an employee of UCB Pharma. Shareholder/stock ownership; BI is a shareholder of GSK and UCB Pharma. D. Assudani: Corporate appointments; DA is an employee of UCB Pharma. Shareholder/stock ownership; DA is a shareholder of UCB Pharma. J. Coarse: Corporate appointments; JC is an employee of UCB Pharma. Shareholder/stock ownership; JC is a shareholder of UCB Pharma. J. Eells: Corporate appointments; JE is an employee of UCB Pharma. Shareholder/stock ownership; JE is a shareholder of UCB Pharma. L.C. Coates: Consultancies; LCC has received consulting fees from AbbVie, Amgen, Biogen, Boehringer Ingelheim, Celgene, Domain, Eli Lilly, Gilead and Janssen. Member of speakers’ bureau; LCC has been on speaker’s bureau for AbbVie, Amgen, Biogen, Celgene, Eli Lilly, Gilead, GSK, Janssen, Medac, Novartis, Pfizer and UCB Pharma. Grants/research support; LCC has received grants/research support from AbbVie, Amgen, Celgene, Eli Lilly, Gilead, Janssen, Novartis, Pfizer and UCB Pharma.

POS1022 BIMEKIZUMAB SAFETY AND EFFICACY IN PATIENTS WITH PSORIATIC ARTHRITIS: 3-YEAR RESULTS FROM A PHASE 2b OPEN-LABEL EXTENSION STUDY

Background:

Bimekizumab (BKZ), a monoclonal antibody inhibitor of interleukin (IL)-17A and IL-17F, demonstrated clinical improvements in joint and skin outcomes up to 108 weeks (wks) in patients (pts) with active psoriatic arthritis (PsA).1,2

Objectives:

To report up to 3-year safety and efficacy of BKZ in pts with active PsA from a 48-week phase 2b dose-ranging study (BE ACTIVE; NCT02969525) and its open-label extension (OLE; NCT03347110).

Methods:

BE ACTIVE and OLE study design has been described previously.1 All OLE pts received BKZ 160 mg Q4W, irrespective of prior dosing regimen. Treatment-emergent adverse events (TEAEs) are reported for the safety set (SS; pts who received ≥1 dose BKZ in the dose-ranging study). Data are presented from dose-ranging study baseline (BL) to Wk 152. Efficacy outcomes are reported for the full analysis set (FAS): ACR50, minimal or very low disease activity (MDA/VLDA), Psoriasis Area and Severity Index (PASI) 90/100, body surface area affected by psoriasis (BSA) 0% and dactylitis/enthesitis resolution.

Results:

Over 152 wks, the exposure-adjusted incidence rate (EAIR) per 100 patient-years (PY) was 126.4 for all TEAEs, 4.1 for serious TEAEs, 0.7 for serious infections and 4.6 for Candida infections (Table 1). One event was adjudicated by an independent committee as inflammatory bowel disease (microscopic colitis). All Candida infections were localised, mild/moderate, and resolved with appropriate anti-fungal therapy. Overall, the proportions of patients with ACR50 response were sustained through Wk 152 (52.9%, non-responder imputation [NRI]; Figure 1). Response rates were also sustained through Wk 152 for MDA (51.5%), VLDA (30.1%), PASI90 (64.2%), PASI100 (57.7%) and resolution of dactylitis (71.2%) and enthesitis (62.6%) (NRI; Table 1).

Table 1.

Safety and efficacy outcomes up to 3 years

Safety (SS)n (%) [EAIR/100 PY]BKZ160 mg [a](n=126)BKZ320 mg [b](n=78)Total(N=206)Any TEAE114 (90.5) [136.1]70 (89.7) [113.3]184 (89.3) [126.4]Serious TEAEs17 (13.5) [5.2]5 (6.4) [2.3]22 (10.7) [4.1]Key TEAEs of special monitoringSerious infections3 (2.4) [0.9]1 (1.3) [0.5]4 (1.9) [0.7]Candida infections15 (11.9) [4.7]9 (11.5) [4.4]24 (11.7) [4.6]Inflammatory bowel disease [c]1 (0.8) [0.3]01 (0.5) [0.2]Malignancies [d]1 (0.8) [0.3]01 (0.5) [0.2]Injection site reactions03 (3.8) [1.4]3 (1.5) [0.5]Suicidal ideation1 (0.8) [0.3]01 (0.5) [0.2]Liver function analyses13 (10.3) [4.1]11 (14.1) [5.3]24 (11.7) [4.6]Study discontinuation due to TEAEs12 (9.5) [3.5]4 (5.1) [1.8]16 (7.8) [2.8]Efficacy (FAS)n (%)BKZ160 mg [a](n=124)BKZ320 mg [b](n=82)Total(N=206)OCNRI, %OCNRI, %OCNRI, %MDA, Wk 15264/95 (67.4)51.642/62 (67.7)51.2106/157 (67.5)51.5VLDA, Wk 15241/95 (43.2)33.121/62 (33.9)25.662/157 (39.5)30.1PASI90 [e] Wk 15251/61 (83.6)64.637/46 (80.4)63.888/107 (82.2)64.2PASI100 [e] Wk 15247/61 (77.0)59.532/46 (69.6)55.279/107 (73.8)57.7BSA 0% [e] Wk 4848/72 (66.7)60.838/55 (69.1)65.586/127 (67.7)62.8Wk 15246/61 (75.4)58.231/45 (68.9)53.477/106 (72.6)56.2Dactylitis [f]/Enthesitis [g] resolution, Wk 48–70.6/56.9–84.0/57.1–76.3/57.0Wk 152–67.6/63.1–76.0/61.9–71.2/62.6

No anaphylactic reactions or major adverse cardiac events were reported. [a] Includes pts within the indicated analysis set originally assigned to all arms who were subsequently re-randomized to 160 mg, or [b] 320 mg, after double-blind period; [c] Microscopic colitis; [d] Malignant melanoma in situ; [e] Pts with BL BSA ≥3%, NRI: n=79, 58, 137 respectively; [f] Pts with BL LDI >0, NRI: n=34, 25, 59 respectively; [g] Pts with BL MASES >0, NRI: n=65, 42, 107 respectively. LDI: Leeds Dactylitis Index; MASES: Maastricht AS Enthesitis Score; OC: observed case.

Conclusion:

The safety profile of BKZ in pts with PsA reflects previous observations1,2 for up to 3 years. High threshold disease control was achieved by >50% of BKZ-treated pts up to 3 years, reflected in long-term improvements in joint and skin outcomes.

References:

[1]Ritchlin CT. Lancet 2020;395:427–40;

[2]McInnes I. Ann Rheum Dis 2020;79:1153–4.

Acknowledgements:

This study was funded by UCB Pharma. Editorial services were provided by Costello Medical.

Disclosure of Interests:

Laura C Coates Speakers bureau: AbbVie, Amgen, Biogen, Celgene, Gilead, GSK, Janssen, Lilly, Medac, Novartis, Pfizer, UCB Pharma, Consultant of: AbbVie, Amgen, Biogen, Boehringer Ingelheim, Celgene, Domain, Gilead, Janssen, Lilly, Grant/research support from: AbbVie, Amgen, Celgene, Gilead, Janssen, Lilly, Novartis, Pfizer, UCB Pharma, Richard B. Warren Consultant of: AbbVie, Almirall, Amgen, Arena, Avillion, BMS, Boehringer Ingelheim, Celgene, Eli Lilly, Janssen, LEO Pharma, Novartis, Pfizer, Sanofi, UCB Pharma, Grant/research support from: AbbVie, Almirall, Amgen, Janssen, LEO Pharma, Novartis, UCB Pharma, Christopher T. Ritchlin Consultant of: Amgen, AbbVie, Lilly, Pfizer, Novartis, Gilead, Janssen, UCB Pharma, Grant/research support from: AbbVie, Amgen, UCB Pharma, Laure Gossec Speakers bureau: AbbVie, Amgen, Biogen, BMS, Celgene, Janssen, Lilly, Novartis, Pfizer, Samsung, Sanofi, UCB Pharma, Consultant of: AbbVie, Amgen, Biogen, BMS, Celgene, Janssen, Lilly, Novartis, Pfizer, Samsung, Sanofi, UCB Pharma, Grant/research support from: Eli Lilly, Pfizer, Sandoz, Joseph F. Merola Consultant of: AbbVie, Amgen, Bayer, Biogen, BMS, Celgene, Eli Lilly, Janssen, Novartis, Sanofi-Regeneron, Pfizer, UCB Pharma, Grant/research support from: AbbVie, Amgen, Bayer, Biogen, BMS, Celgene, Eli Lilly, Janssen, Novartis, Sanofi-Regeneron, Pfizer, UCB Pharma, Principal investigator for Dermavant, LEO Pharma, UCB Pharma, Deepak Assudani Employee of: UCB Pharma, Jason Coarse Employee of: UCB Pharma, Jason Eells Shareholder of: UCB Pharma, Employee of: UCB Pharma, Barbara Ink Shareholder of: GSK, UCB Pharma, Employee of: UCB Pharma, Iain McInnes Consultant of: AbbVie, BMS, Boehringer Ingelheim, Celgene, Lilly, Janssen, Novartis, UCB Pharma, Grant/research support from: BMS, Boehringer Ingelheim, Celgene, Janssen, UCB Pharma.

AB0778 ASSOCIATION BETWEEN PATIENT-REPORTED OUTCOMES AND DISEASE ACTIVITY IN BIMEKIZUMAB-TREATED PATIENTS WITH PSORIATIC ARTHRITIS

Background:

Bimekizumab (BKZ) is a humanised IgG1 monoclonal antibody, which selectively neutralises interleukin (IL)-17A and IL-17F. There is support for the BKZ mechanism of action as a novel therapeutic approach for psoriatic arthritis (PsA).1-3The phase 2b dose-ranging BE ACTIVE study assessed the efficacy and safety of BKZ in patients (pts) with PsA; data are reported elsewhere.4Patient-reported outcomes (PROs) are increasingly recognised as important endpoints in clinical trials.5The Psoriatic Arthritis Impact of Disease-9 (PsAID-9) questionnaire was specifically developed to assess health-related quality of life (QoL) in pts with PsA5and its validity in clinical practice has been demonstrated.5-6

Objectives:

To report the association between PsAID-9 score (a PRO) and disease activity response (very low disease activity [VLDA], minimal disease activity [MDA] or Disease Activity Index for Psoriatic Arthritis [DAPSA] remission) during 48 weeks’ (wks’) BKZ treatment.

Methods:

Details of the study design (NCT02969525) are reported elsewhere.4Here, we report the proportion of pts who achieved a PsAID-9 score ≤3, and the association between PsAID-9 score at Wk 48 (range 0–10, where 10 corresponds to worst QoL) and VLDA/MDA (binary states of disease control) or DAPSA (range 0–>28 where 0–4 is remission, 5–14 is low, 15–28 is moderate, and >28 is high disease activity) at Wk 12.

Results:

Across 206 randomised pts at baseline, 66.5% had psoriasis body surface area (BSA) ≥3%, 18.9% had prior tumour necrosis factor inhibitor (TNFi) exposure, and 63.6% received concomitant methotrexate. A substantial proportion of pts achieved MDA and/or DAPSA remission by Wk 12, which generally increased through to Wk 24 and 48 (Table 1). The 160 mg BKZ group saw the highest Wk 48 rates of MDA response (60.0%) and DAPSA remission (45.0%) (Table 1). The proportion of pts achieving a PsAID-9 score ≤3 was consistently high across all active treatment arms (Figure 1). PsAID-9 score was consistently lower (indicating better QoL) for pts with VLDA or MDA, and those in DAPSA remission (Figure 2), indicating that low disease activity was associated with improved PROs.

Conclusion:

In BKZ-treated pts, improvements in PsAID-9 were associated with achievement of VLDA/MDA response and DAPSA remission. These results suggest that pts achieving higher disease control have improved QoL.

References:

[1]Glatt S. Ann Rheum Dis 2018;77:523–32;2.Glatt S. Br J Clin Pharmacol 2017;83:991–1001;3.Papp KA. J Am Acad Dermatol 2018;79:277–86;4.Ritchlin CT. Ann Rheum Dis 2019;78:127–8;5.Gossec L. Ann Rheum Dis 2014;73:1012–19;6.Johnson K. Semin Arthritis Rheum 2019;49:241–45.

Table 1.

MDA and DAPSA responder rates

Treatment armMDA (%) [a]DAPSA remission (%) [b]Wk 12Wk 24Wk 48Wk 12Wk 24Wk 48BKZ 160 mg (n=40)47.550.060.020.035.045.0BKZ 160 mg LD (n=37) [c]43.259.554.129.748.637.8BKZ 320 mg (n=41)29.336.646.312.219.534.1

[a] DBS, pts with missing data were counted as non-responders; [b] DBS, missing data are imputed using last observation carried forward; [c] 160 mg with 320 mg LD at baseline. BKZ: bimekizumab; DAPSA: Disease Activity Index for Psoriatic Arthritis; DBS: dose-blind set; LD: loading dose; MDA: minimal disease activity.

Acknowledgments:

This study was funded by UCB Pharma. Editorial services were provided by Costello Medical.

Disclosure of Interests:

Laure Gossec Grant/research support from: Lilly, Mylan, Pfizer, Sandoz, Consultant of: AbbVie, Amgen, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Sandoz, Sanofi-Aventis, UCB, Philip J Mease Grant/research support from: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – grant/research support, Consultant of: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – consultant, Speakers bureau: Abbott, Amgen, Biogen Idec, BMS, Eli Lilly, Genentech, Janssen, Pfizer, UCB – speakers bureau, Alice B Gottlieb Grant/research support from:: Research grants, consultation fees, or speaker honoraria for lectures from: Pfizer, AbbVie, BMS, Lilly, MSD, Novartis, Roche, Sanofi, Sandoz, Nordic, Celltrion and UCB., Consultant of:: Research grants, consultation fees, or speaker honoraria for lectures from: Pfizer, AbbVie, BMS, Lilly, MSD, Novartis, Roche, Sanofi, Sandoz, Nordic, Celltrion and UCB., Speakers bureau:: Research grants, consultation fees, or speaker honoraria for lectures from: Pfizer, AbbVie, BMS, Lilly, MSD, Novartis, Roche, Sanofi, Sandoz, Nordic, Celltrion and UCB., Alexis Ogdie Grant/research support from: Pfizer to Penn, Novartis to Penn, Amgen to Forward/NDB, Consultant of: Abbvie, Amgen, Bristol-Myers Squibb, Celgene, Corrona, Janssen, Eli Lilly, Novartis, Pfizer, Deepak Assudani Employee of: UCB Pharma, Jason Coarse Employee of: UCB Pharma, Barbara Ink Shareholder of: GlaxoSmithKline and UCB Pharma, Employee of: UCB Pharma, Laura C Coates: None declared

Bimekizumab in patients with active psoriatic arthritis: results from a 48-week, randomised, double-blind, placebo-controlled, dose-ranging phase 2b trial

BACKGROUND

Dual neutralisation of interleukin 17A (IL17A) and interleukin 17F (IL17F) is a potential novel therapeutic approach in psoriatic arthritis. We assessed bimekizumab, a monoclonal antibody that selectively neutralises IL17A and IL17F, in patients with active psoriatic arthritis.

METHODS

BE ACTIVE was a randomised, double-blind, placebo-controlled, dose-ranging phase 2b study done at 41 sites in the Czech Republic, Germany, Hungary, Poland, Russia, and the USA. Eligible patients aged 18 years or older with active adult-onset psoriatic arthritis and symptoms for at least 6 months were randomly assigned (1:1:1:1:1) to placebo, 16 mg bimekizumab, 160 mg bimekizumab, 160 mg bimekizumab with a one-off 320 mg loading dose, or 320 mg bimekizumab, which were administered as subcutaneous injections every 4 weeks for 12 weeks. After 12 weeks, patients assigned to the placebo and 16 mg bimekizumab groups were randomly reassigned (1:1) to either 160 mg or 320 mg bimekizumab, and all other patients remained on their originally assigned initial dose up to 48 weeks. Both participants and researchers were blinded to treatment allocation in the first 12 weeks, and blinded to the dose of bimekizumab thereafter. The primary endpoint was the proportion of patients with at least 50% improvement in the American College of Rheumatology response criteria at week 12, which was assessed in all patients who received at least one dose of study treatment and had a valid measurement of the primary efficacy endpoint at baseline. The trial, including all follow-up, has been completed. This trial is registered with ClinicalTrials.gov, NCT02969525.

FINDINGS

Between Oct 27, 2016, and July 16, 2018, 308 patients were screened, and 206 were randomly assigned: 42 to the placebo group, and 41 each to the four bimekizumab groups. At 12 weeks, compared with the placebo group, significantly more patients in the 16 mg bimekizumab (odds ratio [OR] 4·2 [95% CI 1·1-15·2]; p=0·032), 160 mg bimekizumab (8·1 [2·3-28·7]; p=0·0012), and 160 mg (loading dose) bimekizumab (9·7 [2·7-34·3]; p=0·0004) groups achieved an ACR50 response. At 12 weeks, 24 (57%) of 42 patients in the placebo group and 68 (41%) of the 164 patients in the bimekizumab groups reported treatment-emergent adverse events. Most of these adverse events were mild or moderate. Serious treatment-emergent adverse events occurred in nine patients, eight of whom were receiving bimekizumab. No deaths or cases of inflammatory bowel disease were reported.

INTERPRETATION

Bimekizumab doses of 16 mg and 160 mg (with or without a 320 mg loading dose) were associated with significant improvements in ACR50 compared with placebo, with an acceptable safety profile. Our results support phase 3 investigation of bimekizumab as a treatment for psoriatic arthritis.

FUNDING

UCB Pharma.

Similar efficacy, safety and immunogenicity of adalimumab biosimilar BI 695501 and Humira reference product in patients with moderately to severely active rheumatoid arthritis: results from the phase III randomised VOLTAIRE-RA equivalence study

OBJECTIVE

To demonstrate clinical equivalence of adalimumab biosimilar candidate BI 695501 with Humira.

METHODS

Patients with active rheumatoid arthritis on stable methotrexate were randomised to BI 695501 or Humira in a double-blind, parallel-group, equivalence study. At week 24, patients were rerandomised to continue BI 695501 or Humira, or switch from Humira to BI 695501. The coprimary endpoints were the percentage of patients achieving the American College of Rheumatology 20% response criteria (ACR20) at weeks 12 and 24. Further efficacy and safety endpoints and immunogenicity were assessed up to week 58.

RESULTS

645 patients were randomised. At week 12, 67.0% and 61.1% (90% CI -0.9 to 12.7) of patients receiving BI 695501 (n=324) and Humira (n=321), respectively, achieved ACR20; at week 24 the corresponding values were 69.0% and 64.5% (95% CI -3.4 to 12.5). These differences were within prespecified margins (week 12: 90% CI (-12% to 15%); week 24: 95% CI (-15% to 15%)), demonstrating therapeutic bioequivalence. 593 patients were rerandomised at week 24. Up to week 48, mean change from baseline in Disease Activity Score 28-erythrocyte sedimentation rate and ACR20/ACR50/ACR70 response rates were similar across the switched (n=147), continuous BI 695501 (n=298) and continuous Humira (n=148) groups. Similar immunogenicity (antidrug antibodies (ADAs), ADA titres and neutralising antibodies) was seen between BI 695501 and Humira (to week 24) and across rerandomised groups (to week 48). Safety and tolerability profiles were similar between groups.

CONCLUSIONS

BI 695501 demonstrated similar efficacy, safety and immunogenicity to Humira; switch from Humira to BI 695501 had no impact on efficacy, safety and immunogenicity.

TRIAL REGISTRATION NUMBER

NCT02137226, Results.

Successful administration of BI 695501, an adalimumab biosimilar, using an autoinjector (AI): results from a Phase II open-label clinical study (VOLTAIRE®-RL)

BACKGROUND

This study examined the patient handling experience and self-injection success of patients with rheumatoid arthritis (RA) administering BI 695501 using an AI.

METHODS

This Phase II, 7-week, open-label, interventional study (NCT02636907) included adult patients with moderately to severely active RA not adequately controlled by DMARDs, with no experience of self-injecting with AI/pen. Patients self-injected BI 695501 via AI every 2 weeks in the AI Assessment Period (AAP). Training was given on first injection; AI handling events were recorded. Percentage of self-injection success was the primary end point. Patients could enter a 42-week pre-filled syringe (PFS) safety extension.

RESULTS

The AAP was completed by 73/77 patients. In total, 216/218 (99.1%) self-injections on Days 15, 29, and 43, were successful. Nine (11.7%) patients had drug-related adverse events (AEs). Two patients reported four serious AEs (SAEs), none drug-related. Overall (in the AAP and PFS extension), 28 (36.4%) patients had drug-related AEs; nine patients had SAEs, one was considered drug-related. Five (6.5%) patients reported injection-site reactions in the AAP; 13 (18.1%) in the PFS extension.

CONCLUSIONS

After training, almost all patients were successfully able to self-administer BI 695501 using an AI. BI 695501 via AI (and via PFS in the extension) was well tolerated.

CLINICAL TRIAL REGISTRATION

NCT02636907.

Safety and reactogenicity of the combined diphtheria-tetanus-acellular pertussis-inactivated poliovirus-Haemophilus influenzae type b (DTPa-IPV/Hib) vaccine in healthy Vietnamese toddlers: An open-label, phase III study

The introduction of combination vaccines plays a significant role in increasing vaccine acceptance and widening vaccine coverage. Primary vaccination against diphtheria, tetanus, pertussis, poliomyelitis and Haemophilus influenza type b (Hib) diseases has been implemented in Vietnam. In this study we evaluated the safety and reactogenicity of combined diphtheria-tetanus-pertussis-inactivated polio (DTPa-IPV)/Hib vaccine when administered as a booster dose in 300 healthy Vietnamese children <2 years of age (mean age: 15.8 months). During the 4-day follow-up period, pain (31.7%) and redness (27.3%) were the most frequent solicited local symptoms. Pain (2%) was also the most frequent grade 3 local symptom. One subject reported 2 serious adverse events that were not causally related to the study vaccine. DTPa-IPV/Hib conjugate vaccine was well tolerated as a booster dose in healthy Vietnamese children aged <2 years.

Safety, immunogenicity and persistence of immune response to the combined diphtheria, tetanus, acellular pertussis, poliovirus and Haemophilus influenzae type b conjugate vaccine (DTPa-IPV/Hib) administered in Chinese infants

We conducted 3 phase III, randomized, open-label, clinical trials assessing the safety, reactogenicity (all studies), immunogenicity (Primary vaccination study) and persistence of immune responses (Booster study) to the combined diphtheria, tetanus, pertussis, poliomyelitis, and Haemophilus influenzae type b vaccine (DTPa-IPV/Hib) in Chinese infants and toddlers.

In the Pilot study (NCT00964028), 50 infants (randomized 1:1) received 3 doses of DTPa-IPV/Hib at 2–3–4 (Group A) or 3–4–5 months of age (Group B). In the Primary study (NCT01086423), 984 healthy infants (randomized 1:1:1) received 3 doses of DTPa-IPV/Hib at 2–3–4 (Group A) or 3–4–5 (Group B) months of age, or concomitant DTPa/Hib and poliomyelitis (IPV) vaccination at 2–3–4 months of age (Control group); 825 infants received a booster dose of DTPa/Hib and IPV at 18–24 months of age (Booster study; NCT01449812).

In the Pilot study, unsolicited symptoms were more frequent in Group A (16 versus 1 infant; mostly upper respiratory tract infection and pyrexia); this observation was attributed to an epidemic outbreak of viral infections. Non-inferiority of 3-dose primary vaccination with DTPa-IPV/Hib over separately administered DTPa/Hib and IPV was demonstrated for Group A (primary objective). Similar antibody concentrations were observed in all groups, except for anti-polyribosyl-ribitol phosphate and anti-poliovirus types 1–3 which were higher in DTPa-IPV/Hib recipients. Protective antibody levels against all vaccine antigens remained high until booster vaccination. Three-dose vaccination with DTPa-IPV/Hib had a clinically acceptable safety profile.

Immunological persistence in 5 y olds previously vaccinated with hexavalent DTPa-HBV-IPV/Hib at 3, 5, and 11 months of age

The combined diphtheria-tetanus-acellular pertussis-hepatitis B-poliomyelitis/Haemophilus influenza vaccine (DTPa-HBV-IPV/Hib: Infanrix™ hexa, GlaxoSmithKline Vaccines) is used for primary vaccination of infants in a range of schedules world-wide. Antibody persistence after 4 DTPa-HBV-IPV/Hib doses in the first 2 y of life has been documented, but long-term persistence data following the 3, 5, 11–12 months (3–5–11) infant vaccination schedule, employed for example in Nordic countries, are limited. We assessed antibody persistence in 57 5-year-old children who had received either DTPa-HBV-IPV/Hib or DTPa-IPV/Hib (Infanrix™-IPV/Hib, GlaxoSmithKline Vaccines) in the 3–5–11 schedule. Among DTPa-HBV-IPV/Hib recipients, 7/12 retained seroprotective antibody concentrations for diphtheria, 10/12 for tetanus, 5/12 for hepatitis and 10/12 for Hib. Detectable antibodies were observed for 0/12 children for pertussis toxin (PT), 12/12 for filamentous haemagglutinin (FHA) and 8/12 for pertactin (PRN). Among DTPa-IPV/Hib recipients, 28/45 retained seroprotective anti-diphtheria concentrations, 34/44 for tetanus and 40/45 for Hib. Detectable antibodies were observed for 9/45 children for PT, 41/45 for FHA and 34/45 for PRN. Antibody persistence in DTPa-HBV-IPV/Hib and DTPa-IPV/Hib-vaccinees appeared similar in 5 y olds to that previously observed in children of a similar age who had received 4 prior doses of DTPa-HBV-IPV/Hib (or DTPa-IPV/Hib). As in subjects primed with 4 prior doses, we observed that antibodies markedly declined by 5 y of age, calling for the administration of a pre-school booster dose in order to ensure continued protection against pertussis.

Immunogenicity and safety of 3-dose primary vaccination with combined DTPa-HBV-IPV/Hib vaccine in Canadian Aboriginal and non-Aboriginal infants

This study compared immune responses of healthy Aboriginal and non-Aboriginal infants to Haemophilus influenzae type b (Hib) and hepatitis B virus (HBV) components of a DTaP-HBV-IPV/Hib combination vaccine, 1 month after completing dosing at 2, 4 and 6 months of age. Of 112 infants enrolled in each group, 94 Aboriginal and 107 non-Aboriginal infants qualified for the immunogenicity analysis. Anti-PRP concentrations exceeded the protective minimum (≥0.15 μg/ml) in ≥97% of infants in both groups but geometric mean concentrations (GMCs) were higher in Aboriginal infants (6.12 μg/ml versus 3.51 μg/ml). All subjects were seroprotected (anti-HBs ≥10 mIU/mL) against HBV, with groups having similar GMCs (1797.9 versus 1544.4 mIU/mL, Aboriginal versus non-Aboriginal, respectively). No safety concerns were identified. We conclude that 3-dose primary vaccination with DTaP-HBV-IPV/Hib combination vaccine elicited immune responses to Hib and HBV components that were at least as high in Aboriginal as in non-Aboriginal Canadian infants. Clinical Trial Registration NCT00753649.

Abstract 5599: Novel mechanism of synergistic effect of cancer immunotherapy and chemotherapy

Despite advances in the development of new chemotherapeutic drugs and improvements in radiation therapy, conventional cancer therapy often falls short of the goal of controlling tumor progression. Emerging clinical and pre-clinical evidence suggests that an immune response elicited by using vaccines augments the anti-tumor effectiveness of subsequent chemotherapy. The main objectives of this study are to determine if combining vaccines with chemotherapeutic agents would render tumor cells more susceptible to T cell mediated killing and to identify the mechanisms involved.

In this study we used three drugs with different mechanisms of action- Paclitaxel (TAX), Doxorubicin (DOX) and Cisplatin (CIS). Using Cr51 release assays, we found that all three agents, at very low doses, accelerated killing of antigen specific tumor cells by Cytotoxic T lymphocytes (CTLs). This effect was observed with CTLs specific to different antigens.

Perforin-granzyme and Fas-FasL pathways are two major mechanisms by which CTLs destroy target cells. All three drugs did not affect the expression of either Fas or FasL on tumor cells but caused dramatic increase in permeability of cell membrane to granzyme B (GrB). Receptor studies revealed that TAX, DOX, and CIS induced substantial increase in the expression of mannose-6-phosphate receptor (MPR) on human and mouse tumor cells, but not in normal cells. MPR is considered an important factor that together with perforin mediates GrB entry into the cell.

Using CTLs from normal (WT) and Perforin Knockout (PKO) mice, we evaluated the levels of CTL mediated killing in chemotherapy treated, antigen specific tumor cells. Simultaneously, we examined CTL mediated killing after blocking MPR receptors on tumor cells. Our data demonstrated that chemotherapy regulates GrB uptake via up-regulation of MPR and bypasses the requirement for perforin. Adoptive transfer of T cells from WT and PKO mice, in tumor models, followed by chemotherapy confirmed the efficacy of combination therapy in delaying tumor growth, independent of perforin.

Our data suggests a mechanism for the combined effect of CTLs and chemotherapy. Chemotherapy, administered immediately after vaccination or T-cell transfer, causes disruption of tumor stroma that allows for better penetration of antigen-specific T cells. In addition, chemotherapy causes substantial increase in MPR expression on tumor cells. Small number of activated CTLs interacting with tumor cells expressing tumor antigen, release GrB that can penetrate into neighboring tumor cells without requirement for perforin, initiating localized bystander killing. Thus large number of tumor cells including those that do not express specific antigen would be susceptible to the effect of CTLs.

This provides a rationale for treatment of advanced stage cancer patients by combining standard of care chemotherapy with relatively non-toxic and highly specific immunotherapy

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 5599.

Safety, Efficacy and pharmacokinetics of T1h, a humanized anti-CD6 monoclonal antibody, in moderate to severe chronic plaque psoriasis - Results from a randomized phase II trial. (96.13)

T1h, a novel humanized monoclonal antibody targeting CD6, a co-stimulatory receptor present on T cells, was evaluated as a potential therapy for psoriasis. In this multi-centric phase II, dose finding, single-blind study, 40 patients with moderate-to-severe psoriasis were randomized to receive T1h intravenously at 3 different doses across weekly, two-weekly and four-weekly schedules (n=5 per dose cohort) for 8 weeks, and followed for further 24 weeks. Safety and PK were the primary endpoints. Efficacy of T1h was evaluated using PASI and PGA. SF-36 and DLQI questionnaires were used to assess changes in quality of life. T1h was well tolerated. The most common adverse events were chills and pyrexia. Only 2 serious adverse events (both related to psoriasis) were ascribed to T1h therapy. T1h was weakly immunogenic with one patient developing an immune response. T1/2 of T1h ranged from 11.72 days to 18.51 days across different dose-schedules. Significant reductions in mean PASI score from baseline were observed at week 12 (22.32 to 6.23, P&lt; 0.0001) with the best response observed in cohort receiving 1.6 mg/kg T1h administered every 2 weeks. Overall, the proportion of patients with PASI50 and 75 responses were 72.5% and 45% respectively. 26 patients (65%) achieved a PGA score of clear or minimum at 12 weeks. A significant improvement in DLQI, SF36 and epidermal thickness was also noted. T1h exhibited a favourable safety profile in the treatment of moderate to severe psoriasis.

Chemotherapy enhances tumor cell susceptibility to CTL-mediated killing during cancer immunotherapy in mice

Cancer immunotherapy faces a serious challenge because of low clinical efficacy. Recently, a number of clinical studies have reported the serendipitous finding of high rates of objective clinical response when cancer vaccines are combined with chemotherapy in patients with different types of cancers. However, the mechanism of this phenomenon remains unclear. Here, we tested in mice several cancer vaccines and an adoptive T cell transfer approach to cancer immunotherapy in combination with several widely used chemotherapeutic drugs. We found that chemotherapy made tumor cells more susceptible to the cytotoxic effect of CTLs through a dramatic perforin-independent increase in permeability to GrzB released by the CTLs. This effect was mediated via upregulation of mannose-6-phosphate receptors on the surface of tumor cells and was observed in mouse and human cells. When combined with chemotherapy, CTLs raised against specific antigens were able to induce apoptosis in neighboring tumor cells that did not express those antigens. These data suggest that small numbers of CTLs could mediate a potent antitumor effect when combined with chemotherapy. In addition, these results provide a strong rationale for combining these modalities for the treatment of patients with advanced cancers.

In vivo expansion, persistence, and function of peptide vaccine-induced CD8 T cells occur independently of CD4 T cells

Significant efforts are being devoted toward the development of effective therapeutic vaccines against cancer. Specifically, well-characterized subunit vaccines, which are designed to generate antitumor cytotoxic CD8 T-cell responses. Because CD4 T cells participate at various stages of CD8 T-cell responses, it is important to study the role of CD4 T cells in the induction and persistence of antitumor CD8 T-cell responses by these vaccines. Recent evidence points to the requirement of CD4 T cells for the long-term persistence of memory CD8 T cells, which in the case of cancer immunotherapy would be critical for the prevention of tumor recurrences. The purpose of the present study was to assess whether CD4 T cells are necessary for the generation and maintenance of antigen-specific CD8 T cells induced by subunit (peptide or DNA) vaccines. We have used a vaccination strategy that combines synthetic peptides representing CD8 T-cell epitopes, a costimulatory anti-CD40 antibody and a Toll-like receptor agonist (TriVax) to generate large numbers of antigen-specific CD8 T-cell responses. Our results show that the rate of decline (clonal contraction) of the antigen-specific CD8 T cells and their functional state is not affected by the presence or absence of CD4 T cells throughout the immune response generated by TriVax. We believe that these results bear importance for the design of effective vaccination strategies against cancer.