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Parikh SV, Aaronson ST, Mathew SJ, Alva G, DeBattista C, Kanes S, Lasser R, Bullock A, Kotecha M, Jung J, Forrestal F, Jonas J, Vera T, Leclair B, Doherty J. Efficacy and safety of zuranolone co-initiated with an antidepressant in adults with major depressive disorder: results from the phase 3 CORAL study. Neuropsychopharmacology 2024; 49:467-475. [PMID: 37875578 PMCID: PMC10724299 DOI: 10.1038/s41386-023-01751-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 09/20/2023] [Accepted: 10/02/2023] [Indexed: 10/26/2023]
Abstract
Major depressive disorder (MDD) is a mental health disorder that can cause disability and functional impairment that standard-of-care (SOC) antidepressant therapies (ADTs) can take weeks to treat. Zuranolone is a neuroactive steroid and positive allosteric modulator of synaptic and extrasynaptic γ-aminobutyric acid (GABA) type A receptors approved as an oral, once-daily, 14-day treatment course in adults with postpartum depression and under investigation in adults with MDD. The phase 3 CORAL Study (NCT04476030) evaluated the efficacy and safety of zuranolone 50 mg co-initiated with SOC ADT (zuranolone+ADT) vs placebo co-initiated with SOC ADT (placebo+ADT) in adults with MDD. Patients were randomized 1:1 to once-daily, blinded zuranolone+ADT or placebo+ADT for 14 days, then continued open-label SOC ADT for 28 more days. The primary endpoint was change from baseline (CFB) in the 17-item Hamilton Rating Scale for Depression (HAMD-17) total score at Day 3. Among 425 patients in the full analysis set, CFB in HAMD-17 total score at Day 3 was significantly improved with zuranolone+ADT vs placebo+ADT (least squares mean [standard error], -8.9 [0.39] vs -7.0 [0.38]; p = 0.0004). The majority of patients receiving zuranolone+ADT that experienced treatment-emergent adverse events (TEAEs) reported mild or moderate events. The most common TEAEs present in ≥10% of patients in either zuranolone+ADT or placebo+ADT groups were somnolence, dizziness, headache, and nausea. These results demonstrate that zuranolone+ADT provided more rapid improvement in depressive symptoms compared with placebo+ADT in patients with MDD, with a safety profile consistent with previous studies. Clinical trial registration: ClinicalTrials.gov identifier: NCT04476030.
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Affiliation(s)
- Sagar V Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
| | - Scott T Aaronson
- Institute for Advanced Diagnostics and Therapeutics, Sheppard Pratt, Baltimore, MD, USA
| | - Sanjay J Mathew
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | | | - Charles DeBattista
- General Psychiatry and Psychology, Stanford University School of Medicine, Stanford, CA, USA
| | | | | | | | | | | | | | - Jeff Jonas
- Sage Therapeutics, Inc., Cambridge, MA, USA
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Cutler AJ, Mattingly GW, Kornstein SG, Aaronson ST, Lasser R, Zhang H, Rana N, Brown C, Levin S, Miller C, Kotecha M, Forrestal F, Doherty J. Long-Term Safety and Efficacy of Initial and Repeat Treatment Courses With Zuranolone in Adult Patients With Major Depressive Disorder: Interim Results From the Open-Label, Phase 3 SHORELINE Study. J Clin Psychiatry 2023; 85:23m14845. [PMID: 38153320 DOI: 10.4088/jcp.23m14845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
Objective: Zuranolone is a positive allosteric modulator of both synaptic and extrasynaptic γ-aminobutyric acid (GABA) type A receptors and a neuroactive steroid approved in the United States as an oral, once-daily, 14-day treatment course for adults with postpartum depression and under investigation for adults with major depressive disorder (MDD). Interim results from the open-label, longitudinal, phase 3 SHORELINE Study (NCT03864614) that evaluated the long-term safety and efficacy of zuranolone in adults with MDD are reported. Methods: This interim report includes patients who were enrolled and had the opportunity to be on study for up to 1 year between February 2019 and September 2021. Adults aged 18-75 years with MDD diagnosed per DSM-5 criteria and a 17-item Hamilton Rating Scale for Depression (HAMD-17) total score ≥ 20 received an initial 30-mg or 50-mg 14-day zuranolone course. HAMD-17 responders (≥ 50% reduction from baseline) at Day (D)15 of the initial treatment period were allowed to continue in the study beyond D28 and were followed up for ≤ 1 year, during which repeat treatment courses were permitted. The primary endpoint was safety and tolerability of the initial and repeat treatment courses through 1 year. Secondary endpoints included change from baseline (CFB) in HAMD-17 total score and need for repeat treatment course(s). Results: As of September 2021, among patients in the 30-mg (n = 725) and 50-mg (n = 199) Cohorts who received a zuranolone dose, 493 (68.0%) and 137 (68.8%), respectively, reported a treatment-emergent adverse event (TEAE); most patients who experienced TEAEs reported mild/moderate events (30-mg Cohort, 90.9% [448/493]; 50-mg Cohort, 85.4% [117/137]). Mean (standard deviation) CFB HAMD-17 total score at D15 of the initial treatment period was -15.2 (7.1) and -16.0 (6.0) for the 30-mg and 50-mg Cohorts, respectively; similar improvements were observed after repeat treatment courses. The proportion of patients who received only 1 treatment course during their time on study was 42.9% (210/489) in the 30-mg Cohort and 54.8% (80/146) in the 50-mg Cohort; 57.1% (279/489) and 45.2% (66/146) patients, respectively, received 2-5 total treatment courses. The majority of patients who initially responded to zuranolone received ≤ 2 total treatment courses (30-mg Cohort, 68.5% [335/489]; 50-mg Cohort, 79.5% [116/146]). Conclusions: Of patients who experienced TEAEs, most reported mild or moderately severe events, and responders to zuranolone experienced improvements in depressive symptoms with initial and repeat treatment courses. Trial Registration: ClinicalTrials.gov identifier: NCT03864614.
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Affiliation(s)
- Andrew J Cutler
- Department of Psychiatry, SUNY Upstate Medical University, Syracuse, New York
- Corresponding Author: Andrew J. Cutler, MD, 8429 Lorraine Rd #350, Lakewood Ranch, FL 34202
| | - Gregory W Mattingly
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Susan G Kornstein
- Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Scott T Aaronson
- Institute for Advanced Diagnostics and Therapeutics, Sheppard Pratt, Baltimore, Maryland
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Clayton AH, Lasser R, Parikh SV, Iosifescu DV, Jung J, Kotecha M, Forrestal F, Jonas J, Kanes SJ, Doherty J. Zuranolone for the Treatment of Adults With Major Depressive Disorder: A Randomized, Placebo-Controlled Phase 3 Trial. Am J Psychiatry 2023; 180:676-684. [PMID: 37132201 DOI: 10.1176/appi.ajp.20220459] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
OBJECTIVE This study assessed the efficacy and safety of a 14-day treatment course of once-daily zuranolone 50 mg, an investigational oral positive allosteric modulator of the γ-aminobutyric acid type A (GABAA) receptor, for the treatment of major depressive disorder. METHODS Patients 18-64 years of age with severe major depressive disorder were enrolled in this randomized, double-blind, placebo-controlled trial. Patients self-administered zuranolone 50 mg or placebo once daily for 14 days. The primary endpoint was change from baseline in total score on the 17-item Hamilton Depression Rating Scale (HAM-D) at day 15. Safety and tolerability were assessed by incidence of adverse events. RESULTS Of 543 randomized patients, 534 (266 in the zuranolone group, 268 in the placebo group) constituted the full analysis set. Compared with patients in the placebo group, patients in the zuranolone group demonstrated a statistically significant improvement in depressive symptoms at day 15 (least squares mean change from baseline HAM-D score, -14.1 vs. -12.3). Numerically greater improvements in depressive symptoms for zuranolone versus placebo were observed by day 3 (least squares mean change from baseline HAM-D score, -9.8 vs. -6.8), which were sustained at all visits throughout the treatment and follow-up periods of the study (through day 42, with the difference remaining nominally significant through day 12). Two patients in each group experienced a serious adverse event; nine patients in the zuranolone group and four in the placebo group discontinued treatment due to adverse events. CONCLUSIONS Zuranolone at 50 mg/day elicited a significantly greater improvement in depressive symptoms at day 15, with a rapid time to effect (day 3). Zuranolone was generally well tolerated, with no new safety findings compared with previously studied lower dosages. These findings support the potential of zuranolone in treating adults with major depressive disorder.
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Affiliation(s)
- Anita H Clayton
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville (Clayton); Sage Therapeutics, Cambridge, Mass. (Lasser, Jung, Jonas, Kanes, Doherty); Department of Psychiatry, University of Michigan, Ann Arbor (Parikh); Nathan Kline Institute for Psychiatric Research and Department of Psychiatry, New York University School of Medicine, New York (Iosifescu); Biogen, Cambridge, Mass. (Kotecha, Forrestal)
| | - Robert Lasser
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville (Clayton); Sage Therapeutics, Cambridge, Mass. (Lasser, Jung, Jonas, Kanes, Doherty); Department of Psychiatry, University of Michigan, Ann Arbor (Parikh); Nathan Kline Institute for Psychiatric Research and Department of Psychiatry, New York University School of Medicine, New York (Iosifescu); Biogen, Cambridge, Mass. (Kotecha, Forrestal)
| | - Sagar V Parikh
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville (Clayton); Sage Therapeutics, Cambridge, Mass. (Lasser, Jung, Jonas, Kanes, Doherty); Department of Psychiatry, University of Michigan, Ann Arbor (Parikh); Nathan Kline Institute for Psychiatric Research and Department of Psychiatry, New York University School of Medicine, New York (Iosifescu); Biogen, Cambridge, Mass. (Kotecha, Forrestal)
| | - Dan V Iosifescu
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville (Clayton); Sage Therapeutics, Cambridge, Mass. (Lasser, Jung, Jonas, Kanes, Doherty); Department of Psychiatry, University of Michigan, Ann Arbor (Parikh); Nathan Kline Institute for Psychiatric Research and Department of Psychiatry, New York University School of Medicine, New York (Iosifescu); Biogen, Cambridge, Mass. (Kotecha, Forrestal)
| | - JungAh Jung
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville (Clayton); Sage Therapeutics, Cambridge, Mass. (Lasser, Jung, Jonas, Kanes, Doherty); Department of Psychiatry, University of Michigan, Ann Arbor (Parikh); Nathan Kline Institute for Psychiatric Research and Department of Psychiatry, New York University School of Medicine, New York (Iosifescu); Biogen, Cambridge, Mass. (Kotecha, Forrestal)
| | - Mona Kotecha
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville (Clayton); Sage Therapeutics, Cambridge, Mass. (Lasser, Jung, Jonas, Kanes, Doherty); Department of Psychiatry, University of Michigan, Ann Arbor (Parikh); Nathan Kline Institute for Psychiatric Research and Department of Psychiatry, New York University School of Medicine, New York (Iosifescu); Biogen, Cambridge, Mass. (Kotecha, Forrestal)
| | - Fiona Forrestal
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville (Clayton); Sage Therapeutics, Cambridge, Mass. (Lasser, Jung, Jonas, Kanes, Doherty); Department of Psychiatry, University of Michigan, Ann Arbor (Parikh); Nathan Kline Institute for Psychiatric Research and Department of Psychiatry, New York University School of Medicine, New York (Iosifescu); Biogen, Cambridge, Mass. (Kotecha, Forrestal)
| | - Jeffrey Jonas
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville (Clayton); Sage Therapeutics, Cambridge, Mass. (Lasser, Jung, Jonas, Kanes, Doherty); Department of Psychiatry, University of Michigan, Ann Arbor (Parikh); Nathan Kline Institute for Psychiatric Research and Department of Psychiatry, New York University School of Medicine, New York (Iosifescu); Biogen, Cambridge, Mass. (Kotecha, Forrestal)
| | - Stephen J Kanes
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville (Clayton); Sage Therapeutics, Cambridge, Mass. (Lasser, Jung, Jonas, Kanes, Doherty); Department of Psychiatry, University of Michigan, Ann Arbor (Parikh); Nathan Kline Institute for Psychiatric Research and Department of Psychiatry, New York University School of Medicine, New York (Iosifescu); Biogen, Cambridge, Mass. (Kotecha, Forrestal)
| | - James Doherty
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville (Clayton); Sage Therapeutics, Cambridge, Mass. (Lasser, Jung, Jonas, Kanes, Doherty); Department of Psychiatry, University of Michigan, Ann Arbor (Parikh); Nathan Kline Institute for Psychiatric Research and Department of Psychiatry, New York University School of Medicine, New York (Iosifescu); Biogen, Cambridge, Mass. (Kotecha, Forrestal)
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Deligiannidis KM, Meltzer-Brody S, Maximos B, Peeper EQ, Freeman M, Lasser R, Bullock A, Kotecha M, Li S, Forrestal F, Rana N, Garcia M, Leclair B, Doherty J. Zuranolone for the Treatment of Postpartum Depression. Am J Psychiatry 2023; 180:668-675. [PMID: 37491938 DOI: 10.1176/appi.ajp.20220785] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
OBJECTIVE Postpartum depression (PPD) is a common perinatal complication with adverse maternal and infant outcomes. This study investigated the efficacy and safety of zuranolone, a positive allosteric modulator of synaptic and extrasynaptic GABAA receptors and neuroactive steroid, as an oral, once-daily, 14-day treatment course for patients with severe PPD. METHODS In this double-blind phase 3 trial, women with severe PPD were randomized in a 1:1 ratio to receive zuranolone 50 mg/day or placebo for 14 days. The primary endpoint was change from baseline in total score on the 17-item Hamilton Depression Rating Scale (HAM-D) at day 15; key secondary endpoints were change from baseline in HAM-D score at days 3, 28, and 45 and change from baseline in Clinical Global Impressions severity (CGI-S) score at day 15. Adverse events were monitored. RESULTS Among 196 patients randomized (zuranolone, N=98; placebo, N=98), 170 (86.7%) completed the 45-day study. Treatment with zuranolone compared with placebo resulted in statistically significant improvement in depressive symptoms at day 15 (least squares mean [LSM] change from baseline in HAM-D score, -15.6 vs. -11.6; LSM difference, -4.0, 95% CI=-6.3, -1.7); significant improvement in depressive symptoms was also reported at days 3, 28, and 45. CGI-S score at day 15 significantly improved with zuranolone compared with placebo. The most common adverse events (≥10%) with zuranolone were somnolence, dizziness, and sedation. No loss of consciousness, withdrawal symptoms, or increased suicidal ideation or behavior were observed. CONCLUSIONS In this trial, zuranolone demonstrated significant improvements in depressive symptoms and was generally well tolerated, supporting the potential of zuranolone as a novel, rapid-acting oral treatment for PPD.
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Affiliation(s)
- Kristina M Deligiannidis
- Division of Women's Behavioral Health, Zucker Hillside Hospital, Northwell Health, New York (Deligiannidis); Feinstein Institutes for Medical Research, Northwell Health, Manhasset, N.Y. (Deligiannidis); Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, N.Y. (Deligiannidis); Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill (Meltzer-Brody); Maximos Obstetrics and Gynecology, League City, Tex. (Maximos); Department of Obstetrics and Gynecology, LCMC Health, New Orleans (Peeper); Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston (Freeman); Sage Therapeutics, Cambridge, Mass. (Lasser, Bullock, Li, Rana, Garcia, Doherty); Biogen, Cambridge, Mass. (Kotecha, Forrestal, Leclair)
| | - Samantha Meltzer-Brody
- Division of Women's Behavioral Health, Zucker Hillside Hospital, Northwell Health, New York (Deligiannidis); Feinstein Institutes for Medical Research, Northwell Health, Manhasset, N.Y. (Deligiannidis); Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, N.Y. (Deligiannidis); Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill (Meltzer-Brody); Maximos Obstetrics and Gynecology, League City, Tex. (Maximos); Department of Obstetrics and Gynecology, LCMC Health, New Orleans (Peeper); Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston (Freeman); Sage Therapeutics, Cambridge, Mass. (Lasser, Bullock, Li, Rana, Garcia, Doherty); Biogen, Cambridge, Mass. (Kotecha, Forrestal, Leclair)
| | - Bassem Maximos
- Division of Women's Behavioral Health, Zucker Hillside Hospital, Northwell Health, New York (Deligiannidis); Feinstein Institutes for Medical Research, Northwell Health, Manhasset, N.Y. (Deligiannidis); Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, N.Y. (Deligiannidis); Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill (Meltzer-Brody); Maximos Obstetrics and Gynecology, League City, Tex. (Maximos); Department of Obstetrics and Gynecology, LCMC Health, New Orleans (Peeper); Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston (Freeman); Sage Therapeutics, Cambridge, Mass. (Lasser, Bullock, Li, Rana, Garcia, Doherty); Biogen, Cambridge, Mass. (Kotecha, Forrestal, Leclair)
| | - E Quinn Peeper
- Division of Women's Behavioral Health, Zucker Hillside Hospital, Northwell Health, New York (Deligiannidis); Feinstein Institutes for Medical Research, Northwell Health, Manhasset, N.Y. (Deligiannidis); Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, N.Y. (Deligiannidis); Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill (Meltzer-Brody); Maximos Obstetrics and Gynecology, League City, Tex. (Maximos); Department of Obstetrics and Gynecology, LCMC Health, New Orleans (Peeper); Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston (Freeman); Sage Therapeutics, Cambridge, Mass. (Lasser, Bullock, Li, Rana, Garcia, Doherty); Biogen, Cambridge, Mass. (Kotecha, Forrestal, Leclair)
| | - Marlene Freeman
- Division of Women's Behavioral Health, Zucker Hillside Hospital, Northwell Health, New York (Deligiannidis); Feinstein Institutes for Medical Research, Northwell Health, Manhasset, N.Y. (Deligiannidis); Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, N.Y. (Deligiannidis); Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill (Meltzer-Brody); Maximos Obstetrics and Gynecology, League City, Tex. (Maximos); Department of Obstetrics and Gynecology, LCMC Health, New Orleans (Peeper); Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston (Freeman); Sage Therapeutics, Cambridge, Mass. (Lasser, Bullock, Li, Rana, Garcia, Doherty); Biogen, Cambridge, Mass. (Kotecha, Forrestal, Leclair)
| | - Robert Lasser
- Division of Women's Behavioral Health, Zucker Hillside Hospital, Northwell Health, New York (Deligiannidis); Feinstein Institutes for Medical Research, Northwell Health, Manhasset, N.Y. (Deligiannidis); Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, N.Y. (Deligiannidis); Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill (Meltzer-Brody); Maximos Obstetrics and Gynecology, League City, Tex. (Maximos); Department of Obstetrics and Gynecology, LCMC Health, New Orleans (Peeper); Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston (Freeman); Sage Therapeutics, Cambridge, Mass. (Lasser, Bullock, Li, Rana, Garcia, Doherty); Biogen, Cambridge, Mass. (Kotecha, Forrestal, Leclair)
| | - Amy Bullock
- Division of Women's Behavioral Health, Zucker Hillside Hospital, Northwell Health, New York (Deligiannidis); Feinstein Institutes for Medical Research, Northwell Health, Manhasset, N.Y. (Deligiannidis); Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, N.Y. (Deligiannidis); Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill (Meltzer-Brody); Maximos Obstetrics and Gynecology, League City, Tex. (Maximos); Department of Obstetrics and Gynecology, LCMC Health, New Orleans (Peeper); Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston (Freeman); Sage Therapeutics, Cambridge, Mass. (Lasser, Bullock, Li, Rana, Garcia, Doherty); Biogen, Cambridge, Mass. (Kotecha, Forrestal, Leclair)
| | - Mona Kotecha
- Division of Women's Behavioral Health, Zucker Hillside Hospital, Northwell Health, New York (Deligiannidis); Feinstein Institutes for Medical Research, Northwell Health, Manhasset, N.Y. (Deligiannidis); Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, N.Y. (Deligiannidis); Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill (Meltzer-Brody); Maximos Obstetrics and Gynecology, League City, Tex. (Maximos); Department of Obstetrics and Gynecology, LCMC Health, New Orleans (Peeper); Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston (Freeman); Sage Therapeutics, Cambridge, Mass. (Lasser, Bullock, Li, Rana, Garcia, Doherty); Biogen, Cambridge, Mass. (Kotecha, Forrestal, Leclair)
| | - Sigui Li
- Division of Women's Behavioral Health, Zucker Hillside Hospital, Northwell Health, New York (Deligiannidis); Feinstein Institutes for Medical Research, Northwell Health, Manhasset, N.Y. (Deligiannidis); Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, N.Y. (Deligiannidis); Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill (Meltzer-Brody); Maximos Obstetrics and Gynecology, League City, Tex. (Maximos); Department of Obstetrics and Gynecology, LCMC Health, New Orleans (Peeper); Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston (Freeman); Sage Therapeutics, Cambridge, Mass. (Lasser, Bullock, Li, Rana, Garcia, Doherty); Biogen, Cambridge, Mass. (Kotecha, Forrestal, Leclair)
| | - Fiona Forrestal
- Division of Women's Behavioral Health, Zucker Hillside Hospital, Northwell Health, New York (Deligiannidis); Feinstein Institutes for Medical Research, Northwell Health, Manhasset, N.Y. (Deligiannidis); Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, N.Y. (Deligiannidis); Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill (Meltzer-Brody); Maximos Obstetrics and Gynecology, League City, Tex. (Maximos); Department of Obstetrics and Gynecology, LCMC Health, New Orleans (Peeper); Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston (Freeman); Sage Therapeutics, Cambridge, Mass. (Lasser, Bullock, Li, Rana, Garcia, Doherty); Biogen, Cambridge, Mass. (Kotecha, Forrestal, Leclair)
| | - Nilanjana Rana
- Division of Women's Behavioral Health, Zucker Hillside Hospital, Northwell Health, New York (Deligiannidis); Feinstein Institutes for Medical Research, Northwell Health, Manhasset, N.Y. (Deligiannidis); Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, N.Y. (Deligiannidis); Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill (Meltzer-Brody); Maximos Obstetrics and Gynecology, League City, Tex. (Maximos); Department of Obstetrics and Gynecology, LCMC Health, New Orleans (Peeper); Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston (Freeman); Sage Therapeutics, Cambridge, Mass. (Lasser, Bullock, Li, Rana, Garcia, Doherty); Biogen, Cambridge, Mass. (Kotecha, Forrestal, Leclair)
| | - Manny Garcia
- Division of Women's Behavioral Health, Zucker Hillside Hospital, Northwell Health, New York (Deligiannidis); Feinstein Institutes for Medical Research, Northwell Health, Manhasset, N.Y. (Deligiannidis); Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, N.Y. (Deligiannidis); Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill (Meltzer-Brody); Maximos Obstetrics and Gynecology, League City, Tex. (Maximos); Department of Obstetrics and Gynecology, LCMC Health, New Orleans (Peeper); Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston (Freeman); Sage Therapeutics, Cambridge, Mass. (Lasser, Bullock, Li, Rana, Garcia, Doherty); Biogen, Cambridge, Mass. (Kotecha, Forrestal, Leclair)
| | - Bridgette Leclair
- Division of Women's Behavioral Health, Zucker Hillside Hospital, Northwell Health, New York (Deligiannidis); Feinstein Institutes for Medical Research, Northwell Health, Manhasset, N.Y. (Deligiannidis); Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, N.Y. (Deligiannidis); Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill (Meltzer-Brody); Maximos Obstetrics and Gynecology, League City, Tex. (Maximos); Department of Obstetrics and Gynecology, LCMC Health, New Orleans (Peeper); Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston (Freeman); Sage Therapeutics, Cambridge, Mass. (Lasser, Bullock, Li, Rana, Garcia, Doherty); Biogen, Cambridge, Mass. (Kotecha, Forrestal, Leclair)
| | - James Doherty
- Division of Women's Behavioral Health, Zucker Hillside Hospital, Northwell Health, New York (Deligiannidis); Feinstein Institutes for Medical Research, Northwell Health, Manhasset, N.Y. (Deligiannidis); Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, N.Y. (Deligiannidis); Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill (Meltzer-Brody); Maximos Obstetrics and Gynecology, League City, Tex. (Maximos); Department of Obstetrics and Gynecology, LCMC Health, New Orleans (Peeper); Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston (Freeman); Sage Therapeutics, Cambridge, Mass. (Lasser, Bullock, Li, Rana, Garcia, Doherty); Biogen, Cambridge, Mass. (Kotecha, Forrestal, Leclair)
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Maximos B, Deligiannidis K, Meltzer-Brody S, Peeper EQ, Lasser R, Bullock A, Kotecha M, Sigui li, Forrestal F, Garcia M, Leclair B, Doherty J. Effect of zuranolone on insomnia symptoms in patients with postpartum depression in the SKYLARK study. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Herring WL, Gould IG, Fillit H, Lindgren P, Forrestal F, Thompson R, Pemberton-Ross P. Predicted Lifetime Health Outcomes for Aducanumab in Patients with Early Alzheimer's Disease. Neurol Ther 2021; 10:919-940. [PMID: 34426940 PMCID: PMC8571451 DOI: 10.1007/s40120-021-00273-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/05/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Alzheimer's disease (AD) is a chronic and progressive neurodegenerative disease that places a substantial burden on patients and caregivers. Aducanumab is the first AD therapy approved by the US Food and Drug Administration to reduce a defining pathophysiological feature of the disease, brain amyloid plaques. In the phase 3 clinical trial EMERGE (NCT02484547), aducanumab reduced clinical decline in patients with mild cognitive impairment (MCI) due to AD and mild AD dementia and confirmed amyloid pathology. METHODS We used a Markov modeling approach to predict the long-term clinical benefits of aducanumab for patients with early AD based on EMERGE efficacy data. In the model, patients could transition between AD severity levels (MCI due to AD; mild, moderate, and severe AD dementia) and care settings (community vs. institution) or transition to death. The intervention was aducanumab added to standard of care (SOC), and the comparator was SOC alone. Data sources for base-case and scenario analyses included EMERGE, published National Alzheimer's Coordinating Center analyses, and other published literature. RESULTS Per patient over a lifetime horizon, aducanumab treatment corresponded to 0.65 incremental patient quality-adjusted life-years (QALYs) and 0.09 fewer caregiver QALYs lost compared with patients treated with SOC. Aducanumab treatment translated to a lower lifetime probability of transitioning to AD dementia, a lower lifetime probability of transitioning to institutionalization (25.2% vs. 29.4%), delays in the median time to transition to AD dementia (7.50 vs. 4.92 years from MCI to moderate AD dementia or worse), and an incremental median time in the community of 1.32 years compared with SOC. CONCLUSION The model predicted long-term benefits of aducanumab treatment in patients with MCI due to AD and mild AD dementia and their caregivers. The predicted outcomes provide a foundation for healthcare decision-makers and policymakers to understand the potential clinical and socioeconomic value of aducanumab.
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Affiliation(s)
| | | | - Howard Fillit
- The Icahn School of Medicine at Mount Sinai, New York, NY, USA
- The Alzheimer's Drug Discovery Foundation, New York, NY, USA
| | - Peter Lindgren
- The Swedish Institute for Health Economics, Stockholm, Sweden
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Cohen S, He P, Benea ML, Miller R, Forrestal F, Pang M, Castrillo‐Viguera C, Harrison JE, Jaeger J, Mummery CJ, Porsteinsson AP, Cummings JL, Tian Y, Yang L, Haeberlein SB. Item‐level analysis of clinical measures in patients with early symptomatic Alzheimer’s disease following treatment with high‐dose aducanumab in the phase 3 study EMERGE. Alzheimers Dement 2021. [DOI: 10.1002/alz.057619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | | | | | | | | | | | | | - John E Harrison
- King's College ‐ Institute of Psychiatry Psychology & Neuroscience London United Kingdom
| | - Judy Jaeger
- Cognition Metrics, Inc Wilmington DE USA
- Albert Einstein College of Medicine New York NY USA
| | | | | | - Jeffrey L. Cummings
- Center for Transformative Neuroscience Department of Brain Health School of Integrated Health Sciences University of Nevada Las Vegas (UNLV) Las Vegas NV USA
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Salloway S, Chalkias S, Barkhof F, Burkett P, Barakos J, Purcell D, Suhy J, Forrestal F, Tian Y, Umans K, Wang G, Singhal P, Budd Haeberlein S, Smirnakis K. Amyloid-Related Imaging Abnormalities in 2 Phase 3 Studies Evaluating Aducanumab in Patients With Early Alzheimer Disease. JAMA Neurol 2021; 79:13-21. [PMID: 34807243 PMCID: PMC8609465 DOI: 10.1001/jamaneurol.2021.4161] [Citation(s) in RCA: 217] [Impact Index Per Article: 72.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Question What are the characteristics of amyloid-related imaging abnormalities (ARIA) during aducanumab treatment in individuals with early Alzheimer disease? Findings In an integrated safety data set of 2 phase 3 clinical trials (EMERGE and ENGAGE) including 3285 participants, 425 patients (41.3%) in the combined 10 mg/kg aducanumab group (n = 1029) experienced ARIA; ARIA-edema occurred in 362 patients (35.2%), and 94 of these patients (26.0%) experienced associated symptoms (eg, headache, confusion, dizziness, and nausea). ARIA-microhemorrhage and ARIA–superficial siderosis occurred in 197 patients (19.1%) and 151 patients (14.7%), respectively. Meaning Amyloid-related imaging abnormalities occurred in approximately 40% of participants in the phase 3 studies of aducanumab, and approximately one-quarter of these patients experienced symptoms. Importance The EMERGE and ENGAGE phase 3 randomized clinical trials of aducanumab provide a robust data set to characterize amyloid-related imaging abnormalities (ARIA) that occur with treatment with aducanumab, an amyloid-β (Aβ)–targeting monoclonal antibody, in patients with mild cognitive impairment due to Alzheimer disease or mild Alzheimer disease dementia. Objective To describe the radiographic and clinical characteristics of ARIA that occurred in EMERGE and ENGAGE. Design, Setting, and Participants Secondary analysis of data from the EMERGE and ENGAGE trials, which were 2 double-blind, placebo-controlled, parallel-group, phase 3 randomized clinical trials that compared low-dose and high-dose aducanumab treatment with placebo among participants at 348 sites across 20 countries. Enrollment occurred from August 2015 to July 2018, and the trials were terminated early (March 21, 2019) based on a futility analysis. The combined studies consisted of a total of 3285 participants with Alzheimer disease who received 1 or more doses of placebo (n = 1087) or aducanumab (n = 2198; 2752 total person-years of exposure) during the placebo-controlled period. Primary data analyses were performed from November 2019 to July 2020, with additional analyses performed through July 2021. Interventions Participants were randomly assigned 1:1:1 to high-dose or low-dose intravenous aducanumab or placebo once every 4 weeks. Dose titration was used as a risk-minimization strategy. Main Outcomes and Measures Brain magnetic resonance imaging was used to monitor patients for ARIA; associated symptoms were reported as adverse events. Results Of 3285 included participants, the mean (SD) age was 70.4 (7.45) years; 1706 participants (52%) were female, 2661 (81%) had mild cognitive impairment due to Alzheimer disease, and 1777 (54%) used symptomatic medications for Alzheimer disease. A total of 764 participants from EMERGE and 709 participants from ENGAGE were categorized as withdrawn before study completion, most often owing to early termination of the study by the sponsor. Unless otherwise specified, all results represent analyses from the 10-mg/kg group. During the placebo-controlled period, 425 of 1029 patients (41.3%) experienced ARIA, with serious cases occurring in 14 patients (1.4%). ARIA-edema (ARIA-E) was the most common adverse event (362 of 1029 [35.2%]), and 263 initial events (72.7%) occurred within the first 8 doses of aducanumab; 94 participants (26.0%) with an event exhibited symptoms. Common associated symptoms among 103 patients with symptomatic ARIA-E or ARIA-H were headache (48 [46.6%]), confusion (15 [14.6%]), dizziness (11 [10.7%]), and nausea (8 [7.8%]). Incidence of ARIA-E was highest in aducanumab-treated participants who were apolipoprotein E ε4 allele carriers. Most events (479 of 488 [98.2%]) among those with ARIA-E resolved radiographically; 404 of 488 (82.8%) resolved within 16 weeks. In the placebo group, 29 of 1076 participants (2.7%) had ARIA-E (apolipoprotein E ε4 carriers: 16 of 742 [2.2%]; noncarriers, 13 of 334 [3.9%]). ARIA-microhemorrhage and ARIA–superficial siderosis occurred in 197 participants (19.1%) and 151 participants (14.7%), respectively. Conclusions and Relevance In this integrated safety data set from EMERGE and ENGAGE, the most common adverse event in the 10-mg/kg group was ARIA-E, which occurred in 362 of the 1029 patients (35.2%) in the 10-mg/kg group with at least 1 postbaseline MRI scan, with 94 patients (26.0%) experiencing associated symptoms. The most common associated symptom was headache. Trial Registrations ClinicalTrials.gov Identifiers: NCT02484547, NCT02477800
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Affiliation(s)
- Stephen Salloway
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | | | - Frederik Barkhof
- Institutes of Healthcare Engineering and Neurology, University College London, London, United Kingdom.,Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | | | - Jerome Barakos
- California Pacific Medical Center, San Francisco.,Bioclinica, Newark, California
| | - Derk Purcell
- California Pacific Medical Center, San Francisco.,Bioclinica, Newark, California
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Naik H, Zhao Y, Forrestal F, Cleall S, Bockbrader H, Chapel S. Population Pharmacokinetics of Vixotrigine in Healthy Volunteers and Subjects with Trigeminal Neuralgia, Painful Lumbosacral Radiculopathy and Erythromelalgia. Eur J Drug Metab Pharmacokinet 2021; 46:395-404. [PMID: 33782834 DOI: 10.1007/s13318-021-00678-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Vixotrigine is a voltage and use dependent sodium channel blocker currently under development for treatment of various neuropathic pain indications. OBJECTIVE The objective of this work was to develop a population pharmacokinetic model and assess effects of various covariates on pharmacokinetic parameters of vixotrigine. METHOD Plasma concentration-time data from 12 Phase 1 or 2 studies were included in the analyses. The data were obtained following administration of single or multiple doses of vixotrigine in healthy volunteers and patients. One- and two-compartment pharmacokinetic models were evaluated as base structural pharmacokinetic models. The inclusion of selected covariates was assessed using a stepwise backward elimination approach (α = 0.001) once the base/full model was developed. The predictive ability of the model was evaluated using a visual predictive check (VPC). The final model was used to evaluate effect of covariates on exposure of vixotrigine. RESULTS A total of 10,263 pharmacokinetic samples collected from 465 subjects were included in the analyses. The pharmacokinetics of vixotrigine was adequately described by a two-compartment model with two transit absorption compartments and first-order elimination. Predictability of the model was also established by VPC. The final model included covariates of age, weight and carbamazepine co-administration on clearance, weight on central volume of distribution, food on absorption rate constant and formulation and Japanese race on bioavailability. None of the covariates identified had a clinically relevant effect, as impact on area under the plasma concentration-time curve (AUC) and maximum plasma concentration (Cmax) was within ± 25%. CONCLUSION The model characterizes the pharmacokinetics of vixotrigine well, and the exposure of vixotrigine was comparable between healthy subjects and patients. None of the covariates evaluated have a clinically relevant impact on the pharmacokinetics of vixotrigine.
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Affiliation(s)
- Himanshu Naik
- Biogen Inc., 225 Binney Street, Cambridge, MA, 02142, USA.
| | - Yuan Zhao
- Biogen Inc., 225 Binney Street, Cambridge, MA, 02142, USA
| | | | - Simon Cleall
- Biogen Inc., 225 Binney Street, Cambridge, MA, 02142, USA
| | | | - Sunny Chapel
- Ann Arbor Pharmacometrics Group, Ann Arbor, MI, USA
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Kapoor R, Ho PR, Campbell N, Chang I, Deykin A, Forrestal F, Lucas N, Yu B, Arnold DL, Freedman MS, Goldman MD, Hartung HP, Havrdová EK, Jeffery D, Miller A, Sellebjerg F, Cadavid D, Mikol D, Steiner D. Effect of natalizumab on disease progression in secondary progressive multiple sclerosis (ASCEND): a phase 3, randomised, double-blind, placebo-controlled trial with an open-label extension. Lancet Neurol 2018; 17:405-415. [PMID: 29545067 DOI: 10.1016/s1474-4422(18)30069-3] [Citation(s) in RCA: 209] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 01/26/2018] [Accepted: 02/01/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Although several disease-modifying treatments are available for relapsing multiple sclerosis, treatment effects have been more modest in progressive multiple sclerosis and have been observed particularly in actively relapsing subgroups or those with lesion activity on imaging. We sought to assess whether natalizumab slows disease progression in secondary progressive multiple sclerosis, independent of relapses. METHODS ASCEND was a phase 3, randomised, double-blind, placebo-controlled trial (part 1) with an optional 2 year open-label extension (part 2). Enrolled patients aged 18-58 years were natalizumab-naive and had secondary progressive multiple sclerosis for 2 years or more, disability progression unrelated to relapses in the previous year, and Expanded Disability Status Scale (EDSS) scores of 3·0-6·5. In part 1, patients from 163 sites in 17 countries were randomly assigned (1:1) to receive 300 mg intravenous natalizumab or placebo every 4 weeks for 2 years. Patients were stratified by site and by EDSS score (3·0-5·5 vs 6·0-6·5). Patients completing part 1 could enrol in part 2, in which all patients received natalizumab every 4 weeks until the end of the study. Throughout both parts, patients and staff were masked to the treatment received in part 1. The primary outcome in part 1 was the proportion of patients with sustained disability progression, assessed by one or more of three measures: the EDSS, Timed 25-Foot Walk (T25FW), and 9-Hole Peg Test (9HPT). The primary outcome in part 2 was the incidence of adverse events and serious adverse events. Efficacy and safety analyses were done in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NCT01416181. FINDINGS Between Sept 13, 2011, and July 16, 2015, 889 patients were randomly assigned (n=440 to the natalizumab group, n=449 to the placebo group). In part 1, 195 (44%) of 439 natalizumab-treated patients and 214 (48%) of 448 placebo-treated patients had confirmed disability progression (odds ratio [OR] 0·86; 95% CI 0·66-1·13; p=0·287). No treatment effect was observed on the EDSS (OR 1·06, 95% CI 0·74-1·53; nominal p=0·753) or the T25FW (0·98, 0·74-1·30; nominal p=0·914) components of the primary outcome. However, natalizumab treatment reduced 9HPT progression (OR 0·56, 95% CI 0·40-0·80; nominal p=0·001). In part 1, 100 (22%) placebo-treated and 90 (20%) natalizumab-treated patients had serious adverse events. In part 2, 291 natalizumab-continuing patients and 274 natalizumab-naive patients received natalizumab (median follow-up 160 weeks [range 108-221]). Serious adverse events occurred in 39 (13%) patients continuing natalizumab and in 24 (9%) patients initiating natalizumab. Two deaths occurred in part 1, neither of which was considered related to study treatment. No progressive multifocal leukoencephalopathy occurred. INTERPRETATION Natalizumab treatment for secondary progressive multiple sclerosis did not reduce progression on the primary multicomponent disability endpoint in part 1, but it did reduce progression on its upper-limb component. Longer-term trials are needed to assess whether treatment of secondary progressive multiple sclerosis might produce benefits on additional disability components. FUNDING Biogen.
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Affiliation(s)
- Raju Kapoor
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK.
| | | | | | | | | | | | | | - Bei Yu
- Biogen, Cambridge, MA, USA
| | - Douglas L Arnold
- Montreal Neurological Institute, Montreal, QC, Canada; NeuroRx Research, Montreal, QC, Canada
| | - Mark S Freedman
- University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Eva Kubala Havrdová
- First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | | | - Aaron Miller
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Finn Sellebjerg
- Danish Multiple Sclerosis Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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O'Connor P, Goodman A, Kappos L, Lublin F, Polman C, Rudick RA, Hauswirth K, Cristiano LM, Forrestal F, Duda P. Long-term safety and effectiveness of natalizumab redosing and treatment in the STRATA MS Study. Neurology 2014; 83:78-86. [PMID: 24898925 DOI: 10.1212/wnl.0000000000000541] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Report long-term safety and effectiveness of natalizumab over 240 weeks in the prospective, observational, open-label Safety of TYSABRI Re-dosing and Treatment (STRATA) Study. METHODS Patients (N = 1,094) previously enrolled in natalizumab multiple sclerosis clinical trials received natalizumab 300 mg IV every 4 weeks, up to 240 weeks. Serious adverse events, Expanded Disability Status Scale (EDSS) scores, and annualized relapse rates were analyzed. RESULTS At data cutoff (February 9, 2012), natalizumab exposure was 3,460 patient-years; a median of 56 (range 1-70) infusions were received. Serious adverse events, including progressive multifocal leukoencephalopathy, were consistent with natalizumab's known profile. Upon natalizumab re-exposure, rates of anti-natalizumab antibodies and hypersensitivity reactions were 3% and 5% overall, and 40% and 24% among patients with 1 to 2 prior natalizumab doses. Patients originally randomized to placebo/another disease-modifying therapy vs natalizumab in previous studies had significantly higher EDSS scores at STRATA baseline; this difference persisted over 240 weeks. EDSS scores generally remained stable. Patients initially randomized to natalizumab had lower annualized relapse rates over 240 weeks. CONCLUSIONS Serious adverse events were consistent with natalizumab's known safety profile; short exposure with a gap before redosing was associated with higher incidences of anti-natalizumab antibodies and hypersensitivity reactions. Stability of EDSS scores and consistently low relapse rates over 5 years of natalizumab treatment are consistent with its known efficacy profile. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that in patients with relapsing-remitting multiple sclerosis, natalizumab stabilizes EDSS scores, decreases relapse rates, and is associated with an increased risk of progressive multifocal leukoencephalopathy.
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Affiliation(s)
- Paul O'Connor
- From the Department of Neurology (P.O.), St. Michael's Hospital, Toronto, Canada; Department of Neurology (A.G.), University of Rochester, NY; Departments of Neurology and Biomedicine (L.K.), University Hospital Basel, Switzerland; Corinne Goldsmith Dickinson Center for MS at The Icahn School of Medicine at Mount Sinai (F.L.), New York, NY; Department of Neurology (C.P.), VU Medical Centre, Amsterdam, the Netherlands; Mellen Center for Multiple Sclerosis Treatment and Research (R.A.R.), Cleveland Clinic Foundation, OH; Infusion Communications (K.H.), Haddam, CT; Departments of Safety and Benefit-Risk Management (L.M.C.) and Biostatistics (F.F.), Biogen Idec Inc., Cambridge; and Sarepta Therapeutics (P.D.), Cambridge, MA; P.D., a former employee of Biogen Idec Inc., was at the company during study conduct.
| | - Andrew Goodman
- From the Department of Neurology (P.O.), St. Michael's Hospital, Toronto, Canada; Department of Neurology (A.G.), University of Rochester, NY; Departments of Neurology and Biomedicine (L.K.), University Hospital Basel, Switzerland; Corinne Goldsmith Dickinson Center for MS at The Icahn School of Medicine at Mount Sinai (F.L.), New York, NY; Department of Neurology (C.P.), VU Medical Centre, Amsterdam, the Netherlands; Mellen Center for Multiple Sclerosis Treatment and Research (R.A.R.), Cleveland Clinic Foundation, OH; Infusion Communications (K.H.), Haddam, CT; Departments of Safety and Benefit-Risk Management (L.M.C.) and Biostatistics (F.F.), Biogen Idec Inc., Cambridge; and Sarepta Therapeutics (P.D.), Cambridge, MA; P.D., a former employee of Biogen Idec Inc., was at the company during study conduct
| | - Ludwig Kappos
- From the Department of Neurology (P.O.), St. Michael's Hospital, Toronto, Canada; Department of Neurology (A.G.), University of Rochester, NY; Departments of Neurology and Biomedicine (L.K.), University Hospital Basel, Switzerland; Corinne Goldsmith Dickinson Center for MS at The Icahn School of Medicine at Mount Sinai (F.L.), New York, NY; Department of Neurology (C.P.), VU Medical Centre, Amsterdam, the Netherlands; Mellen Center for Multiple Sclerosis Treatment and Research (R.A.R.), Cleveland Clinic Foundation, OH; Infusion Communications (K.H.), Haddam, CT; Departments of Safety and Benefit-Risk Management (L.M.C.) and Biostatistics (F.F.), Biogen Idec Inc., Cambridge; and Sarepta Therapeutics (P.D.), Cambridge, MA; P.D., a former employee of Biogen Idec Inc., was at the company during study conduct
| | - Fred Lublin
- From the Department of Neurology (P.O.), St. Michael's Hospital, Toronto, Canada; Department of Neurology (A.G.), University of Rochester, NY; Departments of Neurology and Biomedicine (L.K.), University Hospital Basel, Switzerland; Corinne Goldsmith Dickinson Center for MS at The Icahn School of Medicine at Mount Sinai (F.L.), New York, NY; Department of Neurology (C.P.), VU Medical Centre, Amsterdam, the Netherlands; Mellen Center for Multiple Sclerosis Treatment and Research (R.A.R.), Cleveland Clinic Foundation, OH; Infusion Communications (K.H.), Haddam, CT; Departments of Safety and Benefit-Risk Management (L.M.C.) and Biostatistics (F.F.), Biogen Idec Inc., Cambridge; and Sarepta Therapeutics (P.D.), Cambridge, MA; P.D., a former employee of Biogen Idec Inc., was at the company during study conduct
| | - Chris Polman
- From the Department of Neurology (P.O.), St. Michael's Hospital, Toronto, Canada; Department of Neurology (A.G.), University of Rochester, NY; Departments of Neurology and Biomedicine (L.K.), University Hospital Basel, Switzerland; Corinne Goldsmith Dickinson Center for MS at The Icahn School of Medicine at Mount Sinai (F.L.), New York, NY; Department of Neurology (C.P.), VU Medical Centre, Amsterdam, the Netherlands; Mellen Center for Multiple Sclerosis Treatment and Research (R.A.R.), Cleveland Clinic Foundation, OH; Infusion Communications (K.H.), Haddam, CT; Departments of Safety and Benefit-Risk Management (L.M.C.) and Biostatistics (F.F.), Biogen Idec Inc., Cambridge; and Sarepta Therapeutics (P.D.), Cambridge, MA; P.D., a former employee of Biogen Idec Inc., was at the company during study conduct
| | - Richard A Rudick
- From the Department of Neurology (P.O.), St. Michael's Hospital, Toronto, Canada; Department of Neurology (A.G.), University of Rochester, NY; Departments of Neurology and Biomedicine (L.K.), University Hospital Basel, Switzerland; Corinne Goldsmith Dickinson Center for MS at The Icahn School of Medicine at Mount Sinai (F.L.), New York, NY; Department of Neurology (C.P.), VU Medical Centre, Amsterdam, the Netherlands; Mellen Center for Multiple Sclerosis Treatment and Research (R.A.R.), Cleveland Clinic Foundation, OH; Infusion Communications (K.H.), Haddam, CT; Departments of Safety and Benefit-Risk Management (L.M.C.) and Biostatistics (F.F.), Biogen Idec Inc., Cambridge; and Sarepta Therapeutics (P.D.), Cambridge, MA; P.D., a former employee of Biogen Idec Inc., was at the company during study conduct
| | - Kathy Hauswirth
- From the Department of Neurology (P.O.), St. Michael's Hospital, Toronto, Canada; Department of Neurology (A.G.), University of Rochester, NY; Departments of Neurology and Biomedicine (L.K.), University Hospital Basel, Switzerland; Corinne Goldsmith Dickinson Center for MS at The Icahn School of Medicine at Mount Sinai (F.L.), New York, NY; Department of Neurology (C.P.), VU Medical Centre, Amsterdam, the Netherlands; Mellen Center for Multiple Sclerosis Treatment and Research (R.A.R.), Cleveland Clinic Foundation, OH; Infusion Communications (K.H.), Haddam, CT; Departments of Safety and Benefit-Risk Management (L.M.C.) and Biostatistics (F.F.), Biogen Idec Inc., Cambridge; and Sarepta Therapeutics (P.D.), Cambridge, MA; P.D., a former employee of Biogen Idec Inc., was at the company during study conduct
| | - Lynda M Cristiano
- From the Department of Neurology (P.O.), St. Michael's Hospital, Toronto, Canada; Department of Neurology (A.G.), University of Rochester, NY; Departments of Neurology and Biomedicine (L.K.), University Hospital Basel, Switzerland; Corinne Goldsmith Dickinson Center for MS at The Icahn School of Medicine at Mount Sinai (F.L.), New York, NY; Department of Neurology (C.P.), VU Medical Centre, Amsterdam, the Netherlands; Mellen Center for Multiple Sclerosis Treatment and Research (R.A.R.), Cleveland Clinic Foundation, OH; Infusion Communications (K.H.), Haddam, CT; Departments of Safety and Benefit-Risk Management (L.M.C.) and Biostatistics (F.F.), Biogen Idec Inc., Cambridge; and Sarepta Therapeutics (P.D.), Cambridge, MA; P.D., a former employee of Biogen Idec Inc., was at the company during study conduct
| | - Fiona Forrestal
- From the Department of Neurology (P.O.), St. Michael's Hospital, Toronto, Canada; Department of Neurology (A.G.), University of Rochester, NY; Departments of Neurology and Biomedicine (L.K.), University Hospital Basel, Switzerland; Corinne Goldsmith Dickinson Center for MS at The Icahn School of Medicine at Mount Sinai (F.L.), New York, NY; Department of Neurology (C.P.), VU Medical Centre, Amsterdam, the Netherlands; Mellen Center for Multiple Sclerosis Treatment and Research (R.A.R.), Cleveland Clinic Foundation, OH; Infusion Communications (K.H.), Haddam, CT; Departments of Safety and Benefit-Risk Management (L.M.C.) and Biostatistics (F.F.), Biogen Idec Inc., Cambridge; and Sarepta Therapeutics (P.D.), Cambridge, MA; P.D., a former employee of Biogen Idec Inc., was at the company during study conduct
| | - Petra Duda
- From the Department of Neurology (P.O.), St. Michael's Hospital, Toronto, Canada; Department of Neurology (A.G.), University of Rochester, NY; Departments of Neurology and Biomedicine (L.K.), University Hospital Basel, Switzerland; Corinne Goldsmith Dickinson Center for MS at The Icahn School of Medicine at Mount Sinai (F.L.), New York, NY; Department of Neurology (C.P.), VU Medical Centre, Amsterdam, the Netherlands; Mellen Center for Multiple Sclerosis Treatment and Research (R.A.R.), Cleveland Clinic Foundation, OH; Infusion Communications (K.H.), Haddam, CT; Departments of Safety and Benefit-Risk Management (L.M.C.) and Biostatistics (F.F.), Biogen Idec Inc., Cambridge; and Sarepta Therapeutics (P.D.), Cambridge, MA; P.D., a former employee of Biogen Idec Inc., was at the company during study conduct
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Morrow SA, O'Connor PW, Polman CH, Goodman AD, Kappos L, Lublin FD, Rudick RA, Jurgensen S, Paes D, Forrestal F, Benedict RHB. Evaluation of the symbol digit modalities test (SDMT) and MS neuropsychological screening questionnaire (MSNQ) in natalizumab-treated MS patients over 48 weeks. Mult Scler 2010; 16:1385-92. [PMID: 20739335 DOI: 10.1177/1352458510378021] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Brief cognitive tests to monitor cognitive impairment in patients with multiple sclerosis (MS) are needed. METHODS Performance on monthly administrations of the Symbol Digit Modalities Test (SDMT) and the MS Neuropsychological Questionnaire (MSNQ) was assessed in 660 patients with MS in 21 countries (109 sites) for 48 weeks in an open-label, safety-extension study of natalizumab. RESULTS At baseline, the cohort's mean age was 40.1 years, 67.6% were female and the median Expanded Disability Status Scale score was 2.5. Test-retest correlations were high for both SDMT (range 0.89 for weeks 0-4 to 0.96 for weeks 44-48) and MSNQ (0.82 for weeks 0-4 to 0.93 for weeks 44-48). There were no statistically significant effects of geographic region. While SDMT scores improved by 15 points over 48 weeks (p < 0.0001), incremental monthly changes were small (effect size d < 0.3). Similar results were obtained on the MSNQ except that scores moved downward, suggesting fewer cognitive complaints over 48 weeks (p < 0.0001), but again the incremental monthly changes were small (d <-0.2). CONCLUSIONS These results replicate earlier work in a smaller cohort treated with conventional disease-modifying therapy, and support the reliability of the SDMT and MSNQ as potential screening for monitoring tools for cognition over time.
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Affiliation(s)
- S A Morrow
- Jacobs Neurological Institute, State University of New York at Buffalo, Buffalo, NY, USA
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Rudick RA, O'Connor PW, Polman CH, Goodman AD, Ray SS, Griffith NM, Jurgensen SA, Gorelik L, Forrestal F, Sandrock AW, Goelz SE. Assessment of JC virus DNA in blood and urine from natalizumab-treated patients. Ann Neurol 2010; 68:304-10. [DOI: 10.1002/ana.22107] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kappos L, Traboulsee A, Constantinescu C, Erälinna JP, Forrestal F, Jongen P, Pollard J, Sandberg-Wollheim M, Sindic C, Stubinski B, Uitdehaag B, Li D. Long-term subcutaneous interferon beta-1a therapy in patients with relapsing-remitting MS. Neurology 2006; 67:944-53. [PMID: 17000959 DOI: 10.1212/01.wnl.0000237994.95410.ce] [Citation(s) in RCA: 181] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To conduct systematic long-term follow-up (LTFU) of patients in the Prevention of Relapses and Disability by Interferon beta-1a Subcutaneously in Multiple Sclerosis (PRISMS) study to provide up to 8 years of safety, clinical and MRI outcomes on subcutaneous (s.c.) interferon (IFN) beta-1a in relapsing-remitting multiple sclerosis (RRMS). METHODS The original cohort of 560 patients was randomized to IFNbeta-1a, 44 or 22 microg three times weekly (TIW) or to placebo; after 2 years, patients on placebo were rerandomized to active treatment and the blinded study continued for a further 4 years. The LTFU visit was scheduled 7 to 8 years after baseline. RESULTS LTFU was attended by 68.2% of the original PRISMS study cohort (382/560 patients). 72.0% (275/382) were still receiving IFNbeta-1a s.c. TIW. Patients originally randomized to IFNbeta-1a 44 microg s.c. TIW showed lower Expanded Disability Status Scale progression, relapse rate and T2 burden of disease up to 8 years compared with those in the late treatment group. Brain parenchymal volume did not show differences by treatment group. Overall, 19.7% of patients progressed to secondary progressive MS between baseline and LTFU (75/381). No new safety concerns were identified and treatment was generally well tolerated. CONCLUSIONS Despite the limitations inherent in any long-term study (for example, potential differences between returning and nonreturning patients), these results indicate that patients with relapsing-remitting multiple sclerosis can experience sustained benefit over many years from early interferon beta-1a subcutaneous therapy three times weekly compared with patients whose treatment is delayed. This effect was more apparent in the patients receiving the higher dose.
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Affiliation(s)
- L Kappos
- University of Basel, Basel, Switzerland.
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