Celgene receives positive CHMP opinion for OTEZLA® (apremilast)

Celgene International Sàrl, a wholly-owned subsidiary of Celgene Corporation, announced that the European Medicines Agency’s (EMA) Committee for Medicinal Products for Human Use (CHMP) has adopted a positive opinion for OTEZLA® (apremilast), the company’s oral selective inhibitor of phosphodiesterase 4 (PDE4), in two therapeutic indications: (1)

Celgene International Sàrl, a wholly-owned subsidiary of Celgene Corporation, announced that the European Medicines Agency’s (EMA) Committee for Medicinal Products for Human Use (CHMP) has adopted a positive opinion for OTEZLA® (apremilast), the company’s oral selective inhibitor of phosphodiesterase 4 (PDE4), in two therapeutic indications: (1)

• For the treatment of moderate-to-severe chronic plaque psoriasis in adult patients who failed to respond to or, who have a contraindication to, or are intolerant to other systemic therapy including cyclosporine, methotrexate or psoralen and ultraviolet-A light (PUVA).
• Alone or in combination with Disease Modifying Antirheumatic Drugs (DMARDs), for the treatment of active psoriatic arthritis (PsA) in adult patients who have had an inadequate response or who have been intolerant to a prior DMARD therapy.

Psoriasis is an immune-mediated skin condition characterised by raised scaly lesions on the skin. It affects approximately 14 million people across Europe (2) and about 125 million people worldwide. (3) Plaque psoriasis, also called psoriasis vulgaris, is the most common form of the disease, representing about 80% of cases. (4) Up to 30% of people with psoriasis may develop psoriatic arthritis, which involves pain and swelling in joints and other manifestations and may lead to significant disability. (5)

“This CHMP positive opinion is an important step forward for people with psoriasis and psoriatic arthritis in Europe. These immune mediated diseases are frequently debilitating and cause severe physical and emotional pain to the individual,” stated Tuomo Pätsi, President, Celgene Europe, the Middle East and Africa (EMEA). “We are proud to have moved one step closer to offering patients OTEZLA®, a new, oral treatment approach that could significantly help control their symptoms and make a considerable difference to their quality of life.”

In the ESTEEM studies, which form the basis of CHMP’s positive opinion for apremilast in psoriasis, treatment resulted in significant and clinically meaningful improvements in plaque psoriasis as measured by PASI-75 (a 75% improvement in the Psoriasis Area Severity Index) scores at week 16, the primary endpoint. (6,7) Patients on apremilast also benefited from significant improvements in difficult to treat areas, such as nail and scalp, and itch, known to have a marked impact on patients’ quality of life and perception of disease severity. (8,9,10)

In the PALACE program, which forms the basis for CHMP’s positive opinion for apremilast in psoriatic arthritis, treatment resulted in significant and clinically meaningful improvements in the signs and symptoms of psoriatic arthritis, as measured by the modified ACR-20 (a 20% improvement in the American College of Rheumatology disease activity criteria) response at 16 weeks, the primary endpoint. 7, (11) Patients on apremilast showed improvement across multiple disease manifestations specific to psoriatic arthritis, such as swollen and tender joints, as well as dactylitis, enthesitis and overall physical function. (12–14)

In the Phase III programmes, PALACE and ESTEEM, the clinical response of OTEZLA® was maintained through week 52 across multiple endpoints. (15,16)

Across these Phase III clinical studies, the most commonly reported adverse reactions were consistently diarrhoea, nausea, upper respiratory tract infection, tension headache and headache. (6,7) These adverse reactions were mostly mild to moderate in severity. Gastrointestinal adverse reactions generally occurred within the first 2 weeks of treatment and usually resolved within 4 weeks. (6,7) During the placebo-controlled phase of the clinical trials, the rate of major adverse cardiac events, serious infections, including opportunistic infections, and malignancies, was comparable between placebo and apremilast groups. (6,7)

OTEZLA® was approved on March 21, 2014 by the U.S. Food and Drug Administration (FDA) for the treatment of adults with active psoriatic arthritis and on September 23, 2014 for the treatment of patients with moderate to severe plaque psoriasis who are candidates for phototherapy or systemic therapy.  In Canada, OTEZLA was approved for the treatment of moderate-to-severe plaque psoriasis in November 2014.  A New Drug Submission (NDS) for psoriatic arthritis was submitted to Canadian Health Authorities in the second quarter of 2013.  Marketing authorisation applications are on going in other countries, including Australia and Switzerland.

The European Commission, which generally follows the recommendation of the CHMP, is expected to make its final decision within 2–3 months. If approval is granted, detailed conditions for the use of this product will be described in the Summary of Product Characteristics (SmPC), which will be published in the revised European Public Assessment Report (EPAR).

References:

1. European Medicines Agency CHMP Positive Opinion Statement.
2. Augustin M, Herberger K, Hintzen S, Heigel H, Franzke N, Shäfer I. Prevalence of skin lesions and need for treatment in a cohort of 90880 workers. Br J Dermatol. 2011;165(4):865-873.
3. The International Federation of Psoriasis Associations (IFPA). A report by the International Federation of Psoriasis Associations. Psoriasis is a serious disease deserving global attention. Available online: http://www.ifpa-pso.org/
4. Villasenor-Park j. et al. Psoriasis: Evolving treatment for a complex disease. Cleveland Journal of Medicine. Volume 79 (6) 2012.
5. Gladman DD. Psoriatic arthritis. Dermatologic Therapy, Vol. 22, 2009, 40–55.
6. Papp K et al. Efficacy of apremilast in the treatment of moderate to severe psoriasis: a randomised controlled trial. The Lancet, Volume 380, Issue 9843, Pages 738 – 746, 2012  doi:10.1016/S0140-6736(12)60642-4.
7. Otezla Prescribing information (US Label) Available online: http://www.otezla.com/wp-content/uploads/2014/05/otezla-prescribing-information.pdf.
8. Crowley, J. et al. Apremilast in Moderate to Severe Plaque Psoriasis: 32-Week Results in Patients With Nail, Scalp, and Palmoplantar Involvement (ESTEEM 2) [EADV 2014 abstract].
9. Yosipovitch, G.et al. Effects of Apremilast on Pruritus in Patients With Moderate to Severe Plaque Psoriasis: Results From the ESTEEM 1 and 2 Trials [EADV 2014 abstract].
10. Armstrong, A.W., et al. Quality of life and work productivity impairment among psoriasis patients: findings from the National Psoriasis Foundation survey data 2003-2011. PLoS One. 7.12 (2012): e52935. doi: 10.1371/journal.pone.0052935.
11. Kavanaugh A, et al. Ann Rheum Dis 2014;73:1020–1026. doi:10.1136/annrheumdis-2013-205056.
12. Wells, A. et al. SAT0382: PALACE 4, A phase III, randomized, controlled trial of apremilast, an oral phosphodiesterase 4 inhibitor, for treatment of psoriatic arthritis: long-term (52-week) improvements in physical function [EULAR 2014 abstract].
13. Edwards, C. et al. SAT0389: Apremilast, an oral phosphodiesterase 4 inhibitor, is associated with long-term (52-week) improvements in enthesitis and dactylitis in patients with psoriatic arthritis: results from the PALACE 4 phase III, randomized, controlled trial [EULAR 2014 abstract].
14. Kavanaugh A, et al. Ann Rheum Dis 2014;73:1020–1026. doi:10.1136/annrheumdis-2013-205056.
15. Kavanaugh A, et al. Abstract OP0078. Apremilast, an oral phosphodiesterase 4 inhibitor, is associated with long-term (52 week) improvement in measures of disease activity in patients with psoriatic arthritis: results from 3 phase III, randomized, controlled trials [EULAR 2014 abstract].
16. Carle, P. et al. Apremilast, an Oral Phosphodiesterase 4 Inhibitor, in Patients With Moderate to Severe Psoriasis: Results of a Phase 3, Randomized, Controlled Trial (ESTEEM 2).