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Daiichi Sankyo Company, Limited (hereafter, Daiichi Sankyo) announced that the European Committee for Medicinal Products for Human Use (CHMP) has recommended approval of Lixiana® (edoxaban), an oral, once-daily selective factor Xa inhibitor, for the prevention of stroke and systemic embolism (SE) in adult patients with non-valvular atrial fibrillation (NVAF) with one or more risk factors. The CHMP also recommended approval of Lixiana for the treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), and prevention of recurrent DVT and PE in adults. The two related conditions DVT and PE are collectively referred to as venous thromboembolism (VTE). (1)
“The CHMP recommendation to approve once-daily edoxaban for the NVAF and VTE indications is an important milestone for our company,” said Glenn Gormley, MD, PhD, Senior Executive Officer and Global Head of R&D, Daiichi Sankyo Company, Limited and Executive Chairman and President, Daiichi Sankyo, Inc. “The European regulatory committee has recognised the positive benefit-risk profile of the 60mg dosing regimen [with a dose reduction to 30mg in selected patients with creatinine clearance (CrCL) 15–50ml/min, body weight ≤ 60kg, or concomitant use of certain P-glycoprotein (P-gp) inhibitors].”
The CHMP opinion to approve once-daily edoxaban for the prevention of stroke and SE in adult patients with NVAF with one or more risk factors and for the treatment and prevention of recurrent VTE (DVT and PE) is based on the data of the Phase III ENGAGE AF-TIMI 48 and Hokusai-VTE studies, respectively. (2,3)
In the ENGAGE AF-TIMI 48 study, once-daily edoxaban 60mg demonstrated non-inferiority to well-managed warfarin for the primary efficacy endpoint of occurrence of stroke or SE in patients with NVAF (1.18% versus 1.50% per year, respectively; hazard ratio [HR], 0.79; 97.5% confidence interval [CI], 0.63 to 0.99, p<0.001). In addition, once-daily edoxaban 60mg demonstrated a significant 20% risk reduction of major bleeding in patients with NVAF compared to warfarin (2.75% versus 3.43% per year, respectively; HR, 0.80; 95% CI, 0.71 to 0.91, p<0.001). (2)
In the Hokusai-VTE study, once-daily edoxaban 60mg was non-inferior to warfarin for the primary efficacy endpoint of recurrence of symptomatic VTE (3.2% versus 3.5% of patients, respectively; HR, 0.89; 95% CI, 0.70 to 1.13, p<0.001). In addition, edoxaban demonstrated a significant 19% risk reduction of clinically relevant bleeding in patients with VTE compared to warfarin (8.5% versus 10.3% of patients, respectively; HR, 0.81; 95% CI, 0.71 to 0.94, p=0.004). (3)
Atrial fibrillation (AF) is the most common type of heart rhythm disorder, and is associated with substantial morbidity and mortality. (4) More than six million Europeans suffer from AF and this figure is expected to at least double over the next 50 years. (5,6) One in five of all strokes are as a result of AF. (5)
VTE is a major cause of morbidity and mortality. (7) VTE is a major health problem in Europe, with more than one million VTE events or deaths per year (France, Germany, Italy, Spain, Sweden, UK), including more than 370,000 VTE-related deaths. (7)
About the ENGAGE AF-TIMI 48 Study
ENGAGE AF-TIMI 48 (Effective aNticoaGulation with factor xA next GEneration in Atrial Fibrillation) was a three-arm, randomised, double-blind, double-dummy, global Phase III clinical trial comparing once-daily edoxaban with well-managed warfarin in 21,105 patients with NVAF at moderate-to-high risk of thromboembolic events at 1,393 centers in 46 countries. ENGAGE AF-TIMI 48 compared two edoxaban treatment strategies, a higher dose arm (60mg or 30mg dose reduced) once-daily and a lower dose arm (30mg or 15mg dose reduced) once-daily, with warfarin in patients with NVAF for a median of 2.8 years follow-up. Patients were dose reduced for CrCL 30 to 50ml/min, body weight of 60kg or less or certain P-gp inhibitor use. ENGAGE AF-TIMI 48 represents the largest and longest single comparative global trial with a novel anticoagulant in patients with NVAF performed to date. (2) The full results were presented at the AHA Scientific Sessions 2013 in Dallas and published in the New England Journal of Medicine.
About the Hokusai-VTE Study
Hokusai-VTE was a global, event-driven, randomised, double-blind, double-dummy, parallel-group Phase III clinical study involving 8,292 patients in 439 clinical sites across 37 countries to evaluate once-daily edoxaban in patients with either acute symptomatic DVT, PE or both. The Hokusai-VTE study was designed to reflect clinical practice using a flexible treatment duration of 3–12 months in a broad spectrum of VTE patients, including initial use of parenteral anticoagulant (heparin) for 5–10 days, the proven global standard of care. Patients were randomised to receive edoxaban 60mg once-daily (dose reduced to 30mg for CrCL 30 to 50ml/min, body weight of 60kg or less, or certain P-gp inhibitor use) or the comparator, warfarin, following initial open-label enoxaparin or unfractionated heparin therapy. In the comparator arm, patients received initial heparin therapy concurrently with warfarin, titrated to a target INR of 2.0 to 3.0, followed by warfarin alone. The treatment duration was from three months and up to a maximum of one year. The duration of study treatment was determined by the investigator based on the patient’s clinical features. (3) The full results were presented at the ESC Congress 2013 in Amsterdam and published in the New England Journal of Medicine.
Edoxaban is an investigational, oral, once-daily anticoagulant that specifically inhibits factor Xa, which is an important factor in the coagulation system that leads to blood clotting. (8) The global edoxaban clinical trial program includes two Phase III clinical studies, Hokusai-VTE and ENGAGE AF-TIMI 48, which included nearly 30,000 patients combined. The results from these trials form the basis of regulatory filings for edoxaban for symptomatic VTE in patients with DVT and/or PE, and for the prevention of stroke and SE in NVAF, respectively. (2,3)
Edoxaban is currently marketed in Japan and the U.S. and has received approval in Switzerland. (9–11) In other countries, regulatory review is ongoing.
About Daiichi Sankyo
Daiichi Sankyo Group is dedicated to the creation and supply of innovative pharmaceutical products to address the diversified, unmet medical needs of patients in both mature and emerging markets. While maintaining its portfolio of marketed pharmaceuticals for hypertension, dyslipidaemia and bacterial infections used by patients around the world, the Group has also launched treatments for thrombotic disorders and is building new product franchises.
Furthermore, Daiichi Sankyo research and development is focused on bringing forth novel therapies in oncology and cardiovascular-metabolic diseases, including biologics. The Daiichi Sankyo Group has created a “Hybrid Business Model,” to respond to market and customer diversity and optimise growth opportunities across the value chain. For more information, please visit: http://www.daiichisankyo.com.