FDA批准Promacta血液疾病新适应证

FDA批准Promacta血液疾病新适应证

                               
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发布日期：2014-08-28  来源：新药汇  

8月28日，GSK宣布FDA批准其Promacta（eltrombopag，艾曲波帕）的补充新药申请，一日1次用于对免疫抑制疗法（IST）响应不足的重型再生障碍性贫血（SAA）患者血细胞减少症（cytopenia）的治疗。

                               
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葛兰素史克（GSK）8月26日宣布，FDA已批准Promacta（eltrombopag，艾曲波帕）补充新药申请（sNDA），用于对免疫抑制疗法（IST）反应不足的重型再生障碍性贫血（SAA）患者血细胞减少症（cytopenia）的治疗。

此前，FDA已于今年2月授予Promacta治疗SAA的突破性疗法认定。Promacta sNDA的提交，是基于一项开放标签II期NIH研究的数据，该项研究在43例对IST响应不足的SAA患者中开展。

重型再生障碍性贫血（SAA）是一种罕见性疾病，患者骨髓无法制造足够的新的血细胞。目前，还没有药物获批用于对免疫抑制疗法（IST）无响应的SAA患者的治疗。对初始IST响应不足的SAA患者群体，约40%的患者会在疾病确诊5年内，死于感染或出血。：

目前，Eltrombopag（艾曲波帕）已获全球100多个国家批准，用于慢性免疫（特发性）血小板减少性紫癜（ITP）患者血小板减少症（thrombocytopenia）的治疗，同时已获43个国家批准用于慢性丙型肝炎（CHC）患者血小板减少症的治疗，以便启动并维持以干扰素为基础的肝病标准疗法。

该药在美国的商品名为Promacta，在欧洲及其他国家和地区的商品名为Revolade。

英文原文：GSK receives FDA approval of an additional Promacta® (eltrombopag) indication for use in patients with severe aplastic anaemia (SAA) who have had an insufficient response to immunosuppressive therapy (IST)
26 August 2014
Issued: London, UK

- New first-in-class treatment option for this previously treated SAA patient population

GlaxoSmithKline plc (LSE/NYSE: GSK) announced today that the U.S. Food and Drug Administration (FDA) has approved a supplemental New Drug Application (sNDA) for the once-daily use of Promacta® (eltrombopag) in patients with severe aplastic anaemia (SAA) who have had an insufficient response to immunosuppressive therapy (IST).1

SAA is a blood disorder wher the bone marrow fails to make enough red blood cells, white blood cells, and platelets. 2 Eltrombopag, an oral thrombopoietin (TPO) receptor agonist, works by helping to induce proliferation and differentiation of bone marrow stem cells to increase production of blood cells.1

“FDA approval of Promacta addresses a significant treatment need for this very rare but serious blood disorder in those who have failed current treatment options,” said Dr. Paolo Paoletti, President of Oncology, GSK. “Through collaboration with the National Institutes of Health, whose studies demonstrate the potential for Promacta to achieve a haematologic response in at least one lineage – red blood cells, platelets, or white blood cells – patients now have a treatment option wher one didn’t previously exist.”

Promacta gained Breakthrough Therapy designation status from the FDA in January 2014 and Priority Review in April 2014. Today’s approval by the FDA is based on results from an investigator-sponsored Phase II study (09-H-0154) conducted by the National Heart, Lung and Blood Institute (NHLBI) at the National Institutes of Health (NIH). The study demonstrated a haematologic response in SAA patients treated with eltrombopag who had an insufficient response to IST:1

Forty per cent (95% CI, 25, 56) of patients (N=17) experienced a haematologic response in at least one lineage – platelets, red blood cells (RBC), or white blood cells (ANC) – after Week 12.1
In the extension phase, eight patients achieved a multi-lineage response; four of these patients subsequently tapered off treatment and maintained the response (median follow up 8.1 months, range 7.2-10.6 months).1
Ninety-one per cent of patients were platelet transfusion-dependent at baseline; the platelet transfusion-free period in responders ranged from eight to 1,096 days (median 200 days).1
Eighty-six per cent of patients were RBC-transfusion dependent at baseline; the RBC transfusion-free period in responders ranged from 15 to 1,082 days (median 208 days).1
The most common adverse reactions (≥20%) in the single-arm, open-label trial, in 43 patients with SAA who received Promacta were: nausea (33%), fatigue (28%), cough (23%), diarrhoea (21%), and headache (21%). In this trial, patients had bone marrow aspirates evaluated for cytogenetic abnormalities. Eight patients had a new cytogenetic abnormality reported, including five patients who had complex changes in chromosome 7. If new cytogenetic abnormalities are observed, discontinuation of Promacta should
be considered.1

about the NIH Study1

In the single-arm, single-centre, open-label Phase II 09-H-0154 study, eltrombopag was evaluated in 43 patients with SAA who have had an insufficient response to at least one prior IST and who had a platelet count ≤30 x 109/L. At baseline, the median platelet count was 20 x 109/L, haemoglobin was 8.4 g/dL, absolute neutrophil count (ANC) was 0.58 x 109/L, and absolute reticulocyte count was 24.3 x 109/L.

The treated population had a median age of 45 years (range 17 to 77 years) and 56 per cent were male. The majority of patients (84%) received at least two prior immunosuppressive therapies.

Eltrombopag was administered at an initial dose of 50 mg once daily for two weeks and increased over two-week periods up to a maximum dose of 150 mg once daily. The primary endpoint was haematologic response which was initially assessed after 12 weeks of treatment with eltrombopag. Treatment was discontinued after 16 weeks if no haematologic response was observed. Additional efficacy assessments included median duration of response in months.

about Severe Aplastic Anaemia (SAA)

SAA is a very rare but serious blood disorder wher the bone marrow fails to make enough red blood cells, white blood cells, and platelets.2 The exact cause of the disease is still unknown, but most cases of SAA are believed to be triggered by an autoimmune reaction wher the body attacks blood-forming stem cells located in the bone marrow.3 As a result, patients with SAA are at risk for life-threatening infections or bleeding.2In the U.S., approximately 300 to 600 new cases of SAA are identified each year.2

Treatment of SAA is focused on increasing a patient’s blood cell count; definitive care includes immunosuppressive therapy (IST) or hematopoietic stem cell transplantation.3,4 Supportive treatments – including blood transfusions, platelet transfusions that typically occur once a week, iron chelation therapy, and treatment of infections – help in the short term to relieve specific symptoms.5

Of patients treated with IST, one-quarter to one-third will not respond and 30-40 per cent of responders will relapse, causing symptoms to return.4 Approximately 40 per cent of SAA patients who don’t respond to initial IST die from infection or bleeding within five years of their diagnosis.6

Currently, no established standard of care exists for SAA patients who have had an insufficient response to IST or are ineligible for hematopoietic stem cell transplantation.7

about Eltrombopag1

Eltrombopag is marketed under the brand name Promacta® in the U.S. and Revolade™ in most ex-U.S. countries.

In addition to the approval of Promacta for SAA in the U.S., eltrombopag is indicated for the treatment of thrombocytopenia in patients with:

chronic immune (idiopathic) thrombocytopenia (ITP) who have had an insufficient response to corticosteroids, immunoglobulins, or splenectomy.
Promacta should be used only in patients with ITP whose degree of thrombocytopenia and clinical condition increase the risk for bleeding.
chronic hepatitis C to allow the initiation and maintenance of interferon-based therapy.   
Promacta should be used only in patients with chronic hepatitis C whose degree of thrombocytopenia prevents the initiation of interferon-based therapy or limits the ability to maintain interferon-based therapy.
Safety and efficacy have not been established in combination with direct acting antiviral agents used without interferon for treatment of chronic hepatitis C.

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