New janssen phase 3 data in patients with moderately to severely active rheumatoid arthritis shows sirukumab significantly inhibited radiographic progression

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Janssen Research & Development, LLC (Janssen) announced  results from a pivotal Phase 3 study evaluating subcutaneous sirukumab (CNTO 136), a human anti-interleukin (IL)-6 monoclonal antibody in development for the treatment of adults with moderately to severely active rheumatoid arthritis (RA). Data from the Janssen-sponsored trial of 1,670 patients showed patients receiving sirukumab demonstrated significant inhibition of radiographic progression, or joint destruction, from baseline to week 52 and improvement in signs and symptoms of RA at week 16, the study’s co-primary endpoints, when compared with patients receiving placebo. Sirukumab is being co-developed as part of a collaboration with GSK. These data are being presented for the first time at the Annual European Congress of Rheumatology (EULAR 2016).

The SIRROUND-D study met both co-primary endpoints evaluating treatment with sirukumab in adult patients with active RA who had an inadequate response to treatment with disease-modifying anti-rheumatic drugs (DMARDs):

• Inhibition of radiographic progression, or joint destruction, was significantly greater among sirukumab-treated patients, with a mean change from baseline to week 52 in the van der Heijde-Sharp score of 0.50 among patients receiving sirukumab 50 mg every four weeks (n=557) and 0.46 for patients receiving sirukumab 100 mg every two weeks (n=557) compared with 3.69 among the placebo group (n=556) (both P < 0.001). The van der Heijde-Sharp scoring method is an X-ray measure of changes in joint destruction and damage, including joint erosion and joint space narrowing. With this method, higher scores indicate greater structural damage while lower scores indicate less structural damage. Significant inhibition of radiographic progression was demonstrated in both patients naïve to biologic therapy and those treated with biologics in the past, and was seen as early as week 24.
• At least a 20 percent improvement in RA signs and symptoms as measured by the American College of Rheumatology (ACR20) at week 16 was achieved by 54.8 percent and 53.5 percent of patients receiving sirukumab 50 mg and sirukumab 100 mg, respectively, compared with 26.4 percent of the placebo group (both P < 0.001).

“The results from this Phase 3 study showed significant inhibition of the progression of joint damage for sirukumab and improvements in the pain and inflammation patients with rheumatoid arthritis experience when not adequately controlled with traditional disease-modifying agents. Treatments that may allow rheumatologists to limit the progression of the disease from causing permanent joint damage are valuable in the management of a chronic inflammatory condition like rheumatoid arthritis,” said Tsutomu Takeuchi, Professor of Medicine, Division of Rheumatology and Clinical Immunology, Keio University School of Medicine, Tokyo, Japan. “We look forward to forthcoming data from ongoing Phase 3 programs to better understand the efficacy and safety of sirukumab in a broader and more diverse rheumatoid arthritis patient population.”

All major secondary endpoints were also met with statistical significance for both doses of sirukumab versus placebo (P < 0.001 for all measures across both doses). These included the change from baseline in the health assessment questionnaire disability index (HAQ-DI), percentage of patients achieving at least a 50 percent improvement in RA symptoms (ACR50), percentage of patients with improved disease activity score in 28 joints (DAS28 Remission [DAS28 (CRP) <2.6]) at week 24, and percentage of patients achieving at least a 70 percent improvement in RA signs and symptoms (ACR70) for six consecutive months (major clinical response) by week 52. Mean improvements in HAQ-DI scores were -0.43 for the sirukumab 50 mg group, -0.46 for the sirukumab 100 mg group and -0.22 for the placebo group. ACR50 was achieved by 30 and 33 percent of patients receiving sirukumab 50 mg and 100 mg, respectively, compared with 12 percent of placebo patients. DAS28 remission was achieved by 26 percent of patients in both sirukumab groups compared with 6 percent of patients in the placebo group. Major clinical response was seen in 5 percent and 9 percent of patients receiving sirukumab 50 mg and 100 mg, compared with 2 percent of patients receiving placebo.

In the 18-week control period, the proportion of patients experiencing adverse events (AEs) and serious AEs, respectively, was higher with sirukumab 50 mg (79.6 percent and 11.0 percent) and sirukumab 100 mg (80.2 percent and 9.8 percent) versus placebo (65.5 percent and 6.8 percent), with the most common AEs being (at least 8 percent) elevated liver enzymes, upper respiratory tract infection, injection site erythema and nasopharyngitis. Through week 52, types of AEs and SAEs were similar to placebo. Prior to week 18, the formal placebo-controlled period, three patients died, one in each treatment group (placebo, sirukumab 50 mg and sirukumab 100 mg). From week 18 to week 52, there were eight deaths: three in the group originally on placebo that switched to sirukumab 50 mg, three in the sirukumab 50 mg and two in the sirukumab 100 mg. Long-term safety and efficacy data are currently being collected in ongoing extensions of the three Phase 3 trials.

“Janssen is committed to advancing therapeutic options for people living with RA and for rheumatologists,” said Newman Yeilding, M.D., Head of Immunology Development, Janssen Research & Development, LLC. “We believe sirukumab will represent an important option for the rheumatology community, and we look forward to presenting additional data from the comprehensive Phase 3 development program in the future as we work towards global regulatory submissions this year.”