Eisai Completes Submission of LEQEMBI® (lecanemab-irmb) Supplemental Biologics License Application for IV Maintenance Dosing for the Treatment of Early Alzheimer's Disease to the U.S. FDA
- None.
- The need for additional immunogenicity data delays the BLA submission for the SC formulation.
- Fast Track designation specific for the SC formulation is required for rolling review.
- ARIA-related imaging abnormalities pose risks, especially for ApoE ε4 homozygotes.
- Intracerebral hemorrhages have been observed, including fatal events.
- Hypersensitivity reactions and infusion-related reactions have occurred in patients treated with LEQEMBI.
Insights
The submission of a Supplemental Biologics License Application (sBLA) for LEQEMBI by Eisai to the FDA represents a significant event in the progression of Alzheimer's disease treatment options. This development is particularly noteworthy given that LEQEMBI is one of the few therapies targeting early-stage Alzheimer's, a period when intervention may be most beneficial. The focus on maintaining effective drug concentration through monthly IV dosing to sustain clearance of protofibrils is a strategic approach to prolonging the therapeutic benefits of the drug. The clinical implications of this are substantial, as continued treatment could potentially slow disease progression and improve quality of life for patients.
Furthermore, the request for a Fast Track designation for the subcutaneous (SC) formulation indicates a commitment to enhancing the convenience and accessibility of the treatment. The FDA's response to this request and the subsequent rolling submission process will be critical in determining the speed at which this new dosing option becomes available to patients. The potential for a more convenient SC administration could improve adherence to treatment regimens, a common challenge in chronic disease management.
The announcement by Eisai and Biogen regarding the sBLA for LEQEMBI is likely to have a tangible impact on the market performance of both companies. The progress in regulatory submissions and the expansion of the drug's approval to additional markets, including the U.S., Japan and China, with ongoing applications in numerous other countries, suggests a strategic effort to capture a significant share of the global Alzheimer's treatment market.
Investors should note the potential for increased revenue streams from LEQEMBI, especially considering the high prevalence of Alzheimer's disease and the limited number of effective treatments currently available. The Fast Track and Breakthrough Therapy designations could expedite the approval process, allowing for quicker market entry and competitive advantage. However, the requirement for additional immunogenicity data and the need for a specific Fast Track designation for the SC formulation introduce an element of uncertainty that could affect investor sentiment and stock volatility in the short term.
The economic implications of LEQEMBI's potential widespread use are multifaceted. On one hand, the treatment could lead to reduced long-term healthcare costs by potentially delaying the progression of Alzheimer's disease and decreasing the need for more intensive care. On the other hand, the costs associated with monthly IV treatments and the management of side effects, such as ARIA, could pose financial challenges for healthcare systems and patients. It is important to consider the cost-effectiveness of such treatments, balancing the potential clinical benefits against the economic burden they may impose.
Moreover, the therapeutic landscape of Alzheimer's disease is shifting towards early intervention strategies, which could lead to increased screening and diagnostic procedures. This shift has the potential to increase overall healthcare expenditures but may ultimately result in better patient outcomes and reduced long-term costs associated with advanced stages of the disease.
As part of the monthly IV maintenance regimen, the patients who have completed the biweekly IV initiation phase, exact period under discussion with the FDA, would receive a monthly IV dose that maintains effective drug concentration to sustain the clearance of highly toxic protofibrils* which can continue to cause neuronal injury even after the amyloid-beta (Aβ) plaque has been cleared from the brain. The sBLA is based on modeling of observed data from the Phase 2 study (Study 201) and its open-label extension (OLE) as well as Clarity AD study (Study 301) and its OLE study.
Eisai had aimed to submit a Biologics License Application (BLA) for weekly maintenance therapy using subcutaneous (SC) administration in March 2024. To respond to the FDA's recent requirement of additional three-month immunogenicity data at the proposed maintenance dose of 360 mg weekly, Eisai planned to initiate a rolling BLA for lecanemab SC maintenance in March 2024, under the existing Fast Track and Breakthrough Therapy designations. However, Eisai was recently informed by the FDA that a Fast Track designation specific for the SC formulation is needed to receive rolling review. Following the guidance, Eisai submitted a request for Fast Track designation for the SC formulation and will initiate a rolling submission should the FDA grant this designation. The Fast Track designation will be determined within 60 days from the March 2024 submission.
AD is an ongoing neurotoxic process that begins before and continues after plaque deposition. There is an urgency to treat early AD because early and ongoing treatment can slow the progression of AD and continuing treatment may prolong the benefit even after plaque is cleared from the brain. The earlier Mild Cognitive Impairment (MCI) due to AD and mild AD dementia are diagnosed and treated, the greater the opportunity for the patient to benefit. Continued maintenance dosing is intended to maintain the clinical and biomarker benefits with a dosing regimen that may be more convenient for some patients and their care partners.
LEQEMBI is now approved in the
* Protofibrils are believed to contribute to the brain injury that occurs with AD and are considered to be the most toxic form of Aβ, having a primary role in the cognitive decline associated with this progressive, debilitating condition.1 Protofibrils cause injury to neurons in the brain, which in turn, can negatively impact cognitive function via multiple mechanisms, not only increasing the development of insoluble Aβ plaques but also increasing direct damage to brain cell membranes and the connections that transmit signals between nerve cells or nerve cells and other cells. It is believed the reduction of protofibrils may prevent the progression of AD by reducing damage to neurons in the brain and cognitive dysfunction. 2
LEQEMBI (lecanemab-irmb) 100 mg/ml injection for intravenous (IV) use is indicated for the treatment of Alzheimer's disease. Treatment with LEQEMBI should be initiated in patients with mild cognitive impairment or mild dementia stage of disease, the population in which treatment was initiated in clinical trials.
WARNING: AMYLOID RELATED IMAGING ABNORMALITIES (ARIA)
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CONTRAINDICATION
LEQEMBI is contraindicated in patients with serious hypersensitivity to lecanemab-irmb or to any of the excipients of LEQEMBI. Reactions have included angioedema and anaphylaxis.
WARNINGS AND PRECAUTIONS
Amyloid Related Imaging Abnormalities
- LEQEMBI can cause ARIA-E and ARIA-H. ARIA-E can be observed on MRI as brain edema or sulcal effusions, and ARIA-H as microhemorrhage and superficial siderosis. ARIA can occur spontaneously in patients with Alzheimer's disease. ARIA-H associated with monoclonal antibodies directed against aggregated forms of beta amyloid generally occurs in association with an occurrence of ARIA-E. ARIA-H and ARIA-E can occur together. ARIA usually occurs early in treatment and is usually asymptomatic, although serious and life-threatening events, including seizure and status epilepticus, rarely can occur. Reported symptoms associated with ARIA may include headache, confusion, visual changes, dizziness, nausea, and gait difficulty. Focal neurologic deficits may also occur. Symptoms associated with ARIA usually resolve over time.
ARIA Monitoring and Dose Management Guidelines
- Obtain recent baseline brain magnetic resonance imaging (MRI) prior to initiating treatment with LEQEMBI. Obtain an MRI prior to the 5th, 7th and 14th infusions.
- Recommendations for dosing in patients with ARIA-E and ARIA-H depend on clinical symptoms and radiographic severity. Depending on ARIA severity, use clinical judgment in considering whether to continue dosing, temporarily discontinue treatment, or permanently discontinue LEQEMBI.
- Enhanced clinical vigilance for ARIA is recommended during the first 14 weeks of treatment with LEQEMBI. If a patient experiences symptoms suggestive of ARIA, clinical evaluation should be performed, including MRI if indicated. If ARIA is observed on MRI, careful clinical evaluation should be performed prior to continuing treatment.
- There is no experience in patients who continued dosing through symptomatic ARIA-E or through asymptomatic, but radiographically severe, ARIA-E. There is limited experience in patients who continued dosing through asymptomatic but radiographically mild to moderate ARIA-E. There are limited data in dosing patients who experienced recurrent ARIA-E.
Incidence of ARIA
- In Study 2, symptomatic ARIA occurred in
3% (29/898) of LEQEMBI-treated patients. Serious symptoms associated with ARIA were reported in0.7% (6/898) of patients treated with LEQEMBI. Clinical symptoms associated with ARIA resolved in79% (23/29) of patients during the period of observation. - Including asymptomatic radiographic events, ARIA was observed in LEQEMBI:
21% (191/898); placebo:9% (84/897). ARIA-E was observed in LEQEMBI:13% (113/898); placebo:2% (15/897). ARIA-H was observed in LEQEMBI:17% (152/898); placebo:9% (80/897). There was no increase in isolated ARIA-H for LEQEMBI vs placebo.
ApoE ε4 Carrier Status and Risk of ARIA
- In Study 2,
16% (141/898) of patients in the LEQEMBI arm were ApoE ε4 homozygotes,53% (479/898) were heterozygotes, and31% (278/898) were noncarriers. - The incidence of ARIA was higher in ApoE ε4 homozygotes (LEQEMBI:
45% ; placebo:22% ) than in heterozygotes (LEQEMBI:19% ; placebo:9% ) and noncarriers (LEQEMBI:13% ; placebo:4% ). Among patients treated with LEQEMBI, symptomatic ARIA-E occurred in9% of ApoE ε4 homozygotes compared with2% of heterozygotes and1% noncarriers. Serious events of ARIA occurred in3% of ApoE ε4 homozygotes, and approximately1% of heterozygotes and noncarriers. - The recommendations on management of ARIA do not differ between ApoE ε4 carriers and noncarriers.
Radiographic Findings
- The majority of ARIA-E radiographic events occurred early in treatment (within the first 7 doses), although ARIA can occur at any time and patients can have more than 1 episode. The maximum radiographic severity of ARIA-E in patients treated with LEQEMBI was mild in
4% (37/898), moderate in7% (66/898), and severe in1% (9/898). Resolution on MRI occurred in52% of ARIA-E patients by 12 weeks,81% by 17 weeks, and100% overall after detection. The maximum radiographic severity of ARIA-H microhemorrhage in LEQEMBI-treated patients was mild in9% (79/898), moderate in2% (19/898), and severe in3% (28/898) of patients; superficial siderosis was mild in4% (38/898), moderate in1% (8/898), and severe in0.4% (4/898). Among LEQEMBI-treated patients, the rate of severe radiographic ARIA-E was highest in ApoE ε4 homozygotes5% (7/141), compared to heterozygotes0.4% (2/479) or noncarriers0% (0/278). Among LEQEMBI-treated patients, the rate of severe radiographic ARIA-H was highest in ApoE ε4 homozygotes13.5% (19/141), compared to heterozygotes2.1% (10/479) or noncarriers1.1% (3/278).
Intracerebral Hemorrhage
- Intracerebral hemorrhage >1 cm in diameter was reported in
0.7% (6/898) of patients in Study 2 after treatment with LEQEMBI compared to0.1% (1/897) on placebo. Fatal events of intracerebral hemorrhage in patients taking LEQEMBI have been reported.
Concomitant Antithrombotic Medication:
- In Study 2, baseline use of antithrombotic medication (aspirin, other antiplatelets, or anticoagulants) was allowed if the patient was on a stable dose. The majority of exposures to antithrombotic medications were to aspirin. Antithrombotic medications did not increase the risk of ARIA with LEQEMBI. The incidence of intracerebral hemorrhage was
0.9% (3/328 patients) in patients taking LEQEMBI with a concomitant antithrombotic medication at the time of the event compared to0.6% (3/545 patients) in those who did not receive an antithrombotic. Patients taking LEQEMBI with an anticoagulant alone or combined with an antiplatelet medication or aspirin had an incidence of intracerebral hemorrhage of2.5% (2/79 patients) compared to none in patients who received placebo. - Because intracerebral hemorrhages >1 cm in diameter have been observed in patients taking LEQEMBI, additional caution should be exercised when considering the administration of anticoagulants or a thrombolytic agent (e.g., tissue plasminogen activator) to a patient already being treated with LEQEMBI.
Other Risk Factors for Intracerebral Hemorrhage:
- Patients were excluded from enrollment in Study 2 for findings on neuroimaging that indicated an increased risk for intracerebral hemorrhage. These included findings suggestive of cerebral amyloid angiopathy (prior cerebral hemorrhage >1 cm in greatest diameter, >4 microhemorrhages, superficial siderosis, vasogenic edema) or other lesions (aneurysm, vascular malformation) that could potentially increase the risk of intracerebral hemorrhage. The presence of an ApoE ε4 allele is also associated with cerebral amyloid angiopathy, which has an increased risk for intracerebral hemorrhage. Caution should be exercised when considering the use of LEQEMBI in patients with factors that indicate an increased risk for intracerebral hemorrhage and in particular for patients who need to be on anticoagulant therapy.
Hypersensitivity Reactions
Hypersensitivity reactions, including angioedema, bronchospasm, and anaphylaxis, have occurred in LEQEMBI-treated patients. Promptly discontinue the infusion upon the first observation of any signs or symptoms consistent with a hypersensitivity reaction, and initiate appropriate therapy.
Infusion-Related Reactions
- In Study 2, infusion-related reactions were observed in LEQEMBI:
26% (237/898); placebo:7% (66/897), and the majority of cases in LEQEMBI-treated patients (75% , 178/237) occurred with the first infusion. Infusion-related reactions were mostly mild (69% ) or moderate (28% ) in severity. Infusion-related reactions resulted in discontinuations in1% (12/898) of LEQEMBI-treated patients. Symptoms of infusion-related reactions included fever and flu-like symptoms (chills, generalized aches, feeling shaky, and joint pain), nausea, vomiting, hypotension, hypertension, and oxygen desaturation. - In the event of an infusion-related reaction, the infusion rate may be reduced, or the infusion may be discontinued, and appropriate therapy initiated as clinically indicated. Prophylactic treatment with antihistamines, acetaminophen, nonsteroidal anti-inflammatory drugs, or corticosteroids prior to future infusions may be considered.
ADVERSE REACTIONS
- In Study 2, the most common adverse reactions leading to discontinuation of LEQEMBI was ARIA-H microhemorrhages that led to discontinuation in
2% (15/898) of patients treated with LEQEMBI compared to <1% (1/897) of patients on placebo. - In Study 2, the most common adverse reactions reported in ≥
5% of patients treated with LEQEMBI (N=898) and ≥2% higher than placebo (N=897) were infusion-related reactions (LEQEMBI:26% ; placebo:7% ), ARIA-H (LEQEMBI:14% ; placebo:8% ), ARIA-E (LEQEMBI:13% ; placebo:2% ), headache (LEQEMBI:11% ; placebo:8% ), superficial siderosis of central nervous system (LEQEMBI:6% ; placebo:3% ), rash (LEQEMBI:6% ; placebo:4% ), and nausea/vomiting (LEQEMBI:6% ; placebo:4% ).
Please see full Prescribing Information for LEQEMBI, including Boxed WARNING.
MEDIA CONTACTS
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Eisai Co., Ltd. Public Relations Department TEL: +81 (0)3-3817-5120 Eisai Inc. ( Libby Holman + 1-201-753-1945 Eisai Europe, Ltd. EMEA Communications Department +44 (0) 786 601 1272 | Biogen Inc. Jack Cox + 1-781-464-3260 |
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Eisai Co., Ltd. Investor Relations Department TEL: +81 (0) 3-3817-5122 | Biogen Inc. Chuck Triano + 1-781-464-2442 |
Notes to Editors
1. About lecanemab (Leqembi®)
Lecanemab is the result of a strategic research alliance between Eisai and BioArctic. It is a humanized immunoglobulin gamma 1 (IgG1) monoclonal antibody directed against aggregated soluble (protofibril) and insoluble forms of amyloid-beta (Aβ).3 Lecanemab is approved in the
U.S. : For the treatment of Alzheimer's disease (AD). It should be initiated in patients with mild cognitive impairment (MCI) or mild dementia stage of disease.4Japan : For slowing progression of MCI and mild dementia due to AD.5China : For the treatment of MCI due to AD and mild AD dementia.6
LEQEMBI's FDA approval was based on Phase 3 data from Eisai's, global Clarity AD clinical trial, in which it met its primary endpoint and all key secondary endpoints with statistically significant results.7 The primary endpoint was the global cognitive and functional scale, Clinical Dementia Rating Sum of Boxes (CDR-SB). In the Clarity AD clinical trial, treatment with lecanemab reduced clinical decline on CDR-SB by
Eisai has also submitted applications for approval of lecanemab in 14 countries and regions, including the European Union (EU).
2. About the Collaboration between Eisai and Biogen for AD
Eisai and Biogen have been collaborating on the joint development and commercialization of AD treatments since 2014. Eisai serves as the lead of lecanemab development and regulatory submissions globally with both companies co-commercializing and co-promoting the product and Eisai having final decision-making authority.
3. About the Collaboration between Eisai and BioArctic for AD
Since 2005, Eisai and BioArctic have had a long-term collaboration regarding the development and commercialization of AD treatments. Eisai obtained the global rights to study, develop, manufacture and market lecanemab for the treatment of AD pursuant to an agreement with BioArctic in December 2007. The development and commercialization agreement on the antibody lecanemab back-up was signed in May 2015.
4. About Eisai Co., Ltd.
Eisai's Corporate Concept is "to give first thought to patients and people in the daily living domain, and to increase the benefits that health care provides." Under this Concept (also known as human health care (hhc) Concept), we aim to effectively achieve social good in the form of relieving anxiety over health and reducing health disparities. With a global network of R&D facilities, manufacturing sites and marketing subsidiaries, we strive to create and deliver innovative products to target diseases with high unmet medical needs, with a particular focus in our strategic areas of Neurology and Oncology.
In addition, we demonstrate our commitment to the elimination of neglected tropical diseases (NTDs), which is a target (3.3) of the United Nations Sustainable Development Goals (SDGs), by working on various activities together with global partners.
For more information about Eisai, please visit www.eisai.com (for global headquarters: Eisai Co., Ltd.), and connect with us on X, LinkedIn and Facebook. The website and social media channels are intended for audiences outside of the
5. About Biogen
Founded in 1978, Biogen is a leading biotechnology company that pioneers innovative science to deliver new medicines to transform patient's lives and to create value for shareholders and our communities. We apply deep understanding of human biology and leverage different modalities to advance first-in-class treatments or therapies that deliver superior outcomes. Our approach is to take bold risks, balanced with return on investment to deliver long-term growth.
The company routinely posts information that may be important to investors on its website at www.biogen.com. Follow Biogen on social media – Facebook, LinkedIn, X, YouTube.
Biogen Safe Harbor
This news release contains forward-looking statements, about the potential clinical effects of lecanemab; the potential benefits, safety and efficacy of LEQEMBI; potential regulatory discussions, submissions and approvals and the timing thereof; the treatment of Alzheimer's disease; the anticipated benefits and potential of Biogen's collaboration arrangements with Eisai; the potential of Biogen's commercial business and pipeline programs, including LEQEMBI; and risks and uncertainties associated with drug development and commercialization. These statements may be identified by words such as "aim," "anticipate," "believe," "could," "estimate," "expect," "forecast," "intend," "may," "plan," "possible," "potential," "will," "would" and other words and terms of similar meaning. Drug development and commercialization involve a high degree of risk, and only a small number of research and development programs result in commercialization of a product. Results in early-stage clinical studies may not be indicative of full results or results from later stage or larger scale clinical studies and do not ensure regulatory approval. You should not place undue reliance on these statements.
These statements involve risks and uncertainties that could cause actual results to differ materially from those reflected in such statements, including without limitation unexpected concerns that may arise from additional data, analysis or results obtained during clinical studies; the occurrence of adverse safety events; risks of unexpected costs or delays; the risk of other unexpected hurdles; regulatory submissions may take longer or be more difficult to complete than expected; regulatory authorities may require additional information or further studies, or may fail or refuse to approve or may delay approval of Biogen's drug candidates, including lecanemab; actual timing and content of submissions to and decisions made by the regulatory authorities regarding lecanemab; uncertainty of success in the development and potential commercialization of lecanemab; failure to protect and enforce Biogen's data, intellectual property and other proprietary rights and uncertainties relating to intellectual property claims and challenges; product liability claims; and third party collaboration risks, results of operations and financial condition. The foregoing sets forth many, but not all, of the factors that could cause actual results to differ from Biogen's expectations in any forward-looking statement. Investors should consider this cautionary statement as well as the risk factors identified in Biogen's most recent annual or quarterly report and in other reports Biogen has filed with the
References
- Amin L, Harris DA. Aβ receptors specifically recognize molecular features displayed by fibril ends and neurotoxic oligomers. Nat Commun. 2021;12:3451. doi:10.1038/s41467-021-23507-z
- Ono K, Tsuji M. Protofibrils of Amyloid-β are Important Targets of a Disease-Modifying Approach for Alzheimer's Disease. Int J Mol Sci. 2020;21(3):952. doi: 10.3390/ijms21030952. PMID: 32023927; PMCID: PMC7037706.
- LEQEMBI. Prescribing information. Eisai Inc. 2023.
- US Food and Drug Administration. FDA Grants Accelerated Approval for Alzheimer's Disease Treatment. Available at: https://www.fda.gov/news-events/press-announcements/fda-grants-accelerated-approval-alzheimers-disease-treatment. Last accessed: March 2024.
- Eisai Global. 2023. "LEQEMBI® Intravenous Infusion" (Lecanemab) Approved for the Treatment of Alzheimer's Disease in
Japan Available at: https://www.eisai.com/news/2023/news202359.html. Last accessed: March 2024. - Eisai Global. 2024. "LEQEMBI®" (Lecanemab) Approved for the Treatment of Alzheimer's Disease in
China . Available at: https://www.eisai.com/news/2024/news202403.html. Last accessed: March 2024. - van Dyck, H., et al. Lecanemab in Early Alzheimer's Disease. New England Journal of Medicine. 2023;388:9-21. https://www.nejm.org/doi/full/10.1056/NEJMoa2212948.
SOURCE Eisai Inc.
FAQ
What is the recent announcement by Eisai and Biogen regarding LEQEMBI?
What is the reason for the delay in the BLA submission for the SC formulation of LEQEMBI?
What risks are associated with ARIA-related imaging abnormalities?
What adverse reactions have been reported in patients treated with LEQEMBI?