Nipocalimab demonstrates sustained disease control in adolescents living with generalized myasthenia gravis in Phase 2/3 study

Rhea-AI Summary

Johnson & Johnson (NYSE: JNJ) announced positive results from the Phase 2/3 Vibrance-MG study of nipocalimab in anti-AChR positive adolescents (aged 12-17) with generalized myasthenia gravis (gMG). The study showed that nipocalimab plus standard of care achieved sustained disease control over 24 weeks, with a 70% reduction in IgG and improvements in MG-ADL and QMG scores. Notably, 4 out of 5 patients achieved minimum symptom expression.

Nipocalimab was well-tolerated with no serious adverse events or discontinuations. These results are consistent with findings from the pivotal study in adult gMG patients. Johnson & Johnson has submitted applications to the FDA and EMA for nipocalimab's approval in gMG treatment.

Positive

• Nipocalimab demonstrated sustained disease control in adolescents with gMG over 24 weeks
• 70% reduction in IgG levels observed in adolescent patients
• 4 out of 5 patients achieved minimum symptom expression
• Consistent positive results with adult study findings
• Well-tolerated with no serious adverse events or discontinuations
• FDA and EMA applications submitted for nipocalimab approval in gMG treatment

Negative

• None.

Insights

Medical Research Analyst

The Phase 2/3 Vibrance-MG study results for nipocalimab in adolescents with generalized myasthenia gravis (gMG) are highly promising. Key findings include:

• Sustained disease control over 24 weeks
• ~70% reduction in immunoglobulin G (IgG)
• Improvements in MG-ADL and QMG scores
• 4 out of 5 patients achieved minimum symptom expression
• Well-tolerated with no serious adverse events

These results are consistent with the adult Vivacity-MG3 study, suggesting nipocalimab's potential as the first FcRn blocker for adolescents with gMG. The data support Johnson & Johnson's recent FDA and EMA submissions for nipocalimab in gMG treatment. This could significantly impact the 10% of new gMG cases diagnosed in adolescents, addressing an unmet need in this population with treatment options.

Financial Analyst

The positive results from the Vibrance-MG study could have significant implications for Johnson & Johnson's (JNJ) market position in the neuroscience sector. Key financial considerations include:

• Potential market expansion into the adolescent gMG population
• First-mover advantage as the only FcRn blocker for this age group
• Strengthened competitive position in the broader gMG market
• Possible accelerated regulatory approval based on consistent results across age groups

If approved, nipocalimab could become a valuable asset in JNJ's portfolio, potentially driving revenue growth in their neuroscience division. However, investors should consider the timeline for potential FDA and EMA approvals, as well as the market size for adolescent gMG treatments. The impact on JNJ's stock may be moderate in the short term but could become more significant if nipocalimab gains approval and demonstrates strong market uptake.

First FcRn blocker to demonstrate sustained disease control over 24 weeks in antibody positive adolescents aged 12 – 17 years, broadening the population in which nipocalimab has been studied 

SAVANNAH, Ga., Oct. 15, 2024 /PRNewswire/ -- Johnson & Johnson (NYSE: JNJ) today announced positive results from the Phase 2/3 Vibrance-MG study of nipocalimab in anti-AChR^a positive adolescents (aged 12 – 17 years) living with generalized myasthenia gravis (gMG). Study participants who were treated with nipocalimab plus standard of care (SOC) achieved sustained disease control as measured by the primary endpoint of immunoglobulin G (IgG) reduction from baseline over 24 weeks, and secondary endpoints of improvement in MG-ADL^b and QMG^c scores. These Phase 2/3 data will be featured in an oral presentation (Abstract #MG100) at the Myasthenia Gravis Foundation of America (MGFA) Scientific Session during the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) Annual Meeting, where Johnson & Johnson will present 25 abstracts.  

Experience the full interactive Multichannel News Release here: https://www.multivu.com/johnson-johnson/9296251-en-johnson-and-johnson-nipocalimab

"Findings from the Vibrance-MG study underscore the potential of this investigational therapy for young individuals aged 12 – 17 living with gMG. Results show a significant reduction in IgG of approximately 70% in adolescents and a clinical benefit that is consistent with the Vivacity-MG3 study in adults," said Jonathan Strober, M.D., Director of Clinical Services for Child Neurology and Director of the Muscular Dystrophy Clinic at UCSF Benioff Children's Hospital.^d "It is encouraging to see these positive results as there are currently no approved advanced treatment options for this adolescent population in the United States."

About 10% of new cases of myasthenia gravis are diagnosed in adolescents (12 – 17 years of age) and the severity of gMG in pediatric patients is heightened with 43% having experienced over five hospitalizations in their lifetime, 46% having at least one intensive care unit stay and 68% having periods of exacerbated disease.^1,2,3,4  

Treatment with nipocalimab plus SOC met the study's primary endpoint of reduction in total serum IgG (-69%), and the two secondary endpoints of MG-ADL and QMG, which are measures of disease activity.^5,e Four of five patients achieved minimum symptom expression (MG-ADL score 0-1) by the end of their treatment phase.^f,g  Nipocalimab was well-tolerated over the six-month period, similar to tolerability seen in adult participants in the Vivacity-MG3 study.⁵ There were no serious adverse events and no discontinuations due to an adverse event. 

Presented for the first time, these open-label Phase 2/3 results in adolescents are consistent with findings from the pivotal study of nipocalimab in adult patients with gMG. Nipocalimab when added to SOC is the first FcRn blocker to demonstrate sustained disease control in a registrational trial as measured by improvement in MG-ADL over placebo plus SOC over a period of six months of consistent dosing (Q2 week) among adults living with gMG.

"The Vibrance-MG data add to the expanding clinical profile of nipocalimab and highlight its potential for adolescents living with gMG who are in need of new treatments," said Sindhu Ramchandren, M.D., Executive Medical Director, Neuroscience, Johnson & Johnson Innovative Medicine. "We are committed to developing innovations for autoantibody-driven neurological diseases, like gMG, with the aim of transforming the lives of people living with these conditions."

Earlier this year, Johnson & Johnson announced the submission of applications to the U.S. Food and Drug Administration (FDA) and the European Medicines Agency (EMA) seeking approval for nipocalimab for the treatment of gMG. 

Editor's notes: 

a.  Patients with a positive blood test for acetylcholine receptor (anti-AChR) antibodies or muscle-specific tyrosine kinase (anti-MuSK) antibodies are eligible for the study.
b.  MG-ADL (Myasthenia Gravis – Activities of Daily Living) provides a rapid clinical assessment of the patient's recall of symptoms impacting activities of daily living, with a total score range of 0 to 24; a higher score indicates greater symptom severity.
c.  QMG (Quantitative Myasthenia Gravis) is a 13-item assessment by a clinician that quantifies MG disease severity through muscle weakness. The total QMG score ranges from 0 to 39, where higher scores indicated greater disease severity.
d.  Dr. Jonathan Strober is a paid consultant for Johnson & Johnson. He has not been compensated for any media work.
e.  Treatment with nipocalimab showed a mean percentage change from baseline to week 24 for total serum IgG of -68.98% (standard error [SE] = 7.561).
f.  Adolescents who received nipocalimab plus current SOC had a mean baseline score of 4.29 (SE = 2.430) on the MG-ADL scale and a mean baseline score of 12.50 (SE = 3.708) on the QMG scale.
g.  Adolescents who received nipocalimab plus current SOC had a mean change at week 24 of -2.40 (SE = 0.187) on the MG-ADL scale and -3.80 (SE = 2.683) on the QMG scale.

About Generalized Myasthenia Gravis (gMG)

Myasthenia gravis (MG) is an autoantibody disease in which the immune system mistakenly makes antibodies (e.g., anti-acetylcholine receptor [AChR], anti-muscle-specific tyrosine kinase [MuSK] or anti-low density lipoprotein-related protein 4 [LRP4]), which target proteins at the neuromuscular junction and can block or disrupt normal signaling from nerves to muscles, thus impairing or preventing muscle contraction. ^6,7 The disease impacts an estimated 700,000 people worldwide.⁶ Approximately 10 to 15% of new cases of MG are diagnosed in adolescents (12 – 17 years of age).^1,2,3 Among juvenile MG patients, girls are affected more often than boys with over 65% of pediatric MG cases in the US diagnosed in girls.^8,9,10

Initial disease manifestations are usually ocular but in 85% or more cases, the disease generalizes (gMG), which is characterized by fluctuating weakness of the skeletal muscles leading to symptoms like limb weakness, drooping eyelids, double vision and difficulties with chewing, swallowing, speech, and breathing.^{6,11,12,13,14} Approximately 100,000 individuals in the U.S. are living with gMG.¹⁵ Vulnerable gMG populations, such as pediatric patients, have more limited therapeutic options.³ Currently, SOC treatments for adolescents with gMG are extrapolated from adult trials.³ Other than symptomatic treatments, there are no approved FcRn blockers that may address the root cause of the disease for adolescents with gMG in the United States.³

About the Phase 2/3 Vibrance-MG Study

The Phase 2/3 Vibrance-MG study (NCT05265273) is an on-going open-label study to determine the effect of nipocalimab in pediatric participants with gMG.¹⁶ Seven participants aged 12 – 17 years with a diagnosis of gMG as reflected by a Myasthenia Gravis Foundation of America (MGFA) Class of II through IV at screening, and an insufficient clinical response to ongoing, stable SOC therapy, have been enrolled in the trial.⁵ Participants must have a positive blood test for either anti-AChR or anti-MUSK autoantibodies. The study consists of a screening period of up to four weeks, a 24-week open-label Active Treatment Phase during which participants receive nipocalimab intravenously every two weeks, and a Long-term Extension Phase; a safety follow-up assessment will be conducted at eight weeks after last dose.¹⁶ The primary outcome of the study is the effect of nipocalimab on total serum IgG, safety and tolerability, and pharmacokinetics in pediatric participants with gMG at 24 weeks. Secondary endpoints include change in MG-ADL and QMG scores at 24 weeks.^5,16

About Nipocalimab

Nipocalimab is an investigational monoclonal antibody, designed to bind with high affinity to block FcRn and reduce levels of circulating immunoglobulin G (IgG) antibodies potentially without impact on other immune functions. This includes autoantibodies and alloantibodies that underlie multiple conditions across three key segments in the autoantibody space including Rare Autoantibody diseases, Maternal Fetal diseases mediated by maternal alloantibodies and Prevalent Rheumatology.^{17,18,19,20,21,22,23,24,25} Blockade of IgG binding to FcRn in the placenta is also believed to limit transplacental transfer of maternal alloantibodies to the fetus.^26,27

The U.S. Food and Drug Administration (FDA) and European Medicines Agency (EMA) have granted several key designations to nipocalimab including:  

• U.S. FDA Fast Track designation in hemolytic disease of the fetus and newborn (HDFN) and warm autoimmune hemolytic anemia (wAIHA) in July 2019, gMG in December 2021 and fetal neonatal alloimmune thrombocytopenia (FNAIT) in March 2024
• U.S. FDA Orphan drug status for wAIHA in December 2019, HDFN in June 2020, gMG in February 2021, chronic inflammatory demyelinating polyneuropathy (CIDP) in October 2021 and FNAIT in December 2023
• U.S. FDA Breakthrough Therapy designation for HDFN in February 2024 by the FDA
• EU EMA Orphan medicinal product designation for HDFN in October 2019

About Johnson & Johnson

At Johnson & Johnson, we believe health is everything. Our strength in healthcare innovation empowers us to build a world where complex diseases are prevented, treated, and cured, where treatments are smarter and less invasive, and solutions are personal. Through our expertise in Innovative Medicine and MedTech, we are uniquely positioned to innovate across the full spectrum of healthcare solutions today to deliver the breakthroughs of tomorrow, and profoundly impact health for humanity.  

Learn more at https://www.jnj.com/ or at www.innovativemedicine.jnj.com

Follow us at @JanssenUS and @JNJInnovMed.

Janssen Research & Development, LLC and Janssen Biotech, Inc. are both Johnson & Johnson companies. 

Cautions Concerning Forward-Looking Statements 

This press release contains "forward-looking statements" as defined in the Private Securities Litigation Reform Act of 1995 regarding product development and the potential benefits and treatment impact of nipocalimab. The reader is cautioned not to rely on these forward-looking statements. These statements are based on current expectations of future events. If underlying assumptions prove inaccurate or known or unknown risks or uncertainties materialize, actual results could vary materially from the expectations and projections of Janssen Research & Development, LLC, Janssen Biotech, Inc. and/or Johnson & Johnson. Risks and uncertainties include, but are not limited to: challenges and uncertainties inherent in product research and development, including the uncertainty of clinical success and of obtaining regulatory approvals; uncertainty of commercial success; manufacturing difficulties and delays; competition, including technological advances, new products and patents attained by competitors; challenges to patents; product efficacy or safety concerns resulting in product recalls or regulatory action; changes in behavior and spending patterns of purchasers of health care products and services; changes to applicable laws and regulations, including global health care reforms; and trends toward health care cost containment. A further list and descriptions of these risks, uncertainties and other factors can be found in Johnson & Johnson's Annual Report on Form 10-K for the fiscal year ended December 31, 2023, including in the sections captioned "Cautionary Note Regarding Forward-Looking Statements" and "Item 1A. Risk Factors," and in Johnson & Johnson's subsequent Quarterly Reports on Form 10-Q and other filings with the Securities and Exchange Commission. Copies of these filings are available online at www.sec.gov, www.jnj.com or on request from Johnson & Johnson. None of Janssen Research & Development, LLC, Janssen Biotech, Inc. nor Johnson & Johnson undertakes to update any forward-looking statement as a result of new information or future events or developments.

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Media contact: Bridget Kimmel Mobile: (215) 688-6033 bkimmel@its.jnj.com

Investor contact: Lauren Johnson investor-relations@its.jnj.com

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SOURCE Johnson & Johnson

FAQ

What were the main results of the Vibrance-MG study for nipocalimab (JNJ) in adolescents with gMG?

The Vibrance-MG study showed that nipocalimab plus standard of care achieved sustained disease control over 24 weeks in adolescents with gMG, with a 70% reduction in IgG levels and improvements in MG-ADL and QMG scores. 4 out of 5 patients achieved minimum symptom expression.

How did nipocalimab (JNJ) perform in terms of safety for adolescents with gMG in the Phase 2/3 study?

Nipocalimab was well-tolerated over the six-month period in adolescents with gMG. There were no serious adverse events and no discontinuations due to adverse events, similar to the tolerability seen in adult participants in the Vivacity-MG3 study.

What is the current status of nipocalimab (JNJ) for gMG treatment approval?

Johnson & Johnson has submitted applications to the U.S. Food and Drug Administration (FDA) and the European Medicines Agency (EMA) seeking approval for nipocalimab for the treatment of generalized myasthenia gravis (gMG).

How does the Vibrance-MG study of nipocalimab (JNJ) impact treatment options for adolescents with gMG?

The Vibrance-MG study results are significant as there are currently no approved advanced treatment options for adolescents (aged 12-17) with gMG in the United States. Nipocalimab could potentially become the first FcRn blocker to offer sustained disease control for this population.