OLUMIANT® Improved Pain, Physical Function and Morning Joint Stiffness in Rheumatoid Arthritis in Phase 3 Post-Hoc Analyses
Eli Lilly and Incyte presented data at the EULAR Congress indicating that OLUMIANT® (baricitinib) 4 mg significantly reduced pain and morning joint stiffness while enhancing physical function at 12 weeks in moderate to severe rheumatoid arthritis patients compared to HUMIRA® (adalimumab) and placebo. The analysis, based on the Phase 3 RA-BEAM study with 1,305 participants, highlighted improved patient-reported outcomes and consistent safety results. OLUMIANT is approved in over 75 countries for RA treatment and recently received approval in Japan for COVID-19 pneumonia.
- Improved pain relief of -40.9 on the Pain Visual Analog Scale with OLUMIANT compared to HUMIRA.
- Reduction in duration of morning joint stiffness by 64.9 minutes at 12 weeks with OLUMIANT versus HUMIRA.
- Safety profile consistent with previous reports for OLUMIANT.
- None.
INDIANAPOLIS, June 1, 2021 /PRNewswire/ -- Eli Lilly and Company (NYSE: LLY) and Incyte (NASDAQ: INCY) will present data from post-hoc analyses that suggested OLUMIANT® (baricitinib) 4 mg tablet reduced pain and duration of morning joint stiffness, and improved overall physical function at 12 weeks, among patients with moderate to severe rheumatoid arthritis (RA), compared to HUMIRA® (adalimumab) and placebo. These results are being presented at the virtual Annual European Congress of Rheumatology (EULAR), June 2-5, 2021.
In a post-hoc analysis of the Phase 3 RA-BEAM study, patients treated with OLUMIANT 4 mg saw greater improvements in pain relief and physical function, as well as reduced duration of morning joint stiffness, at 12 weeks compared to HUMIRA and placebo. These differences in pain relief were not influenced by disease activity during treatment. In this analysis, improvements in fatigue with OLUMIANT 4 mg were greater than with placebo and similar to HUMIRA after 12 weeks of treatment. Safety results were consistent with the established safety profile for OLUMIANT in patients with RA. For methodology, see the "About the Analysis" section below.
Patient-Reported Outcomes at week 12 | Remission (Clinical Disease Activity Index [CDAI]=2.8) | Low Disease Activity (CDAI=10) | Moderate Disease Activity (CDAI=22) | ||||||
PBO | ADA | BARI 4 mg | PBO | ADA | BARI | PBO | ADA | BARI | |
Change in Pain, as measured by Pain Visual Analog Scale (Pain VAS) | -28.4 | -37.9 | -40.9 | -24.5 | -32.6 | -36.1 | -18.0 | -23.7 | -28.1 |
Change in Health Assessment Questionnaire-Disability Index (HAQ-DI) | -0.6 | -0.7 | -0.9 | -0.5 | -0.7 | -0.7 | -0.4 | -0.5 | -0.6 |
Change in Duration of Morning Joint Stiffness (min) | -6.9 | -37.8 | -64.9 | -6.3 | -35.3 | -55.7 | -5.3 | -31.3 | -40.2 |
Change in Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) | 9.8 | 11.8 | 11.1 | 8.8 | 10.6 | 10.2 | 7.0 | 8.7 | 8.7 |
"Despite available treatment options, patients with rheumatoid arthritis are still living with daily symptoms, including pain, that continue to limit their day-to-day activities," said Professor Peter C. Taylor, Professor of Musculoskeletal Sciences at the University of Oxford, and lead author of this analysis. "This analysis offers valuable insights to rheumatologists seeking to help their patients reduce disease activity and address the symptoms that are important to patients."
Lilly will also present analyses from the prospective Swiss Clinical Quality Management (SCQM) observational cohort, a study that evaluated the effectiveness and persistence of OLUMIANT compared to other biologics for the treatment of RA.
OLUMIANT is an oral JAK inhibitor discovered by Incyte and licensed to Lilly. OLUMIANT is approved and commercially available in more than 75 countries as a treatment for adults with moderately to severely active RA, and in more than 40 countries, including the European Union and Japan, for the treatment of adult patients with moderate to severe atopic dermatitis who are candidates for systemic therapy. OLUMIANT was recently approved in Japan for the treatment of pneumonia associated with COVID-19 in hospitalized adult patients.
About The Analysis
- Baricitinib Provides Greater Improvements in Patient-Reported Outcomes Across All Disease Activity Levels Compared to Placebo and Adalimumab in Rheumatoid Arthritis
- In a post-hoc analysis, 1,305 patients from the Phase 3 RA-BEAM study were randomized into one of three treatment groups: oral, once-daily, OLUMIANT 4 mg on background methotrexate, injectable every-other-week adalimumab 40 mg on background methotrexate and placebo on background methotrexate.
- Pain was evaluated using a 0-100 mm visual analog scale, with higher scores indicating more pain; physical function was assessed using the HAQ-DI, with lower scores indicating better physical function and, thus, less disability; duration of morning joint stiffness (minutes) was reported by the patient, and fatigue was measured using the FACIT-F scale, with higher scores indicating less fatigue. Disease activity was measured using the CDAI and categorized as remission (REM, ≤2.8), low disease activity (LDA, >2.8 to ≤10), moderate disease activity (MDA, >10 to ≤22), or high disease activity (HDA, >22).
- Linear regression was used to model the relationship between change in patient reported outcomes at Week 12 (response) and CDAI values at 12 weeks (primary explanatory variable) to evaluate the extent of improvement in patient-reported outcomes with OLUMIANT 4 mg relative to placebo and adalimumab across a spectrum of disease activity levels. Last observation carried forward was used to impute missing values.
Indication and Usage for OLUMIANT (baricitinib) tablets (in the United States) for RA patients
OLUMIANT® (baricitinib) 2 mg is indicated for the treatment of adult patients with moderately to severely active rheumatoid arthritis who have had an inadequate response to one or more tumor necrosis factor (TNF) antagonist therapies. Limitation of Use: Not recommended for use in combination with other JAK inhibitors, biologic disease-modifying antirheumatic drugs (DMARDs), or with potent immunosuppressants such as azathioprine and cyclosporine.
IMPORTANT SAFETY INFORMATION FOR OLUMIANT (baricitinib) tablets
WARNING: SERIOUS INFECTIONS, MALIGNANCY, AND THROMBOSIS
SERIOUS INFECTIONS: Patients treated with Olumiant are at risk for developing serious infections that may lead to hospitalization or death. Most patients who developed these infections were taking concomitant immunosuppressants such as methotrexate or corticosteroids. If a serious infection develops, interrupt Olumiant until the infection is controlled. Reported infections include:
- Active tuberculosis (TB), which may present with pulmonary or extrapulmonary disease. Test patients for latent TB before initiating Olumiant and during therapy. If positive, start treatment for latent infection prior to Olumiant use.
- Invasive fungal infections, including candidiasis and pneumocystosis. Patients with invasive fungal infections may present with disseminated, rather than localized, disease.
- Bacterial, viral, and other infections due to opportunistic pathogens.
Carefully consider the risks and benefits of Olumiant prior to initiating therapy in patients with chronic or recurrent infection.
Closely monitor patients for the development of signs and symptoms of infection during and after treatment with Olumiant including the possible development of TB in patients who tested negative for latent TB infection prior to initiating therapy.
MALIGNANCIES: Lymphoma and other malignancies have been observed in patients treated with Olumiant.
THROMBOSIS: Thrombosis, including deep venous thrombosis (DVT) and pulmonary embolism (PE), has been observed at an increased incidence in patients treated with Olumiant compared to placebo. In addition, there were cases of arterial thrombosis. Many of these adverse events were serious and some resulted in death. Patients with symptoms of thrombosis should be promptly evaluated.
WARNINGS AND PRECAUTIONS
SERIOUS INFECTIONS: The most common serious infections reported with Olumiant included pneumonia, herpes zoster, and urinary tract infection. Among opportunistic infections, tuberculosis, multidermatomal herpes zoster, esophageal candidiasis, pneumocystosis, acute histoplasmosis, cryptococcosis, cytomegalovirus, and BK virus were reported with Olumiant. Some patients have presented with disseminated rather than localized disease, and were often taking concomitant immunosuppressants such as methotrexate or corticosteroids. Avoid Olumiant in patients with an active, serious infection, including localized infections. Consider the risks and benefits of treatment prior to initiating Olumiant in patients:
- with chronic or recurrent infection
- who have been exposed to TB
- with a history of a serious or an opportunistic infection
- who have resided or traveled in areas of endemic tuberculosis or endemic mycoses; or
- with underlying conditions that may predispose them to infection.
Closely monitor patients for infections during and after Olumiant treatment. Interrupt Olumiant if a patient develops a serious infection, an opportunistic infection, or sepsis. Do not resume Olumiant until the infection is controlled.
Tuberculosis – Before initiating Olumiant, evaluate and test patients for latent or active infection and treat patients with latent TB with standard antimycobacterial therapy. Olumiant should not be given to patients with active TB. Consider anti-TB therapy prior to initiating Olumiant in patients with a history of latent or active TB in whom an adequate course of treatment cannot be confirmed, and for patients with a negative test for latent TB but who have risk factors for TB infection. Monitor patients for TB during Olumiant treatment.
Viral Reactivation – Viral reactivation, including cases of herpes virus reactivation (e.g., herpes zoster), were reported in clinical studies with Olumiant. If a patient develops herpes zoster, interrupt Olumiant treatment until the episode resolves.
The impact of Olumiant on chronic viral hepatitis reactivation is unknown. Screen for viral hepatitis in accordance with clinical guidelines before initiating Olumiant.
MALIGNANCY AND LYMPHOPROLIFERATIVE DISORDERS: Malignancies were observed in Olumiant clinical studies. Consider the risks and benefits of Olumiant prior to initiating therapy in patients with a known malignancy other than a successfully treated non-melanoma skin cancer (NMSC) or when considering continuing Olumiant in patients who develop a malignancy. NMSCs were reported in patients treated with Olumiant. Periodic skin examination is recommended for patients who are at increased risk for skin cancer.
THROMBOSIS: Thrombosis, including DVT and PE, has been observed at an increased incidence in Olumiant-treated patients compared to placebo. In addition, arterial thrombosis events in the extremities have been reported in clinical studies with Olumiant. Many of these adverse events were serious and some resulted in death. There was no clear relationship between platelet count elevations and thrombotic events. Use Olumiant with caution in patients who may be at increased risk of thrombosis. If clinical features of DVT/PE or arterial thrombosis occur, evaluate patients promptly and treat appropriately.
GASTROINTESTINAL PERFORATIONS: Gastrointestinal perforations have been reported in Olumiant clinical studies, although the role of JAK inhibition in these events is not known. Use Olumiant with caution in patients who may be at increased risk for gastrointestinal perforation (e.g., patients with a history of diverticulitis). Promptly evaluate patients who present with new onset abdominal symptoms for early identification of gastrointestinal perforation.
LABORATORY ABNORMALITIES:
Neutropenia – Olumiant treatment was associated with an increased incidence of neutropenia (absolute neutrophil count [ANC] <1000 cells/mm3) compared to placebo. Avoid initiation or interrupt Olumiant treatment in patients with an ANC <1000 cells/mm3. Evaluate at baseline and thereafter according to routine patient management.
Lymphopenia – Absolute lymphocyte count (ALC) <500 cells/mm3 were reported in Olumiant clinical trials. Lymphocyte counts less than the lower limit of normal were associated with infection in patients treated with Olumiant, but not placebo. Avoid initiation or interrupt Olumiant treatment in patients with an ALC <500 cells/mm3. Evaluate at baseline and thereafter according to routine patient management.
Anemia – Decreases in hemoglobin levels to <8 g/dL were reported in Olumiant clinical trials. Avoid initiation or interrupt Olumiant treatment in patients with hemoglobin <8 g/dL. Evaluate at baseline and thereafter according to routine patient management.
Liver Enzyme Elevations – Olumiant treatment was associated with increased incidence of liver enzyme elevation compared to placebo. Increases of ALT ≥5x upper limit of normal (ULN) and increases of AST ≥10x ULN were observed in patients in Olumiant clinical trials.
Evaluate at baseline and thereafter according to routine patient management. Promptly investigate the cause of liver enzyme elevation to identify potential cases of drug-induced liver injury. If increases in ALT or AST are observed and drug-induced liver injury is suspected, interrupt Olumiant until this diagnosis is excluded.
Lipid Elevations – Treatment with Olumiant was associated with increases in lipid parameters, including total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol. Assess lipid parameters approximately 12 weeks following Olumiant initiation. Manage patients according to clinical guidelines for the management of hyperlipidemia.
VACCINATIONS: Avoid use of live vaccines with Olumiant. Update immunizations in agreement with current immunization guidelines prior to initiating Olumiant therapy.
HYPERSENSITIVITY: Reactions such as angioedema, urticaria, and rash that may reflect drug sensitivity have been observed in patients receiving Olumiant, including serious reactions. If a serious hypersensitivity reaction occurs, promptly discontinue Olumiant while evaluating the potential causes of the reaction.
ADVERSE REACTIONS
Most common adverse reactions include: upper respiratory tract infections (
USE IN SPECIFIC POPULATIONS
PREGNANCY AND LACTATION: No information is available to support the use of Olumiant in pregnancy or lactation. Advise women not to breastfeed during treatment with Olumiant.
HEPATIC AND RENAL IMPAIRMENT: Olumiant is not recommended in patients with severe hepatic impairment or in patients with severe renal impairment.
Please click to access full Prescribing Information, including Boxed Warning about Serious infections, Malignancies, and Thrombosis, and Medication Guide.
BA HCP ISI 09JUL2020
About OLUMIANT®
OLUMIANT, a once-daily, oral JAK inhibitor was discovered by Incyte and licensed to Lilly. It is approved in the U.S. and more than 75 countries as a treatment for adults with moderate to severe rheumatoid arthritis and is approved in more than 40 countries, including the European Union and Japan, for the treatment of adult patients with moderate to severe atopic dermatitis who are candidates for systemic therapy. OLUMIANT was recently approved in Japan for the treatment of pneumonia associated with COVID-19 in hospitalized adult patients. The U.S. FDA-approved labeling for Olumiant includes a Boxed Warning for Serious Infections, Malignancy, and Thrombosis. See the full Prescribing Information here. Baricitinib is also being investigated in alopecia areata (AA), juvenile idiopathic arthritis (JIA) and systematic lupus erythematosus (SLE).1
In December 2009, Lilly and Incyte announced an exclusive worldwide license and collaboration agreement for the development and commercialization of baricitinib and certain follow-on compounds for patients with inflammatory and autoimmune diseases.
About Rheumatoid Arthritis
Rheumatoid arthritis is an autoimmune disease characterized by inflammation and progressive destruction of joints.2,3 More than 23 million people worldwide suffer from RA.4 Approximately three times as many women as men have the disease.5 Patients and physicians indicate there remains an important opportunity to improve patient care. Current treatment of RA includes the use of non-steroidal anti-inflammatory drugs, oral disease-modifying anti-rheumatic drugs such as methotrexate, and injectable biological response modifiers that target selected mediators implicated in the pathogenesis of RA.5
About Lilly in Immunology
Lilly is bringing our heritage of championing groundbreaking, novel science to immunology and is driven to change what's possible for people living with autoimmune diseases. There are still significant unmet needs, as well as personal and societal costs, for people living with a variety of autoimmune diseases and our goal is to minimize the burden of disease. Lilly is investing in leading-edge clinical approaches across its immunology portfolio in hopes of transforming the autoimmune disease treatment experience. We've built a deep pipeline and are focused on advancing cutting edge science to find new treatments that offer meaningful improvements to support the people and the communities we serve.
About Eli Lilly and Company
Lilly is a global health care leader that unites caring with discovery to create medicines that make life better for people around the world. We were founded more than a century ago by a man committed to creating high-quality medicines that meet real needs, and today we remain true to that mission in all our work. Across the globe, Lilly employees work to discover and bring life-changing medicines to those who need them, improve the understanding and management of disease, and give back to communities through philanthropy and volunteerism. To learn more about Lilly, please visit us at lilly.com and lilly.com/newsroom.
About Incyte
Incyte is a Wilmington, Delaware-based, global biopharmaceutical company focused on finding solutions for serious unmet medical needs through the discovery, development and commercialization of proprietary therapeutics. For additional information on Incyte, please visit Incyte.com and follow @Incyte.
OLUMIANT® is a registered trademark owned or licensed by Eli Lilly and Company, its subsidiaries, or affiliates. P-LLY
Lilly Forward-Looking Statement
This press release contains forward-looking statements (as that term is defined in the Private Securities Litigation Reform Act of 1995) about OLUMIANT (baricitinib) as a treatment for patients with rheumatoid arthritis and a possible treatment for other conditions and reflects Lilly's and Incyte's current beliefs and expectations. However, as with any pharmaceutical product, there are substantial risks and uncertainties in the process of drug research, development, and commercialization. Among other things, there can be no guarantee that planned or ongoing studies will be completed as planned, that future study results will be consistent with the results to date, and that OLUMIANT will receive additional regulatory approvals, or be commercially successful. For further discussion of these and other risks and uncertainties, see Lilly's and Incyte's most recent respective Form 10-K and Form 10-Q filings with the United States Securities and Exchange Commission. Except as required by law, Lilly and Incyte undertake no duty to update forward-looking statements to reflect events after the date of this release.
1. | Olumiant Prescribing Information, 2020. |
2. | Klareskog L, Catrina AI, Paget S. Lancet. 2009;373:659-672. |
3. | Hand Clinics, Advances in the Medical Treatment of Rheumatoid Arthritis, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3135413/pdf/nihms305780.pdf. Accessed April 23, 2018. |
4. | WHO Global Burden of Disease Report, (table 7, page 32) 2004, http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_full.pdf. |
5. | Hunter TM, et al. Rheumatol Int. 2017;37:1551–1557. |
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Refer to: | Jen Dial; dial_jennifer_kay@lilly.com; +1-317-220-1172 (media) |
Kevin Hern; hern_kevin_r@lilly.com; +1-317-277-1838 (Lilly investors) | |
Catalina Loveman; cloveman@incyte.com; +1-302-498-6171 (Incyte media) | |
Christine Chiou; cchiou@incyte.com; +1-302-274-4773 (Incyte investors) |
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