Investigational Subcutaneous Formulation of Vedolizumab Achieves Clinical Remission at Week 52 in Patients with Moderately to Severely Active Crohns Disease

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Takeda Pharmaceutical Company Limited announced results from the phase 3 VISIBLE 2 clinical trial evaluating the efficacy and safety of an investigational subcutaneous (SC) formulation of the gut-selective biologic vedolizumab (Entyvio®) for use during maintenance therapy in adult patients with moderately to severely active Crohn’s disease (CD). The study evaluated patients who achieved clinical response* at week 6 following two doses of open-label vedolizumab intravenous (IV) induction therapy at weeks 0 and 2. The results show that at week 52, significantly more patients on vedolizumab SC compared to placebo were in clinical remission (48.0% [n=132/275] vs. 34.3% [n=46/134] respectively; [p=0.008]),** meeting the study’s primary endpoint.1 These data were announced during an oral presentation at the 15th Congress of the European Crohn’s and Colitis Organisation (ECCO) in Vienna, Austria.

“The VISIBLE 2 study showed that the investigational subcutaneous formulation of vedolizumab helped patients with moderately to severely active Crohn’s disease achieve clinical remission at week 52, after first responding to induction therapy with intravenous vedolizumab,” said SéverineVermeire, MD PhD, Head of the Department of Chronic Diseases & Metabolismat the KU Leuven and Honorary Member of ECCO. “These results suggest that the investigational subcutaneous formulation of gut-selective vedolizumab can provide a new treatment modality for patients who might prefer a therapy that can be self-administered outside of the hospital setting.”

Results for the following secondary endpoints were also presented at the congress. The enhanced clinical response*** rate was 52.0% (n=143/275) in patients receiving vedolizumab SC versus 44.8% (n=60/134) in patients on placebo at week 52.1 The difference between the treatment groups was not statistically significant, and consequently statistical testing for the remaining secondary endpoints was not performed.Among patients receiving corticosteroid treatment at baseline, the corticosteroid-free clinical remission†rate at week 52 was 45.3% (n=43/95) in patients who received therapy with vedolizumab SC versus 18.2% (n=8/44) who received placebo.1 The study enrolled patients who were naïve to treatment with anti-tumor necrosis factor-alpha (anti-TNFα) therapy, as well as those with previous experience of anti-TNFα therapy. Of the anti-TNFα-naïve patients, 48.6% (n=52/107) vs. 42.9% (n=27/63) were the clinical remission?rates at week 52 in the vedolizumab SC and placebo arms, respectively.1

Patients received vedolizumab SC injections beginning at week 6 and every 2 weeks up to week 50, with an evaluation of the primary endpoint at week 52.1, The safety findings for vedolizumab SC were in line with the known safety profile of vedolizumab IV in patients with CD.1 Serious infections, malignancy, and liver injury were experienced by fewer than or equal to 5% of patients in both treatment groups.1 Anti-vedolizumab antibodies were detected in 2.5% of patients treated with vedolizumab SC, of whom approximately half developed neutralizing antibodies.1 Fewer than 3% of patients treated with vedolizumab SC reported injection-site reactions.1

“These data indicate that the investigational subcutaneous formulation of vedolizumab seems to havea similar safety profile to the intravenous formulation,” said William Sandborn, MD, Director of the Inflammatory Bowel Disease Center at the University of California, San Diego. “If approved, subcutaneous vedolizumab, together with the intravenous formulation, could provide more choice to patients in how they receive their therapy, helping to meet their individual needs and preferences.”

The investigational subcutaneous formulation of vedolizumab has been submitted for regulatory review with a number of key regulatory authorities worldwide.

* Clinical response is defined as a ≥70 point decrease in Crohn’s Disease Activity Index (CDAI) score from baseline (week 0).1
** Primary endpoint: Clinical remission is defined as a CDAI score ≤150 at week 52.1
*** Secondary endpoint: Enhanced clinical response is defined as decrease of ≥100 in CDAI score from baseline (week 0).1
† Secondary endpoint: Corticosteroid-free remission is defined as participants using oral corticosteroids at baseline (week 0) who have discontinued oral corticosteroids and are in clinical remission (CDAI score ≤150) at week 52.2
‘Secondary endpoint: Anti-TNFα-naïve patients in clinical remission (CDAI score ≤150) at week 52.2

About the VISIBLE 2 Study
VISIBLE 2 is a phase 3, randomized, double-blind, placebo-controlled study to evaluate the efficacy and safety of vedolizumab SC for use during maintenance therapy in patients with moderately to severely active CD.2 The study enrolled 644 participants, all of whom had an inadequate response with, loss of response to, or intolerance to corticosteroids, immunomodulators, or tumor necrosis factor-alpha (TNFα)-antagonist therapy prior to being enrolled.2 Patients who achieved clinical response at week 6 (n=409), following two doses of open-label vedolizumab IV 300 mg therapy at weeks 0 and 2, were randomized into one of two treatment groups, vedolizumab SC 108 mg or placebo SC.1,2 Both treatment groups received a subcutaneous injection every two weeks starting at week 6 up to week 50, with an evaluation of the primary endpoint at week 52.1,2

About the VISIBLE Clinical Trial Program
The VISIBLE clinical trial program aims to assess the efficacy and safety of an investigational subcutaneous (SC) formulation of vedolizumab for use during maintenance therapy in adult patients with moderately to severely active ulcerative colitis (UC) or Crohn’s disease (CD).

The VISIBLE program consists of three phase 3 studies involving over 1,000 UC and CD patients which includes two randomized, double-blind, placebo-controlled studies examining the proportion of patients achieving clinical remission at week 52, and an open-label extension study to determine the long-term safety and efficacy of vedolizumab SC.2,3,4

About Crohn’s Disease
Crohn’s disease (CD) is one of the most common forms of inflammatory bowel disease (IBD).5 CD is a chronic, relapsing, remitting, inflammatory condition of the gastrointestinal (GI) tract which can progress over time.6 CD can affect any part of the GI tract from mouth to anus and can affect the entire thickness of the bowel wall.7 The condition commonly presents with symptoms of abdominal pain, diarrhea, and weight loss.6 The cause of CD is not fully understood; however, recent research suggests hereditary, genetics, environmental factors, and/or an abnormal immune response to microbial antigens in genetically predisposed individuals can lead to CD.8,9

About Entyvio® (vedolizumab)
Vedolizumab is a gut-selective biologic and is approved as an intravenous (IV) formulation.10,11 It is a humanized monoclonal antibody designed to specifically antagonize the alpha4beta7 integrin, inhibiting the binding of alpha4beta7 integrin to intestinal mucosal addressin cell adhesion molecule 1 (MAdCAM-1), but not vascular cell adhesion molecule 1 (VCAM-1).1,2 MAdCAM-1 is preferentially expressed on blood vessels and lymph nodes of the gastrointestinal tract.13 The alpha 4 beta 7 integrin is expressed on a subset of circulating white blood cells.12 These cells have been shown to play a role in mediating the inflammatory process in ulcerative colitis (UC) and Crohn’s disease (CD).12.14,15 By inhibiting alpha4beta7 integrin, vedolizumab may limit the ability of certain white blood cells to infiltrate gut tissues.12

Vedolizumab IV is approved for the treatment of adult patients with moderately to severely active UC and CD, who have had an inadequate response with, lost response to, or were intolerant to either conventional therapy or a tumor necrosis factor-alpha (TNFα)-antagonist.10,11 Vedolizumab IV has been granted marketing authorization in over 60 countries, including the United States and European Union, with more than 415,000 patient years of exposure to date.16

Therapeutic Indications for vedolizumab IV

Ulcerative colitis
Vedolizumab is indicated for the treatment of adult patients with moderately to severely active ulcerative colitis who have had an inadequate response with, lost response to, or were intolerant to either conventional therapy or a tumor necrosis factor-alpha (TNFα) antagonist.

Crohn’s disease
Vedolizumab is indicated for the treatment of adult patients with moderately to severely active Crohn’s disease who have had an inadequate response with, lost response to, or were intolerant to either conventional therapy or a tumor necrosis factor-alpha (TNFα) antagonist.

Important Safety Information for vedolizumab IV

Contraindications
Hypersensitivity to the active substance or to any of the excipients.

Special warnings and special precautions for use
Vedolizumab should be administered by a healthcare professional prepared to manage hypersensitivity reactions, including anaphylaxis, if they occur. Appropriate monitoring and medical support measures should be available for immediate use when administering vedolizumab. Observe patients during infusion and until the infusion is complete.

Infusion-related reactions
In clinical studies, infusion-related reactions (IRR) and hypersensitivity reactions have been reported, with the majority being mild to moderate in severity. If a severe IRR, anaphylactic reaction, or other severe reaction occurs, administration of vedolizumab must be discontinued immediately and appropriate treatment initiated (e.g., epinephrine and antihistamines). If a mild to moderate IRR occurs, the infusion rate can be slowed or interrupted and appropriate treatment initiated (e.g., epinephrine and antihistamines). Once the mild or moderate IRR subsides, continue the infusion. Physicians should consider pre-treatment (e.g., with antihistamine, hydrocortisone and/or paracetamol) prior to the next infusion for patients with a history of mild to moderate IRR to vedolizumab, in order to minimize their risks.

Infections
Vedolizumab is a gut-selective integrin antagonist with no identified systemic immunosuppressive activity. Physicians should be aware of the potential increased risk of opportunistic infections or infections for which the gut is a defensive barrier. Vedolizumab treatment is not to be initiated in patients with active, severe infections such as tuberculosis, sepsis, cytomegalovirus, listeriosis, and opportunistic infections until the infections are controlled, and physicians should consider withholding treatment in patients who develop a severe infection while on chronic treatment with vedolizumab. Caution should be exercised when considering the use of vedolizumab in patients with a controlled chronic severe infection or a history of recurring severe infections. Patients should be monitored closely for infections before, during and after treatment.

Before starting treatment with vedolizumab, screening for tuberculosis may be considered according to local practice. Some integrin antagonists and some systemic immunosuppressive agents have been associated with progressive multifocal leukoencephalopathy (PML), which is a rare and often fatal opportunistic infection caused by the John Cunningham (JC) virus. By binding to the α4β7 integrin expressed on gut-homing lymphocytes, vedolizumab exerts an immunosuppressive effect specific to the gut. Although no systemic immunosuppressive effect was noted in healthy subjects, the effects on systemic immune system function in patients with inflammatory bowel disease are not known. Healthcare professionals should monitor patients on vedolizumab for any new onset or worsening of neurological signs and symptoms, and consider neurological referral if they occur.

If PML is suspected, treatment with vedolizumab must be withheld; if confirmed, treatment must be permanently discontinued. Typical signs and symptoms associated with PML are diverse, progress over days to weeks, and include progressive weakness on one side of the body, clumsiness of limbs, disturbance of vision, and changes in thinking, memory, and orientation leading to confusion and personality changes. The progression of deficits usually leads to death or severe disability over weeks or months.

Malignancies
The risk of malignancy is increased in patients with ulcerative colitis and Crohn’s disease. Immunomodulatory medicinal products may increase the risk of malignancy.

Prior and concurrent use of biological products
No vedolizumab clinical trial data are available for patients previously treated with natalizumab. No clinical trial data for concomitant use of vedolizumab with biologic immunosuppressants are available. Therefore, the use of vedolizumab in such patients is not recommended.

Vaccinations
Prior to initiating treatment with vedolizumab all patients should be brought up to date with all recommended immunizations. Patients receiving vedolizumab may receive non-live vaccines (e.g., subunit or inactivated vaccines) and may receive live vaccines only if the benefits outweigh the risks.

Adverse reactions include: nasopharyngitis, headache, arthralgia, upper respiratory tract infection, bronchitis, influenza, sinusitis, cough, oropharyngeal pain, nausea, rash, pruritus, back pain, pain in extremities, pyrexia, fatigue and anaphylaxis.

Takeda’s Commitment to Gastroenterology
Gastrointestinal (GI) diseases can be complex, debilitating and life-changing. Recognizing this unmet need, Takeda and our collaboration partners have focused on improving the lives of patients through the delivery of innovative medicines and dedicated patient disease support programs for over 25 years. Takeda aspires to advance how patients manage their disease. Additionally, Takeda is leading in areas of gastroenterology associated with high unmet need, such as inflammatory bowel disease, acid-related diseases and motility disorders. Our GI Research & Development team is also exploring solutions in celiac disease and liver diseases, as well as scientific advancements through microbiome therapies.

About Takeda Pharmaceutical Company Limited
Takeda Pharmaceutical Company Limited is a global, values-based, R&D-driven biopharmaceutical leader headquartered in Japan, committed to bringing Better Health and a Brighter Future to patients by translating science into highly-innovative medicines. Takeda focuses its R&D efforts on four therapeutic areas: Oncology, Rare Diseases, Neuroscience and Gastroenterology (GI). We also make targeted R&D investments in Plasma-Derived Therapies and Vaccines. We are focusing on developing highly innovative medicines that contribute to making a difference in people’s lives by advancing the frontier of new treatment options and leveraging our enhanced collaborative R&D engine and capabilities to create a robust, modality-diverse pipeline. Our employees are committed to improving quality of life for patients and to working with our partners in health care in approximately 80 countries.

Reference


[1] Vermeire S, Sandborn W, Baert F, et al. OP23 Efficacy and safety of vedolizumab SC in patients with moderately to severely active Crohn’s disease: Results of the VISIBLE 2 study. J Crohns Colitis [Internet]. 2020 Jan 15;14(Supplement_1):S020–1.
[2] Efficacy and safety of vedolizumab subcutaneous (SC) as maintenance therapy in Crohn’s disease. Available at: https://clinicaltrials.gov/ct2/show/NCT02611817. Last updated: November 12, 2019. Last accessed: February 2020.
[3] Efficacy and safety of vedolizumab subcutaneously (SC) as maintenance therapy in ulcerative colitis. Available at: https://clinicaltrials.gov/ct2/show/NCT02611830. Last updated: January 23, 2020. Last accessed: February 2020.
[4] Vedolizumab subcutaneous long-term open-label extension study. Available at: https://clinicaltrials.gov/ct2/show/NCT02620046. Last updated: May 6, 2019. Last accessed: February 2020.
[5] Baumgart DC, Carding SR. Inflammatory bowel disease: cause and immunobiology. Lancet. 2007;369:1627-1640.
[6] Baumgart DC, Sandborn WJ. Crohn’s disease. Lancet. 2012;380:1590-1605.
[7] Feuerstein JD, Cheifetz AS. Crohn’s disease: Epidemiology, diagnosis and management. Mayo Clin Proc. 2017;92:1088-1103.
[8] Henckaerts L, Pierik M, Joossens M, et al. Mutations in pattern recognition receptor genes modulate seroreactivity to microbial antigens in patients with inflammatory bowel disease. Gut. 2007;56:1536-1542.
[9] Kaser A, Zeissig S, Blumberg RS. Genes and environment: How will our concepts on the pathophysiology of IBD develop in the future? Dig Dis. 2010;28:395-405.
[10] Entyvio Prescribing Information. Available at: https://general.takedapharm.com/ENTYVIOPI. Last updated: May 2019. Last accessed: February 2020.
[11] Entyvio EPAR _ 20/02/2019 Entyvio – EMEA/H/C/002782_ European Medicines Agency – Entyvio _ Annex I Summary of product characteristics. Committee For Medicinal Products For Human Use. Available at: https://www.ema.europa.eu/en/medicines/human/EPAR/entyvio. Last updated: April 2019. Last accessed: February 2020.
[12] Soler D, Chapman T, Yang LL, et al. The binding specificity and selective antagonism of vedolizumab, an anti-α4β7 integrin therapeutic antibody in development for inflammatory bowel diseases. J Pharmacol Exp Ther. 2009;330:864-875.
[13] Briskin M, Winsor-Hines D, Shyjan A, et al. Human mucosal addressin cell adhesion molecule-1 is preferentially expressed in intestinal tract and associated lymphoid tissue. Am J Pathol. 1997;151:97?110.
[14] Eksteen B, Liaskou E, Adams DH. Lymphocyte homing and its roles in the pathogenesis of IBD. Inflamm Bowel Dis. 2008;14:1298?1312.
[15] Wyant T, Fedyk E, Abhyankar B. An overview of the mechanism of action of the monoclonal antibody vedolizumab. J Crohns Colitis. 2016;10:1437-1444.
[16] Takeda. Data on file. 2019.