The US Food and Drug Administration has approved Amjevita® (adalimumab-atto) as a biosimilar to Humira® (adalimumab). In adult patients, Amjevita® is approved for moderately to severely active rheumatoid arthritis; active psoriatic arthritis; active ankylosing spondylitis (an arthritis that affects the spine); moderately to severely active Crohn’s disease; moderately to severely active ulcerative colitis; and moderate to severe plaque psoriasis. Amjevita® is also indicated for moderately to severely active polyarticular juvenile idiopathic arthritis in patients four years of age and older.
Amjevita® is the third antibody-based drug to gain approval as a biosimilar in the US this year. Inflectra® (infliximab-dyyb), a biosimilar to Remicade® (infliximab), was approved in April 2016 and Erelzi® (etanercept-szzs) , a biosimilar to Enbrel® (etanercept), was approved in August 2016.
Antibody-based biosimilar products approved in the EU or US
The number of antibody-based biosimilar therapeutics approved in the European Union or United States is poised to grow substantially in 2016 and 2017. The originator products that target tumor necrosis factor (TNF) have been of particular interest to the biosimilar industry due to the expiration of key patents and the large global markets for the products. In 2013, the three top-selling originator anti-TNF products were infliximab (Remicade®), etanercept (Enbrel®) and adalimumab (Humira®), which combined had global sales of nearly $18 billion that year. The first biosimilar anti-TNF products approved in either the EU or US were Inflectra® and Remsima®, both of which are versions of infliximab. Inflectra® and Remsima® were approved in the EU in September 2013 for rheumatoid arthritis, Crohn’s disease, ulcerative colitis, ankylosing spondylitis, psoriatic arthritis, and psoriasis.
While no antibody-based biosimilar products were approved in either the EU or US in 2014 or 2015, two products have been approved in each of these regions so far in 2016, and more may be approved soon. In the EU, the biosimilar etanercept BENEPALI® was approved in January 2016 for moderate to severe rheumatoid arthritis, psoriatic arthritis, severe ankylosing spondylitis, severe non-radiographic axial spondyloarthritis, and plaque psoriasis, and the biosimilar infliximab Flixabi® was approved in May 2016 for rheumatoid arthritis, Crohn’s disease, ulcerative colitis, ankylosing spondylitis, psoriatic arthritis, and psoriasis. In the US, Inflectra® was approved in April 2016 for the treatment of moderately to moderately to severely active rheumatoid arthritis, severely active Crohn’s disease, moderately to severely active ulcerative colitis, active ankylosing spondylitis, active psoriatic arthritis, chronic severe plaque psoriasis, and the biosimilar etanercept Erelzi® was approved in August 2016 for moderate to severe rheumatoid arthritis, moderate to severe polyarticular juvenile idiopathic arthritis, active psoriatic arthritis, active ankylosing spondylitis, and chronic moderate to severe plaque psoriasis. A biosimilar adalimumab (ABP-501) may be approved soon, as the Food and Drug Administration’s (FDA) Arthritis Advisory Committee voted unanimously to support approval of it in July 2016. The product was recommended for the treatment of rheumatoid arthritis, juvenile idiopathic arthritis in patients aged 4 years and older, psoriatic arthritis, ankylosing spondylitis, adult Crohn’s disease, adult ulcerative colitis, and plaque psoriasis.
Although the FDA does not release comprehensive lists of products in review, the European Medicines Agency (EMA) does provide limited information on applications for centralized marketing authorization under evaluation. As of August 3, 2016, a total of 6 applications for biosimilar adalimumab (3 applications), etanercept (1 application), and the anti-CD20 rituximab (2 applications) were under evaluation. In late August, EMA also accepted for review a marketing authorization application for a proposed biosimilar trastuzumab, which is used to treat certain HER2-positive breast and gastric cancers. Thus, there may soon be as many as 11 biosimilar antibody-based therapeutics on the market in the EU, and many of these could also gain approval in the US.
Update on antibodies in regulatory review
A biologics license application (BLA) for romosozumab, an IgG2 monoclonal antibody targeting sclerostin, was recently submitted to the US Food and Drug Administration (FDA). The application includes data from the randomized, double-blind, placebo-controlled Phase 3 FRAME study (NCT01575834) of ~7,200 postmenopausal women with osteoporosis, defined as low bone mineral density at the total hip or femoral neck. The study met the primary endpoint of reduction of the incidence of new vertebral fracture through 12 months in postmenopausal women with osteoporosis treated with romosozumab. The study also evaluated whether romosozumab treatment for 12 months followed by denosumab (Prolia®) treatment for 12 months, compared with placebo followed by denosumab treatment, reduced the risk of new vertebral fractures through 24 months; this endpoint was also met. The effects of romosozumab were compared to teriparatide (FORTEO®), a recombinant form of parathyroid hormone, in the randomized, open-label Phase 3 STRUCTURE study (NCT01796301). In this study, postmenopausal women with osteoporosis transitioning from bisphosphonate treatment who were administered romosozumab demonstrated a statistically significant increase in hip bone mineral density and strength compared with those who received teriparatide.
In other news, the FDA requested the submission of new data and analyses from the MODIFY I (NCT01241552) and MODIFY II (NCT01513239) clinical trials of bezlotoxumab, which has extended the review time on bezlotoxumab by three months, to October 23, 2016. Bezlotoxumab, a human IgG1 mAb that targets Clostridium difficile (C. difficile) toxin B, was evaluated for prevention of C. difficile infection recurrence. MODIFY I was a Phase 3, randomized, double-blind, placebo-controlled, adaptive design study of a single infusion of bezlotoxumab, an anti-C. difficile toxin A human monoclonal antibody (MK-3415, and the combination of bezlotoxumab + MK-3415 in patients receiving antibiotic therapy for C. difficile infection. The Phase 3 MODIFY II study compared only bezlotoxumab and the combination of bezlotoxumab + MK-3415 to placebo in patients receiving antibiotic therapy for C. difficile infection. The primary endpoint, the rate of C. difficile infection recurrence through week 12 compared to placebo, was met in both studies.
The Antibody Society maintains a comprehensive table of approved antibody therapeutics and those in regulatory review in the European Union and United States. Of the 8 mAbs currently in regulatory review in these regions, 4 have FDA action dates known to occur in late October-December 2016. One additional mAb is likely to have an FDA action date by the end of 2016, based on the date of BLA submission and review status. Please log in to access the table, located in the Members Only section.
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Two antibodies in first regulatory review
First marketing applications were recently submitted for two novel antibody therapeutics, ocrelizumab and inotuzumab ozogamicin, intended as treatments for multiple sclerosis (MS) and CD22-positive acute lymphoblastic leukemia (ALL), respectively. Applications for ocrelizumab (OCREVUS), a humanized IgG1 antibody that targets CD20, as a treatment of relapsing multiple sclerosis (RMS) and primary progressive multiple sclerosis (PPMS) are undergoing regulatory review by the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA). No products are currently approved for both forms of MS. A priority review designation has been granted by FDA, and a first action on ocrelizumab’s biologics license application (BLA) is thus expected by December 28, 2016. The marketing applications are based on positive results from two identical Phase 3 studies (OPERA I and OPERA II) in people with RMS and the Phase 3 ORATORIO study in people with PPMS. All primary and key secondary endpoints were met in these three studies.
The antibody-drug conjugate inotuzumab ozogamicin targets CD22, an antigen found on the surface of cancer cells in most ALL patients. Results of a Phase 3 study evaluating the safety and efficacy of inotuzumab ozogamicin compared with investigator-choice chemotherapy in 326 adult patients with relapsed or refractory CD22-positive ALL were recently published in the New England Journal of Medicine. Improvements over chemotherapy on a number of measures, including complete hematologic remission and progression-free survival, were observed in this study. A marketing application for inotuzumab ozogamicin is undergoing review by the EMA; a BLA submission is likely. Inotuzumab ozogamicin received Breakthrough Therapy designation for ALL from FDA, and priority review of applications is a benefit of the designation, which suggests that an approval by FDA is thus possible by the end of 2016.
The Antibody Society maintains a comprehensive table of approved antibody therapeutics and those in regulatory review (currently 8 mAbs) in the European Union and United States. The antibody target, format and year of first approval are included. Please log in to access the table, located in the Members Only section.
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New antibody therapeutics for multiple sclerosis
On May 27, 2016 the Food and Drug Administration (FDA) approved daclizumab (Zinbryta®) for the treatment of adults with relapsing forms of multiple sclerosis (MS). The product, which targets interleukin-2 receptor alpha chain (CD25), is manufactured using a high-yield process. Daclizumab (Zenapax®) was first approved in 1997 for the prevention of organ transplant rejection. While the two products have the same amino acid sequence, Zinbryta has a different glycosylation pattern and reduced antibody-dependent cytotoxicity compared to Zenapax. Zinbryta’s approval was based in part on the results of the Phase 3 DECIDE study (NCT01064401) of Zinbryta versus interferon β 1a (Avonex®) in patients with relapsing-remitting MS. In this study, patients administered Zinbryta experienced fewer clinical relapses than those who received Avonex (annualized relapse rate 0.22 vs. 0.39; 45% lower rate with Zinbryta; P<0.001). Due to serious safety risks, FDA has included a boxed warning on the product label, and it is available only through a restricted distribution program under a Risk Evaluation and Mitigation Strategy.
Another antibody therapeutic, ocrelizumab, has been evaluated in a Phase 3 study of patients with primary progressive multiple sclerosis (PPMS). The antibody targets CD20 on B cells, which are implicated in the inflammatory and neurodegenerative processes of MS. Ocrelizumab was granted FDA’s Breakthrough Therapy Designation for PPMS, which is a debilitating form of MS characterized by steadily worsening symptoms. PPMS patients typically do not experience distinct relapses or periods of remission. Currently, no treatments are approved for treatment of the disease. In the pivotal Phase 3 ORATORIO study, treatment with ocrelizumab significantly reduced disability progression and other markers of disease activity compared with placebo. Ocrelizumab is also undergoing evaluation in Phase 3 studies of patients with relapsing-remitting forms of the disease. Genentech plans to submit a marketing application for ocrelizumab as a treatment for MS in 2016. If an application is submitted to FDA by the end of June and receives a priority review, which is a benefit of the Breakthrough Therapy Designation, then ocrelizumab could be approved for marketing in the US by the end of 2016.
