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Exhibit 99.1

 

Blisibimod, an Inhibitor of B cell Activating Factor, in Patients with Moderate-to-Severe Systemic Lupus Erythematosus

 

Richard A Furie, MD(1); Morton A Scheinberg, MD(2); Gustavo Leon, MD(3); Edgar B Ramiterre, MD(4); Matthew Thomas, MD (5); Alvina Chu, MD(6); Renee S Martin, PhD(6); Michelle A Petri, MD(7);  for the PEARL-SC Study.

 


(1)North Shore—Long Island Jewish Health System, Lake Success, New York, USA, (2)Rheumatology Hospital Abreu Sodre Pesquisa Clínica, São Paulo, Brazil, (3)Rheumatology Gynecology & Reproduction Institute, Lima, PERU, (4)Brokenshire Memorial Hospital, Davao City, Philippines, (5)Health and Research Centre, Trivandrum, Kerala India, (6)Anthera Pharmaceuticals, Hayward, California USA, (7)Hopkins University School of Medicine, Baltimore, Maryland, USA

 

Introduction

 

Bliisibimod is a potent and selective inhibitor of soluble and membrane-bound  forms of BAFF (KD = 1 pM, Hsu 2012).  It is a peptibody dimer, comprised of 4 high-affinity binding domains fused to a fully-human IgG1 Fc domain.  As with other Fc-continaing molecules, it has a long serum  half life of ~ 10 days (Stohl 2008).

 

The PEARl-SC study evaluated the efficacy and safety of subcutaneously-administered blisibimod on top of standard-of-care medication in patients with moderate-to-severe, seropositive SLE.

 

Methods and Materials

 

 

Key Inclusion Criteria

·                  Fulfill at least 4 of the criteria for SLE defined by the ACR.

·                  Receiving stable SLE treatment.

·                  Seropositive for ANA or anti-dsDNA antibodies.

 

Key Exclusion Criteria

·                  Severe vasculitis, CNS lupus, lupus nephritis.

·                  Anemia, neutropenia, or thrombocytopenia.

·                  Malignancy within past 5 years

·                  Exposure to B cell depleting therapy in the past 18 months.

 

The primary efficacy endpoint compared responder rates in the pooled active and pooled placebo groups using the  SLE Responder Index (SRI-5) at week 24, defined as:

·                  >5 point improvement in the SELENA-SLEDAI AND

·                  No new BILAG 1A or 2B organ domain flares AND

·                  No worsening in Physician’s Global Assessment (PGA) (< 0.3 increase)

·                  No new or increased doses of steroids or immunosuppressives beyond protocol-mandated limits.

 

Secondary end point analyses included:

·                  SRI response using more stringent forms of the SRI requiring improvements in SELENA-SLEDAI score of >6, >7, >8 and >9

·                  SRI response in subgroups of subjects with more severe disease, SELENA-SLEDAI >10 and receiving corticosteroids

·                  Time to, and incidence of SLE flare

·                  Changes in SLE biomarkers

·                  Safety and tolerability

 

Subjects were invited to participate in an open-label extension study after completion of this trial

 



 

Results

 

Summary of Demographics

 

Demographics

 

 

 

Age (years)

 

37.5

 

Weight (kg)

 

65.6

 

Gender, %

 

 

 

Female

 

94.0

 

Male

 

6.0

 

Race, %

 

 

 

White

 

25.0

 

Asian

 

19.7

 

Black or African

 

8.4

 

Other

 

46.8

 

Region, %

 

 

 

Asia/Pacific

 

19.0

 

Latin America

 

71.1

 

North America

 

9.9

 

SLE Duration (years)

 

6.1

 

Baseline Disease Characteristics

 

 

 

SELENA-SLEDAI (mean, SD)

 

10.1 (3.6)

 

BILAG 1A or 2B, %

 

50.3

 

PGA (mean score, SD)

 

1.4 (0.4)

 

Proteinuria > 2g/24h, %

 

4.4

 

ANA > 1:80, %

 

78.8

 

Anti-dsDNA >30 IU, %

 

68.4

 

Low C3 (< 900 mg/L), %

 

42.4

 

Low C4 (<16 mg/dL), %

 

50.2

 

Prednisone dose (mg/day)

 

12.0

 

Steroid >7.5 mg prednisone/day, %

 

60.1

 

Immunosuppressive use, %

 

45.0

 

Anti-malarial use, %

 

70.9

 

 

Baseline Disease Characteristics

 

 

SRI-5 Response at Week 24 in the mITT population

 

 

Kaplan Meier Analysis of Time to

First Severe Flare

(SLE Flare Index)

Decrease in Proteinuria

Subgroup: baseline proteinuria=1-6 g/24h

 

 



 

Increases in SRI Response with more Stringent
SELENA-SLEDAI Criteria in mITT Population

 

 

SRI Responses in mITT Population

 

 

 

Placebo

 

Blisibimod

 

 

 

 

 

Pooled

 

200mg Q4W

 

100mg QW

 

200mg QW

 

Pooled

 

200mg Q4W

 

100mg QW

 

200mg QW

 

 ∆SRI

 

Endpoint 

 

N=269

 

N=89

 

N=88

 

N=92

 

N=277

 

N=92

 

N=93

 

N=92

 

200mg QW

 

 

 

95

 

31

 

32

 

32

 

103

 

33

 

30

 

40

 

 

 

 

 

35.3%

 

34.8%

 

36.4%

 

34.8%

 

37.2%

 

35.9%

 

32.3%

 

43.5%

 

8.7%

 

SRI-5

 

 

 

 

 

 

 

 

 

*p=0.635

 

*p=0.925

 

*p=0.603

 

*p=0.154

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

#p=0.884

 

#p=0.561

 

#p=0.227

 

 

 

 

 

93

 

30

 

32

 

31

 

97

 

29

 

30

 

38

 

 

 

 

 

34.6%

 

33.7%

 

36.4%

 

33.7%

 

35.0%

 

31.5%

 

32.3%

 

41.3%

 

7.6%

 

SRI-6

 

 

 

 

 

 

 

 

 

*p=0.901

 

*p=0.588

 

*p=0.695

 

*p=0.237

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

#p=0.754

 

#p=0.561

 

#p=0.286

 

 

 

 

 

48

 

16

 

24

 

8

 

55

 

15

 

17

 

23

 

 

 

 

 

17.8%

 

18.0%

 

27.3%

 

8.7%

 

19.9%

 

16.3%

 

18.3%

 

25.0%

 

16.3%

 

SRI-7

 

 

 

 

 

 

 

 

 

*p=0.521

 

*p=0.711

 

*p=0.887

 

*p=0.119

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

#p=0.765

 

#p=0.149

 

#p=0.003

 

 

 

 

 

45

 

16

 

22

 

7

 

55

 

15

 

17

 

23

 

 

 

 

 

16.7%

 

18.0%

 

25.0%

 

7.6%

 

19.9%

 

16.3%

 

18.3%

 

25.0%

 

17.4%

 

SRI-8

 

 

 

 

 

 

 

 

 

*p=0.321

 

*p=0.905

 

*p=0.692

 

*p=0.069

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

#p=0.765

 

#p=0.272

 

#p=0.001

 

 

 

 


SRI calculated for 200mgQW blisibimod - 200mgQW placebo; #vs regimen-matched placebo, *vs pooled placebo

 

Change in SLE Biomarkers in the mITT Population

 

 

 



 

Increases in SRI Response in Subjects with Baseline

SELENA-SLEDAI >10 and Receiving Steroid

 

 

SRI Responses in Subjects with SELENA-SLEDAI>10, Receiving Steroid

 

 

 

Placebo

 

Blisibimod

 

 

 

 

 

Pooled

 

200mg Q4W

 

100mg QW

 

200mg QW

 

Pooled

 

200mg Q4W

 

100mg QW

 

200mg QW

 

∆SRI

 

Endpoint 

 

N=138

 

N=44

 

N=47

 

N=47

 

N=140

 

N=42

 

N=50

 

N=48

 

200mg QW

 

 

 

65

 

21

 

25

 

19

 

64

 

21

 

17

 

26

 

 

 

 

 

47.1%

 

47.7%

 

53.2%

 

40.4%

 

45.7%

 

50.0%

 

34.0%

 

54.2%

 

13.8%

 

SRI-5

 

 

 

 

 

 

 

 

 

*p=0.682

 

*p=0.819

 

*p=0.084

 

*p=0.482

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

#p=0.833

 

#p=0.057

 

#p=0.18

 

 

 

 

 

64

 

21

 

25

 

18

 

63

 

20

 

17

 

26

 

 

 

 

 

46.4%

 

47.7%

 

53.2%

 

38.3%

 

45.0%

 

47.6%

 

34.0%

 

54.2%

 

15.9%

 

SRI-6

 

 

 

 

 

 

 

 

 

*p=0.682

 

*p=0.971

 

*p=0.100

 

*p=0.428

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

#p=0.992

 

#p=0.057

 

#p=0.121

 

 

 

 

 

39

 

13

 

20

 

6

 

45

 

12

 

13

 

20

 

 

 

 

 

28.3%

 

29.5%

 

42.6%

 

12.8%

 

32.1%

 

28.6%

 

26.0%

 

41.7%

 

28.9%

 

SRI-7

 

 

 

 

 

 

 

 

 

*p=0.517

 

*p=0.983

 

*p=0.773

 

*p=0.105

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

#p=0.921

 

#p=0.085

 

#p=0.002

 

 

 

 

 

36

 

13

 

18

 

5

 

45

 

12

 

13

 

20

 

 

 

 

 

26.1%

 

29.5%

 

38.3%

 

10.6%

 

32.1%

 

28.6%

 

26.0%

 

41.7%

 

31.1%

 

SRI-8

 

 

 

 

 

 

 

 

 

*p=0.291

 

*p=0.795

 

*p=0.996

 

*p=0.054

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

#p=0.921

 

#p=0.194

 

#p<0.001

 

 

 

 


SRI calculated for 200mgQW blisibimod - 200mgQW placebo; #vs regimen-matched placebo, *vs pooled placebo

 

SRI-8 Response is Driven by Clinical Improvement

 

 

Clinical Improvement meets SRI-8 criteria without counting low complement, increased DNA binding, thrombocytopenia, leukopenia

 



 

Summary of Adverse Events

 

 

 

Pooled Placebo
N=266

 

Pooled Blisibimod
N=280

 

200mg QW Blisibimod
N=92

 

Overview (% incidence)

 

 

 

 

 

 

 

AE

 

85.0

 

82.5

 

83.7

 

Serious AE

 

15.8

 

11.1

 

7.6

 

AEs related to study drug

 

37.2

 

40.0

 

48.9

 

AEs leading to withdrawal

 

7.9

 

5.7

 

6.5

 

AEs leading to death

 

1.1

 

1.4

 

1.1

 

Severe Infection AEs

 

1.1

 

1.4

 

2.2

 

Severe Injection site reactions

 

0

 

0

 

0

 

Serious Adverse Events, n(%)

 

 

 

 

 

 

 

Herpes zoster

 

2 (0.8)

 

2 (0.7)

 

0

 

Pneumonia

 

4 (1.5)

 

3 (1.1)

 

2 (2.2)

 

Urinary tract infections

 

2 (0.8)

 

2 (0.7)

 

0

 

SLE

 

3 (1.1)

 

2 (0.7)

 

0

 

Deep vein thrombosis

 

2 (0.8)

 

3 (1.1)

 

1 (1.1)

 

 

·                  2 malignancies were reported (1 blisibimod, 1 placebo)

·                  6 subjects withdrew due to pregnancy (3 blisibimod, 3 placebo)

 

Conclusions

 

·                  Blisibimod was safe and well-tolerated at all dose levels with no meaningful imbalances in serious adverse events or infections compared with placebo.

·                  While the primary endpoint was not achieved, analyses identified patient populations and endpoints with superior responses to regimen-matched placebo:

·                  Subjects treated with 200mg QW achieving SRI-7 and SRI-8 response criteria.

·                  Subjects with baseline SELENA-SLEDAI>10 and receiving steroids treated with 200mg QW and meeting SRI-7 and SRI-8 response criteria.

·                  Early onset of response was observed across all SRI analyses in the mITT population and in subjects with SELENA-SLEDAI>10 who were receiving steroid therapy.

·                  Significant improvements in proteinuria, C3, C4 and anti-dsDNA were observed in subjects treated with blisibimod.

·                  The data support further evaluation of 200mg QW blisibimod using more stringent thresholds of the SRI in patients with severe seropositive SLE.

·                  Phase 3 clinical studies with blisibimod are anticipated to commence in Q1 2013.

 

References

 

Stohl W et al. Phase 1a Single- and Phase 1b Multiple-Dose Studies of AMG 623 (an Anti-BAFF Peptibody) in SLE. ACR; October, 2008.

 

Hsu H et al.  A novel modality of BAFF-specific inhibitor AMG623 peptibody reduces B-cell number and improves outcomes in murine models of autoimmune disease. Clin Exp Rheumatol. 2012;30(2) 197.

 

Presented at the American College of Rheumatology Annual Meeting, November 10-14 2012, Washington DC, USA