Darmstadt, Germany: New real-world data show MAVENCLAD® (cladribine tablets) had lower annualised relapse rates and longer time to first relapse and time to switch than fingolimod, dimethyl fumarate and teriflunomide in relapsing multiple sclerosis patients Additional clinical trial data show patients treated with MAVENCLAD early after a first clinical demyelinating event had a lower occurrence of further relapses or disability progression as compared to placeboNot intended for UK and U.S. based media
Merck, a leading science and technology company, today announced new real-world data from the MSBase Registry demonstrating MAVENCLAD® (cladribine tablets) had more favourable relapse outcomes and longer time to switch to another disease modifying therapy (DMT) compared to the oral DMTs fingolimod, dimethyl fumarate (DMF) and teriflunomide in relapsing multiple sclerosis (RMS) patients. A second study, analysing real-world follow up of clinical trial patients with a first attack suggestive of MS, showed those treated with MAVENCLAD had a lower rate of conversion to clinically definite multiple sclerosis (CDMS), defined by further relapse or disability progression, and lower risk of relapse than those not exposed to MAVENCLAD. These data will be presented at the Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) Forum 2022, taking place 24-26 February 2022.
In this first analysis of its size from the Generating Learnings In MultiPle SclErosis (GLIMPSE) study, data from 633 patients prescribed MAVENCLAD in the MSBase Registry was matched using propensity scores to patients receiving fingolimod (n=1195), DMF (n=912) or teriflunomide (n=735). Results showed the annualised relapse rate (ARR) for patients treated with MAVENCLAD was 0.09 compared to 0.15, 0.15 and 0.17 for fingolimod, DMF and teriflunomide, respectively. Time-to-first relapse in MAVENCLAD-treated patients was 40%, 42% and 67% lower than in patients treated with fingolimod, DMF and teriflunomide, respectively. The time to switch rate in patients treated with MAVENCLAD was 4, 7 and 6.5 times lower than fingolimod, DMF and teriflunomide, respectively. The GLIMPSE study was a longitudinal, retrospective analysis of adult patients identified with RMS from the MSBase Registry, an international online registry for neurologists studying MS and other neuro-immunological diseases.
“It is important in a lifelong disease like MS to continue assessing the efficacy and safety of available treatment options in the real world,” said Helmut Butzkueven, MBBS, FRACP, PhD, Department of Neuroscience, Central Clinical School, Monash University, Melbourne. “This is where the MSBase Registry, using standardised data records from over 79,000 people with MS around the world, can provide information that is not possible to obtain in a randomised clinical trial. This information showed us that in GLIMPSE, MAVENCLAD had better relapse outcomes and longer treatment persistence compared to other oral DMTs, including fingolimod.”
Also being presented are new data from an exploratory Phase IV CLASSIC-MS follow-up of patients (n=227) from the Phase III ORACLE-MS study which suggest early use of cladribine tablets reduced the risk of further relapse or disability progression (CDMS) in patients who experienced a first episode of neurologic attack with characteristics that put them at high risk of CDMS. Over half the patients (53.2%) treated with cladribine tablets remained relapse free compared to 28.2% of those who did not receive cladribine tablets. In patients who received cladribine tablets, 42.9% were diagnosed with CDMS in the median of 9.5 years since their last dose. In patients never treated with cladribine tablets, 70.4% were diagnosed with CDMS.
In ORACLE-MS, patients with a first clinical demyelinating event were randomised to receive cladribine tablets 3.5 mg/kg, cladribine tablets 5.25 mg/kg or placebo. This analysis at the ACTRIMS Forum 2022 investigated the long-term efficacy in patients from the ORACLE-MS trial who had received at least one course of cladribine tablets (68.7%) or placebo (31.3%). Cladribine tablets (5.25 mg/kg) are not approved for any use in any region.
MAVENCLAD® is a short-course oral therapy that selectively and periodically targets lymphocytes thought to be integral to the pathological process of relapsing MS (RMS). In August 2017, the European Commission (EC) granted marketing authorization for MAVENCLAD® for the treatment of relapsing forms of multiple sclerosis (RMS) in the 28 countries of the European Union (EU) in addition to Norway, Liechtenstein and Iceland. MAVENCLAD® has since then been approved in over 80 countries, including Canada, Australia and the U.S. Refer to the respective prescribing information for further details.
The clinical development programme for cladribine tablets includes:
The CLARITY (Cladribine Tablets Treating MS Orally) study: a two-year Phase III placebo-controlled study designed to evaluate the efficacy and safety of cladribine tablets as a monotherapy in patients with RRMS.
The CLARITY extension study: a Phase III placebo-controlled study following on from the CLARITY study, which evaluated the safety and exploratory efficacy of cladribine tablets over two additional years beyond the two-year CLARITY study, according to the treatment assignment scheme for years 3 and 4.
The ORACLE MS (Oral Cladribine in Early MS) study: a two-year Phase III placebo-controlled study designed to evaluate the efficacy and safety of cladribine tablets as a monotherapy in patients at risk of developing MS (patients who have experienced a first clinical event suggestive of MS).
The ONWARD (Oral Cladribine Added ON to Interferon beta-1a in Patients With Active Relapsing Disease) study: a Phase II placebo-controlled study designed primarily to evaluate the safety and tolerability of adding cladribine tablets treatment to patients with relapsing forms of MS, who have experienced breakthrough disease while on established interferon-beta therapy.
PREMIERE (Prospective Observational Long-term Safety Registry of Multiple Sclerosis) study: a long-term observational follow-up safety registry of MS patients who participated in cladribine tablets clinical studies.
In the two-year CLARITY study, the most commonly reported adverse event (AE) in patients treated with cladribine tablets was lymphopenia (26.7% with cladribine tablets and 1.8% for placebo). The incidence of infections was 48.3% with cladribine tablets and 42.5% with placebo, with 99.1% and 99.0% respectively rated mild-to-moderate by investigators. Adverse Events reported in other clinical studies were similar.
About Multiple Sclerosis
Multiple sclerosis (MS) is a chronic, inflammatory condition of the central nervous system and is the most common non-traumatic, disabling neurological disease in young adults. It is estimated that approximately 2.8 million people have MS worldwide. While symptoms can vary, the most common symptoms of MS include blurred vision, numbness or tingling in the limbs and problems with strength and coordination. The relapsing forms of MS are the most common.
Merck in Neurology and Immunology
Merck has a long-standing legacy in neurology and immunology, with significant R&D and commercial experience in multiple sclerosis (MS). The company`s current MS portfolio includes two products for the treatment of relapsing MS – Rebif® (interferon beta-1a) and MAVENCLAD® (cladribine tablets). Merck aims to improve the lives of patients by addressing areas of unmet medical needs. In addition to Merck`s commitment to MS, the company also has a pipeline focusing on discovering new therapies that have the potential in other neuroinflammatory and immune-mediated diseases, including systemic lupus erythematosus (SLE).
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