FDA Approves OLUMIANT (baricitinib) 2-mg Tablets for the Treatment of Adults with Moderately-to-Severely Active Rheumatoid Arthritis
The approval of OLUMIANT is based on the Phase 3 clinical trial program that demonstrated efficacy for difficult to treat patients1
INDIANAPOLIS,- Eli Lilly and Company (NYSE: LLY) and Incyte Corporation (NASDAQ: INCY) announced today that the U.S. Food and Drug Administration (FDA) has approved the 2-mg dose of OLUMIANT? (baricitinib), a once-daily oral medication for the treatment of adults with moderately-to-severely active rheumatoid arthritis (RA) who have had an inadequate response to one or more tumor necrosis factor (TNF) inhibitor therapies.1 Use of OLUMIANT in combination with other Janus kinase (JAK) inhibitors or biologic disease-modifying antirheumatic drugs (bDMARDs), or with potent immunosuppressants such as azathioprine and cyclosporine is not recommended.1 OLUMIANT may be used as monotherapy or in combination with methotrexate (MTX) or other non-biologic DMARDs.1 ?
"We are pleased to provide RA patients in the U.S. an effective treatment option with OLUMIANT, as people with RA who have had an inadequate response to TNF inhibitors are generally considered to be some of the most difficult to treat RA patients," said Christi Shaw, president, Lilly Bio-Medicines.
The OLUMIANT clinical trial program included the RA-BEACON study, a randomized, double-blind, placebo-controlled study in which patients were randomly assigned to receive OLUMIANT 2 mg, baricitinib 4 mg or placebo, in addition to conventional DMARDs that they were currently using.1 This study included 527 patients who had an inadequate response or intolerance to one or more TNF inhibitor therapies.1 Patients could have had prior therapy with other bDMARDs.1
The study results showed that significantly higher ACR20 response rates and improvement in all individual ACR20 component scores were observed at Week 12 with OLUMIANT.1 The study found that patients treated with OLUMIANT had significantly higher rates of ACR20 response versus placebo-treated patients at Week 12 (49% of OLUMIANT-treated patients versus 27% of placebo-treated patients).1 OLUMIANT also demonstrated early symptom relief, with ACR20 responses seen as early as Week 1.1 Patients treated with OLUMIANT reported significant improvements in physical function based on the Health Assessment Questionnaire Disability Index (HAQ-DI) (recording an average score of 1.71 before treatment and 1.31 at Week 12) compared to placebo-treated patients (who recorded an average score of 1.78 before treatment and 1.59 at Week 12).1
OLUMIANT is approved with a Boxed Warning for the risk of serious infections, malignancies and thrombosis.1 Serious infections leading to hospitalization or death, including tuberculosis and bacterial, invasive fungal, viral, and other opportunistic infections, have occurred in patients receiving OLUMIANT.1 Lymphoma and other malignancies have been observed in patients treated with OLUMIANT as well.1 Additionally, thrombosis, including deep venous thrombosis, pulmonary embolism and arterial thrombosis, some fatal, have occurred in patients treated with OLUMIANT.1 Other warnings and precautions include gastrointestinal perforations, laboratory abnormalities (including neutropenia, lymphopenia, anemia, liver enzyme elevations, and lipid elevations) and a warning against the use of live vaccines with OLUMIANT.1 The most common adverse events (occurring in greater than or equal to 1% of OLUMIANT 2 mg- and baricitinib 4 mg-treated patients in placebo-controlled trials) included upper respiratory tract infections, nausea, herpes simplex and herpes zoster.1 See Important Safety Information including Boxed Warning below.
As part of the approval, the companies have agreed to conduct a randomized controlled clinical trial to evaluate the long-term safety of baricitinib in patients with rheumatoid arthritis.
"Despite the advancements we've seen in the RA treatment landscape over the past several decades, many patients are still failing to achieve their disease management goals," said Seth Ginsberg, co-founder and president of CreakyJoints and the Global Healthy Living Foundation. "As it's important for RA patients to have multiple treatment options available to best suit their disease characteristics and experiences, the approval of OLUMIANT is very encouraging for our community."
RA is a chronic, painful and progressive form of arthritis.2-3 It is estimated that about two-thirds of established RA patients will not reach clinical remission with their first TNF inhibitor therapy, and a significant percentage will not maintain efficacy as time goes on.4
"In my clinical practice, I continue to see patients who experience debilitating symptoms and who are waiting for a medicine that may be right for them," said Elizabeth L. Perkins, M.D., Rheumatology Care Center, Birmingham, Alabama. "OLUMIANT is an important option for rheumatologists to help address these patients' unmet needs."
"RA patients continue to experience unique challenges accessing the treatments prescribed by their healthcare providers.?Therefore, we are determined to continue our work with stakeholders to demonstrate value across the healthcare system so providers have greater choice in prescribing treatments to fit individual patient needs," said Shaw.
Lilly will launch OLUMIANT in the U.S. by the end of the second quarter of 2018. The price of OLUMIANT will be 60% less than the leading TNF inhibitor.5 Lilly will be offering a patient support program, Olumiant Together?. For more information about this program, please call 1-844-OLUMIANT.
Incyte is now eligible to receive a $100 million milestone payment from Lilly as a result of the OLUMIANT approval, which Incyte expects to recognize in the second quarter of 2018.
Indications and Usage
OLUMIANT? (baricitinib) 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: Use of OLUMIANT in combination with other JAK inhibitors, biologic disease-modifying antirheumatic drugs (DMARDs), or with potent immunosuppressants such as azathioprine and cyclosporine is not recommended.
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. Treatment for latent infection should be considered 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.
- 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.
- Olumiant [package insert]. Indianapolis, IN: Eli Lilly and Company; 2018.
- Klareskog L, Catrina AI, Paget S. Lancet. 2009;373:659-672.
- 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.
- Curtis JR and Singh JA.Clin Ther. 2011;33(6):679-707.
- Reprinted with permission by First Databank, Inc. All rights reserved. ?2016.
- Walker JG and Smith MD. J Rheumatol. 2005;32;1650-1653.
- Hunter TM, et al. Rheumatol Int. 2017;37:1551?1557.
- Arthritis Foundation, Rheumatoid Arthritis Treatment, https://www.arthritis.org/about-arthritis/types/rheumatoid-arthritis/treatment.php. Accessed April 23, 2018.
- Smolen JS, Aletaha D, McInnes IB. Lancet. 2016;388:2023-2038.
- Sustained Rheumatoid Arthritis Remission is Uncommon in Clinical Practice, Arthritis Research & Therapy, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3446437/. Accessed April 23, 2018.