Late-Breaking Phase 2 Data for Investigational Oral Factor XIa Inhibitor Milvexian Suggest Favorable Antithrombotic Profile Across a Wide Range of Doses
The Janssen Pharmaceutical Companies of
Johnson & Johnson in collaboration with Bristol Myers Squibb today announced
results from the Phase 2 AXIOMATIC-TKR study, which showed investigational oral
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milvexian reduced the risk of postoperative venous thromboembolism (VTE) in a
dose dependent manner without increasing the risk of bleeding compared with
enoxaparin in patients undergoing total knee replacement (TKR) surgery. These
data were presented today at a Late-Breaking Science session at the American
Heart Association (AHA) Scientific Sessions 2021 and simultaneously published in
The New England Journal of Medicine (NEJM).
?This study establishes proof-of-principle for milvexian as a differentiated
antithrombotic agent,? said Jeffrey Weitz, M.D., Professor of Medicine &
Biochemistry and Biomedical Sciences at McMaster University and Executive
Director of the Thrombosis and Atherosclerosis Research Institute.i ?Furthermore,
the consistently low rates of bleeding across a 16-fold range of milvexian doses
suggest that it has a wide therapeutic window, which opens the opportunity to
explore milvexian across a broad range of patients including those for whom factor
Xa inhibitors are underutilized or not indicated.?
The trial met both of its pre-specified proof-of-principle requirements: the dose
response for efficacy with twice-daily milvexian was significant (p<0.001), and the
12% rate of VTE with combined twice-daily doses of milvexian was significantly
lower (p<0.0001) than the prespecified benchmark rate of 30%.
At daily doses of at least 100 mg, the rates of VTE with milvexian were significantly
lower than with enoxaparin (p=0.014).
Milvexian
Twice Daily
Milvexian
Once Daily
Enoxaparin
Once Daily
25 mg 50 mg 100 mg 200 mg 25 mg 50 mg 200 mg 40 mg
No. of patients evaluated 129 124 134 131 28 127 123 252
Venous
thromboembolism* 21% 11% 9% 8% 25% 24% 7% 21%
No. of patients evaluated? 148 148 149 148 33 150 147 296
Any bleeding 1% 5% 5% 3% 0 5% 6% 4%
Major or clinically relevant
nonmajor bleeding 0 1% 1% 1% 0 1% 1% 2%
Major bleeding 0 0 0 0 0 0 0 0.3%
*Primary efficacy outcome defined as the composite of asymptomatic deep-vein thrombosis (detected by
mandatory unilateral venography performed 10 to 14 days after surgery), confirmed symptomatic venous
thromboembolism (symptomatic deep-vein thrombosis of the leg or nonfatal pulmonary embolism), or death.
? Safety outcomes were assessed in the safety population, which consisted of all patients who received at least one
dose of trial medication.
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There were no major bleeds with milvexian and one with enoxaparin. The rates of
major plus clinically relevant nonmajor bleeds (CRNM) with milvexian and
enoxaparin were 0.8% and 1.4%, respectively. Across a 16-fold range of doses,
milvexian demonstrated a low risk of major plus CRNM bleeding with no major
bleeds and no dose-response on this composite outcome.
?These promising Phase 2 data support a profile that is consistent with better
efficacy and safety than enoxaparin and reinforce our confidence in
milvexian,? said James List, M.D., Ph.D., Global Therapeutic Area Head,
Cardiovascular, Metabolism, & Retina, Janssen Research & Development, LLC.
?We?re optimistic about the milvexian program and its potential impact for
patients.?
The TKR study is the first of two studies to read out from the Phase 2
milvexian program. Results from the ongoing Phase 2 study of milvexian for
secondary stroke prevention (AXIOMATIC-SSP) are expected in the first half
of 2022. Janssen and Bristol Myers Squibb thank the patients and
investigators involved in this clinical trial.
About AXIOMATIC-TKR
AXIOMATIC-TKR is a Phase 2, randomized, open-label, parallel-group, dose-ranging
multicenter study that evaluated the efficacy and safety of milvexian, an oral factor
XIa (FXIa) inhibitor, versus subcutaneous enoxaparin in patients undergoing
elective TKR surgery. The primary efficacy outcome was the incidence of total VTE
up to 14 days. The principal safety outcome was any bleeding, defined as the
composite of major, clinically relevant nonmajor and minimal bleeding.
A total of 1,242 patients were randomized to receive one of seven regimens of oral
milvexian given twice or once-daily or to receive 40 mg of subcutaneous enoxaparin
once-daily. The assignment to milvexian or enoxaparin was open label, but the
milvexian dose assignment was blinded. Treatment was given for 10-14 days. More
information can be found on www.clinicaltrials.gov (NCT03891524).
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About Milvexian*
Milvexian is a potential first-in-class oral factor XIa (FXIa) inhibitor (antithrombotic) for the prevention and treatment of major thrombotic conditions.
Phase 2 TKR data, complementing human genetic, epidemiologic, and
preclinical evidence, now provide further support for the hypothesis that
inhibiting FXIa can reduce the risk of vascular events without increasing the
risk of bleeding. The milvexian Phase 2 clinical trial program consists of two
Phase 2 studies: AXIOMATIC-TKR (NCT03891524) evaluating milvexian in
TKR surgery and AXIOMATIC-SSP (NCT03766581) evaluating milvexian for
secondary stroke prevention (SSP).
*Milvexian is an investigational agent and has not been approved for use in
any country, for any indication.
About The Bristol Myers Squibb-Janssen Collaboration
Bristol Myers Squibb and Janssen Pharmaceuticals, Inc., two leaders in thrombosis
treatment and care, are collaborating to develop and commercialize milvexian, a
potentially first-in-class oral factor XIa (FXIa) inhibitor, with the goal of improving
upon the benefit-risk profile of existing anticoagulants. With extensive expertise
and unparalleled leadership in cardiovascular treatments spanning decades, Bristol
Myers Squibb and Janssen share a long-standing commitment to improving
treatment options for patients with life-threatening cardiovascular conditions.
About the Janssen Pharmaceutical Companies of Johnson & Johnson
At Janssen, we're creating a future where disease is a thing of the past. We're the
Pharmaceutical Companies of Johnson & Johnson, working tirelessly to make that
future a reality for patients everywhere by fighting sickness with science, improving
access with ingenuity and healing hopelessness with heart. We focus on areas of
medicine where we can make the biggest difference: Cardiovascular & Metabolism,
Immunology, Infectious Diseases & Vaccines, Neuroscience, Oncology and
Pulmonary Hypertension.
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Learn more at https://www.janssen.com/. Follow us at @JanssenGlobal. Janssen
Research & Development, LLC is one of the Janssen Pharmaceutical Companies of
Johnson & Johnson.
Cautions Concerning Forward-Looking Statements
This press release contains "forward-looking statements" as defined in the Private
Securities Litigation Reform Act of 1995 regarding milvexian. The reader is
cautioned not to rely on these forward-looking statements. These statements are
based on current expectations of future events. If underlying assumptions prove
inaccurate or known or unknown risks or uncertainties materialize, actual results
could vary materially from the expectations and projections of Janssen Research &
Development, LLC, any of the other Janssen Pharmaceutical Companies and/or
Johnson & Johnson. Risks and uncertainties include, but are not limited to:
challenges and uncertainties inherent in product research and development,
including the uncertainty of clinical success and of obtaining regulatory approvals;
uncertainty of commercial success; manufacturing difficulties and delays;
competition, including technological advances, new products and patents attained
by competitors; challenges to patents; product efficacy or safety concerns resulting
in product recalls or regulatory action; changes in behavior and spending patterns
of purchasers of health care products and services; changes to applicable laws and
regulations, including global health care reforms; and trends toward health care
cost containment. A further list and descriptions of these risks, uncertainties and
other factors can be found in Johnson & Johnson's Annual Report on Form 10-K for
the fiscal year ended January 3, 2021, including in the