March 8, 2002
Serono, S.A. announced today that the US Food and Drug Administration (FDA) has approved Rebif® (interferon beta-1a) for the treatment of relapsing forms of multiple sclerosis. This approval was based upon the results of two large multi-center studies in patients with relapsing remitting multiple sclerosis (RRMS). The data collected in the PRISMS and EVIDENCE studies, along with years of clinical experience with Rebif outside the US, have shown that Rebif provides significant treatment benefits for people with relapsing forms of MS.
"This is an important milestone for our company. The FDA approval, based upon all the evidence, enables us to make Rebif available to people in the US with multiple sclerosis," said Ernesto Bertarelli, Chief Executive Officer of Serono. "This is a great day to celebrate Serono's commitment to science and clinical advancement."
In the treatment of relapsing forms of multiple sclerosis, Rebif decreases the frequency of clinical exacerbations and delays the accumulation of physical disability.(1) Until now, Rebif could not be marketed in the US due to the Orphan Drug status of another interferon beta-1a product, Avonex, whose exclusivity under the Orphan Drug Act (ODA) was granted in 1996 and will not expire until May 2003. Rebif was able to gain marketing approval under the terms of the ODA by demonstrating clinical superiority over Avonex at 24 weeks in the EVIDENCE head-to-head study.(2)
"The approval of Rebif is good news for people with multiple sclerosis in the US," said Patricia K. Coyle, MD, Health Science Center, State University of New York at Stony Brook. "Physicians are now free to prescribe Rebif to patients in the US who have relapsing forms of multiple sclerosis."
Multiple sclerosis is a chronic, inflammatory condition of the central nervous system. It is the most common non-traumatic disease of the central nervous system in young adults and today affects approximately 350,000 people in the US. While symptoms can vary from person to person affected by MS, common symptoms include: blurred vision, numbness and tingling in the limbs and problems with strength and coordination. The relapsing forms of the disease are the most common forms of MS.
The EVIDENCE study(3) is the largest prospective, randomized comparative study of two disease modifying drugs in RRMS to date. The open-label, assessor-blinded study included 677 patients with RRMS who had not been treated with interferon before, ages 18-55, at 56 centers in the US, Canada and Europe. Patients underwent repeated clinical and MRI assessments while taking either Rebif (44 mcg three times weekly, subcutaneously) or Avonex® (30 mcg once weekly, intramuscularly). During the study, assessing neurologists and radiologists were blinded from knowing which drug the patients were taking.
Results showed statistically significant differences in favor of Rebif on all primary and secondary efficacy measures at 24 weeks. The primary endpoint of the study was based on a comparison of the proportion of patients who did not experience a relapse of MS during the first 24 weeks of treatment. Approximately 75 percent of the patients in the EVIDENCE study who received Rebif did not have a relapse, compared to 63 percent of patients in the study who received Avonex. This reflects a 32 percent relative reduction in the proportion of Rebif patients who experienced relapses during the study period.
The main secondary endpoint of the study was an assessment of combined unique active lesions as measured by magnetic resonance imaging (MRI). Those patients treated with Rebif had an average of 0.8 active lesions per scan while patients treated with Avonex had an average of 1.2 active lesions per scan, a reduction of approximately one-third in lesion activity for Rebif patients.
The PRISMS study examined the long-term efficacy and safety of Rebif versus placebo in RRMS. Statistical significance was achieved on the study's endpoints at two years measuring delay in progression of disability, reduction in number and severity of relapses and reduction in burden of disease and MS activity as shown on brain scans. The PRISMS two-year data formed the basis for the initial approvals of Rebif outside the US. Additional data from the PRISMS study at four years was published in the journal Neurology in 2001.(4)
Rebif is recommended for use at a dosage of 44 mcg three times per week injected subcutaneously, just below the skin. Rebif is supplied in single-use, pre-filled syringes. Most commonly reported side effects are injection site disorders, flu-like symptoms, abdominal pain, depression, elevation of liver enzymes and blood cell abnormalities. Rebif is contraindicated in patients with hypersensitivity to natural or recombinant interferon, human albumin, or any other component of the formulation. Caution is advised in patients with depression, pre-existing seizure disorders, liver disease, alcohol abuse or elevated liver enzyme levels. Women who are or are planning to become pregnant should not take Rebif without consulting their doctor.
A comparison of safety based on the EVIDENCE study indicates that both Rebif and Avonex are associated with a similar overall side effect profile. Consistent with the higher and more frequent dose of interferon used in Rebif therapy, injection site reactions, liver function disorders and reduced white blood cell counts were observed with greater frequency with Rebif. When considering severe side effects, no difference between patients taking Rebif and Avonex was seen and such side effects usually responded to dose adjustment.
Rebif was approved in Europe in 1998 and is registered for use in more than 70 countries worldwide. During 2001, Rebif increased its leading position as the treatment of choice for patients with relapsing forms of MS with a market share of 38 percent in value terms and sales of $379.6 million outside the US.
(1) PRISMS (Prevention of Relapses
and disability by Interferon beta-1a Subcutaneously in MS) Study Group.
Randomized, double-blind, placebo-controlled study of interferon beta-1a
in relapsing/remitting multiple sclerosis. Lancet 1998; 352: 1498-1504.
(2) EVIDENCE: Evidence for Interferon Dose-response European-North American Comparative Efficacy.
(3) See Rebif full prescribing information.
(4) The PRISMS (Prevention of Relapses and Disability by Interferon beta-1a Subcutaneously in Multiple Sclerosis) Study Group and the University of British Columbia MS/MRI Analysis Group. PRISMS-4: Long-term efficacy of interferon beta-1a in relapsing MS. Neurology 2001; 56: 1628-1636.
(5) Package inserts for the company's US products are available at http://www.seronousa.com or by calling 1-888-275-7376.
SOURCE Serono, Inc.
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