Late-Breaking Phase 2 Data for Investigational Oral Factor XIa Inhibitor Milvexian Suggest Favorable Antithrombotic Profile Across a Wide Range of Doses

Milvexian demonstrated efficacy and no increase in bleeding across doses, with no major bleeds in the milvexian arms, when compared with enoxaparin, for postoperative venous thromboembolism (VTE) prevention in patients undergoing elective total knee replacement (TKR) surgery

AXIOMATIC-TKR is the first of two studies to read out from the Phase 2 milvexian program, which together will inform the design and dose regimens of the Phase 3 program

Data simultaneously published in The New England Journal of Medicine and presented at the American Heart Association Scientific Sessions 2021

Milvexian is being developed by The Bristol Myers Squibb-Janssen Collaboration

PRINCETON, NJ, USA I November 15, 2021 IBristol Myers Squibb (NYSE:BMY) in collaboration with Janssen Pharmaceuticals, Inc., one of the Janssen Pharmaceutical Companies of Johnson and Johnson (Janssen), today announced results from the Phase 2 AXIOMATIC-TKR study, which showed investigational oral 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. “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).




Twice Daily


Once Daily

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.

There were no major bleeds with milvexian and one with enoxaparin. The rates of major plus clinically relevant non-major 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.

“We are encouraged by the results of the milvexian TKR trial, which are consistent with our scientific understanding of the FXIa mechanism,” said Roland Chen, M.D., senior vice president and head of cardiovascular development, global drug development at Bristol Myers Squibb. “The clear dose efficacy response without increased bleeding provides additional evidence to support our belief in the promise of milvexian. We look forward to results from our second Phase 2 trial of milvexian for secondary stroke prevention, which will add to our body of evidence for milvexian and help inform our Phase 3 development program.”

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. Bristol Myers Squibb and Janssen thank the patients and investigators involved in this clinical trial.


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 (NCT03891524).

About Milvexian*

Milvexian is a potential first-in-class oral factor XIa (FXIa) inhibitor (anti-thrombotic) 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 Bristol Myers Squibb

Bristol Myers Squibb is a global biopharmaceutical company whose mission is to discover, develop and deliver innovative medicines that help patients prevail over serious diseases. For more information about Bristol Myers Squibb, visit us at or follow us on LinkedIn, Twitter, YouTube, Facebook and Instagram.

Celgene and Juno Therapeutics are wholly owned subsidiaries of Bristol-Myers Squibb Company. In certain countries outside the U.S., due to local laws, Celgene and Juno Therapeutics are referred to as, Celgene, a Bristol Myers Squibb company and Juno Therapeutics, a Bristol Myers Squibb company.

SOURCE: Bristol Myers Squibb

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