Bristol Myers Squibb’s Investigational LPA1 Antagonist Reduces Rate of Lung Function Decline in Progressive Pulmonary Fibrosis Cohort of Phase 2 Study
- Category: Antibodies
- Published on Monday, 11 September 2023 09:56
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Results show 26 weeks of treatment with twice-daily 60 mg dose of BMS-986278 resulted in a 69% relative reduction in the rate of decline in percent predicted forced vital capacity versus placebo
Treatment effect was consistent with or without background therapy and BMS-986278 was well tolerated, with rates of adverse events similar to placebo and low discontinuation rates
These progressive pulmonary fibrosis findings, along with the previously reported idiopathic pulmonary fibrosis cohort results, support continued development of BMS-986278 in Phase 3 ALOFT program
Bristol Myers Squibb (NYSE: BMY) today announced results from a Phase 2 study evaluating BMS-986278, a potential first-in-class, oral, lysophosphatidic acid receptor 1 (LPA1) antagonist in patients with progressive pulmonary fibrosis (PPF). The study showed that twice-daily administration of 60 mg of BMS-986278 over 26 weeks reduced the rate of decline in percent predicted forced vital capacity (ppFVC) by 69% compared to placebo (overall, 38% of patients in the study received background antifibrotic therapy). These data will be presented during the Abstracts Leading to Evolution in Respiratory Medicine Trials (ALERT) session 1 at the European Respiratory Society (ERS) 2023 International Congress held September 9-13 in Milan, Italy.
“People living with pulmonary fibrosis are in urgent need of new treatment options for this devastating disease, which has a median overall survival of 3-5 years,” said Professor Tamera J. Corte, clinical trial investigator and Consultant Respiratory Physician and Director of Interstitial Lung Disease, Department of Respiratory Medicine, Royal Prince Alfred Hospital. “The Phase 2 progressive pulmonary fibrosis results, which demonstrate consistent efficacy with or without background antifibrotic therapy and a favorable tolerability profile, reinforce the potential of BMS-986278 and highlight advancements in the space as we race to find a potential new standard of care.”
This Phase 2 study was a global, randomized trial in which parallel cohorts of patients with idiopathic pulmonary fibrosis (IPF) and PPF received 30 mg or 60 mg of BMS-986278 or matched placebo orally twice-daily for 26 weeks. Stable background use of antifibrotics in the IPF cohort and/or select immunosuppressives in the PPF cohort were allowed. The primary endpoint of the study was rate of change in ppFVC from baseline to Week 26 in the IPF cohort. Rate of change in ppFVC from baseline through 26 weeks in the PPF cohort was a key secondary endpoint of the study and was assessed based on two prespecified estimands* (treatment policy estimand and while-on-treatment estimand).
In the PPF cohort, treatment with 60 mg of BMS-986278 led to a 69% relative reduction in the rate of change in ppFVC versus placebo in the while-on-treatment analysis (treatment difference versus placebo 2.9%; 95% CI: 0.4, 5.5), and a 74% relative reduction versus placebo in the treatment policy analysis (3.2%; 95% CI: 0.7, 5.6). In the 30 mg group, a 42% relative reduction was observed in the while-on-treatment analysis (1.8%, 95% CI: -0.9, 4.4), and a 37% relative reduction was observed in the treatment policy analysis (1.6%; 95% CI: −1.0, 4.1). The treatment effect was consistent in the presence or absence of background antifibrotics and usual interstitial pneumonia (UIP) pattern (in the placebo, 30 mg and 60 mg groups, 41%, 38% and 36% of patients were on background antifibrotic therapy, respectively; UIP pattern was present in 51%, 55% and 50% of patients in the placebo, 30 mg and 60 mg groups, respectively).
Rate of Change in ppFVC from Baseline to Week 26 in the PPF Cohort
30 mg BMS-986278 BID
60 mg BMS-986278 BID
|Treatment policy strategya|
|Rate of change in ppFVC,b mean||−4.3||−2.7||−1.1|
|95% CI of difference||—||−1.0, 4.1||0.7, 5.6|
|Rate of change in ppFVC,b mean||−4.2||−2.5||−1.3|
|95% CI of difference||—||−0.9, 4.4||0.4, 5.5|
aAll observed data regardless of dose reduction were included and analyzed as randomized.
bLinear mixed model: ppFVC (%) = treatment + time + treatment*time + UIP pattern + exposure to antifibrotics.
cAll observed data prior to dose reduction were included and analyzed as randomized; data on and after dose reduction was excluded.
BID, twice-daily; CI, confidence interval; FVC, forced vital capacity; ppFVC, percent of predicted FVC.
BMS-986278 was well tolerated in both treatment arms of the PPF cohort, with rates of adverse events (AEs) similar to placebo and low discontinuation rates. In the placebo, 30 mg and 60 mg arms, AEs occurred in 78%, 83% and 67% of patients, respectively, while serious AEs occurred in 32%, 10% and 12% of patients, respectively. The most frequent AEs in the placebo, 30 mg and 60 mg arms included diarrhea (15%, 15%, 7%), COVID-19 (5%, 15%, 14%), cough (10%, 8%, 12%) and dyspnea (15%, 5%, 0%). Treatment discontinuation rates due to AEs were highest in the placebo arm, occurring in 15%, 3% and 0% of patients in the placebo, 30 mg and 60 mg arms, respectively.
“The results from this innovative study investigating idiopathic and progressive pulmonary fibrosis give us unprecedented insights that will inform our scientific understanding of pulmonary fibrosis and the role of LPA1 inhibition,” said Jonathan Sadeh, MD, MSc, senior vice president of Immunology Development, Bristol Myers Squibb. “Our industry-leading drug discovery and development capabilities and collective results from this Phase 2 study provide us the expertise and confidence to support continued development of BMS-986278 in our global Phase 3 ALOFT program in idiopathic and progressive pulmonary fibrosis.”
Results from the IPF cohort of the Phase 2 study were previously presented at the American Thoracic Society (ATS) International Conference in May 2023, showing a 62% relative reduction in the rate of decline in ppFVC with 60 mg BMS-986278 versus placebo with or without background therapy. BMS-986278 will now be evaluated in the global Phase 3 ALOFT (An LPA1 antagonist for pulmonary Fibrosis Trial) program.
Bristol Myers Squibb would like to thank the patients and investigators who were involved in this study.
|*The treatment policy estimand (similar to an Intention-to-Treat [ITT] analysis) included all observed data regardless of dose reduction and provides an estimate of efficacy with dose reduction as part of the treatment regimen. The while-on-treatment estimand included all observed data prior to dose reduction and provides an estimate of efficacy without dose reduction as part of the treatment regimen. Dose reductions occurred across all three treatment arms: placebo (n=1), 30 mg (n=6) and 60 mg (n=5) treatment arms.|
BMS-986278 is a potential first-in-class, oral, small molecule lysophosphatidic acid receptor 1 (LPA1) antagonist currently being evaluated as a novel antifibrotic treatment for patients with idiopathic pulmonary fibrosis and progressive pulmonary fibrosis. Increased LPA levels and activation of LPA1 are involved in the pathogenesis of pulmonary fibrosis. A preclinical in vitro and in vivo study found that antagonizing LPA1 may be beneficial in treating lung injury and fibrosis.
About the BMS-986278 Phase 2 Study
This Phase 2 study was a global, randomized study in which parallel cohorts of patients with idiopathic pulmonary fibrosis (IPF) and progressive pulmonary fibrosis (PPF) received 30 mg or 60 mg of BMS-986278 or matched placebo orally twice-daily. The study consisted of a 26-week placebo-controlled treatment period, an optional 26-week active treatment extension period and a 4-week post-treatment follow-up period. Patients were permitted to take background antifibrotics in the IPF cohort and background antifibrotics and/or immunosuppressants in the PPF cohort. The primary endpoint was rate of change in percent predicted forced vital capacity (ppFVC) from baseline to Week 26 in the IPF cohort. ppFVC compares the observed FVC to that which is expected for a healthy person of the same age, gender, race and height. Rate of change in ppFVC from baseline through Week 26 in the PPF cohort was a key secondary endpoint. Patients who met prespecified blood pressure reduction criteria were to receive a dose reduction to 10 mg of BMS-986278 or matching placebo twice-daily.
More information can be found on www.clinicaltrials.gov (NCT04308681).
About Pulmonary Fibrosis
Pulmonary fibrosis is a chronic, life-threatening interstitial lung disease (ILD) that occurs when lung tissue becomes damaged and scarred, impacting how lungs function. Progressive pulmonary fibrosis (PPF) is the preferred term to describe patients who have an ILD with a progressive fibrotic phenotype. Idiopathic pulmonary fibrosis (IPF) is the most common type of progressive fibrosing ILD. As an idiopathic disease, there is no identifiable cause, and as of 2021, more than 700,000 adults are living with IPF globally.
Many people living with PPF and IPF are physically impaired, experience a progressive decline in lung function, have difficulty performing simple daily activities due to breathlessness and require continuous supplemental oxygen to ease the burden of normal breathing.
IPF is a fatal disease with a median survival time of 3-5 years following diagnosis and 5-year survival rate of approximately 45%; PPF has shown similar prognosis. Innovation in treatment has been limited with few new therapies approved in nearly 10 years.
Bristol Myers Squibb: Pioneering Paths Forward in Immunology to Transform Patients’ Lives
Bristol Myers Squibb is inspired by a single vision – transforming patients’ lives through science. For people living with immune-mediated diseases, the debilitating reality of enduring chronic symptoms and disease progression can take a toll on their physical, emotional and social well-being, making simple tasks and daily life a challenge. Driven by our deep understanding of the immune system that spans over 20 years of experience, and our passion to help patients, the company continues to pursue pathbreaking science with the goal of delivering meaningful solutions that address unmet needs in rheumatology, gastroenterology, dermatology and pulmonology. We follow the science, aiming to tailor therapies to individual needs, improve outcomes and expand treatment options by working to identify mechanisms with the potential to achieve long-term remission – and perhaps even cures – in the future. By building partnerships with researchers, patients and caregivers to deliver innovative treatments, Bristol Myers Squibb strives to elevate patient care to new standards and deliver what matters most – the promise of living a better life.
About Bristol Myers Squibb
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SOURCE: Bristol Myers Squibb