The mean (SD) age was 51.0 (16.79) years[LNP023 group: 51.7 (16.94) years and anti-C5 group: 49.8 (16.69) years]. 69.1% (69.4%,68.6%) were female. 76.3 (77.4, 74.3%) were White, 4.1% (3.2%, 5.7%) were Black or African American, and 19.6% (19.4%, 20.0%) were Asian.
Vaccination against Neisseria meningitidis, Streptococcus pneumoniae and Haemophilus influenzae infections was given at least 2 weeks prior to the start of treatment according to local regulations. If LNP023 treatment had to start earlier than 2 weeks post vaccination, prophylactic antibiotic treatment was initiated.
In LNP023 group, after 24 weeks of LNP023 200mg b.i.d. treatment in the randomized treatment period, participants had the option to enter the extension treatment period to receive an additional 24 weeks of LNP023 200mg b.i.d.
In anti-C5 group, after 24 weeks of anti-C5 antibody treatment in the randomized treatment period, participants had the option to enter the extension treatment period to receive 24 weeks of LNP023 200mg b.i.d.
1 participant in the LNP023 group discontinued study treatment due to pregnancy, but continued study assessments until the end of randomized treatment period (RTP). Of the 96 participants completing the RTP on treatment, 94 participants entered the treatment extension treatment period. 2 participants, initially randomized to anti-C5 group, did not enter the extension treatment period. As of the data cut-off (26-Sep-2022), 51 participants completed the extension treatment period. 1 participant in LNP023 to LNP023 group discontinued study treatment due to pregnancy, and 42 participants were still ongoing.
Vaccination against Neisseria meningitidis, Streptococcus pneumoniae and Haemophilus influenzae infections was given at least 2 weeks prior to the start of treatment according to local regulations. If LNP023 treatment had to start earlier than 2 weeks post vaccination, prophylactic antibiotic treatment was initiated.
In LNP023 group, after 24 weeks of LNP023 200mg b.i.d. treatment in the randomized treatment period, participants had the option to enter the extension treatment period to receive an additional 24 weeks of LNP023 200mg b.i.d.
In anti-C5 group, after 24 weeks of anti-C5 antibody treatment in the randomized treatment period, participants had the option to enter the extension treatment period to receive 24 weeks of LNP023 200mg b.i.d.
1 participant in the LNP023 group discontinued study treatment due to pregnancy, but continued study assessments until the end of randomized treatment period (RTP). Of the 96 participants completing the RTP on treatment, 94 participants entered the treatment extension treatment period. 2 participants, initially randomized to anti-C5 group, did not enter the extension treatment period. As of the data cut-off (26-Sep-2022), 51 participants completed the extension treatment period. 1 participant in LNP023 to LNP023 group discontinued study treatment due to pregnancy, and 42 participants were still ongoing.
Adverse events (AEs) of LNP023 group were reported from first dose of study treatment until the cut-off date (26-Sep-2022), up to a maximum duration of 48 weeks. AEs of anti-C5 antibody were reported from the date of first administration of anti-C5 treatment in the RTP period (24W) to the date of the last actual administration of anti-C5 antibody in the RTP.
No deaths were reported through this study period.
In the RTP, the incidence of serious adverse events (SAEs) was 9.68% in LNP023 group and 14.29% in anti-C5 group. The SAEs reported in LNP023 group were sinus node dysfunction, COVID-19, pyelonephritis, urinary tract infection, blood creatine phosphokinase increased, basal cell carcinoma, myelodysplastic syndrome, and transient ischaemic attack (one participant for each). The SAEs reported in anti-C5 group were COVID-19 (2 participants), and breakthrough haemolysis, extravascular haemolysis, jaundice, arthritis bacterial, intervertebral discitis, sepsis, influenza A virus test positive, acute kidney injury, and bilirubinuria (one participant for each).
The incidence of other AEs (not including SAEs) in LNP023 group was 54.84% and that in anti-C5 groups was 60.00%. Other AEs reported by >= 10% of participants in any group were headache (LNP023 group: 16.13%, anti-C5 group: 2.86%), diarrhoea (14.52%, 5.71%), nasopharyngitis (11.29%, 5.71%), COVID-19 (6.45%, 20.00%), breakthrough haemolysis (3.23%, 17.14%).
14.52% of participants in the LNP023 to LNP023 treatment group experienced SAEs until the data cut-off(randomized treatment period and extension treatment period). Reported SAEs were sinus node dysfunction, COVID-19, cellulitis, pyelonephritis, septic shock, urinary tract infection, blood creatine phosphokinase increased, basal cell carcinoma, myelodysplastic syndrome, transient ischaemic attack, and ovarian cyst (one participant for each).
64.52% of the participants in the LNP023 to LNP023 treatment group experienced other AEs until the data cut-off. Other AEs reported by >= 10% of participants were COVID-19 (22.58%), headache (16.13%), diarrhea (14.52%), nasopharyngitis (14.52%), nausea (11.29%), and arthralgia (11.29).
The results of 2 primary endpoints:
- Marginal proportion of participants with sustained increase in hemoglobin levels from baseline of >= 2 g/dL between day 126 and day 168 in the absence of red blood cell transfusions between day 14 and day 168 was 82.3% (95% CI:73.4, 90.2) for LNP023 group and 2.0% (95% CI:1.1, 4.1) for anti-C5 group.
- Marginal proportion of participants with sustained hemoglobin levels of >= 12 g/dL between day 126 and day 168 in the absence of red blood cell transfusions between day 14 and day 168 was 68.8% (95% CI:58.3, 78.9) for LNP023 group and 1.8% (95% CI:0.9, 4.0) for anti-C5 group.
Requiring RBC transfusions refers to any patients receiving transfusions or meeting protocol defined criteria (Hemoglobin level =< 9 g/dL with signs /and or symptoms of sufficient severity to warrant a transfusion or Hemoglobin of =< 7 g/dL, regardless of presence of clinical signs and/or symptoms).
The term 'marginal proportion' can be interpreted as the population average probability of being a responder for each treatment group. These values include adjustment for baseline covariates and missing data has also been taken into account.
The results of secondary endpoints:
- Marginal proportion of participants who did not require transfusions between day 14 and day 168 was 96.4 (95% CI:90.7, 100.0) in LNP023 group and 26.1 (95%CI: 12.4, 42.7) in anti-C5 group.
- Change from baseline in hemoglobin levels as mean of visits between day 126 and day 168 was 3.59 (95% CI:3.32, 3.86) g/dL in LNP023 group and -0.04 (95%CI: -0.42, 0.35) g/dL in anti-C5 group.
For this analysis, in order to factor out the effect of transfusions, if a patient had a transfusion during the randomized treatment period, then the hemoglobin values 30 days following the transfusion were excluded and hemoglobin data were imputed.
- Change from baseline in FACIT-Fatigue scores as mean of visits between day 126 and day 168 was 8.59 (95% CI:6.72, 10.47) in LNP023 treatment and 0.31 (95%CI: -2.20, 2.81) in anti-C5 antibody treatment.
- Change from baseline in absolute reticulocyte count as mean of visits between day 126 and day 168 was -115.89 (95% CI:-126.49, -105.30) x109/L in LNP023 treatment and 0.37 (95%CI: -13.03, 13.77) x109/L in anti-C5 antibody treatment.
- Average of the Lactate dehydrogenase (LDH) log transformed ratio to baseline in each treatment estimated (natural log, base of e) between day 126 and day 168 was 0.96 (95% CI:0.90, 1.03) in LNP023 treatment and 0.98 (95%CI: 0.89, 1.07) in anti-C5 antibody treatment.
- Adjusted annualized rate of clinical breakthrough hemolysis (BTH) events are from negative binomial model between day 1 and day 168 was 0.07 (95% CI:0.02, 0.31) in LNP023 treatment and 0.67 (95%CI: 0.26, 1.72) in anti-C5 antibody treatment.
The breakthrough is defined clinical if either there is a decrease in hemoglobin levels equal to or more than 2 g/dL (compared to the latest assessment, or within 15 days) or if patients present signs or symptoms of gross hemoglobinuria, painful crisis, dysphagia or any other significant clinical PNH-related signs & symptoms, in presence of laboratory evidence of intravascular hemolysis.
- Adjusted annualized Major Adverse Vascular Events (MAVEs) rate between day 1 and day 168 was 0.03 (95% CI:0.00, 0.25) in LNP023 treatment and 0.00 (95%CI: 0.00, 0.00) in anti-C5 antibody treatment.
This study evaluated the efficacy and safety of twice daily oral administration of LNP023 in adult patients with PNH presenting with residual anemia despite treatment with anti-C5 antibody. The result of the study demonstrated that the efficacy and safety of LNP023 in adult patients with PNH presenting with residual anemia despite treatment with anti-C5 antibody.
Novartis is committed to sharing with qualified external researchers, access to patient-level data and supporting clinical documents from eligible studies. These requests are reviewed and approved by an independent review panel on the basis of scientific merit. All data provided is anonymized to respect the privacy of patients who have participated in the trial in line with applicable laws and regulations.
- Male and female participants >= 18 years of age with a diagnosis of PNH confirmed by high-sensitivity flow cytometry with clone size >= 10%
- Stable regimen of anti-C5 antibody treatment (either eculizumab or ravulizumab) for at least 6 months prior to randomization
- Mean hemoglobin level <10 g/dL
- Vaccination against Neisseria meningitidis infection is required prior to the start of treatment.
- If not received previously, vaccination against Streptococcus pneumoniae and Haemophilus influenzae infections should be given
- Participants on a stable eculizumab dose but with a dosing interval of 11 days or less
- Known or suspected hereditary complement deficiency at screening
- History of hematopoietic stem cell transplantation
- Patients with laboratory evidence of bone marrow failure (reticulocytes <100x10E9/L; platelets <30x10E9/L; neutrophils <500x10E6/L).
- Active systemic bacterial, viral or fungal infection within 14 days prior to study drug administration
- A history of recurrent invasive infections caused by encapsulated organisms, e.g. meningococcus or pneumococcus.
- Major concurrent comorbidities including but not limited to severe kidney disease (e.g., dialysis), advanced cardiac disease (e.g., NYHA class IV), severe pulmonary disease (e.g., severe pulmonary) hypertension (WHO class IV)), or hepatic disease (e.g., active hepatitis) that in the opinion of the investigator precludes participant's participation in the study.
年齢下限 / Age Minimum
18歳 以上
18age old over
年齢上限 / Age Maximum
上限なし
No limit
性別 / Gender
男性・女性
Both
中止基準
対象疾患名 / Health Condition(s) or Problem(s) Studied
発作性夜間ヘモグロビン尿症
Paroxysmal nocturnal hemoglobinuria
対象疾患コード / Code
対象疾患キーワード / Keyword
貧血
PNH
介入の有無
あり
介入の内容 / Intervention(s)
投与群A:LNP023単剤投与
投与群B:抗C5抗体治療(エクリズマブ又はラブリズマブ)
Arm A : LNP023 monotherapy
Arm B : Anti-C5 antibody treatment(Eculizumab or Ravulizumab)
- Percentage of participants achieving a sustained increase in hemoglobin levels of >= 2 g/dL in the absence of red blood cell transfusions
- Percentage of participants achieving sustained hemoglobin levels >= 12 g/dL in the absence of red blood cell transfusions