ChemoCentryx, Inc., and Vifor Fresenius Medical Care Renal Pharma (VFMCRP) announced positive topline data from the pivotal Phase III ADVOCATE trial of avacopan, an orally-administered selective complement 5a receptor inhibitor, for the treatment of patients with anti-neutrophil cytoplasmic antibody-associated vasculitis (ANCA-associated vasculitis or ANCA vasculitis).
This global study, in which a total of 331 patients with acute ANCA vasculitis were enrolled, met both of its primary endpoints, disease remission at 26 weeks and sustained remission at 52 weeks, as assessed by the Birmingham Vasculitis Activity Score, or BVAS. Remission was defined as a BVAS score of zero and being off glucocorticoid treatment for ANCA vasculitis for at least the preceding four weeks. The pre-specified primary endpoints were remission of acute vasculitis activity at week 26 and sustained remission at week 52, where avacopan therapy was at least statistically non-inferior to the currently used glucocorticoid-containing standard of care (glucocorticoid SOC). The two primary endpoints were tested sequentially using a gatekeeping procedure to preserve the Type I error.
BVAS remission at week 26 was achieved in 72.3% of the avacopan treated subjects vs. 70.1% of subjects in the glucocorticoid SOC control group (p<0.0001 for non-inferiority). Sustained remission at 52 weeks was observed in 65.7% of the avacopan treated subjects vs. 54.9% in the glucocorticoid SOC control group, achieving both non-inferiority and superiority to glucocorticoid standard of care (p=0.0066 for superiority of avacopan).
Importantly, subjects who received avacopan experienced additional benefits compared to those in the glucocorticoid SOC control group. These benefits, assessed as pre-specified secondary endpoints, include:
1. Significant reduction in glucocorticoid-related toxicity
- In the Glucocorticoid Toxicity Index (GTI version 2), the avacopan therapy arm vs. the glucocorticoid SOC control group was statistically significantly improved for:
- The GTI Cumulative Worsening Score: avacopan therapy 39.7 vs. 56.6 for glucocorticoid SOC (p=0.0002 for avacopan superiority), and for
- The GTI Aggregate Improvement Score: avacopan therapy 11.2 vs. 23.4 for glucocorticoid SOC (p=0.0082 for avacopan superiority).
- Other measures of glucocorticoid-related adverse event assessments (i.e., those based on EULAR-recommended adverse event terms and those based on Investigator Assessment of causality) also showed statistically significantly fewer events in the avacopan therapy arm vs. the glucocorticoid SOC control group.
2. Significant improvement in kidney function in patients with renal disease
- The avacopan group exhibited a statistically significant improvement in estimated glomerular filtration rate (eGFR) from baseline to week 26 and to week 52 compared to the glucocorticoid SOC control group:
- Mean change from baseline to week 26 in eGFR: avacopan treated subjects had an increase of 5.8 mL/min/1.732 vs. an increase of 2.8 mL/min/1.732 in the glucocorticoid SOC control group (p=0.0413)
- Mean change from baseline to week 52 in eGFR: avacopan treated subjects had an increase of 7.3 mL/min/1.732 vs. an increase in eGFR of 4.0 mL/min/1.732 in the glucocorticoid SOC control group (p=0.0259).
3. Improvements in health-related quality of life metrics
- The avacopan group demonstrated statistically significant improvements in the majority of domains measured by the validated quality of life instrument SF-36 version 2 at week 26 and 52.
- The avacopan group reported statistically significantly better outcomes on the EuroQOL-5D-5L instrument (both Visual Analogue Scale and EQ Index).
The topline safety results revealed an acceptable safety profile in this serious and life-threatening disease, with fewer subjects having serious adverse events (SAEs) in the avacopan group than in the glucocorticoid SOC control group (42% vs. 45%, respectively). Most reported SAEs were related to underlying ANCA vasculitis disease and commensurate with rates in previously published ANCA vasculitis trials. There were fewer subjects with serious infections in the avacopan group than the glucocorticoid SOC control group. A full analysis of the data is underway and expanded results are expected to be announced in the coming weeks.
“This is the transformational result that clinicians and patients all over the world had been hoping for,”
said Dr. David Jayne, Director of the Vasculitis and Lupus Clinic, Addenbrooke’s Hospital, Cambridge.
“The ADVOCATE trial demonstrated clearly that avacopan effectively brought patients into a state of remission for their acute vasculitis symptoms and kept them there for the entire period of this study. Importantly, avacopan did this in the absence of the traditional sustained daily steroid therapy that is the current standard of care and against which avacopan was compared. Indeed, avacopan was actually superior to the traditional standard of care, keeping patients in remission over the one year of treatment in the trial. The notable and significant improvements in quality of life, the reductions in overall glucocorticoid toxicities and especially the improvements in renal function with avacopan therapy when compared to the steroid-containing standard of care are remarkable. These each has direct impacts on the lives of ANCA vasculitis patients, with the renal function improvement having long-term implications on patient survival and kidney failure risk. In addition to changing the landscape of ANCA vasculitis therapy, these results have ramifications for other inflammatory diseases beyond ANCA vasculitis. Today is a wonderful day for the community of many thousands of patients each year who are diagnosed and living with this devastating disease.”
“These results exceed our expectations,”
said Thomas J. Schall, Ph.D., President and Chief Executive Officer of ChemoCentryx.
“Today we mark the dawn of a new and historic period in the lives of ANCA vasculitis patients. This day we have for the first time demonstrated that a highly targeted therapy aimed at the very center of the ANCA disease process is superior to the traditional approach of broad immune suppression therapy; a therapy that the present findings may make obsolete. Until now ANCA vasculitis patients have had to endure regimens that contain chronic high doses of steroids and all their noxious effects, but with today’s data, it is clear that the time of making patients sick with steroid therapy in an attempt to make their acute vasculitis better may, at last, be over. Working with our partner VFMCRP, we plan to make regulatory submissions for full marketing approval to both the European Medicines Agency (EMA) and the U.S. Food and Drug Administration (FDA) in 2020.”
“We are delighted with the positive topline data from the Phase III ADVOCATE trial for the treatment of ANCA vasculitis,”
said Stefan Schulze, Vifor Pharma President of the Executive Committee and Chief Operating Officer.
“By successfully meeting both primary endpoints and establishing superiority at 12 months, it confirms our belief that avacopan is a novel and better way to provide vasculitis control while reducing the risks of the current standard of care and improving the patient experience. This outcome is of high clinical relevance and an eagerly awaited change in the long-term treatment paradigm. The result is another significant milestone in our progress towards becoming the global leader in nephrology.”
ChemoCentryx is responsible for the discovery and development of avacopan and owns and retains commercial rights to the drug in the United States. VFMCRP has an exclusive license to commercialize the drug in all countries outside the United States. VFMCRP has granted KISSEI PHARMACEUTICAL CO LTD., an exclusive sub-license to develop and commercialize the drug in Japan.