ENBREL® (etanercept) Is First Therapy Approved
for Treatment of Psoriatic Arthritis
January 16, 2002
SEATTLE, WA - Immunex Corporation (Nasdaq: IMNX) and
Wyeth-Ayerst Laboratories, a division of American Home Products
(NYSE: AHP) announced today that the U.S. Food and Drug
administration (FDA) has approved ENBREL® (etanercept)
to treat people with psoriatic arthritis. ENBREL is the first
therapy to receive approval to reduce the signs and symptoms of
active arthritis in patients with psoriatic arthritis. ENBREL can
be used without methotrexate. ENBREL can also be used in
combination with methotrexate in patients who do not respond
adequately to methotrexate alone. Psoriatic arthritis is an often
painful chronic inflammatory disease characterized by both joint
and skin manifestations.
"Unlike other types of arthritis, people with psoriatic
arthritis often experience progressive joint pain and swelling,
coupled with scaly red skin lesions," said Gail Zimmerman,
president and CEO, National Psoriasis Foundation. "There is a
definite need for new approved therapies to specifically treat
this disease. Current therapies for psoriatic arthritis have been
borrowed from other diseases and do not work for everyone."
Because this disease typically begins with skin plaque symptoms
and then progresses to joint involvement, physicians have faced
special diagnostic challenges in identifying patients with
psoriatic arthritis.
"As a dermatologist, I have seen many psoriatic arthritis
patients who have received conflicting diagnoses," said
Kenneth Gordon, MD, Department of Dermatology, Northwestern
University. "Now that there is an approved therapy for this
disease, my hope is that this approval heightens physicians' and
the public's awareness of the symptoms of psoriatic arthritis,
which may lead to quicker and more accurate diagnoses, thus more
effective treatment."
A supplemental Biologics License Application (sBLA) was
submitted for use of ENBREL in psoriatic arthritis on July 16,
2001. In September, the FDA granted "priority review"
status requiring that the agency act on the sBLA within six months
of submission date. The sBLA approval is based on two randomized,
double-blind, multicenter trials.
A 24-week, multicenter, randomized, double-blind,
placebo-controlled phase 3 study assessed the efficacy and
tolerability of ENBREL (25-mg twice-weekly subcutaneous
injections) or placebo in 205 patients with psoriatic arthritis.
The primary endpoint was measured by the proportion of patients
who met the American College of Rheumatology preliminary criteria
for improvement (ACR 20), which includes tender and swollen joint
counts, a patient as well as a physician global assessment,
patient assessment of pain, a disability index, and acute phase
reactant. In addition, a subset of clinical study patients was
measured by improvement in the psoriasis area and severity index (PASI).
PASI measures improvement in both the amount of psoriatic plaque
throughout the body, as well as the severity of the skin disease.
- 59 percent of 101 patients receiving ENBREL achieved an ACR
20 response compared to 15 percent of 104 patients receiving
placebo, after 12 weeks of treatment;
- 38 percent of 101 patients receiving ENBREL achieved an ACR
50 response compared to 4 percent of 104 patients receiving
placebo after 12 weeks of treatment;
- 11 percent of 101 patients receiving ENBREL achieved an ACR
70 response compared to 0 percent receiving placebo, after 12
weeks of treatment;
- Similar results were seen at 24 weeks.
In a subset of patients with a pre-defined severity of psoriasis,
responses increased over time, and at 6 months, the proportions of
patients achieving a 50% or 75% improvement in the psoriasis area
and severity index (PASI), were 47% and 23%, respectively, in the
ENBREL group (n=66) compared to 18% and 3%, respectively, in the
placebo group (n=62).
The results of this study were similar to those seen in an
earlier, single-center, randomized, placebo-controlled study of 60
patients with psoriatic arthritis.
Adverse events in the psoriatic arthritis trial were similar to
those reported in previous clinical trials of ENBREL in patients
with rheumatoid arthritis. There was no increase in the number of
serious adverse events including serious infections occurring in
psoriatic arthritis patients receiving ENBREL compared with those
receiving placebo. Only the rate of injection site reactions (ISRs)
in patients receiving ENBREL was statistically different compared
to placebo (36 percent vs. 9 percent). The most common type of
infection was upper respiratory infection (URI).
Following its launch in November 1998, ENBREL has been approved
for reducing signs and symptoms and inhibiting the progression of
structural damage in patients with moderately to severely active
RA; and in 1999 for reducing signs and symptoms in patients four
years of age and older with moderately to severely active
polyarticular-course juvenile rheumatoid arthritis who have had an
inadequate response to one or more disease modifying medicines.
ENBREL is the only tumor necrosis factor (TNF) inhibitor that can
be used as monotherapy (without methotrexate) and the only
biologic response modifier approved for use as a first-line
monotherapy for RA. The latest addition of psoriatic arthritis to
the approved indications for ENBREL demonstrates the significant
role of TNF in this condition.
"We have been laser-focused on developing ENBREL to its
full potential," said Peggy Phillips, Immunex executive vice
president and chief operating officer. "Psoriatic arthritis
represents another significant market where there is true need for
a breakthrough, effective product like ENBREL."
"Physicians will now, for the first time, have an approved
medication to address the painful signs and symptoms of psoriatic
arthritis from a unique biological perspective," said
Victoria Kusiak, MD, vice president and North American medical
director, global medical affairs, Wyeth-Ayerst Laboratories.
"Our collaboration with Immunex continues to develop novel
approaches to address potentially debilitating diseases."
ABOUT PSORIATIC ARTHRITIS
Like rheumatoid arthritis (RA), psoriatic arthritis is a
chronic inflammatory disease causing joint pain and swelling that
can lead to crippling along with inflamed and irritated scaly red
patches of skin throughout the body. It is a progressive and
debilitating disease and because there are no treatments
specifically approved for psoriatic arthritis, doctors often use
therapies approved for RA, including nonsteroidal
anti-inflammatory drugs (NSAIDs) and disease modifying
anti-rheumatic drugs (DMARDs). However, no DMARDs are currently
approved for use in psoriatic arthritis. The disease affects both
men and women most commonly between the ages 30 and 50. Psoriatic
arthritis patients are generally comanaged by rheumatologists and
dermatologists due to joint and skin manifestations of the
disease.
The National Psoriasis Foundation is an independent, non-profit
organization dedicated to improving the lives of people with
psoriasis and psoriatic arthritis. For more information on the
Foundation or psoriatic arthritis visit www.psoriasis.org.
ABOUT ENBREL
ENBREL is the only TNF receptor on the market. It acts by
binding TNF, one of the dominant inflammatory cytokines or
regulatory proteins that play an important role in both normal
immune function and the cascade of reactions that cause the
inflammatory process of RA and psoriatic arthritis. The binding of
ENBREL to TNF renders the bound TNF biologically inactive,
resulting in significant reduction in inflammatory activity.
SINCE THE PRODUCT WAS FIRST INTRODUCED, SERIOUS INFECTIONS,
SOME INVOLVING DEATH, HAVE BEEN REPORTED IN PATIENTS USING ENBREL.
MANY OF THESE INFECTIONS OCCURRED IN PATIENTS WHO WERE PRONE TO
INFECTIONS, SUCH AS THOSE WITH ADVANCED OR POORLY CONTROLLED
DIABETES. RARE CASES OF TUBERCULOSIS HAVE ALSO BEEN REPORTED.
ENBREL SHOULD BE DISCONTINUED IN PATIENTS WITH SERIOUS INFECTIONS.
DO NOT START ENBREL IF YOU HAVE AN INFECTION OF ANY TYPE OR IF YOU
HAVE AN ALLERGY TO ENBREL OR ITS COMPONENTS. ENBREL SHOULD BE USED
WITH CAUTION IN PATIENTS PRONE TO INFECTION. CONTACT YOUR
PHYSICIAN IF YOU HAVE ANY QUESTIONS ABOUT ENBREL OR INFECTIONS.
There have been reports of serious nervous system disorders
such as multiple sclerosis, seizures, or inflammation of the
nerves of the eyes. Tell your doctor if you have ever had any of
these disorders or if you develop them after starting ENBREL®
(etanercept). There have also been rare reports of serious blood
disorders, some involving death. Contact your doctor
immediately if you develop symptoms such as persistent fever,
bruising, bleeding, or paleness. It is unclear if ENBREL has
caused these nervous system or blood disorders. If your doctor
confirms serious blood problems, you may need to stop using ENBREL.
The most frequent adverse events in placebo-controlled RA
clinical trials involving 349 adults were injection site reactions
(ISR) (37%), infections (35%), and headache (17%). Only the rate
of ISR was higher than that of placebo. The most frequent adverse
events in a methotrexate-controlled clinical trial of 415 adults
with early-stage RA were infections (64%), ISR (34%), and headache
(24%). Of these, only the rate of ISR was higher than that of
methotrexate. In all 1,197 RA patients studied, malignancies were
rare (1%).
Adverse events in the psoriatic arthritis trial were similar to
those reported in RA clinical trials.
In a study of 69 patients with JRA, infections (62%), headache
(19%), abdominal pain (19%), vomiting (13%), and nausea (9%)
occurred more frequently than in adults. The types of infections
reported in JRA patients were generally mild and consistent with
those commonly seen in children. Serious adverse reactions
reported rarely were chicken pox (3%), gastroenteritis (3%),
serious infection (2%), depression/personality disorder (1%), skin
ulcer (1%), inflammation in parts of the upper digestive tract
(1%), and diabetes (1%).
Immunex Corporation and Wyeth-Ayerst Laboratories, a division
of American Home Products Corporation(NYSE: AHP), market ENBREL in
North America. Other AHP affiliates market ENBREL outside of North
America. Immunex manufactures ENBREL. Additional information about
ENBREL, including full prescribing information, can be found on
the company-sponsored Web site at (www.enbrel.com) or by calling
toll-free 888-4ENBREL (888-436-2735).
Immunex Corporation is a leading biopharmaceutical company
dedicated to improving lives through immune system science
innovations.
Wyeth-Ayerst Laboratories, a division of AHP, is a major
research-oriented pharmaceutical company with leading products in
the areas of women's health care, cardiovascular therapies,
central nervous system drugs, anti-inflammatory agents, infectious
disease, hemophilia, oncology, and vaccines. AHP is one of the
world's largest research-based pharmaceutical and health care
products companies. It is a leader in the discovery, development,
manufacturing and marketing of prescription drugs and
over-the-counter medications. It is also a leader in vaccines,
biotechnology, and animal health care.
NOTE: Except for the historical information contained
herein, this news release contains forward-looking statements that
involve substantial risks and uncertainties. Among the factors
that could cause actual results or timelines to differ materially
are risks associated with research and clinical development,
regulatory approvals, our supply capabilities and reliance on
third-party manufacturers, product commercialization, competition,
litigation and other risk factors listed from time to time in
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to risks described under the caption "Important Factors That
May Affect Our Business, Our Results of Operations and Our Stock
Price" within our most recently filed Form 10-Q. The
forward-looking statements contained in this news release
represent our judgment as of the date of this release. Immunex
undertakes no obligation to publicly update any forward-looking
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© 2002, Wyeth, Philadelphia, PA 19101 and
Immunex Corporation, Seattle, WA 98101