Bristol-Myers Squibb Company has announced that the FDA has
approved a subcutaneous (SC) formulation of ORENCIA(R) (abatacept) for the
treatment of adults with moderate to severe rheumatoid arthritis (RA). ORENCIA
is indicated for reducing signs and symptoms, inducing major clinical response,
inhibiting the progression of structural damage, and improving physical
function in adult patients with moderately to severely active rheumatoid arthritis.
ORENCIA may be used as monotherapy or concomitantly with disease-modifying
antirheumatic drugs (DMARDs) other than tumor necrosis factor (TNF)
antagonists.ORENCIA should not be administered concomitantly with TNF antagonists.
ORENCIA is not recommended for use concomitantly with other biologic RA
therapy, such as anakinra.
ORENCIA is the first and only biologic for the treatment of
RA available in self-injectable (SC) and also an intravenous (IV) infusion
formulation. Since the majority of RA patients initiating therapy with a
biologic receive their treatment by SC injection, the approval of ORENCIA SC
offers physicians a choice for more of their patients.
The new self-injectable formulation is a fixed 125 mg dose administered
weekly through an injection under the skin following a single IV loading dose
of approximately 10 mg/kg. Patients who are unable to receive an infusion may
initiate weekly injections of subcutaneous ORENCIA without an intravenous
loading dose. Patients transitioning from ORENCIA intravenous therapy to
subcutaneous administration should administer the first subcutaneous dose
instead of the next scheduled intravenous dose.
ORENCIA SC demonstrated similar efficacy
(non-inferior for ACR 20 responses at 6 months) and safety to ORENCIA IV in a
large non-inferiority trial. Concurrent therapy with ORENCIA and a biologic DMARD
is not recommended. In controlled clinical trials, patients receiving
concomitant ORENCIA and TNF antagonist therapy experienced more infections (63
and serious infections (4.4%) compared to patients treated with only TNF
antagonists (43% and 0.8%, respectively), without an important enhancement of
efficacy. In the cumulative clinical trial program for IV, serious infections
were 3% in ORENCIA(R) (abatacept) vs. 1.9% in placebo while malignancies were 1.3%
in ORENCIA vs. 1.1% in placebo.
“Physicians now have a new option of a non anti-TNF,
with a different mechanism of action, when administering a biologic in a
subcutaneous formulation,” said Mark C. Genovese, M.D., professor of
medicine and co-chief, Division of Immunology and Rheumatology, Stanford University Medical Center
and lead investigator of the registrational study supporting the approval.
“The ORENCIA subcutaneous formulation demonstrated efficacy and safety
consistent with the IV formulation.
This choice is important for both patients and physicians
when managing moderate to severe RA.” The ORENCIA SC development program
is composed of four clinical trials which studied nearly 2,000 patients. The
Phase 3 comparative trial studied 1,457 patients, making it the single largest
Phase 3 registrational trial of biologics in RA patients. The other three studies
primarily evaluated safety and immunogenicity in three clinical scenarios:
patients receiving ORENCIA as a monotherapy, patients withdrawn from and
re-introduced to ORENCIA SC
therapy and patients switching from ORENCIA IV to ORENCIA SC
“Delivering medicines that meet the needs of patients
and physicians is core to Bristol-Myers Squibb’s mission and commitment,”
said Anthony Hooper, senior vice president, commercial operations, and president
U.S., Japan and Intercontinental,
Bristol-Myers Squibb. “The continued development of ORENCIA exemplifies
our company’s focus on areas of serious diseases and biologics drug
development.” ACQUIRE (Abatacept Comparison of Sub(Qu)cutaneous vs.
Intravenous in Inadequate Responders to MethotrexatE), the Phase 3
registrational trial, was a randomized, double-blind, double-dummy,
multinational study. The primary endpoint of ACQUIRE was to determine non-inferiority
of ORENCIA SC plus methotrexate (MTX) to ORENCIA IV plus
MTX by difference in ACR 20 response at 6 months. The study included 1,457
patients with moderately to severely active RA, most of whom had an inadequate
response to MTX. Patients were randomized to weekly injections of a 1 mL
solution containing a 125 mg dose of ORENCIA
SC plus MTX, following a single
IV loading dose (approximately 10 mg/kg) on Day 1, or ORENCIA IV (approximately
10 mg/kg) plus MTX on Days 1, 15, 29 and every 4 weeks thereafter, for 6 months.
Comparable ACR 20 response rates of 76% (95% confidence
interval CI: -4.
, 4.8 based on prespecified margin for non-inferiority of
-7.5% for the SC group) were seen in both groups of patients receiving SC injections
plus MTX or IV infusions plus MTX at month 6. ACR 50 and ACR 70 responses were
comparable between ORENCIA SC
and IV as were improvements in all patient-reported outcomes studied – pain,
physical function and global assessment of disease activity for ORENCIA SC
and IV at 6 months. High retention rates were seen at month 6: 94% of patients
receiving SC injections plus MTX and 94% of patients receiving ORENCIA IV plus
MTX remained in the study.
The safety experience and immunogenicity for ORENCIA SC
was consistent with the profile for IV therapy. Local subcutaneous
injection-site reactions occurred in 2.6% of patients receiving ORENCIA SC
plus MTX and 2.5% of patients receiving SC placebo plus MTX. All injection-site
reactions (including hematoma, pruritus and erythema) were mild (83 to moderate
(17 and none necessitated drug discontinuation.
Immunogenicity was observed in 1.1% and 2.3% of ORENCIA(R)
(abatacept) SC plus MTX and ORENCIA IV plus MTX patients, respectively. There
was no correlation of immunogenicity with effects on pharmacokinetics, efficacy
The most common adverse events reported in greater than 5%
of patients in either the SC or IV ORENCIA groups were headache,
nasopharyngitis, upper respiratory tract infection, diarrhea and nausea.
Serious adverse events occurred in 4.
% of patients in the ORENCIA SC plus MTX group and 4.9% of
patients in the ORENCIA IV plus MTX group. Of those, serious infections
occurred in 0.7% of patients in the ORENCIA SC plus MTX group versus 1.4% of
patients in the ORENCIA IV plus MTX group while malignancies occurred in 0.4%
of patients in the ORENCIA SC plus MTX group versus 0.7% of patients in the ORENCIA
IV plus MTX group.
will be commercially available in the U.S. in September 2011.