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Otsuka scores EU schizophrenia approval, but acute myeloid leukaemia drug flops at Phase 3

Published on 01/08/18 at 11:03am

It’s bittersweet news for Otsuka as it emerges that the European Commission saw fit to approve its therapy Rxulti (brexpiprazole) for the treatment of schizophrenia in adults, but its subsidiary’s investigational treatment guadecitabine failed to achieve its co-primary endpoint in treatment-naïve acute myeloid leukaemia (AML) patients.

The second-generation (atypical) oral antipsychotic drug, developed in partnership with Lundbeck, was approved on the back of a positive recommendation from the Committee for Medicinal Products for Human Use (CHMP) back in May. The two companies will now work with pricing and reimbursement bodies across Europe to make the drug accessible, with first availability expected in early 2019.

However, this good news was somewhat muted by guadecitabine only a day earlier. In 815 treatment-naïve AML patients who are ineligible for intensive induction chemotherapy, the drug failed to significantly prolong overall survival (OS) or improve complete response rates versus controls.

Otsuka subsidiary Astex said that secondary endpoint and safety analysis is ongoing, but the company is also focusing on late-stage trials of the drug into relapsed and refractory AML, relapsed and refractory myelodysplastic syndromes and chronic myelomonocytic leukaemia.

“We are disappointed in the outcome of the ASTRAL-1 study. The study used very strict criteria of ineligibility to receive intensive chemotherapy based on age (over 75 years) or poor performance status (ECOG PS of 2 or 3) or comorbidities, which made it a difficult population to show superior benefit of guadecitabine,” said Mohammad Azab, Astex’s President and Chief Medical Officer.  “ASTRAL-1 is the largest global prospective study ever conducted in this specific patient population with low intensity therapy, with 815 patients randomized, of whom about 90% were treated with hypomethylating agents or HMAs (guadecitabine, azacitidine, or decitabine). The large body of clinical and genetic data will still provide the medical community with very valuable insights into the role of several prognostic clinical and genetic markers that may influence outcome with HMA treatment. We are extremely grateful to all the patients, physicians and other healthcare professionals, and partner research and manufacturing organisations who contributed to this global effort. We are now looking forward to the completion of the ASTRAL-2 and ASTRAL-3 studies currently actively recruiting in two different indications.”

Matt Fellows

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