Bristol Myers Squibb announced results from the open-label switch period of Early AMPLE, a Phase IV exploratory biomarker study assessing the differences by which Orencia (abatacept) and another treatment, adalimumab, interfere with disease progression in moderate-to-severe early rheumatoid arthritis (RA) patients who tested positive (seropositive) for certain autoantibodies. Findings of the open-label switch period showed that early seropositive RA patients treated with Orencia demonstrated substantial clinical improvements at week 48, sustaining the level of responses achieved at week 24 compared to adalimumab. In seropositive patients switching from adalimumab to Orencia, the efficacy responses generally increased over the open-label period to week 48. These results are featured in a poster presentation at the European E-Congress of Rheumatology (EULAR) 2020.
The Early AMPLE study included early (≤ 12 months from symptom onset) moderate-to-severe RA patients who had never been treated with a biologic medication and who were seropositive for autoantibodies called anti-citrullinated protein antibody (ACPA) and rheumatoid factor (RF). These patients are considered to have more highly active, progressive RA and a poor disease prognosis.
Findings showed that among the 76 seropositive RA patients who entered the open-label switch period: The efficacy responses observed at 24 weeks with Orencia were sustained at week 48 in the patients who continued on Orencia. At week 48, ACR 20/50/70 responses with Orencia in the non-switch arm were 78, 63 and 50, respectively. At week 24, ACR 20/50/70 responses with Orencia were 83, 73 and 50, respectively; ACR 20/50/70 scores for adalimumab at week 24 were 63, 45 and 30, respectively.
In the patients who switched from adalimumab to Orencia, while the trial was not powered to show superiority or non-inferiority, the efficacy responses generally increased over the open-label period through week 48. ACR 20/50/70 scores for patients who switched from adalimumab to Orencia were 75, 63 and 38, respectively, at week 48.
Overall, patients with a well-known genetic marker of RA prognosis, called the “Shared Epitope” (SE), who continued on Orencia achieved numerically higher responses than the broader seropositive patient population at week 48, indicating the potential importance of SE as a predictor of response to Orencia. ACR 20/50/70 responses were 77, 67 and 53, respectively, for SE+ patients continuing on Orencia.
The overall safety profile of Orencia was consistent with prior studies, with no new safety signals identified.
The HLA-DRB1 allele, which codes for the Shared Epitope, provides instructions for making a protein that plays a key role in helping the immune system distinguish one’s own proteins from those of harmful invaders, such as bacteria and viruses. Shared Epitope has been shown to be strongly associated with RA, and is thought to be involved with the overactivation of immune cells, called T cells, that characterizes RA. Shared Epitope is present in 70-80 percent of RA patients positive for ACPA.
“We know that RA patients who are seropositive for anti-citrullinated protein antibodies and/or carry the Shared Epitope genotype are likely to have a more severe disease course and experience worse outcomes,” said Vivian P. Bykerk, MD, rheumatologist at Hospital for Special Surgery. “Early AMPLE results from the first phase, and now from the open-label switch period, suggest that seropositive early RA patients can achieve durable clinical responses with abatacept. Additionally, the findings indicate that these biomarkers have a role in early disease detection and may be useful in deriving personalized care plans for patients. This is a smaller trial, and further research is needed to confirm the results.”
Following the encouraging results of this study, Bristol Myers Squibb has initiated a clinical trial program to further explore the potential for improved efficacy of Orencia in seropositive RA, and the additional impact that Shared Epitope may have on this, through new head-to-head studies versus a TNF inhibitor and a JAK inhibitor.
“These data further support Orencia as a first-line treatment option for patients with key biomarkers of RA, showing that the high levels of response achieved by patients with a more severe disease course may be maintained over a long-term period,” said Dr. Brian Gavin, development lead, Orencia, Bristol Myers Squibb. “Through our precision-focused approach in immunology, we continue to advance biomarker science to guide treatment decisions, improve outcomes and expand therapeutic options for patients with immune-mediated diseases.”
At the European E-Congress of Rheumatology (EULAR) 2020, Bristol Myers Squibb is sponsoring a total of 27 abstracts. These include clinical and real-world results on Orencia that support our focus on furthering precision medicine and biomarker science in RA, as well as results that reinforce the safety and efficacy of Orencia as a treatment for moderate-to-severe juvenile idiopathic arthritis. Findings on BMS-986165, an investigational oral, selective tyrosine kinase 2 (TYK2) inhibitor being explored as part of Bristol Myers Squibb’s early Immunology program, will also be shared.
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