Digestive Disease Week

Digestive Disease Week

Perspective from Stephen B. Hanauer, MD
June 05, 2019
3 min read
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Mirikizumab effective in Crohn’s induction

Perspective from Stephen B. Hanauer, MD
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Bruce Sands
Bruce Sands

SAN DIEGO — Patients with Crohn’s disease treated with mirikizumab for induction therapy experienced improvements to clinical and endoscopic outcomes, according to research presented at Digestive Disease Week.

Bruce E. Sands, MD, of the Icahn School of Medicine at Mount Sinai, said agents that target the interleukin-23 pathway, like mirikizumab, have shown efficacy in CD. The drug has also shown success in treating ulcerative colitis and psoriasis.

“Mirikizumab is a humanized immunoglobulin G4 monoclonal antibody, and it binds to the p19 subunit of IL-23,” Sands said in his presentation. “We assessed the safety and efficacy of mirikizumab with a phase 2, multi-center, randomized, parallel-arm, double-blind, placebo-controlled trial in patients with moderate-to-severely active Crohn’s disease.”

Researchers randomly assigned 191 patients to receive either 200 mg (n = 31), 600 mg (n = 32) or 1,000 mg (n = 64) of mirikizumab (LY3074828; Eli Lilly) or placebo (n = 64) intravenously at weeks 0, 4 and 8. Their primary goal was to determine the superiority of mirikizumab over placebo for the induction of endoscopic response — defined as a 50% reduction from baseline in Simple Endoscopic Score for CD (SES-CD) — at week 12. They also included clinical remission and endoscopic remission as secondary outcomes.

At week 12, in which 10.9% of patients achieved endoscopic response (95% CI, 3.3–18.6), response rates were better in all three mirikizumab groups vs. placebo. The 200 mg group experienced a 25.8% response rate (95% CI, 10.4–41.2), the 600 mg group achieved a 37.5% response rate (95% CI, 20.7–54.3) and the 1,000 mg group achieved a 43.8% response rate (95% CI, 31.6–55.9).

Additionally, data showed that patients in the 600 mg and 1,000 mg mirikizumab groups achieved better rates of endoscopic remission (P = .032 and P = .009, respectively) and clinical remission assessed by patient reported outcomes (28.1% and 21.9%, respectively). All three treatment groups showed greater response regarding CD activity index (200 mg: P = .015; 600 mg: P = .001; 1.000 mg: P = .026).

The safety findings of the study were similar to the drug’s previous safety profile, with the frequency of serious and treatment-emergent adverse events in all three treatment arms similar to placebo.

“Mirikizumab treatment resulted in significant improvement in endoscopic findings, significant improvement in patient reported outcomes and Crohn’s disease activity index,” Sands concluded. “We feel that these data support the further development of Mirikizumab for Crohn’s disease.” – by Alex Young

Reference:

Sands B, et al. Abstract 1,003. Presented at: Digestive Disease Week; May 18-21, 2019; San Diego.

Disclosures: Sands reports financial ties to 4D Pharma, Allergan, Sales, Amgen, Arena, Boehringer Ingelheim, Capella Biosciences, Celgene, EnGene, Ferring, Gilead, Janssen, Lilly, Lyndra, MedImmune, Oppilan, Otsuka, Palatin Technologies, Pfizer, Progenity, Rheos Medicine, Seres Therapeutics, Syngery, Takeda, Target Pharmasolutions, Theravance Biopharma, TiGenix, Vivelix and WebMD. Please see the meeting disclosure index for all other authors’ relevant financial disclosures.