Betmiga, INN-Mirabegron
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18 October 2012 EMA/706651/2012/corr. Committee for Medicinal Products for Human Use (CHMP) Assessment report Betmiga International non-proprietary name: mirabegron Procedure No. EMEA/H/C/002388 Note Assessment report as adopted by the CHMP with all information of a commercially confidential nature deleted. 7 Westferry Circus ● Canary Wharf ● London E14 4HB ● United Kingdom Telephone +44 (0)20 7418 8400 Facsimile +44 (0)20 7418 8416 E -mail [email protected] Website www.ema.europa.eu An agency of the European Union © European Medicines Agency, 2017. Reproduction is authorised provided the source is acknowledged. Table of contents 1. Background information on the procedure .............................................. 5 1.1. Submission of the dossier ...................................................................................... 5 1.2. Steps taken for the assessment of the product ......................................................... 6 2. Scientific discussion ................................................................................ 7 2.1. Introduction......................................................................................................... 7 2.2. Quality aspects .................................................................................................... 9 2.2.1. Introduction ...................................................................................................... 9 2.2.2. Active substance ............................................................................................... 9 2.2.3. Discussion on chemical, and pharmaceutical aspects ............................................ 12 2.2.4. Conclusions on the chemical, pharmaceutical and biological aspects ...................... 12 2.2.5. Recommendation(s) for future quality development ............................................. 12 2.3. Non-clinical aspects ............................................................................................ 12 2.3.1. Introduction .................................................................................................... 12 2.3.2. Pharmacology ................................................................................................. 13 2.3.3. Pharmacokinetics............................................................................................. 15 2.3.4. Toxicology ...................................................................................................... 17 2.3.5. Ecotoxicity/environmental risk assessment ......................................................... 20 2.3.6. Discussion on non-clinical aspects...................................................................... 21 2.3.7. Conclusion on the non-clinical aspects ................................................................ 23 2.4. Clinical aspects .................................................................................................. 23 2.4.1. Introduction .................................................................................................... 23 2.4.2. Pharmacokinetics............................................................................................. 24 2.4.3. Pharmacodynamics .......................................................................................... 29 2.4.4. Discussion on clinical pharmacology ................................................................... 30 2.4.5. Conclusions on clinical pharmacology ................................................................. 32 2.5. Clinical efficacy .................................................................................................. 32 2.5.1. Dose response study(ies) ................................................................................. 33 2.5.2. Main study(ies) ............................................................................................... 34 2.5.3. Discussion on clinical efficacy ............................................................................ 93 2.5.4. Conclusions on the clinical efficacy ..................................................................... 98 2.6. Clinical safety .................................................................................................... 98 2.6.1. Discussion on clinical safety ............................................................................ 114 2.6.2. Conclusions on the clinical safety ..................................................................... 116 2.7. Pharmacovigilance ............................................................................................ 117 2.8. User consultation ............................................................................................. 127 3. Benefit-Risk Balance ......................................................................... 127 4. Recommendations ............................................................................. 129 Assessment report EMA/706651/2012 Page 2/130 List of abbreviations AE Adverse event APTC/MACE Antiplatelet Trialists’ Collaboration/Major adverse cardiovascular events AR Adrenoceptor AUR Acute urinary retention BCS Biopharmaceutical Classification System BMI Body mass index BOO Bladder outlet obstruction Bpm Beats per minute cAMP Cyclic adenosine 3', 5'-monophosphate CFR Code of Federal Regulations CHMP Committee for Medicinal Products for Human Use CIOMS Council of International Organizations of Medical Sciences CL Total body clearance CLcr Creatinine clearance CLR Renal clearance CNS Central nervous system CSR Clinical study report CYP Cytochrome P450 DBP Diastolic blood pressure DDI Drug-drug interaction ddQTcI Difference in baseline-adjusted QTcI from placebo ECG Electrocardiogram eGFR Estimated glomerular filtration rate Emax Maximum effect ER Extended release EU/NA Europe, North America and Australia FAS Full analysis set FAS-I Full analysis set-incontinence GCP Good Clinical Practice HRQL Health-related quality of life ICH International Conference on Harmonisation IND Investigational New Drug IOP Intraocular pressure IR Immediate release ISS Integrated Summary of Safety ITT Intent-to-treat ITT-I Intent-to-treat-incontinence LOCF Last observation carried forward LUTS Lower urinary tract symptoms Assessment report EMA/706651/2012 Page 3/130 MAA Marketing Authorization Application MDRD Modification of diet in renal disease MRHD Maximum recommended human dose (50 mg mirabegron daily) NDA New Drug Application NSA National Scientific Advice OAB Overactive bladder OAB-q Overactive Bladder Questionnaires OCAS Oral controlled absorption system OCAS-M Oral controlled absorption system with an intermediate dissolution rate OCT Organic cation transporters PD Pharmacodynamic PDCO Pediatric Committee P-gp P-glycoprotein PIP Pediatric Investigation Plan PK Pharmacokinetic PPBC Patient perception of bladder condition PPIUS Patient perception of intensity of urgency scale PPS Per protocol set PPS-I Per protocol set-incontinence PRO Patient related outcomes PT Preferred term PVR Postvoid residual PYE Patient-years of exposure QTc Corrected QT interval QTcF Corrected QT interval by Fridericia’s formula QTcI Individually corrected QT interval SAE Serious adverse event SAF Safety analysis set SAP Statistical Analysis Plan SBP Systolic blood pressure SIADH Syndrome of inappropriate antidiuretic hormone secretion SPA Special protocol assessment TEAE Treatment-emergent adverse event TEN Toxic epidermal necrolysis TQT Thorough QT TS-VAS Treatment satisfaction – visual analog scale UGT Uridine diphospho-glucuronosyltransferase US United States UTI Urinary tract infection Assessment report EMA/706651/2012 Page 4/130 1. Background information on the procedure 1.1. Submission of the dossier The applicant Astellas Pharma Europe B.V. submitted on 25 August 2011 an application for Marketing Authorisation to the European Medicines Agency (EMA) for Betmiga, through the centralised procedure under Article 3 (2) (a) of Regulation (EC) No 726/2004. The eligibility to the centralised procedure was agreed upon by the EMA/CHMP on 22 July 2010. The applicant applied for the following indication: Symptomatic treatment of urgency, increased micturition frequency and/or urgency incontinence as may occur in patients with overactive bladder (OAB) syndrome. The legal basis for this application refers to: Article 8.3 of Directive 2001/83/EC - complete and independent application. The application submitted is composed of administrative information, complete quality data, non- clinical and clinical data based on applicants’ own tests and studies and/or bibliographic literature substituting/supporting certain test(s) or study(ies). Information on Paediatric requirements Pursuant to Article 7 of Regulation (EC) No 1901/2006, the application included an EMA Decision P/172/2010 on the agreement of a paediatric investigation plan (PIP). At the time of submission of the application, the PIP P/172/2010 was not yet completed as some measures were deferred. Information relating to orphan market exclusivity Similarity Pursuant to Article 8 of Regulation (EC) No 141/2000 and Article 3 of Commission Regulation (EC) No 847/2000, the applicant did not submit a critical report addressing the possible similarity with authorised orphan medicinal products because there is no authorised orphan medicinal product for a condition related to the proposed indication. Applicant’s request for consideration New active Substance status The applicant requested the active substance mirabegron contained in the above medicinal product to be considered