Australian Public Assessment Report for Apremilast
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Australian Public Assessment Report for Apremilast Proprietary Product Name: Otezla Sponsor: Celgene Pty Ltd October 2015 Therapeutic Goods Administration About the Therapeutic Goods Administration (TGA) · The Therapeutic Goods Administration (TGA) is part of the Australian Government Department of Health and is responsible for regulating medicines and medical devices. · The TGA administers the Therapeutic Goods Act 1989 (the Act), applying a risk management approach designed to ensure therapeutic goods supplied in Australia meet acceptable standards of quality, safety and efficacy (performance), when necessary. · The work of the TGA is based on applying scientific and clinical expertise to decision- making, to ensure that the benefits to consumers outweigh any risks associated with the use of medicines and medical devices. · The TGA relies on the public, healthcare professionals and industry to report problems with medicines or medical devices. TGA investigates reports received by it to determine any necessary regulatory action. · To report a problem with a medicine or medical device, please see the information on the TGA website <https://www.tga.gov.au>. About AusPARs · An Australian Public Assessment Report (AusPAR) provides information about the evaluation of a prescription medicine and the considerations that led the TGA to approve or not approve a prescription medicine submission. · AusPARs are prepared and published by the TGA. · An AusPAR is prepared for submissions that relate to new chemical entities, generic medicines, major variations, and extensions of indications. · An AusPAR is a static document, in that it will provide information that relates to a submission at a particular point in time. · A new AusPAR will be developed to reflect changes to indications and/or major variations to a prescription medicine subject to evaluation by the TGA. Copyright © Commonwealth of Australia 2015 This work is copyright. You may reproduce the whole or part of this work in unaltered form for your own personal use or, if you are part of an organisation, for internal use within your organisation, but only if you or your organisation do not use the reproduction for any commercial purpose and retain this copyright notice and all disclaimer notices as part of that reproduction. Apart from rights to use as permitted by the Copyright Act 1968 or allowed by this copyright notice, all other rights are reserved and you are not allowed to reproduce the whole or any part of this work in any way (electronic or otherwise) without first being given specific written permission from the Commonwealth to do so. Requests and inquiries concerning reproduction and rights are to be sent to the TGA Copyright Officer, Therapeutic Goods Administration, PO Box 100, Woden ACT 2606 or emailed to <[email protected]>. AusPAR Apremilast (Otezla) Celgene Pty Ltd PM-2013-04920-1-3 Page 2 of 94 Final 22 October 2015 Therapeutic Goods Administration Contents List of abbreviations __________________________________________________________ 5 I. Introduction to product submission _____________________________________ 7 Submission details ____________________________________________________________________ 7 Product background __________________________________________________________________ 7 Regulatory status _____________________________________________________________________ 8 Product Information__________________________________________________________________ 9 II. Quality findings _____________________________________________________________ 9 Introduction ___________________________________________________________________________ 9 Drug substance (active ingredient) ________________________________________________ 10 Drug product _________________________________________________________________________ 10 Quality summary and conclusions _________________________________________________ 11 III. Nonclinical findings _____________________________________________________ 13 Introduction __________________________________________________________________________ 13 Pharmacology ________________________________________________________________________ 13 Pharmacokinetics ____________________________________________________________________ 16 Toxicology ____________________________________________________________________________ 18 Nonclinical summary and conclusions _____________________________________________ 24 IV. Clinical findings __________________________________________________________ 27 Introduction __________________________________________________________________________ 27 Pharmacokinetics ____________________________________________________________________ 31 Pharmacodynamics__________________________________________________________________ 32 Dosage selection for the pivotal studies ___________________________________________ 33 Efficacy _______________________________________________________________________________ 34 Safety _________________________________________________________________________________ 38 First round benefit-risk assessment _______________________________________________ 45 First round recommendation regarding authorisation ___________________________ 47 Clinical questions ____________________________________________________________________ 47 Population pharmacokinetics ______________________________________________________ 48 First round benefit-risk assessment _______________________________________________ 50 First round recommendation regarding authorisation ___________________________ 51 Clinical questions ____________________________________________________________________ 51 Second round benefit-risk assessment ____________________________________________ 52 Second round recommendation regarding authorisation ________________________ 52 V. Pharmacovigilance findings ____________________________________________ 52 Risk management plan ______________________________________________________________ 52 AusPAR Apremilast (Otezla) Celgene Pty Ltd PM-2013-04920-1-3 Page 3 of 94 Final 22 October 2015 Therapeutic Goods Administration VI. Overall conclusion and risk/benefit assessment __________________ 70 Quality ________________________________________________________________________________ 70 Nonclinical ___________________________________________________________________________ 70 Clinical ________________________________________________________________________________ 70 Risk management plan ______________________________________________________________ 82 Proposed regulatory action and indication ________________________________________ 82 Outcome ______________________________________________________________________________ 92 Attachment 1. Product Information ______________________________________ 93 Attachment 2. Extract from the Clinical Evaluation Report __________ 93 AusPAR Apremilast (Otezla) Celgene Pty Ltd PM-2013-04920-1-3 Page 4 of 94 Final 22 October 2015 Therapeutic Goods Administration List of abbreviations Abbreviation Meaning ACPM Advisory Committee on Prescription Medicines AE adverse event AMP adenosine monophosphate APR apremilast ASA Australian Specific Annex AUC area under the plasma concentration-time curve BID twice daily BMI body mass index BSA Body Surface Area cAMP cyclic adenosine monophosphate Cmax maximum plasma drug concentration Cmin minimum plasma drug concentration CrCL creatinine clearance CRF Case Report Form CsA cyclosporine DMARD disease modifying anti rheumatic drug EAIR Exposure Adjusted Incidence Rate EMA European Medicines Agency FDA US Food and Drug Administration GCP Good Clinical Practice HAQ-DI Health Assessment Questionnaire Disability Index IC50 half maximal inhibitory concentration IL interleukin IV intravenous LEF leflunomide AusPAR Apremilast (Otezla) Celgene Pty Ltd PM-2013-04920-1-3 Page 5 of 94 Final 22 October 2015 Therapeutic Goods Administration Abbreviation Meaning MACE Major Adverse Cardiac Events MTX methotrexate NSAID non steroidal anti inflammatory drug PASI Psoriasis Area Severity Index PBO placebo PDE4 phosphodiesterase 4 PI Product Information PO per os (oral) PsA psoriatic arthritis PSOR psoriasis PBO placebo QOL quality of life QTC corrected QT interval RA rheumatoid arthritis RMP Risk Management Plan SAE serious adverse event SSZ sulfasalazine t1/2 elimination half life TEAE treatment emergent adverse event Tmax time to reach maximum plasma concentration following drug administration TNF tumour necrosis factor TNF- tumour necrosis factor alpha TNF α tumour necrosis factor URTI upper respiratory tract infection AusPAR Apremilast (Otezla) Celgene Pty Ltd PM-2013-04920-1-3 Page 6 of 94 Final 22 October 2015 Therapeutic Goods Administration I. Introduction to product submission Submission details Type of submission: New chemical entity Decision: Approved Date of decision: 12 March 2015 Active ingredient(s): Apremilast Product name(s): Otezla Sponsor’s name and address: Celgene Pty Ltd Level 7, 607 St Kilda Road Melbourne VIC 3004 Dose form(s): Film coated tablets, unscored Strength(s): 10, 20 and 30 mg Container(s): Blister pack Pack size(s): 56 x 30 mg tablet 168 x 30 mg tablets ‘Titration pack’: 4 x 10 mg + 4 x 20 mg + 19 x 30 mg tablets Approved therapeutic use: Otezla is indicated for: · The treatment of signs and symptoms of active psoriatic arthritis in adult patients. · The treatment of adult patients with moderate to severe plaque psoriasis who are candidates for phototherapy or systemic therapy. Route(s) of administration: Oral Dosage: 30