FDA Grants Accelerated Approval for SIRTURO™ (bedaquiline) as Part of Combination Therapy to Treat Adults with Pulmonary Multi-Drug Resistant Tuberculosis
Titusville, NJ (December 31, 2012) — Janssen Therapeutics, Division of Janssen Products, LP today announced the U.S. Food and Drug Administration (FDA) has granted accelerated approval to SIRTURO™ (bedaquiline) tablets in the treatment of pulmonary multi-drug resistant tuberculosis (MDR-TB) as part of combination therapy in adults. The accelerated approval is based on the surrogate endpoint of time to sputum culture conversion.
“SIRTURO™ was first discovered in our laboratories more than a decade ago and it is gratifying to see our discovery and development lead to its accelerated approval. This underscores our commitment as a company to discover, develop and responsibly deliver innovative medicines that address serious unmet medical needs,” said Paul Stoffels, M.D., Chief Scientific Officer and Worldwide Chairman, Pharmaceuticals, Johnson & Johnson.
SIRTURO™ inhibits mycobacterial ATP (adenosine 5'‑triphosphate) synthase, an enzyme that is essential for the generation of energy in Mycobacterium tuberculosis.
SIRTURO™ is a diarylquinoline antimycobacterial drug indicated as part of combination therapy in adults (≥ 18 years) with pulmonary MDR-TB. Reserve SIRTURO™ for use when an effective treatment regimen cannot otherwise be provided. SIRTURO™ should be administered by directly observed therapy (DOT). This indication is based on analysis of time to sputum culture conversion from two controlled Phase 2 trials in patients with pulmonary MDR-TB. The safety and efficacy of SIRTURO™ for the treatment of latent infection due to Mycobacterium tuberculosis has not been established. The safety and efficacy of SIRTURO™ for the treatment of drug-sensitive TB has not been established. In addition, there are no data on the treatment with SIRTURO™ of extra-pulmonary TB (e.g., central nervous system). Therefore, use of SIRTURO™ in these settings is not recommended.
The prescribing information for SIRTURO™ includes Boxed Warnings regarding increased risk of death and occurrence of QT prolongation. The Warnings and Precautions section provides additional information regarding these risks and includes risk of hepatic-related adverse drug reactions, drug interactions, use in HIV-TB co-infected patients and treatment failure. The most common adverse drug reactions were nausea, arthralgia and headache. Additional adverse events were hemoptysis and chest pain. Please see Important Safety Information below for more details.
The FDA accelerated approval of SIRTURO™ was based on data from TMC207-C208 Study 1 and Study 2. The primary endpoint was time to sputum culture conversion, defined as the interval in days between the first dose of study drug and the date of the first of two consecutive negative sputum cultures collected at least 25 days apart during treatment.
TMC207-C208 Study 1 is a placebo-controlled, double-blind, randomized trial conducted in newly diagnosed patients with multi-drug resistant pulmonary Mycobacterium tuberculosis. Patients were randomized to receive treatment with either SIRTURO™ and other drugs used to treat MDR-TB (SIRTURO™ treatment group) (n=79) or placebo plus other drugs to treat MDR-TB (placebo treatment group) (n=81); the other drugs used to treat MDR-TB consisted of a combination of five other antimycobacterial drugs (ethionamide, kanamycin, pyrazinamide, ofloxacin, and cycloserine/terizidone or available alternative). SIRTURO™ was administered as 400 mg once daily for the first two weeks and as 200 mg three times per week for the following 22 weeks. After the 24 week study drug (SIRTURO™ or placebo) treatment phase, patients continued to receive their other drugs used to treat MDR-TB until a total treatment duration of 18 to 24 months was achieved, or at least 12 months after the first confirmed negative culture.
The SIRTURO™ treatment group had decreased time to culture conversion and improved culture conversion rates compared to the placebo treatment group at week 24. Median time to culture conversion was 83 days for the SIRTURO™ treatment group, compared to 125 days for the placebo treatment group.
At week 24, culture conversation status results were:
- 77.6 percent of patients in the SIRTURO™ treatment group reached treatment success vs. 57.6 percent of patients in the placebo treatment group (p=0.014).
- 22.4 percent of patients in the SIRTURO™ treatment group experienced treatment failure vs. 42.4 percent of patients in the placebo treatment group.
- 7.5 percent of patients in the SIRTURO™ treatment group vs. 24.2 percent in the placebo treatment group experienced lack of conversion.
- Discontinuation rates were 14.9 percent for SIRTURO™ treatment group vs. 18.2 percent for the placebo treatment group.
At week 72, culture conversation status results were:
- 70.1 percent of patients in the SIRTURO™ treatment group reached treatment success vs. 56.1 percent of patients in the placebo treatment group (p=0.092).
- 29.9 percent of patients in the SIRTURO™ treatment group experienced treatment failure vs. 43.9 percent of patients in the placebo treatment group.
- 4.5 percent of patients in the SIRTURO™ treatment group vs. 10.6 percent in the placebo treatment group experienced lack of conversion.
- Discontinuation rates were 25.4 percent for SIRTURO™ treatment group vs. 33.3 percent for placebo treatment group.
TMC207-C208 Study 2 is a smaller, placebo-controlled study designed similarly to Study 1 except that SIRTURO™ or placebo was given for only 8 weeks instead of 24 weeks. Patients were randomized to either SIRTURO™ and other drugs used to treat MDR-TB (SIRTURO™ treatment group) (n=23) or placebo and other drugs used to treat MDR-TB (placebo treatment group) (n=24). Twenty-one patients randomized to the SIRTURO™ treatment group and 23 patients randomized to the placebo treatment group had confirmed MDR-TB based on subjects’ baseline M. tuberculosis isolate obtained prior to randomization. The SIRTURO™ treatment group had a decreased time to culture conversion and improved culture conversion rates compared to the placebo treatment group at week 8. At weeks 8 and 24, the differences in culture conversion proportions were 38.9 percent and 15.7 percent, respectively.
Important Safety Information
Warnings and Precautions
Increased Mortality: An increased risk of death was seen in the SIRTURO™ treatment group. The imbalance in deaths is unexplained.
QT Prolongation: SIRTURO™ prolongs the QT interval. An electrocardiogram (ECG) should be obtained before initiation of treatment, and at least 2, 12, and 24 weeks after starting treatment with SIRTURO™. Serum potassium, calcium, and magnesium should be obtained at baseline and corrected if abnormal. Discontinue SIRTURO™ and all other QT prolonging drugs if the patient develops clinically significant ventricular arrhythmia or a QTcF interval of >500 ms (confirmed by repeat ECG).
The following may increase the risk for QT prolongation when patients are receiving SIRTURO™, and therefore ECGs should be monitored closely: use with other QT-prolonging drugs including fluoroquinolones and macrolide antibacterial drugs and the antimycobacterial drug, clofazimine; a history of Torsade de Pointes; a history of cogenital long QT syndrome; a history of hypothyroidism and bradyarrhythmias; a history of uncompensated heart failure; serum calcium, magnesium, or potassium levels below the lower limits of normal.
SIRTURO™ has not been studied in patients with ventricular arrhythmias or recent myocardial infarction.
Hepatic-related Adverse Drug Reactions: More hepatic-related adverse drug reactions were reported with the use of SIRTURO™ plus other drugs to treat TB compared to other drugs used to treat TB without the addition of SIRTURO™. Alcohol and other hepatotoxic drugs should be avoided while on SIRTURO™, especially in patients with diminished hepatic reserve. Monitor symptoms and liver-related laboratory tests. Discontinue SIRTURO™ if aminotransferase elevations are accompanied by total bilirubin elevation >2X ULN; aminotransferase elevations are >8x ULN; or aminotransferase elevations persist beyond 2 weeks.
Drug Interactions: Co-administration of strong systemic CYP3A4 inducers (e.g., rifamycins such as rifampin, rifapentine, and rifabutin) should be avoided. Co-administration with strong systemic CYP3A4 inhibitors for more than 14 consecutive days should be avoided. Appropriate clinical monitoring for SIRTURO™-related adverse reactions is recommended.
HIV-TB Co-infected Patients: There are no clinical data on the combined use of antiretroviral agents and SIRTURO™ in HIV/MDR-TB co-infected patients, and only limited clinical data on the use in HIV/MDR-TB co-infected patients who were not receiving antiretroviral therapy.
Treatment Failure: SIRTURO™ should be administered by directly observed therapy. SIRTURO™ should only be administered in combination with at least 3 drugs active against the patient’s TB isolate. Nonadherence to the treatment regimen could result in failure or resistance.
The most common adverse drug reactions reported in greater than or equal to 10.0% of patients treated with SIRTURO™ compared to the placebo treatment group were nausea (38.0% vs. 32.1%), arthralgia (32.9% vs. 22.2%), headache (27.8% vs. 12.3%), and additional adverse events reported in greater than or equal to 10.0% of patients and with a higher frequency than the placebo treatment group were hemoptysis (17.7% vs. 11.1%) and chest pain (11.4% vs. 7.4%).
Please see full Prescribing Information and Medication Guide for more details.
About Janssen Therapeutics
At Janssen, we are dedicated to addressing and solving some of the most important unmet medical needs of our time in HIV and other infectious diseases. Driven by our commitment to patients, we develop innovative products, services and healthcare solutions to help people throughout the world. Headquartered in Titusville, New Jersey, Janssen Therapeutics, Division of Janssen Products, LP, is one of the Janssen Pharmaceutical Companies of Johnson & Johnson. Visit www.JanssenTherapeutics.com for more information and follow us on Twitter at @JanssenUS.
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