New Real-World Observational Analysis of UPTRAVI® (selexipag) Underscores the Importance of Risk Assessment for Treating Pulmonary Arterial Hypertension (PAH) Patients

SOUTH SAN FRANCISCO, Calif., April 6, 2021 /PRNewswire/ — Findings from an evaluation of the primary 500 sufferers enrolled within the SPHERE registry (SelexiPag: tHe usErs dRug rEgistry) discovered greater than three-quarters (76%) of pulmonary arterial hypertension (PAH) sufferers handled with UPTRAVI® (selexipag) both maintained (56%) or diminished (20%) their one-year mortality danger rating. The SPHERE outcomes have been revealed within the April concern of the Journal of Heart and Lung Transplantation (JHLT). SPHERE is an ongoing real-world, observational, person registry utilizing two totally different danger evaluation strategies that describes the medical traits, outcomes and dosing/titration regimens in sufferers with PAH who’re being handled with UPTRAVI.

PAH is a quickly progressive illness with no identified treatment. For people with PAH, danger evaluation is critical to judge illness development and inform therapy choices primarily based on sufferers’ prognosis.1 UPTRAVI is an oral prostacyclin pathway agent (PPA) indicated for the therapy of sufferers with PAH (World Health Organization [WHO] Group I, practical class [FC] II-III) to delay illness development and cut back the danger of hospitalization. In the pivotal GRIPHON trial, UPTRAVI was confirmed to scale back the danger of illness development by 40%. 

“Within the PAH treatment paradigm, real-world evidence has become valuable information for physicians to consider when it comes to elevating the standard of care,” mentioned Nick Kim, M.D.*, major research investigator and professor of drugs on the University of California San Diego. “Findings from the SPHERE analysis reinforce the need for physicians to be conducting routine comprehensive risk assessments and utilizing available tools such as risk calculators to ensure that PAH patients are achieving their treatment goals.” 

In treating sufferers with PAH, routine complete danger evaluation is strongly beneficial by the 2015 European Society of Cardiology and the European Respiratory Society (ESC/ERS) Guidelines, as there isn’t a single variable that may present adequate diagnostic and prognostic data. Additionally, attaining and/or sustaining a low-risk profile is a beneficial sufficient therapy response for sufferers with PAH.2

In the evaluation of the info from the SPHERE registry, danger classes for one-year mortality are assigned to sufferers utilizing two totally different assessments, the Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension (COMPERA) and the Registry to Evaluate Early and Long-Term PAH Disease Management (REVEAL) danger calculators, and PAH sufferers are categorised as low, intermediate or excessive danger. Results from this evaluation confirmed that on the finish of the 18-month follow-up, 19.2% of sufferers had a decrease REVEAL 2.Zero danger rating, 57.8% skilled no change of their REVEAL 2.Zero danger rating, and 20.2% seen a rise of their REVEAL 2.Zero danger rating. The findings on this evaluation have been according to the COMPERA calculations as nicely, as 21.4% of sufferers skilled a optimistic change of their danger class (transferring from a extra severe to much less severe class), 54.4% maintained their danger class, and 19.4% skilled a adverse change of their danger class (transferring from a much less severe to a extra severe class).

SPHERE enrolled sufferers who have been both newly initiated on UPTRAVI (≤60 days earlier than enrollment) or beforehand acquired UPTRAVI with documentation of dose titration at research enrollment. Data from this SPHERE evaluation counsel that 87.8% of sufferers titrated UPTRAVI at a slower charge than 200-mcg BID increments, revealing that within the real-world surroundings sufferers have been titrated lower than the beneficial titration schedule within the GRIPHON research.3,4

“We’re proud to support SPHERE, as data from this registry furthers our understanding of UPTRAVI within a clinical setting in the U.S.,” mentioned Siân Walker, Head of Medical Affairs, Janssen U.S., Pulmonary Hypertension. “These findings add to the growing body of evidence that demonstrates the need for utilizing risk assessment tools in clinical practice that may optimize the standard of care for patients with PAH.”

Data from SPHERE are restricted to what’s collected throughout routine medical visits, and sufferers are noticed for as much as 18 months after enrollment. In this cohort, 94.8% of sufferers have PAH (WHO Group I), mostly idiopathic (49.2%) adopted by connective tissue illness (CTD)-associated PAH (26.4%). 31.0% and 49.6% of sufferers have WHO FC II and WHO FC III illness at baseline respectively. There have been no new security alerts recognized with UPTRAVI within the real-world setting, and the incidence of discontinuation on account of UPTRAVI treatment-related opposed occasions (AEs) remained low within the SPHERE evaluation (7.2%). The most typical AEs resulting in discontinuation have been headache (6.5%) and diarrhea (5.1%) in newly initiated sufferers, and worsening PAH (3.3%) and proper ventricular failure (1.9%) in beforehand initiated sufferers.

To learn the complete manuscript and study extra concerning the SPHERE evaluation, please go to https://www.jhltonline.org/article/S1053-2498(21)00018-8/fulltext

Real-World Data Limitations
Real-world information have the potential to complement randomized managed trial information by offering extra data as to how a drugs performs in routine medical observe. There are limitations, nevertheless, and real-world information can’t be used as stand-alone proof to validate the efficacy or security of a therapy.

About UPTRAVI® (selexipag) and the GRIPHON Trial
UPTRAVI is an oral selective prostacyclin IP receptor agonist for the therapy of PAH. UPTRAVI is the one globally out there oral therapy that works on the prostacyclin pathway with proof of long-term outcomes. UPTRAVI is offered for the therapy of sufferers with PAH (WHO Group I, FC II-III) in additional than 40 international locations. In the US, UPTRAVI is indicated for the therapy of PAH to delay illness development and cut back the danger of PAH-related hospitalization.2 In Europe, UPTRAVI is indicated for the long-term therapy of PAH in grownup sufferers with WHO FC II–III, both as mixture remedy in sufferers insufficiently managed with an endothelin receptor antagonist (ERA) and/or a phosphodiesterase kind 5 inhibitor (PDE-5), or as monotherapy in sufferers who usually are not candidates for these therapies.

The efficacy of UPTRAVI in PAH was established in GRIPHON (Prostacyclin [PGI2] Receptor agonist In Pulmonary arterial HypertensiON), the most important randomized, managed trial ever performed in PAH sufferers. The GRIPHON trial was the primary multicenter, long-term, double-blind, placebo-controlled, parallel-group, event-driven Phase Three research in sufferers with symptomatic PAH (N=1156; practically all WHO FC II-III at baseline) evaluating the consequences of UPTRAVI (n=574) vs placebo (n=582) focusing on the prostacyclin pathway (median period of publicity 1.Four years, as much as 4.2 years). UPTRAVI was proven to delay illness development and cut back the danger of hospitalization in contrast with placebo.3 Overall, the commonest AEs within the UPTRAVI group have been according to the identified unwanted side effects of prostacyclin, together with headache, diarrhea, nausea, and jaw ache.3

*Dr. Nick Kim has acquired analysis help from Janssen and has served as a paid advisor to the corporate.

The REVEAL Registry™ is a registered trademark of Actelion Pharmaceuticals Ltd.

Siân Walker Peasegood is an worker of Actelion Pharmaceuticals US, Inc.

IMPORTANT SAFETY INFORMATION

INDICATION
UPTRAVI® (selexipag) is indicated for the therapy of pulmonary arterial hypertension (PAH, WHO Group I) to delay illness development and cut back the danger of hospitalization for PAH.

Effectiveness was established in a long-term research in PAH sufferers with WHO Functional Class II-III signs.

Patients had idiopathic and heritable PAH (58%), PAH related to connective tissue illness (29%), and PAH related to congenital coronary heart illness with repaired shunts (10%).

CONTRAINDICATIONS
Concomitant use of sturdy inhibitors of CYP2C8 (eg, gemfibrozil) with UPTRAVI is contraindicated.

WARNINGS AND PRECAUTIONS

Pulmonary Veno-Occlusive Disease (PVOD)
Should indicators of pulmonary edema happen, think about the potential of related PVOD. If confirmed, discontinue UPTRAVI.

ADVERSE REACTIONS
Adverse reactions extra frequent in comparison with placebo (≥3%) are headache (65% vs 32%), diarrhea (42% vs 18%), jaw ache (26% vs 6%), nausea (33% vs 18%), myalgia (16% vs 6%), vomiting (18% vs 9%), ache in extremity (17% vs 8%), flushing (12% vs 5%), arthralgia (11% vs 8%), anemia (8% vs 5%), decreased urge for food (6% vs 3%), and rash (11% vs 8%).

These opposed reactions are extra frequent through the dose titration part.

Hyperthyroidism was noticed in 1% (n=8) of sufferers on UPTRAVI and in not one of the sufferers on placebo.

DRUG INTERACTIONS

CYP2C8 Inhibitors
Concomitant administration with gemfibrozil, a robust inhibitor of CYP2C8, doubled publicity to selexipag and elevated publicity to the lively metabolite by roughly 11-fold. Concomitant use of UPTRAVI with sturdy inhibitors of CYP2C8 is contraindicated.

Concomitant administration of UPTRAVI with clopidogrel, a reasonable inhibitor of CYP2C8, had no related impact on the publicity to selexipag and elevated the publicity to the lively metabolite by roughly 2.7-fold. Reduce the dosing of UPTRAVI to as soon as every day in sufferers on a reasonable CYP2C8 inhibitor.

CYP2C8 Inducers
Concomitant administration with an inducer of CYP2C8 and UGT 1A3 and 2B7 enzymes (rifampin) halved publicity to the lively metabolite. Increase UPTRAVI dose, as much as twice, when co-administered with rifampin. Reduce UPTRAVI when rifampin is stopped.

DOSAGE AND ADMINISTRATION

Recommended Dosage
Recommended beginning dose is 200 mcg twice every day. Tolerability could also be improved when taken with meals. Increase by 200 mcg twice every day, often at weekly intervals, to the best tolerated dose as much as 1600 mcg twice every day. If dose isn’t tolerated, cut back to the earlier tolerated dose.

Patients With Hepatic Impairment
For sufferers with reasonable hepatic impairment (Child-Pugh class B), the beginning dose is 200 mcg as soon as every day. Increase by 200 mcg as soon as every day at weekly intervals, as tolerated. Avoid use of UPTRAVI in sufferers with extreme hepatic impairment (Child-Pugh class C).

Co-administration With Moderate CYP2C8 Inhibitors
When co-administered with reasonable CYP2C8 inhibitors (eg, clopidogrel, deferasirox and teriflunomide), cut back the dosing of UPTRAVI to as soon as every day. Revert again to twice every day dosing frequency of UPTRAVI when co-administration of reasonable CYP2C8 inhibitor is stopped.

Dosage Strengths
UPTRAVI pill strengths:
200, 400, 600, 800, 1000, 1200, 1400, and 1600 mcg.
Please see full Prescribing Information.

About Pulmonary Arterial Hypertension (PAH)
PAH is a selected type of pulmonary hypertension (PH) that causes the partitions of the pulmonary arteries (blood vessels main from the best aspect of the guts to the lungs) to turn into thick and stiff, narrowing the house for blood to circulate, and inflicting an elevated blood strain to develop throughout the lungs. PAH is a severe, progressive illness with quite a lot of etiologies and has a significant impression on sufferers’ functioning in addition to their bodily, psychological and social wellbeing. There is at the moment no treatment for PH and it’s usually deadly.1,5,6 However, the final decade has seen vital advances within the understanding of the pathophysiology of PAH, reworking the prognosis for PAH sufferers from symptomatic enhancements in train tolerance 10 years in the past, to delayed illness development immediately.

About the Janssen Pharmaceutical Companies of Johnson & Johnson
At Janssen, we’re making a future the place illness is a factor of the previous. We’re the Pharmaceutical Companies of Johnson & Johnson, working tirelessly to make that future a actuality for sufferers in all places by combating illness with science, bettering entry with ingenuity, and therapeutic hopelessness with coronary heart. We give attention to areas of drugs the place we will make the largest distinction: Cardiovascular & Metabolism, Immunology, Infectious Diseases & Vaccines, Neuroscience, Oncology, and Pulmonary Hypertension.

Learn extra at www.janssen.com. Follow us at www.twitter.com/JanssenGlobal and www.twitter.com/JanssenUS. Actelion Pharmaceuticals US, Inc. and Actelion Pharmaceuticals Ltd. are a part of the Janssen Pharmaceutical Companies of Johnson & Johnson.

Cautions Concerning Forward-Looking Statements

This press launch accommodates “forward-looking statements” as outlined within the Private Securities Litigation Reform Act of 1995 relating to UPTRAVI® and the SPHERE registry. The reader is cautioned to not depend on these forward-looking statements. These statements are primarily based on present expectations of future occasions. If underlying assumptions show inaccurate or identified or unknown dangers or uncertainties materialize, precise outcomes might differ materially from any of the opposite Janssen Pharmaceutical Companies and/or Johnson & Johnson. Risks and uncertainties embody, however usually are not restricted to: challenges and uncertainties inherent in product analysis and growth, together with the uncertainty of medical success and of acquiring regulatory approvals; uncertainty of business success; manufacturing difficulties and delays; competitors, together with technological advances, new merchandise and patents attained by rivals; challenges to patents; product efficacy or security issues leading to product recollects or regulatory motion; modifications in conduct and spending patterns of purchasers of well being care services and products; modifications to relevant legal guidelines and rules, together with international well being care reforms; and traits towards well being care value containment. An additional checklist and descriptions of those dangers, uncertainties and different components could be present in Johnson & Johnson’s Annual Report on Form 10-Ok for the fiscal yr ended January 3, 2021, together with within the sections captioned “Cautionary Note Regarding Forward-Looking Statements” and “Item 1A. Risk Factors,” and within the firm’s most not too long ago filed Quarterly Report on Form 10-Q, and the corporate’s subsequent filings with the Securities and Exchange Commission. Copies of those filings can be found on-line at www.sec.gov, www.jnj.com, or on request from Johnson & Johnson. None of the Janssen Pharmaceutical Companies nor Johnson & Johnson undertakes to replace any forward-looking assertion on account of new data or future occasions or developments.




1 Galiè N, Humbert M, et al. Eur Heart J 2016; 37:67-119

2 Galiè N, et al. 2015 ESC/ERS pointers for the analysis and therapy of pulmonary hypertension. https://erj.ersjournals.com/content/erj/46/4/903.full.pdf. Accessed March 1, 2021.

3 UPTRAVI® (selexipag) full prescribing data. Actelion Pharmaceuticals US, Ltd.

4 Sitbon O, et al. N Engl J Med. 2015;373:2522-2533.

5 Vachiéry JL, Gaine S. Eur Respir Rev 2012; 21:313-20.

6 Hoeper MG, Gibbs SR. Eur Respir Rev 2014; 23:450-7.


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