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Lilly’s arthritis drug hits trouble at FDA committee

Published on 24/04/18 at 09:52am

FDA’s advisory committee were openly conflicted about deciding on the safety of Eli Lilly and Incyte’s drug, baricitinib, for the treatment of rheumatoid arthritis (RA).

The drug had initially been rejected by the FDA in April of 2017, citing the lack of data on safety and to determine the correct dosage. It then performed an about-turn, allowing Lilly to reapply for approval.

Somewhat predictably, the same issues arose again during the discussions of the drug – despite Lilly offering additional data.

In the end, the committee voted 10-5 in favour of approving the lower 2mg dose of the drug but rejected the higher dose of 4mg by the same margin.

This comes as a blow for the companies involved, the 4mg was the treatment that they had wanted to take forward to patients.

It leaves the JAK inhibitor in troubled water when it comes to a launch – the FDA’s less-than-glowing appraisal will place it at a disadvantage, particularly with Pfizer’s Xeljanz already established on the market.

“Lilly is pleased that the Advisory Committee recommended approval of baricitinib and we are confident in the efficacy and safety data of this molecule,” said Christi Shaw, president, Lilly Bio-Medicines. “That said, we are disappointed with the committee's assessment of the 4-mg dose and continue to believe in its positive benefit/risk profile. Baricitinib 2-mg and 4-mg doses are approved in more than 40 countries, including Japan and the member states of the European Union.”

The main issue with safety comes after an instance of thrombosis occurred in a patient taking a 4mg dose. There was no question of the 4mg drug’s ability to treat RA, with the panel voting 15-0 in favour of recognising its efficacy.

Acting Chair, Jose Cher, Assistant Professor in Medicine and Rheumatology at New York University School of Medicine, noted: “None of these studies is powered to look for rare events”.

In particular, this would mean to determine what risk there was for further evidence of thrombosis or for blood clots, making it much harder to determine the safety of treatment. In conclusion, the panel voted to be cautious, although its decision is not binding, the FDA usually follows through on its recommendation.

Ben Hargreaves

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