Pfizer’s Xeljanz rejected in Europe

pharmafile | April 28, 2013 | News story | Sales and Marketing CHMP, Humira, Pfizer, RA, Xeljanz, rheumatoid arthritis 

Pfizer has suffered a major setback with the rejection of its new arthritis drug in Europe.

The EMA’s medicines committee the CHMP has rejected Xeljanz (tofacitinib citrate) for moderate-to-severe active rheumatoid arthritis (RA). The committee concluded that the drug doesn’t demonstrate a favorable risk:benefit profile, saying its benefits were weak and that side-effects were of concern.

Xeljanz promises to be the next generation of RA treatments, coming in a more convenient pill form compared to existing treatments, most notably Abbott’s injectable, Humira. Analysts predict Xeljanz could reach $2.5 billion in peak sales, but the EU rejection could ultimately affect this figure.

The rejection is surprising, as the FDA approved the drug in November, but the European experts seem to be more concerned about long-term exposure to the drug, and possible serious side-effects.

In the US, the FDA approved Xeljanz with a Risk Evaluation and Mitigation Strategy (REMS), and Pfizer is obliged to conduct a post-marketing study that will evaluate two doses of Xeljanz, and include a group of patients on another approved treatment to serve as a comparison.

However Europe’s expert committee said the drug did not show a consistent reduction in disease activity, and reduction of structural damage to joints had not been sufficiently demonstrated. The CHMP was also concerned about the raised risk of serious infections, gastrointestinal perforations, as well as cancers and lymphoma.

Pfizer has vowed to appeal against the ruling, and says its safety and efficacy have been established from its trials in around 5,000 patients across Phase 2 and 3 trials in more than 40 countries, resulting in 7,000 patient-years of exposure. The application was based on the same data provided to regulators in Japan and Russia and the US, which have all already approved the drug. This leads many analysts to believe the EU decision will be reversed, although extra restrictions on its use and safety measures are likely.

 “We have confidence in Xeljanz and believe our application to the EMA demonstrates that Xeljanz has a favourable risk:benefit profile. Xeljanz’s safety profile is well-characterised, and the issues raised by the EMA, including serious infections, gastrointestinal perforations and malignancies, are familiar to rheumatologists who are experienced working with treatments for patients to manage this difficult disease,” said Dr. Yvonne Greenstreet, senior vice president and the head of the Medicines Development Group for Pfizer Specialty Care.

“Each regulatory authority will review and interpret applications individually and different assessments are not uncommon. The re-examination process will enable us to seek to address the CHMP’s questions, and we will continue to work closely with the EMA with the goal of making this medicine available to appropriate patients in Europe.”

 

Andrew McConaghie

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