Janssen Pharmaceuticals, Inc., and its development partner, Bayer HealthCare, today announced results from PMSS (Post-Marketing Safety Surveillance) and XANTUS (XARELTO® for Prevention of Stroke in Patients with Atrial Fibrillation), their landmark real-world studies evaluating the safety of XARELTO® in people with non-valvular atrial fibrillation (NVAF). The results found the rates and patterns of major bleeding in routine clinical practice were low (2.89 and 2.1 per 100 person-years, respectively) and generally consistent with those observed in Phase 3 clinical research. The studies, which collectively include more than 45,000 patients from 22 countries, were presented at ESC Congress 2015.
"Real-world research is an essential complement to clinical trials and helps inform treatment decisions, and these studies confirm the safety profile of rivaroxaban in real-world settings around the globe," said PMSS study investigator W. Frank Peacock, M.D., FACEP, Associate Chair and Research Director, Emergency Medicine, Baylor College of Medicine. "These findings show the use of rivaroxaban in day-to-day care is consistent with the safety profile observed in ROCKET AF, the landmark Phase 3 study used by regulatory authorities worldwide to approve the medicine for the prevention of stroke in patients with non-valvular atrial fibrillation."
Global Real-World Findings in NVAF
Janssen and Bayer HealthCare initiated the PMSS and XANTUS observational studies to evaluate the real-world safety performance of XARELTO® in patients with NVAF, as part of the global development program for the medicine:
PMSS (Post-Marketing Safety Surveillance)
PMSS is an ongoing, five-year, observational study that evaluates major bleeding in NVAF patients in the U.S. taking once-daily XARELTO® over the course of treatment. The two-year data, presented at ESC, found the rates and patterns of major bleeding were generally consistent with the Phase 3 ROCKET AF trial.
Of the 39,052 patients taking XARELTO® in PMSS, the incidence of major bleeding was observed at 2.89 per 100 person-years. The most common bleeding site was gastrointestinal, followed by intracranial. Fatal bleeds were uncommon, with an incidence of 0.1 per 100 person-years. Of the 7,111 patients who took XARELTO® in ROCKET AF, the incidence of major bleeding was observed at 3.6 per 100 person-years. The most common bleeding site was gastrointestinal, followed by intracranial. Fatal bleeds were uncommon, with an incidence of 0.2 per 100 person-years.
Of note, PMSS is a retrospective study with no comparator arm. Methodological differences limit the interpretation of the comparison to clinical trials.
XANTUS (XARELTO® for Prevention of Stroke in Patients with Atrial Fibrillation)
Designed by Bayer HealthCare, XANTUS is an international, prospective, single-arm, observational study to observe the rates of major bleeding and stroke over one year for people with NVAF taking once-daily XARELTO® for stroke prevention in Europe, Canada and Israel. Also presented at ESC and simultaneously published in the European Heart Journal, XANTUS, like PMSS, found the rates and patterns of major bleeding in routine clinical practice to be generally consistent with Phase 3 research. Of the 6,784 patients taking XARELTO®, the incidence of major bleeding was 2.1 per 100 person-years. Fatal bleeding, critical organ bleeding and intracranial hemorrhage were uncommon, and observed in 0.2, 0.7 and 0.4 per 100 person-years, respectively. The incidence of stroke was 0.7 per 100 person-years. Like PMSS, the XANTUS study had no comparator arm. Similar studies to XANTUS (XANTUS-EL and XANAP) are ongoing in the EMEA (Europe, Middle East & Africa), Latin America and Asia-Pacific regions.
"Unmatched by any oral anticoagulant in the non-vitamin K class in its size, scope and ambition, our EXPLORER research program continues to generate important clinical evidence on the real-world safety performance of XARELTO® and its potential role in addressing additional critical medical needs," said Paul Burton, M.D., Ph.D., Vice President, Medical Affairs, Janssen. "Through our global real-world safety studies, like PMSS and XANTUS, along with our clinical trials, including ROCKET AF, X-VeRT in cardioversion, VENTURE-AF in catheter ablation and PIONEER AF-PCI in percutaneous coronary intervention, we are examining the complete spectrum of anticoagulant use in patients with non-valvular atrial fibrillation."
Our Commitment to Atrial Fibrillation and Thrombosis Research
The EXPLORER program is an integral part of the extensive clinical development program for XARELTO®, evaluating its use in a broad range of cardiovascular conditions. By the time of its completion, more than 275,000 patients will have participated in the XARELTO® EXPLORER clinical development program, which includes ongoing and completed studies, independent registries and non-interventional studies.
The program is a collaborative research effort with Bayer HealthCare and is a blend of completed and ongoing studies that includes six additional indication-seeking trials. EXPLORER continues to assess the safety and efficacy of XARELTO® in high-risk patient populations, such as those with chronic heart failure, coronary artery disease, peripheral artery disease, acute coronary syndrome, embolic stroke of undetermined source, active cancer or who are medically ill. Three of the studies look at different NVAF populations:
- X-VeRT was the first prospective, exploratory trial comparing the safety and efficacy of XARELTO® to vitamin K antagonists (VKA), such as warfarin, in NVAF patients undergoing cardioversion, a common procedure that uses electrical stimulation to return the heart to normal rate and rhythm. Results were presented at ESC Congress 2014 and published last year in the European Heart Journal.
- VENTURE-AF was the first prospective, exploratory trial examining XARELTO® as an alternative to VKA in NVAF patients undergoing catheter ablation, a frequently used interventional procedure to remove abnormal tissue in the heart that is causing the irregular heartbeat or if cardioversion is unsuccessful. Results were published in the European Heart Journal in May of this year.
- PIONEER AF-PCI is an ongoing study evaluating XARELTO® in NVAF patients following percutaneous coronary intervention, also known as angioplasty, with stent placement, a common procedure used to open blocked coronary arteries and restore blood flow to the heart.
Janssen Pharmaceuticals, Inc.