Eli Lilly and Company announced today that the Medicines and Healthcare products Regulatory Agency (MHRA) has granted marketing authorisation (MA) for mirikizumab (OMVOH®) for the treatment of adult patients with moderately to severely active ulcerative colitis who have had an inadequate response with, lost response to, or were intolerant to either conventional therapy or a biologic treatment.
“Ulcerative colitis is a chronic, relapsing inflammatory disorder affecting the large intestine. It is characterized by symptoms of diarrhoea, bleeding and urgency, with multidimensional, and often negative effects on patients’ personal, psychological, professional and social well-being. Our understanding of the aetio-pathogenesis is improving, but our treatment options remain limited,” said Professor Jimmy Limdi, Consultant Gastroenterologist/Head of IBD Section at Northern Care Alliance NHS Foundation Trust and Professor of Gastroenterology at University of Manchester. “The recent authorization of Mirikizumab, the first IL-23p19 inhibitor, is positive news for eligible people living with ulcerative colitis and gastroenterologists/specialists caring for them. It is a significant scientific advance welcomed by the medical community.”
Sarah Sleet, Chief Executive of Crohn’s & Colitis UK, welcomes the news: “Over 500,000 people in the UK are living with Crohn’s Disease and Ulcerative Colitis. They are lifelong conditions for which there is no known cure, and the symptoms are painful and debilitating. Existing medications may not work for some people, or indeed stop working for others. Expanding the treatment options for eligible people living with Colitis is a promising step forward and we welcome the MHRA’s decision to authorize mirikizumab.”
This authorization establishes mirikizumab as the first IL-23p19 antagonist to be authorized in Great Britain for the treatment of adults with moderate to severe Ulcerative Colitis and reflects our commitment to immunological diseases with high unmet need. We understand the importance of having novel treatment options for eligible patients and Lilly would like to thank the patients and investigators around the world who have made this possible.”
Laura Steele, President & General Manager, Northern Europe, Eli Lilly and Company
The authorization was based on results from the LUCENT program, which included two randomized, double-blind, placebo-controlled Phase 3 clinical trials, consisting of one 12-week induction study (LUCENT-1) and one 40-week maintenance study (LUCENT-2) for 52 weeks of continuous treatment.
In the LUCENT-1 induction study, 1,162 patients were included in the primary efficacy population. Patients were randomized 3:1 to receive mirikizumab (300 mg) intravenous (IV) or placebo IV every 4 weeks for 12 weeks. After 12 weeks of treatment with mirikizumab 24.2% (n=210/868) of patients achieved the primary endpoint of clinical remission compared to 13.3% (n=39/294) of placebo.
544 patients who achieved a clinical response with mirikizumab in LUCENT-1 (63.5%, n=551/868) were re-randomized 2:1 to receive mirikizumab (200 mg) subcutaneous injection or placebo subcutaneous injection every 4 weeks for another 40 weeks in LUCENT-2. Of the LUCENT-1 patients who achieved clinical response at 12 weeks, 49.9% (n=182/365) achieved clinical remission (primary end point) and 43.3% (n=158/365) achieved histologic-endoscopic mucosal remission (secondary end point) at one year, compared to placebo (25.1%, n=45/179 and 21.8%, n=39/179 for clinical remission and histologic-endoscopic mucosal remission, respectively).
Patients treated with mirikizumab achieved a greater reduction in rectal bleeding and stool frequency subscores as early as two weeks. The LUCENT studies also investigated endpoints such as bowel urgency remission and bowel urgency severity using the validated Urgency Numeric Rating Scale (NRS) of 0-10, with zero being no urgency and 10 being worst possible urgency. Decreases in bowel urgency severity were observed as early as two weeks in patients treated with mirikizumab. After treatment with mirikizumab, 42.9% (n=144/336) of patients achieved bowel urgency remission at one year, compared to 25% (n=43/172) of placebo.
The Phase 3 LUCENT clinical program also evaluated the safety profile of mirikizumab. The most frequently reported adverse reactions are upper respiratory tract infections (7.9 %, most frequently nasopharyngitis), headache (3.3 %), rash (1.1 %) and injection site reactions (8.7 %, subcutaneous injection, LUCENT-2).