A new kid on the block

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FDA APPROVAL OF DIROXIMEL FUMARATE FOR MULTIPLE SCLEROSIS

Time for another me-too or better-tolerated fumarate to treat relapsing-forms MS. 

The following is a summary and adapted version of yesterday’s press release

Biogen and Alkermes announced yesterday that the U.S. Food and Drug Administration (FDA) approved diroximel fumarate, a novel oral fumarate with a distinct chemical structure, for the treatment of relapsing forms of multiple sclerosis (MS), to include clinically isolated syndrome, relapsing-remitting disease and active secondary progressive disease. 

“The FDA’s approval of diroximel fumarate delivers on Biogen’s commitment to pursue new therapies that may provide meaningful impact for people living with relapsing MS, and we look forward to bringing it to the MS community as an additional treatment option,” said Alfred Sandrock, executive vice president, research and development, and chief medical officer at Biogen. 

“Diroximel fumarate is a novel fumarate that offers the well-characterized efficacy of dimethyl fumarate and has been studied for improved patient-reported gastrointestinal tolerability.”

“The approval of diroximel fumarate for relapsing MS marks the culmination of a multi-year development program and is the latest milestone in our mission to develop new treatments for patients living with chronic central nervous system disorders,” said Craig Hopkinson, M.D., chief medical officer and senior vice president of medicines development and medical affairs at Alkermes. “We are grateful to the patients and study investigators who have participated in our diroximel fumarate clinical trials and we look forward to working with our collaboration partners at Biogen to make this new treatment available to patients.”

The FDA approval of diroximel fumarate was based on a New Drug Application (NDA) submitted under the 505(b)(2) filing pathway. It included data from pharmacokinetic bridging studies comparing diroximel fumarate and dimethyl fumarate to establish bioequivalence, and relied, in part, on the FDA’s findings of safety and efficacy for dimethyl fumarate.

The NDA submission also included interim exposure and safety findings from EVOLVE-MS-1, an ongoing, Phase 3, single-arm, open-label, two-year safety study evaluating diroximel fumarate in patients with relapsing-remitting MS. Interim results from EVOLVE-MS-1 at the time of NDA submission included a low overall rate of diroximel fumarate treatment discontinuation due to adverse events (6.3 percent), and a rate of less than one percent of patients who discontinued diroximel fumarate treatment due to gastrointestinal (GI) adverse events. Additional exploratory efficacy endpoints in the ongoing EVOLVE-MS-1 study showed changes in clinical and radiological measures compared to baseline.

“MS is a heterogeneous disease, and real-world patient circumstances can vary, reinforcing the benefits of having therapeutic choices to support the diverse range of treatment considerations,” said Robert Naismith, M.D., professor of neurology, Washington University School of Medicine in St. Louis. “Throughout its clinical development program, diroximel fumarate has demonstrated a desirable therapeutic profile, making it a compelling new option for patients.”

“MS is a lifelong disease that has a significant impact on the people affected and their caregivers. We are encouraged by the progress being made in the treatment of MS, and pleased that another treatment option will soon be available,” said Bruce Bebo, Ph.D., executive vice president, research, National MS Society. “It’s important for people with MS to have treatments that are both efficacious and tolerable to help manage their disease.”

Under the terms of the license and collaboration agreement between Biogen and Alkermes, Biogen will pay Alkermes $150 million in connection with the FDA’s approval of diroximel fumarate. Biogen plans to account for this milestone payment as an asset that will be amortized over the expected useful life of the product. Alkermes is also entitled to receive a mid-teens percentage royalty on worldwide net commercial sales of diroximel fumarate, subject, under certain circumstances, to minimum annual payments for the first five years following FDA approval and customary reductions as set forth in the agreement.

Please see full Prescribing Information for diroximel fumarate.

About diroximel fumarate (diroximel fumarate)

Diroximel fumarate is a novel oral fumarate with a distinct chemical structure approved in the U.S. for the treatment of relapsing forms of multiple sclerosis, to include clinically isolated syndrome, relapsing-remitting disease and active secondary progressive disease. Once in the body, diroximel fumarate rapidly converts to monomethyl fumarate, the same active metabolite of dimethyl fumarate.

About the diroximel fumarate EVOLVE-MS Clinical Development Program

The key components of the EVOLVE-MS (Endeavoring to Advance Treatment for Patients Living with Multiple Sclerosis) clinical development program of diroximel fumarate include the EVOLVE-MS-1 study, a Phase 3, open-label, two-year safety study in relapsing-remitting multiple sclerosis (MS) patients, along with pharmacokinetic bridging studies comparing diroximel fumarate and dimethyl fumarate to demonstrate bioequivalence. The EVOLVE-MS clinical development program also includes the EVOLVE-MS-2 study, an elective Phase 3, five-week randomized, prospective, double-blind, multi-centre study that assessed the gastrointestinal (GI) tolerability of diroximel fumarate and dimethyl fumarate using self-administered GI questionnaires.

INDICATION and IMPORTANT SAFETY INFORMATION for diroximel fumarate (diroximel fumarate)

What is diroximel fumarate (diroximel fumarate)?

Diroximel fumarate is a prescription medicine used to treat people with relapsing forms of multiple sclerosis (MS), to include clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease, in adults. It is not known if diroximel fumarate is safe and effective in children.

Important Safety Information

Who should not take diroximel fumarate?

Patients should not use diroximel fumarate if they have had an allergic reaction (such as welts, hives, swelling of the face, lips, mouth or tongue, or difficulty breathing) to diroximel fumarate, dimethyl fumarate, or any of the ingredients in diroximel fumarate or if they are taking dimethyl fumarate.

Before taking and while taking diroximel fumarate, patients should tell their healthcare provider if they: have liver problems; kidney problems; have or have had low white blood cell counts or an infection; are pregnant or plan to become pregnant because it is not known if diroximel fumarate will harm an unborn baby; are breastfeeding or plan to breastfeed because it is not known if diroximel fumarate passes into breast milk; are taking prescription or over-the-counter medicines, vitamins, or herbal supplements.

What should patients avoid while taking diroximel fumarate?

Patients should not drink alcohol at the same time they take a diroximel fumarate dose.

What are the possible side effects of diroximel fumarate?

Diroximel fumarate may cause serious side effects including:

  • Allergic reaction (such as welts, hives, swelling of the face, lips, mouth or tongue, or difficulty breathing).
  • PML (progressive multifocal leukoencephalopathy), a rare brain infection that usually leads to death or severe disability over a period of weeks or months. Patients should tell their doctor right away if they get any of these symptoms of PML: weakness on one side of the body that gets worse, clumsiness in their arms or legs, vision problems, changes in thinking and memory, confusion, or personality changes.
  • Decreases in your white blood cell count, the patient’s healthcare provider should do a blood test to check their white blood cell count before starting treatment with diroximel fumarate and while on therapy. Patients should have bloods tests after 6 months of treatment and every 6 to 12 months after that.
  • Liver problems, the patient’s healthcare provider should do blood tests to check liver function before starting treatment with diroximel fumarate and during treatment if needed. Patients should tell their healthcare provider right away if they get any of these symptoms of a liver problem during treatment: severe tiredness, loss of appetite, pain on the right side of the stomach, have dark or brown (tea color) urine, or yellowing of the skin or the white part of the eyes.

The most common side effects of diroximel fumarate include: flushing, redness, itching, or rash; nausea, vomiting, diarrhea, stomach pain, or indigestion. Flushing and stomach problems are the most common reactions, especially at the start of therapy, and may decrease over time. Taking diroximel fumarate with food (avoid high-fat, high-calorie meal or snack) may help reduce flushing. Patients should call their healthcare provider if they have any of these symptoms, are bothered by them, or if they do not go away.

These are not all the possible side effects of diroximel fumarate. Patients should call their healthcare provider for medical advice about side effects. Patients may report side effects to FDA at 1-800-FDA-1088. For more information go to dailymed.nlm.nih.gov.

CoI: multiple

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.

9 comments

  • You used to discourage patients to go diy for their DMF but now you support it, the same moment Biogen no longer needs it as Vumerity is out. Great timing dont you think? 😉

    • ProfG still does discourage DIY chemistry. It can be very dangerous if you have impurities in chemicals this is why pharma spend a lot of time ensuring quality control

      • Diy as compound pharmacies, same for Pharma 😉

        “Prof G
        On the contrary, I am advocating good quality compounding by a pharmacy.”

        • Prior to the Big Pharma model of doing business, pharmacists worked as compounding pharmacists; it was part of their core skill set.

          • How do you find a good quality compounding pharmacy? Will they be doing the analytical chemistry and formulation?

            RE: The other option is to advocate untreated MS or catastrophic health expenditure.

            We need to help people get the medication that they need. Pharma companies need to be compensated _fairly_ for the value that they bring.

            But we also need to address other problems, too: Publicly traded companies are under enormous pressure to give shareholders as much money as they can squeeze from patients. Pharma companies only have 8-10 years to recoup the costs of development before the patent expires. And it may have taken 20-25 years to get to that point. Lastly, pharma companies also have to pay for researchers working on projects that didn’t make it to market. A lot of money is spent making a new drug.

            We want new innovative medicines to treat MS, but we don’t want to pay for it.

    • Kinda. The body metabolises it to that stuff. Good thing MS patients are not furniture 😀

      Not unusual for pharmaceuticals to be derived from other plants / chemicals.

      Gilenya from the cordyceps mushroom, vincristine from the periwinkle….list goes on.

  • Hurray another recycled drug with a very slight change from its underwhelming predecessor, Tecfidera.

    Didn’t Tecfidera cancel it’s trials on progressive MS because of likely failure? The breakthroughs in the MS research world just keep coming non stop.

    What is next? Liquid or monthly interferon? Once monthly Copaxone? Another fingolimod clone? Another derivative of rituximab?

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