On December 11, 2022 Agios Pharmaceuticals, Inc. (NASDAQ: AGIO), a leader in the field of cellular metabolism pioneering therapies for rare diseases, reported new data from the ongoing extension study assessing the long-term efficacy and safety of PYRUKYND (mitapivat) in adults with pyruvate kinase (PK) deficiency who had participated in one of the pivotal studies, ACTIVATE and ACTIVATE-T, conducted in not regularly transfused and regularly transfused adults with PK deficiency, respectively (Press release, Agios Pharmaceuticals, DEC 12, 2022, View Source [SID1234625078]). Data from the studies were featured in multiple presentations at the 64th American Society of Hematology (ASH) (Free ASH Whitepaper) Annual Meeting and Exposition, hosted Dec. 10-13, 2022, in New Orleans. PYRUKYND is a first-in-class, oral PK activator and the first approved disease-modifying therapy for patients in the U.S. and EU with this rare, debilitating, lifelong hemolytic anemia.
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Long-term extension data (abstract # 2328) show that previously reported effects of PYRUKYND on hemoglobin and transfusion burden were maintained over time. As of the March 27, 2022 data cut-off, the median duration of hemoglobin response among the 31 hemoglobin responders from ACTIVATE and the long-term extension study was 18.3 months, with responses ongoing up to 32.9 months. Hemoglobin response rate among patients who switched from placebo in ACTIVATE to PYRUKYND in the extension study (39.5 percent Hb response rate) was similar to that observed in patients treated with PYRUKYND in ACTIVATE. All regularly transfused patients who achieved transfusion-free status in ACTIVATE-T with PYRUKYND treatment maintained transfusion-free status through the extension study for up to 38.3 months. PYRUKYND was well tolerated, and the safety profile was consistent with that in ACTIVATE and ACTIVATE-T, as well as previous studies.
"PYRUKYND is the first oral agent that has the potential to improve symptoms and long-term complications of PK deficiency in adult patients," said Rachael Grace, M.D., MMSc, director of hematology clinical research at Boston Children’s Hospital and investigator on the long-term extension study. "People living with PK deficiency experience a wide range of complications throughout their lives, including osteopenia, iron overload and pulmonary hypertension, many of which occur at earlier ages than would be expected. We are encouraged by the long-term extension data reported today and look forward to researching the efficacy and safety of PYRUKYND in the ACTIVATE-Kids and ACTIVATE-KidsT studies in pediatric PK deficiency patients who are not regularly transfused and are regularly transfused, respectively."
"Collectively, the data we have presented at ASH (Free ASH Whitepaper) continue to demonstrate the benefits of long-term treatment with PYRUKYND for adults with PK deficiency, including improvements in hemoglobin, transfusion burden, iron overload and patient-reported outcomes," said Sarah Gheuens, M.D., Ph.D., chief medical officer and head of R&D at Agios. "In addition to progressing our pivotal trials in pediatric patients, we are encouraged by the results from the long-term extension study of our Phase 2 study of PYRUKYND in both alpha- and beta-thalassemia, which we also presented at ASH (Free ASH Whitepaper), and believe the consistency of the data between indications further supports the potential of PYRUKYND to make a positive impact across rare blood disorders with similar underlying pathophysiology."
Agios also presented data at ASH (Free ASH Whitepaper) further supporting the potential of PYRUKYND to address hallmark symptoms and complications of PK deficiency. More details on the presentations are provided below and on the ASH (Free ASH Whitepaper) 2022 page on Agios.com.
Long-term Improvements in Patient-reported Outcomes in Patients with Pyruvate Kinase Deficiency Treated with Mitapivat (Abstract #506)
In an oral presentation, data from ACTIVATE, ACTIVATE-T and the long-term extension study were reported, showing that treatment with PYRUKYND was associated with long-term, durable and clinically meaningful improvements in signs, symptoms and functional impacts, irrespective of transfusion status. Patient-reported outcome (PRO) improvements among patients treated with PYRUKYND were sustained over time in the long-term extension (LTE) study through Week 84. At Week 84 of the LTE study, clinically meaningful improvements in PROs mean scores were achieved in more than half of patients. These results suggest that by improving health-related quality of life, treatment with PYRUKYND may provide meaningful patient-centric benefits.
Mitapivat Improves Iron Overload in Patients with Pyruvate Kinase Deficiency (Abstract #1021)
In a poster presentation, data from ACTIVATE and the long-term extension study were reported that showed meaningful long-term improvements in key systemic regulators of iron homeostasis and measures of iron overload – including erythroferrone, soluble transferrin receptor (sTfR) and hepcidin – continued up to 96 weeks in patients treated with PYRUKYND. Additionally, patients treated with PYRUKYND who had evidence of iron overload at baseline showed clinically meaningful and continued improvements in iron overload over time as measured by liver iron concentration (median [Q1, Q3] decrease from baseline to Week 96 of PYRUKYND treatment of –1.95 [–4.85, –0.70] mg Fe/g dw). Ferritin levels remained stable across both patient groups treated with PYRUKYND or placebo.
Mitapivat Improves Markers of Hemolysis and Erythropoiesis in Patients with Pyruvate Kinase Deficiency Irrespective of Hemoglobin Response (Abstract #3644)
In a separate poster presentation, data from the ACTIVATE study were reported showing that treatment with PYRUKYND improved markers of hemolysis and ineffective erythropoiesis in adults with PK deficiency. The analysis also shows that directional improvements occur even in patients who did not achieve the clinical trial definition of hemoglobin response.
PYRUKYND was approved in February 2022 by the U.S. Food and Drug Administration (FDA) and received marketing authorization in November 2022 by the European Medicines Agency (EMA) for adults with PK deficiency. Both the FDA and EMA have granted orphan drug designation to PYRUKYND in PK deficiency. In addition, PYRUKYND has been granted FDA orphan drug designation for the treatment of thalassemia and sickle cell disease, for which enrollment for ongoing pivotal studies is underway.
Conference Call Information
Agios will host a live investor event on Dec. 12, 2022, at 7:00 a.m. CT in New Orleans to review the key clinical oral and poster presentations from this year’s ASH (Free ASH Whitepaper) meeting. The event will be webcast live and can be accessed under "Events & Presentations" in the Investors and Media section of the company’s website at www.agios.com. The archived webcast will be available on the company’s website beginning approximately two hours after the event.
About PK Deficiency
Pyruvate kinase (PK) deficiency is a rare, inherited disease that presents as chronic hemolytic anemia, which is the accelerated destruction of red blood cells. The inherited mutation in the PKLR gene can cause a deficit in energy within the red blood cell, as evidenced by lower PK enzyme activity, a decline in adenosine triphosphate (ATP) levels and a build-up of upstream metabolites, including 2,3-DPG (2,3-diphosphoglycerate).
PK deficiency is associated with serious complications, including gallstones, pulmonary hypertension, extramedullary hematopoiesis, osteoporosis and iron overload and its sequelae, which can occur regardless of the degree of anemia or transfusion burden. PK deficiency can also cause quality of life problems, including challenges with work and school activities, social life and emotional health. Current management strategies for PK deficiency, including red blood cell transfusions and splenectomy, are associated with both short- and long-term risks. For more information, please visit www.knowpkdeficiency.com.
About PYRUKYND (mitapivat)
PYRUKYND is a pyruvate kinase activator indicated for the treatment of hemolytic anemia in adults with pyruvate kinase (PK) deficiency in the United States, and for the treatment of PK deficiency in adult patients in the European Union.
IMPORTANT SAFETY INFORMATION
Acute Hemolysis: Acute hemolysis with subsequent anemia has been observed following abrupt interruption or discontinuation of PYRUKYND in a dose-ranging study. Avoid abruptly discontinuing PYRUKYND. Gradually taper the dose of PYRUKYND to discontinue treatment if possible. When discontinuing treatment, monitor patients for signs of acute hemolysis and anemia including jaundice, scleral icterus, dark urine, dizziness, confusion, fatigue, or shortness of breath.
Adverse Reactions: Serious adverse reactions occurred in 10% of patients receiving PYRUKYND in the ACTIVATE trial, including atrial fibrillation, gastroenteritis, rib fracture, and musculoskeletal pain, each of which occurred in 1 patient. In the ACTIVATE trial, the most common adverse reactions including laboratory abnormalities (≥10%) in patients with PK deficiency were estrone decreased (males), increased urate, back pain, estradiol decreased (males), and arthralgia.
Drug Interactions:
Strong CYP3A Inhibitors and Inducers: Avoid concomitant use.
Moderate CYP3A Inhibitors: Do not titrate PYRUKYND beyond 20 mg twice daily.
Moderate CYP3A Inducers: Consider alternatives that are not moderate inducers. If there are no alternatives, adjust PYRUKYND dosage.
Sensitive CYP3A, CYP2B6, CYP2C Substrates Including Hormonal Contraceptives: Avoid concomitant use with substrates that have narrow therapeutic index.
UGT1A1 Substrates: Avoid concomitant use with substrates that have narrow therapeutic index.
P-gp Substrates: Avoid concomitant use with substrates that have narrow therapeutic index.
Hepatic Impairment: Avoid use of PYRUKYND in patients with moderate and severe hepatic impairment.
Please see full Prescribing Information and Summary of Product Characteristics for PYRUKYND.