Pfizer Marstacimab regulatory submissions for treatment of Hemophilia A and B accepted by USFDA, EMA

New York: Pfizer Inc. has announced that the U.S. Food and Drug Administration (FDA) has accepted the company’s Biologics License Application (BLA) for its anti-tissue factor pathway inhibitor (anti-TFPI) candidate marstacimab for individuals living with hemophilia A or hemophilia B without inhibitors to Factor VIII (FVIII) or Factor IX (FIX). The European marketing authorization application (MAA) for marstacimab also passed validation and is currently under review by the European Medicines Agency (EMA).

The FDA has set a Prescription Drug User Fee Act (PDUFA) action date in the fourth quarter of 2024, and a decision from the European Commission is anticipated by the first quarter of 2025. “If approved in the U.S. and EU, marstacimab is expected to become the first once-weekly subcutaneous treatment for people living with haemophilia B and the first treatment administered as a flat dose for people living with haemophilia A or B,” the Company stated in a release.

“Marstacimab has demonstrated that it may be an efficacious treatment option with once-weekly, subcutaneous flat-dose administration via an auto-injector pen, for appropriate patients, if approved. This is critical as intravenous infusions are typically required for people living with these diseases today,” said James Rusnak, M.D., Ph.D., Senior Vice President, Chief Development Officer, Internal Medicine and Infectious Diseases, Research and Development, Pfizer. “We look forward to progressing the review of this novel therapy with the FDA, EMA, and global regulatory authorities to bring this important medicine to patients globally.”

For more than five decades, the most common treatment approach for hemophilia A and B has been factor replacement therapy, which replaces missing clotting factors to facilitate proper blood coagulation. Marstacimab is a novel, investigational treatment for hemophilia that is designed to restore hemostasis by inhibiting TFPI. For appropriate patients living with hemophilia A and B, the goal of this treatment is to prevent potentially life-threatening bleeds with a once-weekly, subcutaneous flat-dose administration.

The submissions for marstacimab are based on efficacy and safety data from the Phase 3 BASIS trial (NCT03938792). Key findings were recently presented at the American Society of Hematology (ASH) Annual Meeting and Exposition on December 9, 2023. The inhibitor cohort of the BASIS trial has completed enrollment and is expected to read out as early as late 2024.

Read also: Pfizer Elrexfio gets European Commission approval for Multiple Myeloma

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Are intracavernosal injections of platelet-rich plasma effective against erectile dysfunction?

Italy: Platelet-rich plasma (PRP) intracavernosal injections may objectively improve or at least show a tendency for recovery in erectile function in men affected by primary organic erectile dysfunction (ED), a recent meta-analysis has revealed. The findings were published online in the International Journal of Impotence Research on November 22 2023.

“The generalizability of these observations may be limited by the short-term follow-up and patient numbers,” the researchers wrote. “Large-scale, high-quality, and standardized controlled trials would be needed before recommending its definitive use in clinical practice.”

According to the study, plasma-rich intracavernosal injections appeared to offer a small but clinically meaningful improvement in erectile function in patients with mild-to-moderate primary, organic, non-introgenic erectile dysfunction.

Off-label plasma-rich intracavernosal injections are not currently recommended for the treatment of erectile dysfunction as administration technique, dose, and timing are unknown. However, the studies have not shown any significant adverse effects. Therefore, Alessandro Tafuri, Department of Urology, “Vito Fazzi” Hospital, Lecce, Italy, and colleagues aimed to summarize the latest evidence on PRP intracavernosal injections efficacy in men affected by primary organic erectile dysfunction.

For this purpose, the Italian researchers reviewed the literature for randomized controlled trials (RCTs) or prospective and retrospective comparative studies that evaluated PRP alone or in combination for treating ED. A qualitative and quantitative data synthesis was provided after conducting a comprehensive search in online databases.

Seven records were included: three RCTs assessed PRP versus placebo, three studies compared low-intensity shock wave therapy (Li-SWT) or low-intensity pulsed ultrasound alone with their combination with PRP, and one study separately tested PRP and Li-SWT. Of 641 included patients, 320 received PRP.

The study led to the following findings:

· Despite the heterogeneity among inclusion criteria, dose and protocol of PRP administration, and outcomes measured, most studies independently reported better sexual outcomes in patients who received PRP, without significant severe side effects.

· In meta-analysis, where only placebo-controlled studies were included, patients treated with PRP showed higher International Index of Erectile Function (erectile function domain) score compared to patients who received placebo: pooled mean difference of 2.99 after 1 month (209 patients) versus 2.85 after 3 months (204 patients) versus 3.21 after 6 months (199 patients) of follow-up.

· Plasma-rich injections resulted in continued improvements in at least one erectile function/domain score over time (between 1 and 6 months) compared with placebo.

“There would be a need for high-quality, large-scale, and standardized controlled trials before recommending definitive use of platelet-rich plasma intracavernosal injections in clinical practice,” the researchers concluded.

The limitations include a dearth of randomized controlled studies, absence of patient homogeneity, variable ED criteria, and lack of agreement and standardization of intracavernosal injection preparation, dosing, and administration.

Reference:

Panunzio, A., Labate, C., Zacheo, F., Orlando, R., Rizzo, F. L., Porcaro, A. B., Migliorini, F., Pagliarulo, V., & Tafuri, A. (2023). Platelet-rich plasma intracavernosal injections for the treatment of primary organic erectile dysfunction: A systematic review and meta-analysis of contemporary controlled studies. International Journal of Impotence Research, 1-10. https://doi.org/10.1038/s41443-023-00798-y

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Resin-based composites containing finer fillers best maintain glossiness after routine tooth brushing: Study

USA: A recent study published in the Journal of Esthetic and Restorative Dentistry has shed light on the isolated effect of filler particle size on surface properties of experimental resin composites before and after toothbrush abrasion.

The researchers showed a significant reduction in gloss of resin-based composites (RBCs) containing fillers with larger particle sizes. There was an increase in surface roughness after toothbrushing abrasion for all RBCs, except those containing the finest-sized fillers.

“The particle size of the filler is a crucial determinant of the gloss and surface roughness of RBCs, after polishing and toothbrushing,” reported Mikihiro Kobayashi, Oregon Health & Science University, Portland, Oregon, USA, and colleagues.

The study was conducted to isolate the relationship between filler size and the surface properties of roughness and gloss before and after toothbrush abrasion for experimental resin-based composites containing uniform spherical fillers.

For this purpose, the researchers studied five experimental light-cured RBCs with different spherical filler sizes and three commercial RBCs. Using silicon carbide papers, forty specimens were polished. Gloss measurement was done after 0, 90, 180, and 360 min of simulated toothbrushing, and surface roughness was measured before and after 360 min of toothbrushing. The RBCs were compared using the two-way ANOVA/Tukey’s multiple comparison tests, and the correlation between particle size and surface gloss or roughness was also determined.

The study led to the following findings:

  • After polishing and toothbrushing, RBCs with smaller fillers exhibited significantly lower surface roughness and higher gloss, and RBCs with larger fillers exhibited lower gloss and higher surface roughness.
  • There was a significant correlation between filler particle size and gloss and surface roughness, both before and after toothbrush abrasion.

“The gloss of resin-based composites is reduced by increased surface roughness caused by toothbrush abrasion,” the researchers wrote. “Resin-based composites containing finer fillers best maintain glossiness after routine tooth brushing.”

Reference:

Kobayashi, M., Koi, K., Wiskoski, S., Watanabe, H., Lewis, S., & Ferracane, J. L. (2023). Isolated effect of filler particle size on surface properties of experimental resin composites before and after toothbrush abrasion. Journal of Esthetic and Restorative Dentistry, 35(8), 1286-1292. https://doi.org/10.1111/jerd.13105

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Which are most effective medications for migraine?

USA: Selected acute medications (e.g., ergots, anti-emetics, triptans) are associated with higher odds of user-rated positive response versus ibuprofen for patients with migraine, a recent study published in Neurology has shown.

Using a big-data approach, the researchers analyzed patient-generated real-time records of 10 million migraine attacks, and simultaneous head-to-head comparisons of 25 acute migraine medications were conducted. They found that anti-emetics, ergots, and triptans are the most effective classes of medications, their findings aligned with the guideline recommendations and offered generalizable insights to complement clinical practice.

“For relief of acute migraine, ergots, triptans, and antiemetics are two to five times more effective than ibuprofen, and acetaminophen is the least effective medication,” the researchers reported.

There are several acute treatment options for migraine. However, there is a lack of large-scale, head-to-head comparisons of treatment effectiveness from real-world patient experience reports. Therefore, Chia-Chun Chiang, Department of Neurology, Mayo Clinic, Rochester, MN, United States, and colleagues simultaneously compared 25 acute migraine medications based on self-reported records of 10 million users from a smartphone application.

A retrospective analysis was done of 10,842,795 migraine attack records extracted from an e-diary smartphone application between 2014 and 2020. 25 acute medications were analyzed among seven classes — NSAIDs, opioids, anti-emetics, ergots, combination analgesics, acetaminophen., and triptans. The analysis did not include ditan and gepants.

Different formulations and doses of each medication were combined according to the generic names. A two-level nested logistic regression model was employed to analyze the odds ratio (OR) of treatment effectiveness of each medication by adjusting concurrent medications and the covariance within the same user. Subgroup analyses were conducted for users in the United Kingdom (UK), the United States (US), and Canada (CAN).

The final analysis included 4,777,524 medication-outcome pairs from 3,119,517 migraine attacks among 278,006 users.

The researchers reported the following findings:

  • Triptans (mean OR 4.8), anti-emetics (mean OR 2.67), and ergots (mean OR 3.02), were the top three classes of medications with the highest effectiveness, followed by opioids (mean OR 2.49), NSAIDs (other than ibuprofen, mean OR 1.94), combination analgesics (acetaminophen/acetylsalicylic acid/caffeine) (OR 1.69), others (OR 1.49), and acetaminophen (OR 0.83), using ibuprofen as the reference.
  • Individual medications with the highest ORs were eletriptan (OR 6.1), zolmitriptan (OR 5.7), and sumatriptan (OR 5.2).
  • The ORs of acetaminophen, NSAIDs, combination analgesics and opioids were mostly around or less than 1, suggesting similar or lower reported effectiveness compared to ibuprofen.
  • The ORs for 24 medications, except that of acetylsalicylic acid, achieved statistical significance, and the nested logistic regression model achieved an area under the curve (AUC) of 0.849.
  • Country-specific subgroup analyses revealed similar ORs of each medication and AUC (US 0.849, UK 0.864, and CAN 0.842), demonstrating the robustness of the analysis.

“The findings provide Class IV evidence that for migraine patients, selected acute medications (e.g., triptans, ergots, anti-emetics) are associated with higher odds of user-rated positive response than ibuprofen,” the researchers concluded.

Reference:

The study titled, “Simultaneous Comparisons of 25 Acute Migraine Medications Based on 10 Million Users’ Self-Reported Records From a Smartphone Application,” was published in the journal Neurology. DOI: https://doi.org/10.1212/WNL.0000000000207964

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Major breakthrough-Benralizumab may independently control severe asthma without use of inhaled steroids

A landmark study has shown that severe asthma can be controlled using biologic therapies, without the addition of regular high-dose inhaled steroids which can have significant side effects.

The findings from the multinational SHAMAL study, published in The Lancet, demonstrated that 92% of patients using the biologic therapy benralizumab could safely reduce inhaled steroid dose and more than 60% could stop all use.

The study’s results could be transformative for severe asthma patients by minimising or eliminating the unpleasant, and often serious, side effects of inhaled steroids. These include osteoporosis which leads to increased risk of fractures, diabetes and cataracts.

Asthma is one of the most common respiratory diseases worldwide – affecting almost 300 million people – and around 3 to 5% of these have severe asthma. This leads to daily symptoms of breathlessness, chest tightness and cough, along with repeated asthma attacks which require frequent hospitalisation.

The SHAMAL study was led by Professor David Jackson, head of the Severe Asthma Centre at Guy’s and St Thomas’ and Professor of Respiratory Medicine at King’s College London.

Professor Jackson said: “Biological therapies such as benralizumab have revolutionised severe asthma care in many ways, and the results of this study show for the first time that steroid related harm can be avoided for the majority of patients using this therapy.”

Benralizumab is a biologic therapy that reduces the number of inflammatory cells called eosinophil. This is produced in abnormal numbers in the airway of patients with severe asthma and is critically involved in the development of asthma attacks. Benralizumab is injected every four to eight weeks and is available in specialist NHS asthma centres.

The SHAMAL study took place across 22 sites in four countries – the UK, France, Italy and Germany.

The 208 patients were randomly assigned to taper their high dose inhaled steroid by varying amounts over 32 weeks, followed by a 16 week maintenance period. Approximately 90% of patients experienced no worsening of asthma symptoms and remained free of any exacerbations throughout the 48 week study.

Similar studies to SHAMAL will be necessary before firm recommendations can be made regarding the safety and efficacy of reducing or eliminating high dose steroid use with other biologic therapies.

Reference:

Prof David J Jackson, Prof Liam G Heaney, Prof Marc Humbert, Brian D Kent, Anat Shavit, Lina Hiljemark, Reduction of daily maintenance inhaled corticosteroids in patients with severe eosinophilic asthma treated with benralizumab (SHAMAL): a randomised, multicentre, open-label, phase 4 study, DOI:https://doi.org/10.1016/S0140-6736(23)02284-5.

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Vitamin D Deficiency Linked to Higher Risk of Noninfectious Uveitis

A recent systematic review and meta-analysis exploring the relationship between vitamin D levels and noninfectious uveitis have revealed a striking association. The findings suggest that individuals with vitamin D deficiency face more than a twofold increased risk of developing noninfectious uveitis compared to those without such deficiency. This study was published in the Autoimmunity Reviews journal.

Conducted by a team led by William Rojas-Carabali, MD, from Nanyang Technological University, the study involved a meticulous analysis of numerous studies from databases such as Embase, PubMed, and Lilacs. Among over 900 articles initially screened, 11 studies were included for review and analysis.

The investigation covered a spectrum of study designs, including case-control, cohort, and cross-sectional studies, encompassing data from 6082 individuals with noninfectious uveitis. The analysis indicated that patients with noninfectious uveitis displayed notably lower 25(OH)D levels in serum compared to control groups.

In-depth meta-analyses revealed compelling trends: those who developed uveitis showcased significantly reduced vitamin D levels compared to the control group. This disparity persisted even when examining studies that measured vitamin D levels one year before the onset of uveitis (Standardized Mean Difference [SMD], -0.37; 95% CI, -0.56 to -0.17). Moreover, a meta-analysis of studies reporting odds ratios (ORs) indicated patients with noninfectious uveitis had a greater likelihood of low vitamin D levels 1 year before disease onset (OR, 2.04; 95% CI, 1.55 to 2.68; P = .00001).

However, the investigators highlighted the study’s limitations, including its reliance on observational data, relatively smaller sample sizes, and inherent heterogeneity in the data. Despite these constraints, the findings strongly suggest a notable correlation between hypovitaminosis D and the elevated risk of noninfectious uveitis.

The study’s lead author emphasized the importance of further research in this area to corroborate and expand upon these findings. Additionally, the need for standardized measurement techniques and cutoff values for serum vitamin D was highlighted to enhance the consistency and reliability of future meta-analyses.

These findings indicate a potential preventive strategy in managing noninfectious uveitis through vitamin D supplementation, providing a direction for clinicians in considering vitamin D deficiency screening and management in patients at risk for this ocular condition.

Reference:

Rojas-Carabali W, Pineda-Sierra JS, Cifuentes-González C, et al. Vitamin D deficiency and non-infectious uveitis: A systematic review and Meta-analysis. Autoimmun Rev. Published online December 3, 2023. doi:10.1016/j.autrev.2023.103497 

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Cell therapy appears safe and effective for lymphoma in remission

A study led by researchers at Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine suggests that CAR-T immunotherapy remains a viable option for patients who have lymphoma that goes into remission before the cell therapy begins.

While the study doesn’t answer the question of whether cell therapy in remission is the right choice, it does say that it’s not the wrong choice.

“I don’t think it answers the question of: Should we give these patients cell therapy? But I think it answers the question that we can-that it’s safe and that it’s a reasonable strategy when you’re in that spot,” said Trent Wang, D.O., a Sylvester hematologist and cellular therapy specialist who will present study findings in an oral presentation at the 65th ASH Annual Meeting and Exposition, the American Society of Hematology’s conference taking place in San Diego, California, Dec. 9-12.

Most patients receiving cell therapy, a form of immunotherapy that uses immune cells engineered to recognize and attack the patient’s cancer, desperately need it. For some, it comes after many other treatments have failed. But Wang noticed an odd phenomenon in the past few years when treating lymphoma patients with this form of therapy: Some of his patients went into complete remission before the cells ever touched their bodies.

This uncommon scenario occurs during the process of getting to cell therapy, which in the case of Wang’s study uses a kind of engineered immune cell known as CAR-T cells. When a patient starts the process, there’s a waiting period of three to five weeks before they get the treatment. Insurance approval is needed, and the cells themselves need to be manufactured from the patient’s own cells. But many of these patients are very sick with their cancer, so physicians will often treat them with a short course of chemotherapy or other drugs to tamp down the symptoms.

A small handful of these patients end up in remission during this waiting period treatment, the clinicians have found.

“That prompted this dilemma: Now what are we supposed to do?” Wang said. “Should we change the plan or give the therapy anyway? We just didn’t have a lot of information on this scenario.”

Wang said more often than not his team would proceed with the cell therapy in these cases, mainly to prevent yet another stretch of time where the patients’ cancer might come back again. But it didn’t feel like a very informed decision.

Wang and his colleagues noticed that their patients who received the cells while in remission tended to fare well after their infusion. But they didn’t know if those results would hold up in an analysis of a larger group. They proposed a research study to the Center for International Blood & Marrow Transplant Research, a nationwide registry that tracks patients who have received transplants and/or cell therapies.

The study included data from 134 patients in the registry who had gone into complete remission in the waiting period before receiving their cell therapy. To find that group, the scientists screened the records for more than 5,000 cell therapy patients.

They found that this group of patients had a 43% probability of progression-free survival over the two years following their treatment, about the same percentage as patients in the registry who were not in remission when they received CAR-T. However, the patients in remission had very low levels of toxicities related to their cell therapies, namely an immune overreaction known as cytokine release syndrome and neurotoxicity, two side effects that can sometimes accompany CAR-T cell therapy.

The study used data from patients treated with CAR-T cell therapy between 2015 to 2021, and current frequencies of specific cell therapy use are slightly different from those that were used in practice just a few years ago, Wang said. Next, the researchers want to explore the data paralleling more recent treatment trends.

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Metabolic syndrome in women associated with carotid artery thickness regardless of obesity

A recent investigation examined the combined influence of metabolic syndrome (MetS) and obesity on markers of early atherosclerosis—carotid artery intima media thickness (cIMT) and adventitial diameter (AD). This study was published in the Menopause journal by Leis and colleagues.

Carotid ultrasound assessments conducted as part of the Study of Women’s Health Across the Nation (SWAN) between 2009 and 2013 were analyzed in a cross-sectional study involving 1,433 women. The findings of the study were as follows:

  • Increased Atherosclerotic Risk: Women with obesity showed an average cIMT increase of 0.051 mm, while those with MetS had a 0.057 mm larger cIMT compared to counterparts without these conditions (both P < 0.001).
  • Combined Impact: A significant interaction was observed between obesity and MetS (P = 0.011). Women affected by both conditions exhibited a higher model-adjusted predicted mean cIMT of 0.955 mm (95% CI, 0.897-1.013) compared to those with MetS alone (0.946 mm; 95% CI, 0.887-1.005), obesity alone (0.930 mm; 95% CI, 0.873-0.988), or neither condition (0.878 mm; 95% CI, 0.821-0.935). Similar patterns were observed in AD measurements.

This study underscores the importance of identifying and addressing atherosclerotic changes at early stages to prevent the development of significant cardiovascular disease. It suggests that the impact of obesity on carotid artery thickness appears to be limited when considering MetS alone.

The findings emphasize the heightened atherosclerotic risk associated with metabolic dysfunction, irrespective of an individual’s obesity status. It reinforces the notion that individuals affected by metabolic abnormalities warrant close attention due to their increased vulnerability to atherosclerosis-related changes.

Understanding the combined effects of MetS and obesity on arterial health provides crucial insights into risk stratification and preventive strategies for early atherosclerosis detection and intervention.

Reference:

Leis, A. M., Jackson, E. A., Baylin, A., Barinas-Mitchell, E., El Khoudary, S. R., & Karvonen-Gutierrez, C. A. Carotid intima media thickness and cardiometabolic dysfunction: the Study of Women’s Health Across the Nation. Menopause (New York, N.Y.),2023;30(12):1190–1198. https://doi.org/10.1097/gme.0000000000002273 

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AstraZeneca gets a CDSCO panel Nod To study Rilvegostomig

New Delhi: The drug major AstraZeneca has got approval from the Subject Expert Committee (SEC) functional under the Central Drug Standard Control Organisation (CDSCO) to conduct the trial of the Rilvegostomig (AZD2936) concentrate for solution for infusion to assess the efficacy and tolerability of rilvegostomig compared to placebo in combination with investigator’s choice of chemotherapy in participants with Biliary Tract Cancer after surgical resection with curative intent.

However, this approval is subject to the condition that they should include a surgical oncologist in the study team to confirm the criteria of surgical resectability.

This came after the drug major AstraZeneca presented the Phase III Clinical Study Protocol no. D7025C00001.

The above clinical study is a Phase III, randomized, double-blind, placebo-controlled, multicenter, global study to assess the efficacy and tolerability of rilvegostomig compared to placebo in combination with investigator’s choice of chemotherapy (capecitabine, S-1(tegafur/ gimeracil/ oteracil) or gemcitabine/cisplatin) as adjuvant treatment in participants with Biliary Tract Cancer after resection with curative intent.

This study will be conducted in patients with Biliary Tract Cancer who are at risk of recurrence after resection with curative intent.

AZD2936 is a monovalent, bispecific, humanized IgG1 antibody that specifically binds to human TIGIT and PD-1 with high affinity and enhances T cell activity within preclinical models.

At the recent SEC meeting for Oncology and Hematology held on 29 and 30 November 2023, the expert panel reviewed the Phase III clinical study protocol no D7025C00001 presented by AstraZeneca.
After detailed deliberation, the committee recommended the grant of permission to conduct the trial as presented by the firm “subject to the condition that they include a surgical oncologist in the study team to confirm the criteria of surgical resectability”.

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Haryana doctors threaten indefinite strike from December 29

The day following a two-hour pen-down strike at government health facilities, Haryana Health Department’s medical professionals announced on Sunday their intention to launch an indefinite strike from December 29 if their demands remained unmet within two weeks. This decision was reached during the core committee meeting of the Haryana Civil Medical Services Association (HCMSA), the collective body representing government medical practitioners. As per details, the protest will commence with a full-day strike on December 27.

For more news & updates, check out the link given below:

https://medicaldialogues.in/

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