Lundbeck reports positive phase III study results for clobazam in the adjunctive treatment of seizures associated with Lennox-Gastaut syndrome
* Data from the pivotal clobazam study were presented at the American Epilepsy
Society meeting in San Antonio, TX
* Two highest dosages of clobazam as add-on therapy achieved the primary
endpoint with a statistically significant reduction in average weekly rate
of drop seizures, compared with placebo(1)
* 77.6 percent of patients who received high-dosage clobazam achieved a 50
percent or greater reduction in average weekly rate of drop seizures(1)
* Lundbeck anticipates NDA submission by year-end after which the agency's
confirmation of receipt of the submission will be awaited.
H. Lundbeck A/S (Lundbeck) today presented positive data from its pivotal phase
III study to determine the efficacy and safety profiles of the investigational
compound clobazam as adjunctive therapy in treating seizures associated with
Lennox-Gastaut syndrome (LGS). In the study, clobazam met its primary efficacy
endpoint and was further supported by several key secondary efficacy
endpoints.(1) LGS is a rare and severe form of epilepsy that is typically
diagnosed in childhood and persists into adulthood.(2,3 )Results from this
largest clinical trial to date in LGS patients( )were presented at the 64(th)
annual meeting of the American Epilepsy Society in San Antonio, Texas (Poster
No. 1.283).(1,4)
This prospective, double-blind, placebo controlled study randomized 238 patients
diagnosed with LGS to one of three different dosages of clobazam or placebo.
Efficacy analyses were done for the modified intent to treat population (mITT),
which included all randomized patients who had baseline data, at least one dose
of study drug and at least one daily seizure measurement during the maintenance
period (N=217).(1)
Data from the study's primary endpoint showed that the high (1.0 mg/kg/day;
N=49) and medium (0.5 mg/kg/day; N=58) dosages of clobazam, evaluated versus
placebo (N=57), met a robust statistically significant (p≤0.01) reduction in the
average weekly rate of drop seizures from the 4-week baseline period compared to
the 12-week maintenance period. Patients in the high-dosage clobazam group
achieved a mean decrease in average weekly rate of drop seizures of 68.3 percent
(p<0.0001 vs. placebo) while those in the medium-dosage arm had an average
decrease of 49.4 percent (p=0.0015 vs. placebo).(1)
A secondary endpoint of the study was responder rates. For each group treated
with one of the three different dosages of clobazam, the percentage of patients
with a decrease in average weekly rate of drop seizures of ≥25%, ≥50%, ≥75% or
100% from baseline to the maintenance period was compared to placebo. Among
patients in the high-dosage arm, 77.6 percent had a 50 percent or greater
reduction (p<0.01); 63.3 percent had a 75 percent or greater reduction
(p<0.01);( )and 24.5 percent achieved 100 percent reduction. Among patients in
the medium-dosage arm, 58.6 percent had a 50 percent or greater reduction
(p<0.05); 37.9 percent had a 75 percent or greater reduction (p<0.01); and 12.1
percent achieved 100 percent reduction. The logistic regression model used in
this study was unable to provide valid p-value estimates for the 100 percent
response thresholds due to the small number of patients enrolled in this
group.(1)
"LGS is a devastating form of epilepsy associated with multiple types of
seizures, including dangerous drop seizures which may cause falls that often
result in injury. This can take a tremendous toll on even the strongest
families,"( )said Joan A. Conry, MD, professor of neurology at Children's
National Medical Center in Washington, D.C., and a principal investigator in the
study. "While several medications are approved in the U.S. for treatment of LGS,
many patients continue to have seizures due to the intractable nature of the
disease. The focus on this small patient population and the results of this
study provide hope for LGS patients, their families and the medical community."
The study also evaluated the effect of clobazam in decreasing total seizures
(drop and non-drop) as another key secondary endpoint. Robust statistical
significance was observed in patients who received the high- and medium-dosage
clobazam (p<0.01 in each arm versus placebo).(1 )
In the study, the most common treatment emergent adverse events (AEs) included
somnolence, lethargy, drooling, fever, and constipation. Serious AEs occurring
in ≥2 patients were lobar pneumonia and pneumonia, which occurred in both
clobazam and placebo treatment arms.(1)
"Lundbeck makes several treatment options available in the U.S. for people
affected by epilepsy, and the development of clobazam for those with LGS
represents our ongoing commitment to making a difference in the lives of those
affected by rare and challenging seizure disorders," said Timothy M. Cunniff,
PharmD, vice president of global regulatory affairs at Lundbeck. "We are
encouraged by these phase III results and look forward to submitting an NDA very
soon for clobazam."
About the Study
This phase III trial was a multicenter, randomized, double-blind, placebo-
controlled, parallel-group study designed to assess the efficacy and safety of
clobazam as adjunctive therapy in patients with LGS. Patient age ranged from
2-54, with a mean age at baseline of 12.4 years. Patients were included if they
were being treated with one to three antiepileptic drugs (AEDs) at stable
dosages for ≥30 days before screening and had ≥2 drop seizures per week during
the 4-week baseline period.(1)
Prior to randomization, patients were stratified by weight (12.5 kg to ≤30 kg,
>30 kg) and then randomized to placebo (N=59) or one of three dosages of
clobazam: low (N=58 at 0.25 mg/kg/day up to a maximum of 10 mg per day), medium
(N=62 at 0.5 mg/kg/day; maximum daily dosage of 20 mg per day), and high (N=59
at 1.0 mg/kg/day; maximum daily dosage of 40 mg). Of 238 patients randomized, a
total of 217 comprised the modified intent to treat (mITT) population, which
included all randomized patients who had baseline data, ≥1 dose of study drug,
and ≥1 daily seizure measurement during the maintenance period. A total of 177
patients completed the study.( )Statistical significance for the primary
efficacy endpoint was prespecified as p≤0.01 and considered robust statistical
evidence in a single multi-center study, and p≤0.05 for secondary measures.(1)
About Clobazam
Clobazam is a 1,5-benzodiazepine that potentiates the inhibitory action of
gamma-aminobutyric acid (GABA) by binding to GABA-A receptors.(5,6)
Additionally, research has identified three subtypes of the benzodiazepine omega
receptor (ω).(5) Diffusely distributed throughout the CNS, these ω receptors
demonstrate a variety of pharmacological effects.(6) In non-clinical studies,
clobazam was shown to have higher affinity for the ω(2) compared to the ω(1)
receptor.(5) The precise mechanism of action by which clobazam exerts its
antiepileptic effects is unknown.
The current study is part of a clinical development program to obtain FDA
approval for clobazam as adjunctive treatment for patients with LGS. Clobazam is
marketed outside of the U.S. in more than 100 countries under various brand
names, including Frisium(®) or Urbanyl(®). Brand names listed are property of
their owners.
About Lennox-Gastaut Syndrome
Lennox-Gastaut syndrome (LGS) is a rare(2) and severe form of epilepsy(7)
characterized by multiple types of seizures, mental retardation or regression,
and abnormal electroencephalogram (EEG) with generalized slow spike and wave
discharges (1.5-2 Hz).(8) Responsible for 1-4 percent of all childhood
epilepsies, LGS typically occurs between two and eight years of age (peak onset
occurs from 3-5 years).(2,8) Eighty percent of those with LGS will have
continued seizures throughout childhood and into their adult years.(2) LGS is
associated with multiple seizure types,(8) including atonic, tonic and myoclonic
seizures, which can all cause falls, or "drop attacks", that are associated with
a high rate of recurrent injuries.(9) Prognosis for individuals with LGS varies,
and complete recovery, including freedom from seizures and normal development,
is uncommon.(7)
Lundbeck contacts
Investors: Media:
Palle Holm Olesen Mads Kronborg
Chief Specialist, Investor Relations Media Relations Manager
+45 36 43 24 26 +45 36 43 28 51
Magnus Thorstholm Jensen Stine Hove Marsling
Investor Relations Officer External Communication Specialist
+45 36 43 38 16 +45 36 43 28 33
Jacob Tolstrup Matt Flesch
Vice President Senior Communications Manager,
Lundbeck Inc.
+1 847 282 5713 +1 847 922 2871
About Lundbeck
H. Lundbeck A/S (LUN.CO, LUN DC, HLUKY) is an international pharmaceutical
company highly committed to improving the quality of life for people suffering
from central nervous system (CNS) disorders. For this purpose, Lundbeck is
engaged in the research and development, production, marketing and sale of
pharmaceuticals across the world. The company's products are targeted at
disorders such as depression and anxiety, schizophrenia, insomnia, epilepsy and
Huntington's, Alzheimer's and Parkinson's diseases.
Lundbeck was founded in 1915 by Hans Lundbeck in Copenhagen, Denmark. Today
Lundbeck employs approximately 5,900 people worldwide. Lundbeck is one of the
world's leading pharmaceutical companies working with CNS disorders. In 2009,
the company's revenue was DKK 13.7 billion (approximately EUR 1.8 billion or USD
2.6 billion). For more information, please visit www.lundbeck.com.
Sources
1 Conry, Joan A. et. Al "Efficacy and Safety of Clobazam in the
Treatment of Seizures Associated with Lennox-Gastaut Syndrome: Results of a
Phase III Trial." Lundbeck Poster 1.283 December 2010.
2 Van Rijckevorsel, Kenou et al. Treatment of Lennox-Gastaut syndrome:
overview and recent findings. Neuropsychiatric Disease and Treatment.
2008: 4(6) 1001-1019
3 Arzimanoglou, Alexis et al. Lennox-Gastaut syndrome: a consensus
approach on diagnosis, assessment, management, and trial methodology. The
Lancet. 2009: 8(1) 82-93
4 Hancock, Eleanor and Helen Cross. "Treatment of Lennox-Gastaut
syndrome." Cochrane Collaboration 2009
5 Nakajima H. A pharmacological profile of clobazam (Mystan), a new
antiepileptic drug. Nippon Yakurigaku Zasshi 2001;118(2):117-122.
6 Sanger DJ, Benavides J, Perrault G, et al. Recent developments in the
behavioral pharmacology of benzodiazepine (omega) receptors: evidence for the
functional significance of receptor subtypes. Neuroscience and Biobehavioral
Review 1994;18:355-372.
7 NINDS. Lennox-Gastaut Syndrome Information Page.
http://www.ninds.nih.gov/disorders/lennoxgastautsyndrome/lennoxgastautsyndrome.h
tm. Last accessed 9/28/10
8 Medscape. Lennox-Gastaut Syndrome.
http://emedicine.medscape.com/article/1176735-overview. Last accessed 10/11/10
9 Dulac, Olivier and Jerome Engel. Lennox-Gastaut Sydnrome.
International League Against Epilepsy. http://www.ilae-
epilepsy.org/Visitors/Centre/ctf/lennox_gastaut.cfm. Last accessed 10/11/10
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