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409 ENERGIZE-T: A Global, Phase 3, Double-Blind, Randomized, Placebo-Controlled Study of Mitapivat in Adults with Transfusion-Dependent Alpha- or Beta-Thalassemia

Program: Oral and Poster Abstracts
Type: Oral
Session: 112. Thalassemia and Globin Gene Regulation: We're Going to Catch a Big One: Towards Targeted Therapies in Thalassemia
Hematology Disease Topics & Pathways:
Clinical trials, Research, Adult, Thalassemia, Clinical Research, Hemoglobinopathies, Diseases, Biological therapies, Treatment Considerations, Study Population, Human, Transfusion
Sunday, December 8, 2024: 9:30 AM

Maria Domenica Cappellini, MD1, Sujit Sheth, MD2, Ali T. Taher, MD, FRCP3, Hanny Al-Samkari, MD4, Ali Bülent Antmen, MD, PhD5*, David Beneitez, MD6*, Giovanna Cannas, MD7*, Thomas D. Coates, MD8, Lauren Czapla, ANP9*, Jayme L. Dahlin, MD, PhD9*, Jeremie H. Estepp, MD10*, Elizabeth Feenstra, MD9*, Pencho Georgiev, MD, PhD11*, Sarah Gheuens, MD, PhD, MMSc9*, Keely S Gilroy, PhD9*, Andreas Glenthøj, MD, PhD12*, Khaled Musallam, MD, PhD13*, Kareem Osman, MD9*, John B. Porter14*, Hui Shao, PhD9*, Katrin Uhlig, MD, MS9*, Eduard J. Van Beers, MD, PhD15, Vip Viprakasit, MD, DPhil(Oxon)16*, Kevin H.M. Kuo, MD, MSc, FRCPC17 and Antonis Kattamis, MD18

1Department of Clinical Sciences and Community University of Milan, Cà Granda Foundation IRCCS Maggiore Policlinico Hospital, Milan, Italy
2Division of Hematology and Oncology, Department of Pediatrics, Weill Cornell Medicine, New York, NY
3American University of Beirut Medical Center, Beirut, Beirut, Lebanon
4Division of Hematology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
5Department of Pediatric Hematology, Acibadem Adana Hospital, Adana, Turkey
6Vall d'Hebron Institute of Oncology, Vall d'Hebron Hospital Universitari, Universitat Autonoma de Barcelona, Barcelona, Spain
7Hopital Edouard Herriot, Lyon, France
8Children's Hospital Los Angeles, Los Angeles, CA
9Agios Pharmaceuticals, Inc., Cambridge, MA
10Medical Director, Agios Pharmaceuticals, Inc., Cambridge, MA
11St. George University Hospital for Active Treatment and Medical University Plovdiv, Plovdiv, Bulgaria
12Danish Red Blood Cell Center, Department of Hematology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
13Center for Research on Rare Blood Disorders (CR-RBD), Burjeel Medical City, Abu Dhabi, United Arab Emirates
14University College London Hospital, London, United Kingdom
15Center for Benign Hematology, Thrombosis and Hemostasis - Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
16Faculty of Medicine Siriraj Hospital, Department of Pediatrics, Mahidol University, Bangkok, Thailand
17Division of Hematology, University of Toronto, Toronto, ON, Canada
18National and Kapodistrian University of Athens, Athens, Greece

Introduction: Transfusions and iron chelators have improved survival and outcomes in transfusion-dependent (TD)-thalassemia. However, they are associated with adverse effects, such as end organ complications and high healthcare resource utilization, and can become a burden for patients (pts), limiting adherence and negatively impacting quality of life. These limitations highlight a need for new agents targeting disease pathophysiology. There are no approved oral disease-modifying therapies for β-thalassemia, and no therapies are approved for α-thalassemia. Mitapivat is a first-in-class, oral, allosteric activator of pyruvate kinase that increases adenosine triphosphate production, which may improve thalassemic red blood cell (RBC) health by addressing their increased cellular energy demands. In a phase 3 trial in non–transfusion-dependent (NTD)-α- or β-thalassemia (ENERGIZE [NCT04770753]), mitapivat significantly improved hemoglobin levels and fatigue vs placebo.

Aim: To assess the efficacy and safety of mitapivat vs placebo in adults with TD-α- or β-thalassemia in ENERGIZE-T (NCT04770779).

Methods: Adults (≥18 years) with TD-α- or β-thalassemia from 19 countries were randomized 2:1 to mitapivat 100 mg or placebo twice daily for 48 weeks. TD was defined as 6–20 RBC units transfused and a ≤6-week transfusion-free period during the 24-week period before randomization. Randomization was stratified by thalassemia genotype (β00 and non-β00, including HbE/β-thalassemia and α-thalassemia/HbH) and geographic region. The primary endpoint was transfusion reduction response (TRR, a ≥50% reduction in transfused RBC units and a reduction of ≥2 units of transfused RBCs in any consecutive 12-week period through Week 48 compared with baseline [BL]). Key secondary endpoints were: TRR2, a ≥50% reduction from BL in transfused RBC units in any consecutive 24-week period through Week 48; TRR3, a ≥33% reduction from BL in transfused RBC units in Weeks 13–48; and TRR4, a ≥50% reduction from BL in transfused RBC units in Weeks 13–48. Transfusion independence (TI, transfusion-free for ≥8 consecutive weeks through Week 48) and safety were among the secondary endpoints.

Results: A total of 258 pts were randomized (mitapivat: N=171; placebo: N=87); 155 (90.6%) and 83 (95.4%) pts in the mitapivat and placebo arms, respectively, completed the 48-week double-blind period. Overall, mean age was 35.5 years; 70.9% of pts had a 24-week BL transfusion burden of >12 RBC units; and 44.2% had β00 genotype. There was no imbalance in BL characteristics between treatment arms deemed to impact the interpretation of the results.

A TRR was achieved in 30.4% of pts in the mitapivat arm vs 12.6% in the placebo arm (2-sided p=0.0003). Statistically significant reductions in transfusion burden for mitapivat vs placebo were also demonstrated by all key secondary endpoints: 13.5% vs 2.3% (2-sided p=0.0003) achieved TRR2; 14.6% vs 1.1% (2-sided p<0.0001) achieved TRR3; and 7.6% vs 1.1% (2-sided p=0.0056) achieved TRR4. Overall results for these endpoints were not driven by any of the individual prespecified subgroups, including genotype and BL transfusion burden. A higher proportion of pts in the mitapivat arm achieved TI (9.9%) vs the placebo arm (1.1%).

The proportion of pts with any treatment-emergent adverse events (TEAEs) was similar across treatment arms (mitapivat: 90.1%; placebo: 83.5%). TEAEs occurring in ≥10% of pts on mitapivat were headache, upper respiratory tract infection, initial insomnia, diarrhea, and fatigue. Serious TEAEs were reported in 11.0% and 15.3% of pts on mitapivat and placebo, respectively; 2.3% and 1.2%, respectively, were considered treatment-related. Discontinuation due to TEAEs occurred in 5.8% of pts on mitapivat and 1.2% on placebo.

Conclusions: In a globally representative population with TD-α- or β-thalassemia, mitapivat vs placebo significantly reduced transfusion burden and demonstrated a durable reduction of up to 36 weeks (Weeks 13–48). Mitapivat was generally safe and well tolerated with a low treatment discontinuation rate. These data, alongside data in NTD-α- or β-thalassemia from ENERGIZE, demonstrate the efficacy of mitapivat across the full range of thalassemia, supporting it as a potential oral disease-modifying therapy.

Disclosures: Cappellini: Novo Nordisk: Membership on an entity's Board of Directors or advisory committees; Vertex Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees; Pfizer: Membership on an entity's Board of Directors or advisory committees; Silence: Membership on an entity's Board of Directors or advisory committees; Sanofi-Genzyme: Membership on an entity's Board of Directors or advisory committees; Pharmacosmos: Membership on an entity's Board of Directors or advisory committees; Bristol Myers Squibb (Celgene): Membership on an entity's Board of Directors or advisory committees; Vifor: Membership on an entity's Board of Directors or advisory committees; Agios Pharmaceuticals, Inc.: Membership on an entity's Board of Directors or advisory committees. Sheth: PER: Honoraria; Bristol Myers Squibb (Celgene): Consultancy, Research Funding; Forma (now Novo Nordisk): Consultancy, Research Funding; bluebird bio: Consultancy; Chiesi: Consultancy; Fulcrum: Consultancy; Vertex Pharmaceuticals: Consultancy, Other: participation on a data safety monitoring board/steering committee; Agios Pharmaceuticals, Inc.: Consultancy, Research Funding; CRISPR Therapeutics: Other: participation on a data safety monitoring board/steering committee; CCO: Honoraria; Plexus: Honoraria. Taher: Vifor: Consultancy, Research Funding; Pharmacosmos: Consultancy, Research Funding; Novo Nordisk: Consultancy; Bristol Myers Squibb (Celgene): Consultancy, Research Funding; Agios Pharmaceuticals, Inc.: Consultancy, Research Funding. Al-Samkari: Sobi: Consultancy, Research Funding; Pharmacosmos: Consultancy; Novartis: Consultancy, Research Funding; Vaderis: Research Funding; argenx: Consultancy; Alnylam: Consultancy; Alpine: Consultancy; Amgen: Consultancy, Research Funding; Agios: Consultancy, Research Funding. Antmen: Novo Nordisk: Other: National and international scientific advisory board committees and speaker’s bureau; CSL Behring: Other: National and international scientific advisory board committees and speaker’s bureau; Pfizer: Other: National and international scientific advisory board committees and speaker’s bureau; Roche: Other: National and international scientific advisory board committees and speaker’s bureau; Sobi: Other: National and international scientific advisory board committees and speaker’s bureau; Takeda: Other: National and international scientific advisory board committees and speaker’s bureau; BioMarin: Other: National and international scientific advisory board committees and speaker’s bureau. Beneitez: Novo Nordisk: Consultancy, Membership on an entity's Board of Directors or advisory committees; Bristol Myers Squibb (Celgene): Consultancy, Membership on an entity's Board of Directors or advisory committees; Pfizer: Consultancy, Membership on an entity's Board of Directors or advisory committees; Sobi: Consultancy, Membership on an entity's Board of Directors or advisory committees; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees; Agios: Consultancy, Membership on an entity's Board of Directors or advisory committees; Vertex Pharmaceuticals: Consultancy, Membership on an entity's Board of Directors or advisory committees. Cannas: Novo Nordisk: Consultancy; Theravia: Consultancy; Agios Pharmaceuticals, Inc.: Consultancy; Pfizer: Consultancy. Coates: Bristol Meyers Squibb: Consultancy, Honoraria; Chiesi pharma: Consultancy, Honoraria; Agios pharma: Consultancy, Honoraria. Czapla: Agios Pharmaceuticals, Inc.: Current Employment, Current equity holder in publicly-traded company. Dahlin: Agios Pharmaceuticals, Inc.: Current Employment, Current equity holder in publicly-traded company. Estepp: Agios Pharmaceuticals, Inc.: Current Employment, Current equity holder in publicly-traded company. Feenstra: Agios Pharmaceuticals, Inc.: Current Employment, Current equity holder in publicly-traded company. Georgiev: Silence: Consultancy. Gheuens: Agios Pharmaceuticals, Inc.: Current Employment, Current equity holder in publicly-traded company. Gilroy: Agios Pharmaceuticals, Inc.: Current Employment, Current equity holder in publicly-traded company. Glenthøj: Agios Pharmaceuticals, Inc.: Consultancy, Research Funding; Novo Nordisk: Consultancy, Research Funding; Sanofi: Research Funding; Pharmacosmos: Consultancy; Vertex: Consultancy; Saniona: Research Funding. Musallam: Vifor Pharma: Consultancy; Pharmacosmos: Consultancy, Research Funding; Novo Nordisk: Consultancy; CRISPR Therapeutics: Consultancy; Agios Pharmaceuticals: Consultancy, Research Funding; Celgene Corp (Bristol Myers Squibb): Consultancy; Novartis: Consultancy. Osman: Agios Pharmaceuticals, Inc.: Current Employment, Current equity holder in publicly-traded company. Porter: Silence therapeutics: Consultancy, Research Funding; bluebird bio: Consultancy; Vifor: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Agios: Honoraria, Membership on an entity's Board of Directors or advisory committees; Bristol Myers Squibb (Celgene): Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Agios Pharmaceuticals, Inc.: Consultancy. Shao: Agios Pharmaceuticals, Inc.: Current Employment, Current equity holder in publicly-traded company. Uhlig: Agios Pharmaceuticals, Inc.: Current Employment, Current equity holder in publicly-traded company. Van Beers: Agios Pharmaceuticals, Inc.: Consultancy, Research Funding. Viprakasit: Bristol Myers Squibb (Celgene): Research Funding; DisperSol Technologies: Research Funding; Ionis Pharmaceuticals: Research Funding; Novartis: Research Funding; Pharmacosmos: Research Funding; Vifor: Research Funding; The Government Pharmaceutical Organization: Research Funding; Agios Pharmaceuticals, Inc.: Research Funding. Kuo: Bristol Myers Squibb: Consultancy, Honoraria; Biossil: Consultancy; Alexion Pharmaceuticals: Consultancy, Honoraria; Agios Pharmaceuticals, Inc.: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Novo Nordisk: Consultancy; Pfizer: Consultancy, Research Funding; Vertex Pharmaceuticals: Consultancy, Honoraria; Sangamo: Membership on an entity's Board of Directors or advisory committees; Forma Therapeutics: Consultancy. Kattamis: Vertex Pharmaceuticals: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Steering Committee Membership; Pfizer: Consultancy; Vifor: Consultancy; Novo Nordisk: Consultancy; Bristol Myers Squibb: Consultancy, Honoraria; Agios Pharmaceuticals: Consultancy, Honoraria.

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