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
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 (β0/β0 and non-β0/β0, 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 β0/β0 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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