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4079 Oral Iptacopan Monotherapy Leads to Long-Term Improvements in Patient (Pt)-Reported Health-Related Quality of Life (HRQoL) and Investigator-Assessed Signs and Symptoms of Paroxysmal Nocturnal Hemoglobinuria (PNH): 48-Week (Wk) Results from the Phase III APPLY-PNH and APPOINT-PNH Trials

Program: Oral and Poster Abstracts
Session: 508. Bone Marrow Failure: Acquired: Poster III
Hematology Disease Topics & Pathways:
Research, Clinical trials, Bone Marrow Failure Syndromes, Clinical Research, Paroxysmal Nocturnal Hemoglobinuria, Diseases
Monday, December 9, 2024, 6:00 PM-8:00 PM

Antonio M Risitano, MD, PhD1,2,3, Bing Han4*, Austin G. Kulasekararaj, MD, MBBS, FRCPath, MRCP3,5,6,7, Yasutaka Ueda8*, Phillip Scheinberg, MD9, Carlos de Castro10*, Jaroslaw Maciejewski11, Josefin Snellman12*, Olivier Somenzi, PhD12*, Randall Winnette13*, Samopriyo Maitra14*, Shujie Li15*, Marion Dahlke, MD, MSc12* and Regis Peffault De Latour3,16,17*

1AORN Moscati, Avellino, Italy
2University of Naples Federico II, Naples, Italy
3The Severe Aplastic Anemia Working Party of the European Society for Blood and Marrow Transplantation, Barcelona, Spain
4Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
5King’s College Hospital NHS, London, United Kingdom
6National Institute for Health and Care Research and Wellcome King’s Research Facility, London, United Kingdom
7King’s College London, London, United Kingdom
8Osaka University Graduate School of Medicine, Suita, Japan
9Hospital A Beneficência Portuguesa, São Paulo, Brazil
10Duke University School of Medicine, Duke Cancer Institute, Durham, NC
11Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
12Novartis Pharma AG, Basel, Switzerland
13Novartis Pharmaceutical Corporation, East Hanover, NJ
14Novartis Healthcare Private Limited, Hyderabad, India
15China Novartis Institutes for BioMedical Research Co Ltd, Shanghai, China
16French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Saint-Louis Hospital, Paris, France
17Université Paris Cité, Paris, France

Background: Iptacopan, an oral factor B inhibitor approved as a monotherapy for treatment of adults with PNH, enabled sustained normalization of hemoglobin (Hb) levels, transfusion independence and decreased pt‑reported fatigue in PNH pts with persistent anemia despite anti-C5 treatment (APPLY‑PNH; NCT04558918) or who were complement inhibitor naïve (APPOINT‑PNH; NCT04820530). We report changes in pt-reported HRQoL outcomes and investigator‑assessed PNH signs/symptoms with 48 wks of iptacopan monotherapy in APPLY‑PNH and APPOINT-PNH.

Methods: In APPLY-PNH, adult PNH pts receiving anti-C5 for ≥6 months with mean Hb <10 g/dL were randomized to receive iptacopan monotherapy 200 mg twice daily (bid) or continue anti-C5 for 24 wks. All pts could then enter a 24-wk extension period (EP) and receive iptacopan monotherapy. In APPOINT‑PNH, complement inhibitor-naïve adult PNH pts with mean Hb <10 g/dL received iptacopan monotherapy 200 mg bid for 48 wks (24‑wk treatment period and 24-wk EP). Changes in pt-reported HRQoL (assessed using the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire [EORTC QLQ-C30]) and investigator-assessed PNH signs/symptoms (reddish or cola-colored urine/hemoglobinuria, feeling weak or tired, shortness of breath/dyspnea, dysphagia, chest pain, abdominal pain and erectile dysfunction) were exploratory endpoints in both trials.

Results: In APPLY-PNH, 62 and 35 pts were randomized into the iptacopan and anti-C5 arms, respectively, 61 and 34 of whom received iptacopan monotherapy in the EP, respectively. In APPOINT-PNH, 40 pts received iptacopan monotherapy for 48 wks. Pts in the iptacopan arm of APPLY-PNH reported improvements in mean change from baseline (CFBL) to Wk 48 in all functional domains of EORTC QLQ‑C30 (mean CFBL [standard deviation (SD)]: cognitive, 9.5 [15.8]; emotional, 11.7 [23.6]; physical, 14.7 [16.4]; role, 14.4 [23.8]; social, 13.2 [30.3]). Mean CFBL in global health status was 16.3 (SD 18.0) at Wk 48 in the iptacopan arm, with pt-reported improvements in dyspnea (mean CFBL: −28.8 [SD 29.5]) and fatigue (mean CFBL: −18.2 [SD 23.5]) observed at Wk 48. Pts who switched from anti-C5 to iptacopan reported improvements comparable with the iptacopan arm in all functional domains, global health status, dyspnea and fatigue at Wk 48 after 24 wks of iptacopan monotherapy. In APPOINT‑PNH, improvements in all functional domains, global health status, dyspnea and fatigue were reported by pts at Wk 48.

In APPLY-PNH, 62.9% of pts in the iptacopan arm and 68.6% in the anti-C5 arm had ≥1 PNH sign/symptom at baseline (BL; most common symptoms: feeling weak or tired and dyspnea). In the iptacopan arm, this decreased to 25.8% at Wk 48. In the anti-C5 arm, 57.1% of pts had ≥1 sign/symptom at Wk 24, decreasing to 26.5% at Wk 48 after 24 wks of iptacopan monotherapy. In the iptacopan arm, the proportion of pts not feeling weak or tired was 48.4% at BL and 75.8% at Wk 48. In the anti-C5 arm, the proportion of pts not feeling weak or tired was 31.4% at BL, 45.7% at Wk 24 and 82.4% at Wk 48 after 24 wks of iptacopan monotherapy. In the iptacopan arm, the proportion of pts who did not have dyspnea was 71.0% at BL and 87.1% at Wk 48. At BL, 62.9% of pts in the anti-C5 arm did not have dyspnea; 74.1% did not have dyspnea at Wk 24, which increased to 85.3% at Wk 48 after 24 wks of iptacopan monotherapy. Most pts did not have other signs/symptoms of PNH at BL.

In APPOINT-PNH, the proportion of pts with ≥1 PNH sign/symptom was 97.5% at BL (most common symptom: hemoglobinuria), decreasing to 27.5% at Wk 48. At BL, 22.5% of pts did not have hemoglobinuria, increasing to 95.0% at Wk 48; improvements in all other PNH signs/symptoms were also observed.

Conclusions: Improvements in pt-reported EORTC QLQ-C30 functional domains, global health status and symptom scores, and investigator-assessed PNH signs/symptoms were observed among pts receiving 48 wks of iptacopan monotherapy in APPLY‑PNH and APPOINT-PNH. Both pts and investigators reported improvements in debilitating symptoms of PNH, including fatigue and dyspnea, with iptacopan treatment. Pts in APPLY‑PNH who switched from anti-C5 to iptacopan experienced improvements in EORTC QLQ-C30 scores and PNH signs/symptoms comparable with those achieved by pts initially randomized to receive iptacopan. These results provide further evidence of the long-term positive impact of iptacopan on HRQoL and common signs/symptoms of PNH.

Disclosures: Risitano: Alexion: Honoraria, Membership on an entity's Board of Directors or advisory committees; Amyndas: Consultancy; Apellis: Speakers Bureau; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Omeros: Membership on an entity's Board of Directors or advisory committees; Pfizer: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Sobi: Consultancy, Speakers Bureau. Han: F. Hoffmann-La Roche Ltd: Other: All authors received support for third-party writing assistance, furnished by Scott Battle, PhD, CMPP, of Nucleus Global, an Inizio company, and funded by F. Hoffmann-La Roche Ltd, Basel, Switzerland.. Kulasekararaj: Janssen: Consultancy; Samsung: Consultancy, Honoraria, Speakers Bureau; Pfizer: Consultancy, Honoraria, Speakers Bureau; Ra Pharma: Consultancy, Honoraria, Speakers Bureau; Agios: Honoraria; Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Achillion: Consultancy, Honoraria, Speakers Bureau; Sobi: Consultancy, Honoraria, Speakers Bureau; Akari: Consultancy, Honoraria, Speakers Bureau; Novo Nordisk: Consultancy, Honoraria, Speakers Bureau; F. Hoffmann-La Roche Ltd: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; BioCryst: Consultancy, Honoraria, Speakers Bureau; Silence Therapeutics: Honoraria; Apellis: Consultancy, Honoraria, Speakers Bureau; Celgene/BMS: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Amgen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Alexion: Consultancy, Honoraria, Speakers Bureau. Ueda: Ono: Consultancy; Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Nippon Shinyaku: Honoraria; Kaken: Honoraria; Alexion: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Asahi Kasei: Consultancy; Chugai: Consultancy, Honoraria, Research Funding; Incyte: Speakers Bureau; Janssen: Consultancy, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Sanofi: Consultancy, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Sobi: Speakers Bureau. Scheinberg: BMS: Consultancy; Janssen: Consultancy; Roche: Consultancy, Speakers Bureau; Pfizer: Consultancy, Research Funding, Speakers Bureau; Novartis: Consultancy, Speakers Bureau; Alnylam: Research Funding; Astellas: Consultancy; AstraZeneca: Consultancy, Speakers Bureau. de Castro: Novartis: Honoraria, Speakers Bureau; Alexion: Honoraria, Speakers Bureau; Omeros: Honoraria, Membership on an entity's Board of Directors or advisory committees. Snellman: Novartis: Current Employment, Current equity holder in publicly-traded company. Somenzi: Novartis: Current Employment. Winnette: Novartis: Current Employment, Current equity holder in private company; BeiGene: Ended employment in the past 24 months; Pfizer: Current equity holder in private company. Maitra: Novartis: Current Employment. Li: Novartis: Current Employment. Dahlke: Novartis: Current Employment, Current equity holder in private company. Peffault De Latour: Alexion: Consultancy, Honoraria, Research Funding; Novartis: Consultancy, Honoraria, Research Funding; Pfizer: Consultancy, Honoraria, Research Funding; Amgen: Research Funding; Apellis: Consultancy, Honoraria; Sobi: Consultancy, Speakers Bureau.

*signifies non-member of ASH