Dupixent(dupikumab) is the first and only biologic to achieve significant improvements in disease remission and symptoms in bullous pemphigoid positive pivotal study

In the study, five times more Dupixent patients achieved sustained disease remission compared to those on placebo. Sustained disease remission was defined as complete clinical remission with completion of oral corticosteroids (OCS) taper by week 16 without relapse and no rescue therapy use during the 36-week treatment period. Dupixent was previously granted Orphan Drug Designation by the FDA for BP, which applies to investigational medicines intended for the treatment of rare diseases that affect fewer than 200,000 people in the U.S. This study will support regulatory submissions around the world, starting with the U.S. later this year.

BP, a chronic and relapsing disease, is characterized by intense itch and blisters, reddening of the skin, and painful chronic lesions. The blisters and rash can form over much of the body and cause the skin to bleed and crust, resulting in patients being more prone to infection and affecting their daily functioning.

Dietmar Berger, M.D., Ph.D. Chief Medical Officer, Global Head of Development at Sanofi; “The itchy blisters caused by bullous pemphigoid can be so intense they are debilitating, especially for elderly patients. There is a significant unmet medical need for new medicines for people suffering with this hard-to-treat disease in which the standard of care is oral and topical corticosteroids and immunosuppressants – treatments that have poor clinical outcomes and safety concerns, respectively, and should be used sparingly in an elderly population. These positive pivotal results for bullous pemphigoid add to an immense body of scientific evidence that underscores the important role IL4 and IL13 play in driving diseases characterized by itch. Combined with the consistent safety profile of the other dermatology indications, these results show the potential of Dupixent to transform the treatment paradigm for bullous pemphigoid.”

In the ADEPT study, 106 adults with moderate-to-severe BP were randomized to receive Dupixent 300 mg (n=53) every two weeks after an initial loading dose or placebo (n=53), along with standard-of-care OCS. During treatment, all patients underwent a protocol-defined OCS tapering regimen if control of disease activity was maintained. For the primary endpoint, 20% of Dupixent patients experienced sustained disease remission at 36 weeks compared to 4% for placebo (p=0.0114). For the components comprising the primary endpoint – with patients having to achieve all components – efficacy among patients receiving Dupixent compared to placebo was as follows: i. Absence of disease relapse after patient completed OCS taper: 59% vs. 16% (nominal p=0.0023). ii. Absence of need for rescue therapy during treatment period: 42% vs. 12% (nominal p=0.0004).  iii. Achievement of complete remission and off OCS by week 16: 38% vs. 27% (not significant) .*Components were not separately included in pre-specified statistical analyses and are therefore nominal.

For selected secondary endpoints, results for Dupixent compared to placebo were statistically significant as follows: i. Patients achieving greater than 90% reduction in disease severity: 41% vs. 10% (p=0.0003) ii. Patients achieving clinically meaningful itch reduction: 40% vs. 11% (p=0.0006) iii. Secondary endpoints assessing decreased OCS use, and time to use of rescue medications, also favored Dupixent and were significant (p=0.0220 and p=0.0016, respectively), iv. Reduction in disease severity from baseline: 77% vs. 51% (p=0.0021). v. Reduction in itch from baseline: 52% vs. 27% (p=0.0021). vi. Days of complete remission off OCS: 40 vs. 13 (p=0.0072).

In this older population, overall rates of adverse events (AEs) were 96% (n=51) for Dupixent and 96% (n=51) for placebo. AEs more commonly observed with Dupixent compared to placebo in more than 3 patients included peripheral edema (n=8 vs. n=5), arthralgia (n=5 vs. n=3), back pain (n=4 vs. n=2), blurred vision (n=4 vs. n=0), hypertension (n=4 vs. n=3), asthma (n=4 vs. n=1), conjunctivitis (n=4 vs. n=0), constipation (n=4 vs. n=1), upper respiratory tract infection (n=3 vs. n=1), limb injury (n=3 vs. n=2), and insomnia (n=3 vs. n=2). There were no AEs leading to death in the Dupixent group and 2 AEs leading to death in the placebo group.

George D. Yancopoulos, M.D., Ph.D.; Board co-Chair, President, and Chief Scientific Officer at Regeneron; “Bullous pemphigoid is a debilitating skin disease with a high mortality rate due to infection. Dupixent is the first medication to show significant and robust impacts in this patient population. These latest pivotal results reaffirm the underlying role type-2 inflammation plays in driving multiple skin diseases. We look forward to further advancing this research and sharing the positive results from the bullous pemphigoid pivotal trial with regulatory authorities.”

Additionally, a small separate phase III study (Study A) evaluating the investigational use of Dupixent in adults with uncontrolled and severe chronic pruritus of unknown origin (CPUO) did not achieve statistical significance in its primary itch responder endpoint (despite favorable numerical improvements), but showed nominally significant improvements in all other itch endpoints including.; i. change from baseline; percent of patients achieving no/mild itch; ii.  and change in itch-related quality of life from baseline. Safety results were generally consistent with the known safety profile of Dupixent in its approved dermatological indications. The Dupixent phase III study program in CPUO consists of Study A and Study B. Study B is planned to initiate as a subsequent pivotal study. Detailed efficacy and safety results for both BP and CPUO studies are planned for presentation at a forthcoming medical meeting.

The safety and efficacy of Dupixent in BP and CPUO are currently under clinical investigation and have not been evaluated by any regulatory authority.

About the Dupixent BP pivotal study; ADEPT is a randomized, phase II/III, double-blind, placebo-controlled study evaluating the efficacy and safety of Dupixent in 106 adults with moderate-to-severe BP for a 52-week treatment period. After randomization, patients received Dupixent or placebo every two weeks, with OCS treatment. During treatment, OCS taper was initiated after patients experienced two weeks of sustained control of disease activity. OCS tapering could start between four to six weeks after randomization and was continued as long as disease control was maintained, with the intent of completion by 16 weeks. After OCS tapering, patients were only treated with Dupixent or placebo for at least 20 weeks, unless rescue treatment was required.

The primary endpoint evaluated the proportion of patients achieving sustained disease remission at 36 weeks. Sustained disease remission was defined as complete clinical remission with completion of OCS taper by 16 weeks without relapse and no rescue therapy use during the 36-week treatment period. Relapse was defined as appearance of  greater than 3 new lesions a month or  greater than 1 large lesion (greater than 10cm in diameter) that did not heal within a week. Rescue therapy could include treatment with high-potency topical corticosteroids, OCS (including increase of OCS dose during the taper or re-initiation of OCS after completion of the OCS taper), systemic non-steroidal immunosuppressive medications, or immunomodulating biologics.

Select secondary endpoints evaluated at 36 weeks included: i. Proportion of patients achieving  greater than 90% reduction in Bullous Pemphigoid Disease Area Index (BPDAI; scale:0-360).. ii. Proportion of patients with greater than 4-point reduction in Peak Pruritus Numerical Rating Scale (PP-NRS; scale 0-10).iii.  Total cumulative OCS dose. iv. Time to first use of rescue medication. v. Percent change from baseline in BPDAI.  vi.  Percent change in weekly average of daily PP-NRS.  vii.Duration of complete remission while not requiring OCS.

About the Dupixent CPUO phase III program
The Dupixent phase III program in CPUO consists of Study A and Study B. Study A was a randomized, phase III, double-blind, placebo-controlled study evaluating the efficacy and safety of Dupixent in adults with uncontrolled, severe CPUO. During the 4-week run-in period, patients received a standard-of-care regimen comprised of a non-sedative antihistamine and moisturizer to confirm they were refractory to available options. During the following 24-week treatment period, patients received Dupixent or placebo every two weeks added to the standard-of-care regimen.

The primary endpoint evaluated the proportion of patients with a clinically meaningful improvement in itch from baseline at 24 weeks, measured by a greater than 4-point reduction in the worst-itch numerical rating scale (WI-NRS; scale: 0-10). 

The key secondary endpoint evaluated the proportion of patients with a greater than 4-point reduction in WI-NRS at 12 weeks. Additional secondary endpoints included: i. Proportion of patients achieving no/mild pruritus on Patient Global Impression of Severity (PGIS) of pruritus.ii.  Absolute change and percent change from baseline in the weekly average of daily itch-related sleep disturbances at 24 weeks measured by the sleep disturbance NRS (scale: 0-10). iii. Absolute change from baseline in itch-related quality of life measured by the ItchyQoL (scale: 22-110). iv. Absolute change from baseline in health-related quality of life at 24 weeks measured by the Dermatology Life Quality Index (scale: 0-30).Study B is planned to initiate as a subsequent pivotal study.