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InterMune Announces Favorable New Clinical Results of Actimmune In IPF
SEATTLE and BRISBANE, Calif., May 19, 2003 /PRNewswire-FirstCall via COMTEX/ -- InterMune, Inc. (Nasdaq: ITMN) announced today that
favorable new follow-up data from its Phase III clinical trial of Actimmune(R) (interferon gamma-1b) in idiopathic pulmonary fibrosis
(IPF), and clinical study results from an interim analysis of an independent European study of interferon gamma-1b in IPF were presented
at the 99th International Conference of the American Thoracic Society (ATS) in Seattle.
Investigators reviewed a final primary data analysis from InterMune's Phase III randomized, placebo controlled, double-blind trial
evaluating interferon gamma-1b therapy in patients with IPF, as well as exploratory analyses from a follow-up observation period and
new follow-up survival data (from time of randomization through May 5, 2003). Separately, European investigators presented new results
from an interim analysis of an independent randomized controlled clinical trial in which a statistically significant survival benefit
(p = 0.01) was observed in IPF patients treated with interferon gamma-1b.
"A survival benefit has now been observed in three out of three randomized, controlled clinical trials with interferon gamma-1b.
Interferon gamma-1b has also been shown to be very well tolerated in over a dozen years of clinical use in many indications," said
James E. Pennington, M.D., InterMune's Executive Vice President of Medical and Scientific Affairs. "We are also extremely excited by the
May 5th follow-up data, which is consistent with previously observed survival observations. We look forward to meeting with the FDA
this year to discuss all the existing data and refine our plans for an additional survival trial."
Phase III Results Review
A randomized, double-blind, placebo-controlled Phase III study of 200 micrograms of interferon gamma-1b administered subcutaneously
three times per week was conducted in 330 IPF patients at 58 centers in the United States, Europe and South Africa. Median duration
of follow-up was 59 weeks.
The primary efficacy endpoint was time to either death or disease progression (as defined by either greater than or equal to 10%
decrease in % predicted forced vital capacity (FVC) or greater than or equal to 5mm Hg increase in A-a gradient). Additional efficacy
endpoints included patient symptoms, measures of disease progression, duration of hospitalization and survival.
According to a review of the final primary analysis (Sept. 13, 2000 through June 26, 2002), there was no significant treatment effect
on the primary endpoint, conventional measures of physiologic function or quality-of-life scales. However, a pre-specified analysis
of survival, a secondary endpoint in the trial, suggested that interferon gamma-1b confers a survival benefit to IPF patients in the
intent-to-treat population (41% relative reduction in the risk of death: p = 0.08). This survival benefit was more pronounced in
the pre-specified cohort of treatment adherent patients (66% relative reduction in risk of death: p = 0.02), defined as patients
receiving greater than 80% of scheduled doses and in patients who had less severely impaired lung function
(FVC greater than or equal to 55%) at baseline (71% relative reduction in risk of death: p = 0.004). In addition, an exploratory analysis
suggested a trend toward less dyspnea (i.e., difficulty breathing) after 48 weeks, according to the Transition Dyspnea Index (TDI) score.
Exploratory Analyses from Follow-up Observation Period
In exploratory analyses from the follow-up observation period (from time of randomization through November 30, 2002), again no
significant treatment effects on conventional markers of physiologic function were observed. However, a possible treatment benefit of
interferon gamma-1b on dyspnea continued to be observed, according to the TDI score.
Exploratory analyses also suggested a survival benefit associated with interferon gamma-1b treatment with a trend toward improved
overall survival in the intent-to-treat analysis (25% relative risk reduction in the risk of death; p = 0.17). Significantly improved
survival was observed in two large, independent subgroups of interferon gamma-1b-treated IPF patients, those with mild-to-moderate disease
at baseline and a pre-specified, treatment-adherent cohort. Interferon gamma-1b-treated IPF patients who had less severely impaired lung
function (FVC greater than or equal to 55% and DL(co) greater than or equal to 35%) at baseline exhibited a 74% relative reduction in
risk of death (p = 0.02). A 47% relative reduction in risk of death (p = 0.04) was observed in patients adherent to interferon gamma-1b
treatment.
Moreover, shorter duration of hospitalizations for respiratory admissions was seen in interferon gamma-1b-treated patients, particularly
those with less severe baseline impairment of lung function.
Interferon gamma-1b generally was well tolerated. The proportion of patients with reported pneumonia was slightly higher in the
interferon gamma-1b group (14.8%) than in the placebo group (10.1%). However, there was no imbalance of patients with recurrent,
severe/life-threatening, or fatal pneumonias. The adverse events were consistent with the known safety profile of interferon gamma-1b.
Long-Term Survival Data
Long-term survival data (from time of initial randomization through May 5, 2003) was also presented. Blinded study treatment ended in all
patients by Nov. 30, 2002, and over 80% of patients who completed the study opted to receive interferon gamma-1b in an open-label extension
study. Assessment of patient vital status ten months after study completion on June 26th continues to suggest enhanced survival in patients
initially randomized to interferon gamma-1b treatment. Occurrence of death in the intent-to-treat population was 17.9% (29/162) in
interferon gamma-1b-treated patients and 25.6% (43/168) in placebo-treated patients, respectively (30% relative reduction in risk of death;
p = 0.07). Interferon gamma-1b-treated IPF patients who had less severely impaired lung function (FVC greater than or equal to 55% and
DL(co) greater than or equal to 35%) at baseline exhibited a 51% relative reduction in risk of death (p = 0.009).
"These data suggest that interferon gamma-1b may confer a survival benefit in patients with IPF, particularly in those adhering to the
treatment regimen and in those with less severely impaired lung function," said Paul Noble, M.D., Professor of Medicine, Yale University
School of Medicine, and an investigator and member of InterMune's protocol steering committee for the Phase III trial. "This is the first
large, placebo controlled trial to suggest a potential survival benefit in IPF. We are excited about this observation and feel it is
important to conduct a confirmatory survival trial."
Independent European Trial Results Review
A prospective, multi-center, randomized controlled trial is currently being conducted by the Hellenic Interstitial Lung Disease Group in
Greece. At ATS, the investigators reported interim data on 42 patients randomized to receive interferon gamma-1b plus prednisone or oral
colchicine plus prednisone.
An interim analysis of survival showed 2/27 (7.4%) patients in the interferon gamma-1b-treated group and 6/15 (40%) patients in the
colchicine-treated group had died, respectively, representing an 81% relative reduction in the risk of death in favor of the interferon
gamma-1b group (p = 0.01). Consistent with InterMune's phase III trial, there appeared to be minimal treatment effect on conventional
physiologic measures of disease progression.
"Our preliminary findings show improved survival with interferon gamma-1b treatment versus colchicine treatment in IPF, and we are
pleased that these results are consistent with those of other controlled trials with respect to the prolongation of survival time
observed in IPF patients treated with interferon gamma-1b," said Demosthenes Bouros, M.D., Professor of Medicine, Medical School
University of Thrace and a principal investigator in the trial. "We believe that interferon gamma-1b is a promising therapeutic that
offers IPF patients hope for improved survival against this uniformly fatal disease."
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