| BENLYSTA™ (belimumab) |
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BENLYSTA is an investigational human monoclonal antibody drug and the first in a new class of drugs called BLyS-specific inhibitors. It is being developed for the treatment of systemic lupus erythematosus (SLE) by HGS and GlaxoSmithKline (GSK) under a co-development and commercialization agreement entered into in August 2006. [1-2] BENLYSTA has successfully met its primary endpoint in two pivotal Phase 3 trials in systemic lupus. [3-6] Following discussions with regulatory authorities, HGS and GSK plan to submit marketing applications in the United States, Europe and other regions in the first half of 2010. HGS believes BENLYSTA has the potential to become the first new approved drug for people living with lupus in more than 50 years. How BENLYSTA WorksBENLYSTA inhibits the biological activity of B-lymphocyte stimulator, or BLyS®. BLyS is a naturally occurring protein discovered by HGS [7-8], which is required for the survival and development of B-lymphocyte cells into mature plasma B cells. Plasma B cells produce antibodies, the body’s first line of defense against infection. In lupus and certain other autoimmune diseases, elevated levels of BLyS are believed to contribute to the production of autoantibodies – antibodies that attack and destroy the body’s own healthy tissues. The results of prospective observational studies show a significant correlation of elevated levels of BLyS with SLE disease activity. [9-16] BENLYSTA acts by: (1) specifically recognizing and binding to BLyS, (2) inhibiting BLyS’s stimulation of B-cell development, and (3) restoring the potential for autoantibody-producing B cells to undergo the normal process of apoptosis (programmed cell death). Preclinical and clinical studies show that BLyS antagonists such as BENLYSTA can reduce autoantibody levels in SLE. [9-53] The results of two pivotal Phase 3 trials show that belimumab can reduce SLE disease activity. [3-6] BENLYSTA Inhibits the Biological Activity of BLyS
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Figure 2. In healthy people, the body signals autoantibody-producing B cells to kill themselves through apoptosis. In patients with autoimmune diseases, such as lupus, the BLyS protein stimulates B-cell hyperactivity and inhibits apoptosis. This allows autoantibody-producing B cells to mature and release autoantibodies into the body. Autoantibodies then attack the body’s own tissues, causing autoimmune diseases like lupus. |
The Phase 3 development program for belimumab includes two double-blind, placebo-controlled, multi-center Phase 3 superiority trials – BLISS-52 and BLISS-76 – to evaluate the efficacy and safety of belimumab plus standard of care, versus placebo plus standard of care, in seropositive (HEp-2 ANA > 1:80 and/or anti-dsDNA > 30 IU/mL) patients with SLE. [54-57] This is the largest clinical trial program ever conducted in lupus patients. BLISS-52 randomized and treated 865 patients at 90 clinical sites in 13 countries, primarily in Asia, South America and Eastern Europe. BLISS-76 enrolled and randomized 826 patients at 133 clinical sites in 19 countries, primarily in North America and Europe. The design of the two trials is similar, but the duration of therapy in the two studies is different – 52 weeks for BLISS-52 and 76 weeks for BLISS-76. HGS designed the Phase 3 program for belimumab in collaboration with GSK and leading international SLE experts, and the program is being conducted under a Special Protocol Assessment agreement with FDA [57].
The primary efficacy endpoint of BLISS-52 and BLISS-76 is the patient response rate at Week 52 based on the SLE Responder Index, which is defined by: (1) a reduction from baseline of at least 4 points on the SELENA SLEDAI disease activity scale (which indicates a clinically important reduction in SLE disease activity); (2) no worsening of disease as measured by the Physician’s Global Assessment (worsening defined as an increase of 0.30 points or more from baseline); (3) no new BILAG A organ domain score (which indicates a severe flare of lupus disease activity) and no more than one new BILAG B organ domain score (which indicates a moderate flare of disease activity). Analysis for the primary endpoint is based on intention-to-treat (ITT) and adjusted for baseline stratification factors, including SELENA SLEDAI score, proteinuria and race. The data from BLISS-76 were analyzed after 52 weeks in support of a potential Biologics License Application in the United States and Marketing Authorization Applications in Europe and other regions. However, the trial is ongoing and will continue for another 24 weeks.
In each of the two Phase 3 trials, patients were randomized to one of three treatment groups: 10 mg/kg belimumab (BLISS-52, n=290), 1 mg/kg belimumab (BLISS-52, n=288), or placebo (BLISS-52, n=287). Patients are dosed intravenously on Days 0, 14 and 28, then every 28 days thereafter for the duration of the study. All patients receive standard of care therapy in addition to the study medication. Safety is reviewed by an independent Data Monitoring Committee throughout both studies.
In October 2006, HGS received a Special Protocol Assessment from the FDA, agreeing that the design of the Phase 3 program and clinical trials is suitable to support regulatory approval. [57] HGS also met with the European Agency for the Evaluation of Medicinal Products (EMEA), and received agreement from EMEA on the major components of the Phase 3 program, including the primary efficacy endpoint measures, target patient population, and dose selection.
BENLYSTA (belimumab) has met the primary efficacy endpoint in two pivotal Phase 3 trials, as specified by Special Protocol Assessment agreement with FDA. [3-6] The efficacy of treatment with BENLYSTA plus standard of care was superior to placebo plus standard of care in both BLISS-52 and BLISS-76, with overall adverse event rates comparable to placebo plus standard of care. HGS and GSK plan to submit marketing applications in the first half of 2010, following discussions with regulatory authorities in the United States, Europe and other regions.
In July 2009, HGS and GSK announced that BENLYSTA met the primary endpoint in BLISS-52, the first of two pivotal Phase 3 trials in seropositive patients with SLE. [4] The results of BLISS-52, which were presented in full in October 2009 at the 73rd Annual Scientific Meeting of the American College of Rheumatology (ACR) [5-6], demonstrated that belimumab plus standard of care achieved a clinically and statistically significant improvement in patient response rate as measured by the SLE Responder Index at Week 52, compared with placebo plus standard of care. Study results also showed that belimumab was generally well tolerated, with adverse event rates comparable between belimumab and placebo treatment groups.
Among 865 patients randomized and treated, belimumab met its primary efficacy endpoint by achieving a superior SLE patient response rate at Week 52 vs. placebo plus standard of care.
Among 865 patients randomized and treated, belimumab met its primary efficacy endpoint by achieving a superior SLE patient response rate at Week 52 vs. placebo plus standard of care.
Key findings of the BLISS-52 study also included the following:
FLARES
DISEASE ACTIVITY
STEROID USE
FATIGUE AND QUALITY OF LIFE
SAFETY
In November 2009, HGS and GSK announced that BENLYSTA met the primary endpoint in BLISS-76, the second of two pivotal Phase 3 trials in seropositive patients with SLE. [3] BLISS-76 topline study results through 52 weeks showed that belimumab 10 mg/kg plus standard of care achieved a statistically significant improvement in patient response rate as measured by the SLE Responder Index at Week 52, compared with placebo plus standard of care. Study results also showed that belimumab was generally well tolerated, as demonstrated by a similar rate of discontinuations due to adverse events across treatment groups, with overall adverse event rates comparable between belimumab and placebo treatment groups.
The data from the BLISS-76 study were analyzed after 52 weeks, in accord with the study protocol, in support of a potential Biologics License Application in the United States and Marketing Authorization Applications in Europe and other regions. However, the BLISS-76 study is ongoing and will continue for 24 more weeks. Additional data will be available following completion of the full 76-week study period.
Topline BLISS-76 results include the following:
Based on an intention-to-treat (ITT) analysis, belimumab 10 mg/kg met its primary efficacy endpoint of superiority versus placebo at Week 52. A statistically significant improvement was shown in patient response rate for belimumab 10 mg/kg plus standard of care, vs. placebo plus standard of care, as measured by the SLE Responder Index at Week 52: 43.2% for 10 mg/kg belimumab, 40.6% for 1 mg/kg belimumab, and 33.8% for placebo (p=0.021 and p=0.10 for 10 mg/kg and 1 mg/kg belimumab, respectively vs. placebo). The 1 mg/kg dose plus standard of care did not achieve statistically significant improvement in the current study. The SLE Responder Index defines patient response as an improvement in SELENA SLEDAI score of 4 points or greater, with no clinically significant BILAG worsening and no clinically significant worsening in Physician’s Global Assessment.
Results for prespecified major secondary efficacy endpoints in BLISS-76 were:
In BLISS-76, belimumab was generally well tolerated, with rates of overall adverse events, serious and/or severe adverse events, all infections, serious and/or severe infections, and discontinuations due to adverse events comparable between treatment groups receiving belimumab plus standard of care and the treatment group receiving placebo plus standard of care.
Serious and/or severe adverse events were reported in 26.8% of patients on belimumab and 24.0% of patients on placebo. Infections were reported in 72.1% of patients on belimumab and 67.3% of patients on placebo. Serious and/or severe infections were reported in 7.2% of patients on belimumab and 8.0% of patients on placebo. Serious and/or severe infusion reactions were reported in 1.1% of patients on belimumab and 0.7% of patients on placebo. Discontinuations due to adverse events were 7.2% in the belimumab treatment groups and 7.6% in the placebo treatment group. Malignancies were reported by 2, 3, and 1 subjects in the belimumab 10 mg/kg, belimumab 1 mg/kg and placebo groups, respectively. There were three deaths in the study, with 1, 2, and 0 reported in the belimumab 10 mg/kg, belimumab 1 mg/kg and placebo groups, respectively.
Results through four years of the long-term Phase 2 continuation study of belimumab were presented in October 2009 at the ACR Annual Scientific Meeting [20] The data showed that belimumab was associated with sustained improvement or stabilization of SLE disease activity and patient response rates and with decreased frequency of SLE disease flares in seropositive patients through four years of treatment.
The evidence of sustained clinical effect from Week 52 to Week 208 in seropositive patients were treated with belimumab from initiation of the Phase 2 study included an increase from 46% at Week 52 to 57% at Week 208 in the percentage achieving the patient response rate selected as the Phase 3 primary efficacy endpoint. The overall incidence of adverse events (in general and by system organ class), serious adverse events, infections, serious infections, malignancies and laboratory abnormalities decreased or stabilized over time from Week 52 to Week 208.
HGS first discovered the naturally occurring protein, BLyS or B-lymphocyte stimulator, in 1997 and published a preliminary description of its activity in the journal, Science, in July 1999. [7-8] Following that discovery, HGS initiated a program to develop human monoclonal antibodies that would specifically recognize and inhibit the biological activity of BLyS. BENLYSTA is a human monoclonal antibody that HGS generated through a collaboration with Cambridge Antibody Technology. [61]
Health professionals and patients interested in BENLYSTA (belimumab) clinical trials or other studies involving HGS products may inquire via email to This e-mail address is being protected from spam bots, you need JavaScript enabled to view it or by calling HGS at (877) 822-8472. Information about HGS clinical trials may also be found at www.clinicaltrials.gov.
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To view announcements on LymphoStat-B and BLyS, click on the following:
Human Genome Sciences and GlaxoSmithKline Announce Positive Results in Second of Two Phase 3 Trials of BENLYSTA in Systemic Lupus Erythematosus - November 2, 2009:
Human Genome Sciences and Glaxosmithkline Announce Full Presentation at ACR of Positive Phase 3 Study Results For BENLYSTA™ in Systemic Lupus Erythematosus - October 20, 2009
Novel Evidence-Based Systemic Lupus Erythematosus (SLE) Responder Index Described in Peer Reviewed Publication as Potentially Significant Advance in Lupus Drug Development - September 4, 2009
Human Genome Sciences And Glaxosmithkline Announce Positive Phase 3 Study Results For Benlysta™ In Systemic Lupus Erythematosus - July 20, 2009
Human Genome Sciences Completes Enrollment in Second Phase 3 Lymphostat-B® Trial -August 27, 2008
Human Genome Sciences Reports Positive Long-Term Data for LymphoStat-B in Patients with Active Systemic Lupus Erythematosus - June 12, 2008
Human Genome Sciences Completes Enrollment in First of Two Phase 3 LymphoStat-B® Trials - April 22, 2008
Human Genome Sciences Reports Positve Data from Long-Term Treatment with LymphoStat-B in Patients with Active Systemic Lupus Erythematosus - November 9. 2007
Human Genome Sciences and Glaxosmithkline Announce Initiation of Phase 3 Clinical Trial of Lymphostat-B® in Systemic Lupus Erythematosus - February 13, 2007
Human Genome Sciences Announces Positive Special Protocol Assessment from FDA for Phase 3 Clinical Trials of Lymphostat-B™ in Systemic Lupus Erythematosus - November 14, 2006
Human Genome Sciences Announces Positive Special Protocol Assessment from FDA for Phase 3 Clinical Trials of Lymphostat-B™ in Systemic Lupus Erythematosus - October 26, 2006
Human Genome Sciences Announces Phase 3 Clinical Development Program for Lymphostat-B™ in Systemic Lupus Erythematosus - August 9, 2006
Human Genome Sciences Announces Full Presentation of Results of Phase 2 Clinical Trial of Lymphostat-B™ in Systemic Lupus Erythematosus - June 22, 2006
Human Genome Sciences Reports Phase 2 Results for Lymphostat-B™ (Belimumab) in Patients with Rheumatoid Arthritis - November 17, 2005
Human Genome Sciences Reports Results of a Phase 2 Clinical Trial of LymphoStat-B™ in Patients with Systemic Lupus Erythematosus - October 5, 2005
GlaxoSmithKline Exercises Option to LymphoStat-B™ - July 7, 2005
Human Genome Sciences Reports Results of a Phase 2 Clinical Trial of LymphoStat-B™ in Patients with Rheumatoid Arthritis - April 6, 2005
Human Genome Sciences Completes Patient Enrollment in a Phase 2 Clinical Trial of Lymphostat-B™ for the Treatment of Rheumatoid Arthritis - July 29, 2004
Human Genome Sciences Announces Selection of Lymphostat-BTM for Participation in FDA's Continuous Marketing Application Pilot 2 Program - March 4, 2004
Human Genome Sciences Initiates Phase 2 Clinical Trial of Lymphostat-BTM for the Treatment of Rheumatoid Arthritis - January 8, 2004
Human Genome Sciences Reports Results of Phase 1 Clinical Trial of Lymphostat-B™ in Patients With Systemic Lupus Erythematosus - October 28, 2003
Human Genome Sciences Initiates Phase 2 Clinical Trial of LymphoStat-B for the Treatment of Systemic Lupus Erythematosus - September 25, 2003
Results of Phase I Clinical Trial Demonstrate That LymphoStat-B is Safe and Biolocically Active in Patients with Systemic Lupus Erythematosus - April 21, 2003
Human Genome Sciences Initiates Trials of a New Drug for Systemic Lupus Erythematosus and Other Autoimmune Diseases - November 1, 2001
Human Genome Sciences Announces Trial For Treatment of Immunoglobulin-A Deficiency - September 19, 2001
Human Genome Sciences Receives Orphan Drug Designation for BLyS Therapeutic Protein for Treatment of Common Variable Immunodeficiency - February 27, 2001
High Levels of BLyS Implicated in Lupus and Rheumatoid Arthritis Patients - October 30, 2000
Human Genome Sciences and Cambridge Antibody Technology Commit to Exclusive Development of Anti-BLyS Antibodies - October 30, 2000
Human Genome Sciences and Dow Agree To Develop HGS' Radiolabeled B-Lymphocyte Stimulator - October 30, 2000
Human Genome Sciences to Initiate Human Clinical Trials of BLyS - June 23, 2000
Human Genome Sciences Announces the Discovery of a Novel Immune Stimulant - July 8, 1999