Steroid Refractory Graft Versus Host Disease

Ironwood Pharmaceuticals will keep tracking participants and reevaluate the safety and efficacy after two years. Ironwood Pharmaceuticals’ stargazing has identified a new frontier for apraglutide by generating early clinical evidence that the GLP-2 analog plays nicely with Incyte’s Jakafi in a rare disease. The company acquired the molecule last year through its $1 billion takeover of VectaBio.  The exploratory phase 2 STARGAZE trial is testing three doses of the long-acting GLP-2 analog apraglutide in 31 people with steroid-refractory gastrointestinal acute graft-versus-host disease (SR GI aGVHD). The GI tract is one of the main tissue systems damaged by aGVHD, and Ironwood sees an ongoing need for non-immunosuppressive treatment options. Subjects received the investigational molecule on top of standard-of-care therapies including ruxolitinib, which Incyte sells as Jakafi, and systemic corticosteroids. Ironwood said “the majority of patients responded to treatment by Day 28 and Day 56.” All the lower gastrointestinal responses seen at Day 28 persisted through to Day 91. Safety and tolerability were in line with expectations for the use of standard of care and a GLP-2 analog in GVHD patients. Robert Zeiser, M.D., professor of hematology and oncology at the University of Freiburg in Germany and principal investigator for the STARGAZE study, called the data “an important step forward for patients with SR GI aGVHD given limited duration of response with currently approved agents.”    “Given its potential GI effect on tissue regeneration and function, apraglutide may have a role in the advanced management of acute GI GVHD through a non-immunosuppressive approach,” Zeiser added. Ironwood will keep tracking participants and reevaluate the safety and efficacy of apraglutide after two years. As well as continuing to track safety and GI responses, researchers are looking at the effect of the molecule on outcomes including graft failure and overall survival out to two years after the start of treatment.  Investors were unmoved by the update, remaining in the funk that began when Ironwood shared phase 3 data on apraglutide one month ago. That study linked apraglutide to improvements in short bowel syndrome (SBS), but investors wanted more and promptly wiped 30% off Ironwood’s share price. The company plans to file for approval in SBS using the data. 

– First prospective trial of a glucagon-like peptide (GLP-2) analog in SR GI aGVHD – – Results up to Day 91 show that apraglutide in SR GI aGVHD was well-tolerated with an acceptable safety profile, the study’s primary objective – – Exploratory secondary efficacy data showed lower GI tract responses maintained through Day 91 in SR GI aGVHD patients treated with apraglutide and standard of care – BOSTON--(BUSINESS WIRE)-- Ironwood Pharmaceuticals, Inc. (Nasdaq: IRWD), a GI-focused healthcare company, today announced positive, primary results up to Day 91 for its Phase II exploratory STARGAZE trial evaluating apraglutide in patients with steroid-refractory gastrointestinal acute Graft-versus-Host Disease (SR GI aGVHD). The primary objective of the trial was to evaluate the safety and tolerability of once-weekly apraglutide, a next-generation, long-acting glucagon-like peptide-2 (GLP-2) analog, in SR GI aGVHD patients treated with standard of care, including systemic corticosteroids and ruxolitinib. This was a first-of-its-kind study combining a GLP-2 analog with immunosuppressive therapy in patients with SR GI aGVHD. The safety and tolerability observed in this trial was consistent with the standard of care and known safety of GLP-2 analogs, as well as observed events in the GVHD population. The emerging safety pro apraglutide in the SR GI aGVHD population was monitored by an independent safety review committee that endorsed the continuation of the study without modification. In addition to evaluating safety, secondary endpoints evaluated efficacy using lower GI and all-organ responses, indicative of organ-level improvement from baseline per the Mount Sinai Acute GVHD International Consortium (MAGIC) grading system. The majority of patients responded to treatment by Day 28 and Day 56. All lower GI responders at Day 28 maintained their response through Days 56 and 91, considering available organ staging assessments. “The findings presented here are an important step forward for patients with SR GI aGVHD given limited duration of response with currently approved agents,” said Robert Zeiser, M.D., Professor of Hematology and Oncology at the University of Freiburg and Principal Investigator for the STARGAZE study. “Given its potential GI effect on tissue regeneration and function, apraglutide may have a role in the advanced management of acute GI GVHD through a non-immunosuppressive approach, and we look forward to longer-term findings in this patient population.” aGVHD is a rare, life-threatening condition that occurs when immune cells of the donor (the graft) attack a recipient’s (host) healthy cells after an allogeneic hematopoietic stem cell transplant (HSCT). The condition typically affects the skin, GI tract, and liver. GI aGVHD, is a leading cause of morbidity and mortality following HSCT with approximately 70% of aGVHD cases having GI involvement. While treatment options exist for aGVHD, a significant number of patients do not respond to 1st line therapy, such as corticosteroids. Despite receiving 2nd line therapy, many patients also do not maintain response over time, with significant non-relapse mortality (NRM) after six months. “These results from the first-of-its-kind STARGAZE trial in a population of patients with SR GI aGVHD add to the body of evidence about the safety and tolerability pro apraglutide,” said Michael Shetzline, M.D., Ph.D., Senior Vice President, Chief Medical Officer and Head of Research and Development at Ironwood Pharmaceuticals. “Other studies have shown that GLP-2 promotes intestinal healing and regeneration, and we look forward to further understanding the data from this trial given the high unmet medical need of these patients who suffer from high morbidity and mortality.” Additional data from the STARGAZE trial are expected to be presented at an upcoming medical congress. The STARGAZE study will continue through its two-year endpoint, where apraglutide will be re-evaluated for safety and efficacy. About STARGAZE STARGAZE (Study of Apraglutide in Graft-versus-Host Disease) is a randomized, single-blind, Phase II exploratory trial designed to evaluate weekly dosing of apraglutide in combination with standard of care, including systemic corticosteroids and ruxolitinib in patients with steroid-refractory GI aGVHD for up to 90 days with a follow-up period lasting up to two years after the first dose. STARGAZE is the first prospective trial of a glucagon-like peptide (GLP-2) analog focusing on patients with steroid-refractory GI aGVHD. The trial enrolled 31 patients and at this primary analysis, evaluated them for safety and tolerability, pharmacokinetics, and efficacy, including response rate, duration of response, and survival-related outcomes. This study’s population consisted of more than 87% Grade III and IV patients, the most severe cohort as measured by the Mount Sinai Acute Graft Versus Host Disease International Consortium (MAGIC) scale. About Acute Graft-Versus-Host Disease (aGVHD) Acute Graft-Versus-Host Disease (aGVHD) is a severe condition which occurs when immune cells from the donor attack a recipient’s healthy cells after an allogeneic hematopoietic stem cell transplant (HSCT), the standard last-line treatment for many forms of blood cancer. aGVHD typically emerges within the first 100 days post-transplant and predominantly affects the skin, gastrointestinal (GI) tract and liver. GI GvHD is one of the leading causes of morbidity and mortality following HSCT. The predominant manifestations of GI GVHD are abdominal pain and diarrhea. The diarrhea is secretory, occurs independently of oral intake and can be profound and incessant, with up to several liters of output and more than 10 episodes per day, often requiring parenteral support to feed and hydrate patients. More than 26,000 allogeneic HSCTs take place in the U.S., Europe and Japan annually and aGVHD occurs in an estimated 30-50% of patients. While treatment options exist for aGVHD, a significant number of patients do not respond to 1st line therapy, such as corticosteroids. Despite receiving 2nd line therapy, many patients also do not maintain response over time, with significant non-relapse mortality (NRM) after six months. About Apraglutide Apraglutide is an investigational, next-generation, long-acting synthetic GLP-2 analog being developed for a range of rare gastrointestinal diseases where GLP-2 can play a central role in addressing disease pathophysiology, including short bowel syndrome with intestinal failure (SBS-IF) and Acute Graft-Versus-Host Disease (aGVHD). About Ironwood Pharmaceuticals Ironwood Pharmaceuticals (Nasdaq: IRWD), an S&P SmallCap 600® company, is a leading global gastrointestinal (GI) healthcare company on a mission to advance the treatment of GI diseases and redefine the standard of care for GI patients. We are pioneers in the development of LINZESS® (linaclotide), which is the U.S. branded prescription market leader for adults with irritable bowel syndrome with constipation (IBS-C) or chronic idiopathic constipation (CIC) and is also indicated for the treatment of functional constipation in pediatric patients ages 6-17 years old. Ironwood is also advancing apraglutide, a next-generation, long-acting synthetic GLP-2 analog being developed for rare gastrointestinal diseases, including short bowel syndrome with intestinal failure (SBS-IF), as well as several earlier stage assets. Building upon our history of GI innovation, we keep patients at the heart of our R&D and commercialization efforts to reduce the burden of GI diseases and address significant unmet needs. Founded in 1998, Ironwood Pharmaceuticals is headquartered in Boston, Massachusetts, with a site in Basel, Switzerland. We routinely post information that may be important to investors on our website at . In addition, follow us on X and on LinkedIn. Forward-Looking Statements This press release contains forward-looking statements. Investors are cautioned not to place undue reliance on these forward-looking statements, including statements about the assessment of the data from the Phase II exploratory STARGAZE trial of apraglutide in patients with steroid-refractory GI aGVHD and the continuation of the study through its two-year endpoint; the safety, tolerability and efficacy of apraglutide in this trial; the potential effect of apraglutide on intestinal healing, function and regeneration; and the therapeutic potential of apraglutide for the treatment of aGVHD. These forward-looking statements speak only as of the date of this press release, and Ironwood undertakes no obligation to update these forward-looking statements. Each forward-looking statement is subject to risks and uncertainties that could cause actual results to differ materially from those expressed or implied in such statement. Applicable risks and uncertainties include those related to the effectiveness of development and commercialization efforts by us and our partners; preclinical and clinical development, manufacturing and formulation development of apraglutide; the risk that clinical programs and studies may not progress or develop as anticipated, including that studies are delayed or discontinued for any reason, such as safety, tolerability, enrollment, manufacturing, economic or other reasons; the risk that findings from completed nonclinical and clinical studies may not be replicated in later studies; the risk of competition or that new products may emerge that provide different or better alternatives for treatment of the conditions that our products are approved to treat; the risk that healthcare reform and other governmental and private payor initiatives may have an adverse effect upon or prevent our products’ or product candidates’ commercial success; the efficacy, safety and tolerability of our product candidates; the risk that the commercial and therapeutic opportunities for our product candidates are not as we expect; the risk that we are unable to successfully partner with other companies to develop and commercialize products or product candidates; decisions by regulatory and judicial authorities; the risk we may never get additional patent protection for our product candidates, that patents for our products may not provide adequate protection from competition, or that we are not able to successfully protect such patents; the risk that the development of apraglutide is not successful or that any of our product candidates does not receive regulatory approval or is not successfully commercialized; outcomes in legal proceedings to protect or enforce the patents relating to our products and product candidates, including abbreviated new drug application litigation; challenges from and rights of competitors or potential competitors; and the risks listed under the heading “Risk Factors” and elsewhere in our Annual Report on Form 10-K for the year ended December 31, 2023, and in our subsequent Securities and Exchange Commission filings.

NEW YORK, March 25, 2024 (GLOBE NEWSWIRE) -- Mesoblast Limited (Nasdaq:MESO; ASX:MSB), global leader in allogeneic cellular medicines for inflammatory diseases, today announced that U.S. FDA has informed the company that following additional consideration the available clinical data from its Phase 3 study MSB-GVHD001 appears sufficient to support submission of the proposed Biologics License Application (BLA) for remestemcel-L for treatment of pediatric patients with steroid-refractory acute graft versus host disease (SR-aGVHD). “We thank the agency for their collaborative approach. The responses and guidance from FDA are clear and provide us with a high level of confidence to refile our BLA for remestemcel-L in children with SR-aGVHD,” said Mesoblast CEO Dr. Silviu Itescu. Mesoblast intends to file the resubmission during the next quarter, seeking to address all remaining product characterization issues. About Mesoblast Mesoblast (the Company) is a world leader in developing allogeneic (off-the-shelf) cellular medicines for the treatment of severe and life-threatening inflammatory conditions. The Company has leveraged its proprietary mesenchymal lineage cell therapy technology platform to establish a broad portfolio of late-stage product candidates which respond to severe inflammation by releasing anti-inflammatory factors that counter and modulate multiple effector arms of the immune system, resulting in significant reduction of the damaging inflammatory process. Mesoblast has a strong and extensive global intellectual property portfolio with protection extending through to at least 2041 in all major markets. The Company’s proprietary manufacturing processes yield industrial-scale, cryopreserved, off-the-shelf, cellular medicines. These cell therapies, with defined pharmaceutical release criteria, are planned to be readily available to patients worldwide. Mesoblast is developing product candidates for distinct indications based on its remestemcel-L and rexlemestrocel-L allogeneic stromal cell technology platforms. Remestemcel-L is being developed for inflammatory diseases in children and adults including steroid refractory acute graft versus host disease, and biologic-resistant inflammatory bowel disease. Rexlemestrocel-L is being developed for advanced chronic heart failure and chronic low back pain. Two products have been commercialized in Japan and Europe by Mesoblast’s licensees, and the Company has established commercial partnerships in Europe and China for certain Phase 3 assets. Mesoblast has locations in Australia, the United States and Singapore and is listed on the Australian Securities Exchange (MSB) and on the Nasdaq (MESO). For more information, please see www.mesoblast.com, LinkedIn: Mesoblast Limited and Twitter: @Mesoblast Forward-Looking StatementsThis press release includes forward-looking statements that relate to future events or our future financial performance and involve known and unknown risks, uncertainties and other factors that may cause our actual results, levels of activity, performance or achievements to differ materially from any future results, levels of activity, performance or achievements expressed or implied by these forward-looking statements. We make such forward-looking statements pursuant to the safe harbor provisions of the Private Securities Litigation Reform Act of 1995 and other federal securities laws. Forward-looking statements should not be read as a guarantee of future performance or results, and actual results may differ from the results anticipated in these forward-looking statements, and the differences may be material and adverse. Forward-looking statements include, but are not limited to, statements about: the initiation, timing, progress and results of Mesoblast’s preclinical and clinical studies, and Mesoblast’s research and development programs; Mesoblast’s ability to advance product candidates into, enroll and successfully complete, clinical studies, including multi-national clinical trials; Mesoblast’s ability to advance its manufacturing capabilities; the timing or likelihood of regulatory filings and approvals (including any future decision that the FDA may make on the BLA for remestemcel-L for pediatric patients with SR-aGVHD), manufacturing activities and product marketing activities, if any; the commercialization of Mesoblast’s product candidates, if approved; regulatory or public perceptions and market acceptance surrounding the use of stem-cell based therapies; the potential for Mesoblast’s product candidates, if any are approved, to be withdrawn from the market due to patient adverse events or deaths; the potential benefits of strategic collaboration agreements and Mesoblast’s ability to enter into and maintain established strategic collaborations; Mesoblast’s ability to establish and maintain intellectual property on its product candidates and Mesoblast’s ability to successfully defend these in cases of alleged infringement; the scope of protection Mesoblast is able to establish and maintain for intellectual property rights covering its product candidates and technology; estimates of Mesoblast’s expenses, future revenues, capital requirements and its needs for additional financing; Mesoblast’s financial performance; developments relating to Mesoblast’s competitors and industry; and the pricing and reimbursement of Mesoblast’s product candidates, if approved. You should read this press release together with our risk factors, in our most recently filed reports with the SEC or on our website. Uncertainties and risks that may cause Mesoblast’s actual results, performance or achievements to be materially different from those which may be expressed or implied by such statements, and accordingly, you should not place undue reliance on these forward-looking statements. We do not undertake any obligations to publicly update or revise any forward-looking statements, whether as a result of new information, future developments or otherwise. Release authorized by the Chief Executive. For more information, please contact: Corporate Communications / InvestorsMediaPaul HughesBlueDot MediaT: +61 3 9639 6036Steve DabkowskiE: investors@mesoblast.comT: +61 419 880 486 E: steve@bluedot.net.au