Leukoencephalopathy, Progressive Multifocal

MINT Study Results Show Clinically Meaningful and Statistically Significant Efficacy in AChR+ and MuSK+ Patients First and Only Phase 3 Placebo-Controlled gMG Trial for a Biologic That Tapered Corticosteroid Use THOUSAND OAKS, Calif., Oct. 15, 2024 /PRNewswire/ -- Amgen (NASDAQ:AMGN) today announced the presentation of positive top-line results from the Phase 3 MINT trial evaluating the efficacy and safety of UPLIZNA® (inebilizumab-cdon) for the treatment of adults with generalized myasthenia gravis (gMG), a rare autoimmune disorder. Results from this randomized, double-blind, placebo-controlled, parallel-group trial will be presented at the Myasthenia Gravis Foundation of America (MGFA) Scientific Session during the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) Annual Meeting, taking place Oct. 15-18 in Savannah, Georgia. The trial met its primary endpoint, with a statistically significant change from baseline in Myasthenia Gravis Activities of Daily Living (MG-ADL) score for UPLIZNA (-4.2) compared with placebo (-2.2) (difference: –1.9, p<0.0001) at Week 26 for the combined study population. The study included patients who are acetylcholine receptor autoantibody-positive (AChR+) and those who are muscle-specific kinase autoantibody-positive (MuSK+), with participants receiving UPLIZNA or placebo on Day 1 and Day 15. UPLIZNA demonstrated continued improvement through Week 26. Notably, patients who entered the study taking corticosteroids were tapered down starting at Week 4 to prednisone 5 mg per day by Week 24. No new safety signals were identified. "Patients living with generalized myasthenia gravis deserve an effective treatment option that provides long-term symptom relief. Once approved, UPLIZNA is expected to offer a new option for patients earlier in their treatment plan," said Jay Bradner, M.D., executive vice president, Research and Development, and chief scientific officer at Amgen. "UPLIZNA targets CD19+ pre-B cells, mature B-cells and some plasmablasts, which are drivers of the disease. The clinically significant results from the MINT trial further strengthen the growing evidence for UPLIZNA in severe autoimmune diseases and reinforce Amgen's leadership in B-cell targeting therapeutics." Key secondary endpoints were tested sequentially in a predefined order. UPLIZNA demonstrated a statistically significant and clinically meaningful change from baseline compared to placebo for the first four key secondary endpoints. UPLIZNA demonstrated a statistically significant change in Quantitative Myasthenia Gravis (QMG) score for the combined population (-4.8) compared to placebo (-2.3) at Week 26 (difference: -2.5, p=0.0002). In the AChR+ population, UPLIZNA demonstrated mean change from baseline (-4.2) in MG-ADL score at Week 26 compared to placebo (-2.4) (difference: -1.8, p=0.0015). In the AChR+ population, UPLIZNA demonstrated mean change from baseline (-4.4) in QMG score at Week 26 compared to placebo (-2.0) (difference -2.5, p=0.0011). In the MuSK+ population, UPLIZNA demonstrated mean change from baseline (-3.9) in MG-ADL score at Week 26 compared to placebo (-1.7) (difference -2.2, p=0.0297). Additionally, in the MuSK+ population, the mean change from baseline in QMG score at Week 26 showed a trend favoring UPLIZNA but was not statistically significant (-5.2 for UPLIZNA and -3.0 for placebo, difference -2.3, p=0.1326). "Myasthenia gravis can have a profound impact on patients by causing severe fatigable muscle weakness that impairs physical functioning, activities of daily living and quality of life," said Richard J. Nowak, M.D., M.S., global principal study investigator and director of the Myasthenia Gravis Clinic at Yale University. "This trial demonstrates clinically meaningful benefits of UPLIZNA, a twice-yearly infused medicine with a unique mechanism of action that selectively targets and depletes CD19+ B cells, which are key upstream drivers of myasthenia gravis. MINT is also the only Phase 3 biologic trial that included a protocol-specified steroid taper, an important consideration for patients as effects of prolonged high-dose steroid use contribute to the overall burden of disease." The overall safety results during the placebo-controlled period of the trial were consistent with the known safety profile of UPLIZNA. The most common treatment-emergent adverse events were COVID-19, nasopharyngitis, urinary tract infection, infusion related reaction, headache and cough in the combined population. MINT is the largest placebo-controlled gMG clinical trial for a biologic therapy (238 adults) and enrolled the largest number of patients (48 adults) who are MuSK+. The trial also included 190 adults who are AChR+. Further data will characterize placebo-controlled efficacy and safety of UPLIZNA over 12 months in AChR+ patients with gMG. At the 2024 AANEM Annual Meeting, Amgen will also be presenting a poster titled, "The Burden of Glucocorticoid Use Among Patients with Generalized Myasthenia Gravis in the United States," highlighting how higher use of glucocorticoids was associated with more toxicities and overall health care resource utilization and costs. UPLIZNA is currently approved for the treatment of neuromyelitis optica spectrum disorder (NMOSD) in adult patients who are anti-aquaporin-4 (AQP4) antibody positive in the United States, European Union, Brazil and Canada, among other countries. UPLIZNA was also recently granted Breakthrough Therapy Designation for IgG4-Related Diseases by FDA following Phase 3 results announced in June. Based on the MINT primary results, Amgen is planning to file for approval in the U.S., followed by other key markets. About the MINT Trial The MINT trial is a randomized, double-blind, placebo-controlled, parallel-group trial (NCT04524273) evaluating the efficacy and safety of UPLIZNA in adults with gMG. The trial enrolled 238 adults with gMG, including 190 patients who are acetylcholine receptor autoantibody-positive (AChR+) and 48 patients who are muscle-specific kinase autoantibody-positive (MuSK+). Eligibility criteria at screening and randomization included a Myasthenia Gravis Foundation of America (MGFA) classification of II, III, or IV disease, MG-ADL score between 6 and 10 with greater than 50% of this score attributed to non-ocular items, or an MG-ADL score of at least 11, QMG score of at least 11, and use of a corticosteroid and/or non-steroidal immunosuppressant. The primary endpoint was change from baseline in MG-ADL score at Week 26 in the combined population. Key secondary endpoints included change from baseline in QMG scores in the combined study population; change from baseline in MG-ADL score at Week 26 for the AChR+ cohort and separately the MuSK+ cohort; and change from baseline in QMG score at Week 26 for the AChR+ cohort and separately the MuSK+ cohort. Patients who entered the study taking a corticosteroid were tapered down to prednisone 5 mg a day, starting at Week 4 to Week 24. The MINT trial also includes an optional three-year open-label treatment period. About Generalized Myasthenia Gravis (gMG) Generalized myasthenia gravis (gMG) is a rare, chronic, B-cell-mediated autoimmune disorder that impairs neuromuscular communication and can cause muscle weakness, trouble breathing, difficulty swallowing and impaired speech and vision.1-4 Approximately 85% of patients with myasthenia gravis have the generalized form, or gMG.4,5 The prevalence and incidence of gMG are increasing worldwide.5 There are between 80,000 and 100,000 patients with myasthenia gravis in the U.S.6,7 Approximately 85% of patients with myasthenia gravis have detectable antibodies against AChR, and approximately 7% have detectable antibodies against MuSK.8 Global prevalence is estimated at 2-36 cases per 100,000.9 The disease is more frequently seen in young women (age 20-30) and men aged 50 years and older.5,9 B cells are central to the pathogenesis of gMG. The disease is thought to be primarily driven by pathogenic CD19+ plasmablasts and plasma cells that target critical proteins in the neuromuscular junction.1-3 About UPLIZNA® (inebilizumab-cdon) in NMOSD INDICATION UPLIZNA® (inebilizumab-cdon) is indicated for the treatment of neuromyelitis optica spectrum disorder (NMOSD) in adult patients who are anti-aquaporin-4 (AQP4) antibody positive. IMPORTANT SAFETY INFORMATION UPLIZNA is contraindicated in patients with: A history of life-threatening infusion reaction to UPLIZNA Active hepatitis B infection Active or untreated latent tuberculosis WARNINGS AND PRECAUTIONS Infusion Reactions: UPLIZNA can cause infusion reactions, which can include headache, nausea, somnolence, dyspnea, fever, myalgia, rash, or other symptoms. Infusion reactions were most common with the first infusion but were also observed during subsequent infusions. Administer pre-medication with a corticosteroid, an antihistamine, and an anti-pyretic. Infections: The most common infections reported by UPLIZNA-treated patients in the randomized and open-label periods included urinary tract infection (20%), nasopharyngitis (13%), upper respiratory tract infection (8%), and influenza (7%). Delay UPLIZNA administration in patients with an active infection until the infection is resolved. Increased immunosuppressive effects are possible if combining UPLIZNA with another immunosuppressive therapy. The risk of Hepatitis B Virus (HBV) reactivation has been observed with other B-cell-depleting antibodies. Perform HBV screening in all patients before initiation of treatment with UPLIZNA. Do not administer to patients with active hepatitis. Although no confirmed cases of Progressive Multifocal Leukoencephalopathy (PML) were identified in UPLIZNA clinical trials, JC virus infection resulting in PML has been observed in patients treated with other B-cell-depleting antibodies and other therapies that affect immune competence. At the first sign or symptom suggestive of PML, withhold UPLIZNA and perform an appropriate diagnostic evaluation. Patients should be evaluated for tuberculosis risk factors and tested for latent infection prior to initiating UPLIZNA. Vaccination with live-attenuated or live vaccines is not recommended during treatment and after discontinuation, until B-cell repletion. Reduction in Immunoglobulins: There may be a progressive and prolonged hypogammaglobulinemia or decline in the levels of total and individual immunoglobulins such as immunoglobulins G and M (IgG and IgM) with continued UPLIZNA treatment. Monitor the level of immunoglobulins at the beginning, during, and after discontinuation of treatment with UPLIZNA until B-cell repletion especially in patients with opportunistic or recurrent infections. Fetal Risk: May cause fetal harm based on animal data. Advise females of reproductive potential of the potential risk to a fetus and to use an effective method of contraception during treatment and for 6 months after stopping UPLIZNA. Adverse Reactions: The most common adverse reactions (at least 10% of patients treated with UPLIZNA and greater than placebo) were urinary tract infection and arthralgia. For additional information on UPLIZNA, please see the Full Prescribing Information at . About Amgen Amgen discovers, develops, manufactures, and delivers innovative medicines to help millions of patients in their fight against some of the world's toughest diseases. More than 40 years ago, Amgen helped to establish the biotechnology industry and remains on the cutting-edge of innovation, using technology and human genetic data to push beyond what's known today. Amgen is advancing a broad and deep pipeline that builds on its existing portfolio of medicines to treat cancer, heart disease, osteoporosis, inflammatory diseases and rare diseases. In 2024, Amgen was named one of the "World's Most Innovative Companies" by Fast Company and one of "America's Best Large Employers" by Forbes, among other external recognitions. Amgen is one of the 30 companies that comprise the Dow Jones Industrial Average®, and it is also part of the Nasdaq-100 Index®, which includes the largest and most innovative non-financial companies listed on the Nasdaq Stock Market based on market capitalization. For more information, visit Amgen.com and follow Amgen on X, LinkedIn, Instagram, TikTok, YouTube and Threads. Forward-Looking Statements This news release contains forward-looking statements that are based on the current expectations and beliefs of Amgen. All statements, other than statements of historical fact, are statements that could be deemed forward-looking statements, including any statements on the outcome, benefits and synergies of collaborations, or potential collaborations, with any other company (including BeiGene, Ltd. or Kyowa Kirin Co., Ltd.), the performance of Otezla® (apremilast) (including anticipated Otezla sales growth and the timing of non-GAAP EPS accretion), our acquisitions of Teneobio, Inc., ChemoCentryx, Inc., or Horizon Therapeutics plc (including the prospective performance and outlook of Horizon's business, performance and opportunities, any potential strategic benefits, synergies or opportunities expected as a result of such acquisition, and any projected impacts from the Horizon acquisition on our acquisition-related expenses going forward), as well as estimates of revenues, operating margins, capital expenditures, cash, other financial metrics, expected legal, arbitration, political, regulatory or clinical results or practices, customer and prescriber patterns or practices, reimbursement activities and outcomes, effects of pandemics or other widespread health problems on our business, outcomes, progress, and other such estimates and results. Forward-looking statements involve significant risks and uncertainties, including those discussed below and more fully described in the Securities and Exchange Commission reports filed by Amgen, including our most recent annual report on Form 10-K and any subsequent periodic reports on Form 10-Q and current reports on Form 8-K. Unless otherwise noted, Amgen is providing this information as of the date of this news release and does not undertake any obligation to update any forward-looking statements contained in this document as a result of new information, future events or otherwise. No forward-looking statement can be guaranteed and actual results may differ materially from those we project. Discovery or identification of new product candidates or development of new indications for existing products cannot be guaranteed and movement from concept to product is uncertain; consequently, there can be no guarantee that any particular product candidate or development of a new indication for an existing product will be successful and become a commercial product. Further, preclinical results do not guarantee safe and effective performance of product candidates in humans. The complexity of the human body cannot be perfectly, or sometimes, even adequately modeled by computer or cell culture systems or animal models. The length of time that it takes for us to complete clinical trials and obtain regulatory approval for product marketing has in the past varied and we expect similar variability in the future. Even when clinical trials are successful, regulatory authorities may question the sufficiency for approval of the trial endpoints we have selected. We develop product candidates internally and through licensing collaborations, partnerships and joint ventures. Product candidates that are derived from relationships may be subject to disputes between the parties or may prove to be not as effective or as safe as we may have believed at the time of entering into such relationship. Also, we or others could identify safety, side effects or manufacturing problems with our products, including our devices, after they are on the market. Our results may be affected by our ability to successfully market both new and existing products domestically and internationally, clinical and regulatory developments involving current and future products, sales growth of recently launched products, competition from other products including biosimilars, difficulties or delays in manufacturing our products and global economic conditions. 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Further, while we routinely obtain patents for our products and technology, the protection offered by our patents and patent applications may be challenged, invalidated or circumvented by our competitors, or we may fail to prevail in present and future intellectual property litigation. We perform a substantial amount of our commercial manufacturing activities at a few key facilities, including in Puerto Rico, and also depend on third parties for a portion of our manufacturing activities, and limits on supply may constrain sales of certain of our current products and product candidate development. An outbreak of disease or similar public health threat, such as COVID-19, and the public and governmental effort to mitigate against the spread of such disease, could have a significant adverse effect on the supply of materials for our manufacturing activities, the distribution of our products, the commercialization of our product candidates, and our clinical trial operations, and any such events may have a material adverse effect on our product development, product sales, business and results of operations. We rely on collaborations with third parties for the development of some of our product candidates and for the commercialization and sales of some of our commercial products. In addition, we compete with other companies with respect to many of our marketed products as well as for the discovery and development of new products. Further, some raw materials, medical devices and component parts for our products are supplied by sole third-party suppliers. Certain of our distributors, customers and payers have substantial purchasing leverage in their dealings with us. The discovery of significant problems with a product similar to one of our products that implicate an entire class of products could have a material adverse effect on sales of the affected products and on our business and results of operations. Our efforts to collaborate with or acquire other companies, products or technology, and to integrate the operations of companies or to support the products or technology we have acquired, may not be successful. There can be no guarantee that we will be able to realize any of the strategic benefits, synergies or opportunities arising from the Horizon acquisition, and such benefits, synergies or opportunities may take longer to realize than expected. We may not be able to successfully integrate Horizon, and such integration may take longer, be more difficult or cost more than expected. A breakdown, cyberattack or information security breach of our information technology systems could compromise the confidentiality, integrity and availability of our systems and our data. Our stock price is volatile and may be affected by a number of events. Our business and operations may be negatively affected by the failure, or perceived failure, of achieving our environmental, social and governance objectives. The effects of global climate change and related natural disasters could negatively affect our business and operations. Global economic conditions may magnify certain risks that affect our business. Our business performance could affect or limit the ability of our Board of Directors to declare a dividend or our ability to pay a dividend or repurchase our common stock. We may not be able to access the capital and credit markets on terms that are favorable to us, or at all. Any scientific information discussed in this news release relating to new indications for our products is preliminary and investigative and is not part of the labeling approved by the U.S. Food and Drug Administration for the products. The products are not approved for the investigational use(s) discussed in this news release, and no conclusions can or should be drawn regarding the safety or effectiveness of the products for these uses. CONTACT: Amgen, Thousand Oaks Madison Howard, 773-636-4910 (media) Elissa Snook, 609-251-1407 (media) Justin Claeys, 805-313-9775 (investors) References Yi, J. S., Guptill, J. T., Stathopoulos, P., Nowak, R. J., & O'Connor, K. C. (2018). B cells in the pathophysiology of myasthenia gravis. Muscle Nerve, 57(2):172-184. Willcox H. N., Newsom-Davis, J., & Calder, L. R. (1984). Cell types required for anti-acetylcholine receptor antibody synthesis by cultured thymocytes and blood lymphocytes in myasthenia gravis. Clinical and Experimental Immunology., 58:97-106. Stathopoulos P., Kumar, A., Nowak, R. J., & O'Connor, K. C. (2017). Autoantibody-producing plasmablasts after B cell depletion identified in muscle-specific kinase myasthenia gravis. JCI Insight, 2(17):e94263. Lazaridis K., & Tzartos, S. J. (2020). Autoantibody Specificities in Myasthenia Gravis; Implications for Improved Diagnostics and Therapeutics. Frontiers in Immunology, 11:212. Dresser L., Wlodarski, R., Rezania, K., & Soliven, B. (2021). Myasthenia Gravis: Epidemiology, Pathophysiology and Clinical Manifestations. J Clin Med, 10(11):2235. Ye et al. Frontiers in Neurology. (2024);15:1339167. Rodrigues E., Umeh, E., Aishwarya, Navaratnarajah, N., Cole, A., & Moy, K. (2024). Incidence and prevalence of myasthenia gravis in the United States: A claims-based analysis. Muscle Nerve, 69(2):166-171. Hehir, M. K., & Silvestri, N. J. (2018). Generalized myasthenia gravis: classification, clinical presentation, natural history, and epidemiology. Neurologic Clinics, 36:253-60. Bubuioc, A. M., Kudebayeva, A., Turuspekova, S., Lisnic, V., & Leone, M. A. (2021). The epidemiology of myasthenia gravis. Journal of Medicine and Life, 14(1):7-16. SOURCE Amgen WANT YOUR COMPANY'S NEWS FEATURED ON PRNEWSWIRE.COM? 440k+ Newsrooms & Influencers 9k+ Digital Media Outlets 270k+ Journalists Opted In GET STARTED

MINT Study Results Show Clinically Meaningful and Statistically Significant Efficacy in AChR+ and MuSK+ Patients First and Only Phase 3 Placebo-Controlled gMG Trial for a Biologic That Tapered Corticosteroid Use THOUSAND OAKS, Calif. , Oct. 15, 2024 /PRNewswire/ -- Amgen (NASDAQ:AMGN) today announced the presentation of positive top-line results from the Phase 3 MINT trial evaluating the efficacy and safety of UPLIZNA ® (inebilizumab-cdon) for the treatment of adults with generalized myasthenia gravis (gMG), a rare autoimmune disorder. Results from this randomized, double-blind, placebo-controlled, parallel-group trial will be presented at the Myasthenia Gravis Foundation of America (MGFA) Scientific Session during the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) Annual Meeting, taking place Oct. 15-18 in Savannah, Georgia . The trial met its primary endpoint, with a statistically significant change from baseline in Myasthenia Gravis Activities of Daily Living (MG-ADL) score for UPLIZNA (-4.2) compared with placebo (-2.2) (difference: –1.9, p<0.0001) at Week 26 for the combined study population. The study included patients who are acetylcholine receptor autoantibody-positive (AChR+) and those who are muscle-specific kinase autoantibody-positive (MuSK+), with participants receiving UPLIZNA or placebo on Day 1 and Day 15. UPLIZNA demonstrated continued improvement through Week 26. Notably, patients who entered the study taking corticosteroids were tapered down starting at Week 4 to prednisone 5 mg per day by Week 24. No new safety signals were identified. "Patients living with generalized myasthenia gravis deserve an effective treatment option that provides long-term symptom relief. Once approved, UPLIZNA is expected to offer a new option for patients earlier in their treatment plan," said Jay Bradner , M.D., executive vice president, Research and Development, and chief scientific officer at Amgen . "UPLIZNA targets CD19+ pre-B cells, mature B-cells and some plasmablasts, which are drivers of the disease. The clinically significant results from the MINT trial further strengthen the growing evidence for UPLIZNA in severe autoimmune diseases and reinforce Amgen 's leadership in B-cell targeting therapeutics." Key secondary endpoints were tested sequentially in a predefined order. UPLIZNA demonstrated a statistically significant and clinically meaningful change from baseline compared to placebo for the first four key secondary endpoints. Additionally, in the MuSK+ population, the mean change from baseline in QMG score at Week 26 showed a trend favoring UPLIZNA but was not statistically significant (-5.2 for UPLIZNA and -3.0 for placebo, difference -2.3, p=0.1326). "Myasthenia gravis can have a profound impact on patients by causing severe fatigable muscle weakness that impairs physical functioning, activities of daily living and quality of life," said Richard J. Nowak , M.D., M.S., global principal study investigator and director of the Myasthenia Gravis Clinic at Yale University . "This trial demonstrates clinically meaningful benefits of UPLIZNA, a twice-yearly infused medicine with a unique mechanism of action that selectively targets and depletes CD19+ B cells, which are key upstream drivers of myasthenia gravis. MINT is also the only Phase 3 biologic trial that included a protocol-specified steroid taper, an important consideration for patients as effects of prolonged high-dose steroid use contribute to the overall burden of disease." The overall safety results during the placebo-controlled period of the trial were consistent with the known safety profile of UPLIZNA. The most common treatment-emergent adverse events were COVID-19, nasopharyngitis, urinary tract infection, infusion related reaction, headache and cough in the combined population. MINT is the largest placebo-controlled gMG clinical trial for a biologic therapy (238 adults) and enrolled the largest number of patients (48 adults) who are MuSK+. The trial also included 190 adults who are AChR+. Further data will characterize placebo-controlled efficacy and safety of UPLIZNA over 12 months in AChR+ patients with gMG. At the 2024 AANEM Annual Meeting, Amgen will also be presenting a poster titled, "The Burden of Glucocorticoid Use Among Patients with Generalized Myasthenia Gravis in the United States ," highlighting how higher use of glucocorticoids was associated with more toxicities and overall health care resource utilization and costs. UPLIZNA is currently approved for the treatment of neuromyelitis optica spectrum disorder (NMOSD) in adult patients who are anti-aquaporin-4 (AQP4) antibody positive in the United States , European Union , Brazil and Canada , among other countries. UPLIZNA was also recently granted Breakthrough Therapy Designation for IgG4-Related Diseases by FDA following Phase 3 results announced in June. Based on the MINT primary results, Amgen is planning to file for approval in the U.S. , followed by other key markets. About the MINT Trial The MINT trial is a randomized, double-blind, placebo-controlled, parallel-group trial ( NCT04524273 ) evaluating the efficacy and safety of UPLIZNA in adults with gMG. The trial enrolled 238 adults with gMG, including 190 patients who are acetylcholine receptor autoantibody-positive (AChR+) and 48 patients who are muscle-specific kinase autoantibody-positive (MuSK+). Eligibility criteria at screening and randomization included a Myasthenia Gravis Foundation of America (MGFA) classification of II, III, or IV disease, MG-ADL score between 6 and 10 with greater than 50% of this score attributed to non-ocular items, or an MG-ADL score of at least 11, QMG score of at least 11, and use of a corticosteroid and/or non-steroidal immunosuppressant. The primary endpoint was change from baseline in MG-ADL score at Week 26 in the combined population. Key secondary endpoints included change from baseline in QMG scores in the combined study population; change from baseline in MG-ADL score at Week 26 for the AChR+ cohort and separately the MuSK+ cohort; and change from baseline in QMG score at Week 26 for the AChR+ cohort and separately the MuSK+ cohort. Patients who entered the study taking a corticosteroid were tapered down to prednisone 5 mg a day, starting at Week 4 to Week 24. The MINT trial also includes an optional three-year open-label treatment period. About Generalized Myasthenia Gravis (gMG) Generalized myasthenia gravis (gMG) is a rare, chronic, B-cell-mediated autoimmune disorder that impairs neuromuscular communication and can cause muscle weakness, trouble breathing, difficulty swallowing and impaired speech and vision. 1-4 Approximately 85% of patients with myasthenia gravis have the generalized form, or gMG. 4,5 The prevalence and incidence of gMG are increasing worldwide. 5 There are between 80,000 and 100,000 patients with myasthenia gravis in the U.S. 6,7 Approximately 85% of patients with myasthenia gravis have detectable antibodies against AChR, and approximately 7% have detectable antibodies against MuSK. 8 Global prevalence is estimated at 2-36 cases per 100,000. 9 The disease is more frequently seen in young women (age 20-30) and men aged 50 years and older. 5,9 B cells are central to the pathogenesis of gMG. The disease is thought to be primarily driven by pathogenic CD19+ plasmablasts and plasma cells that target critical proteins in the neuromuscular junction. 1-3 About UPLIZNA® (inebilizumab-cdon) in NMOSD INDICATION UPLIZNA® (inebilizumab-cdon) is indicated for the treatment of neuromyelitis optica spectrum disorder (NMOSD) in adult patients who are anti-aquaporin-4 (AQP4) antibody positive. IMPORTANT SAFETY INFORMATION UPLIZNA is contraindicated in patients with: WARNINGS AND PRECAUTIONS Infusion Reactions: UPLIZNA can cause infusion reactions, which can include headache, nausea, somnolence, dyspnea, fever, myalgia, rash, or other symptoms. Infusion reactions were most common with the first infusion but were also observed during subsequent infusions.  Administer pre-medication with a corticosteroid, an antihistamine, and an anti-pyretic. Infections: The most common infections reported by UPLIZNA-treated patients in the randomized and open-label periods included urinary tract infection (20%), nasopharyngitis (13%), upper respiratory tract infection (8%), and influenza (7%). Delay UPLIZNA administration in patients with an active infection until the infection is resolved. Increased immunosuppressive effects are possible if combining UPLIZNA with another immunosuppressive therapy. The risk of Hepatitis B Virus (HBV) reactivation has been observed with other B-cell-depleting antibodies. Perform HBV screening in all patients before initiation of treatment with UPLIZNA. Do not administer to patients with active hepatitis. Although no confirmed cases of Progressive Multifocal Leukoencephalopathy (PML) were identified in UPLIZNA clinical trials, JC virus infection resulting in PML has been observed in patients treated with other B-cell-depleting antibodies and other therapies that affect immune competence. At the first sign or symptom suggestive of PML, withhold UPLIZNA and perform an appropriate diagnostic evaluation. Patients should be evaluated for tuberculosis risk factors and tested for latent infection prior to initiating UPLIZNA. Vaccination with live-attenuated or live vaccines is not recommended during treatment and after discontinuation, until B-cell repletion. Reduction in Immunoglobulins: There may be a progressive and prolonged hypogammaglobulinemia or decline in the levels of total and individual immunoglobulins such as immunoglobulins G and M (IgG and IgM) with continued UPLIZNA treatment. Monitor the level of immunoglobulins at the beginning, during, and after discontinuation of treatment with UPLIZNA until B-cell repletion especially in patients with opportunistic or recurrent infections. Fetal Risk: May cause fetal harm based on animal data. Advise females of reproductive potential of the potential risk to a fetus and to use an effective method of contraception during treatment and for 6 months after stopping UPLIZNA. Adverse Reactions: The most common adverse reactions (at least 10% of patients treated with UPLIZNA and greater than placebo) were urinary tract infection and arthralgia. For additional information on UPLIZNA, please see the Full Prescribing Information at www.UPLIZNA.com . About Amgen Amgen discovers, develops, manufactures, and delivers innovative medicines to help millions of patients in their fight against some of the world's toughest diseases. More than 40 years ago, Amgen helped to establish the biotechnology industry and remains on the cutting-edge of innovation, using technology and human genetic data to push beyond what's known today. Amgen is advancing a broad and deep pipeline that builds on its existing portfolio of medicines to treat cancer, heart disease, osteoporosis, inflammatory diseases and rare diseases. In 2024, Amgen was named one of the "World's Most Innovative Companies" by Fast Company and one of "America's Best Large Employers" by Forbes, among other external recognitions . Amgen is one of the 30 companies that comprise the Dow Jones Industrial Average ® , and it is also part of the Nasdaq-100 Index ® , which includes the largest and most innovative non-financial companies listed on the Nasdaq Stock Market based on market capitalization. For more information, visit Amgen.com and follow Amgen on X , LinkedIn , Instagram , TikTok , YouTube and Threads . Forward-Looking Statements This news release contains forward-looking statements that are based on the current expectations and beliefs of Amgen . All statements, other than statements of historical fact, are statements that could be deemed forward-looking statements, including any statements on the outcome, benefits and synergies of collaborations, or potential collaborations, with any other company (including BeiGene, Ltd. or Kyowa Kirin Co., Ltd.), the performance of Otezla ® (apremilast) (including anticipated Otezla sales growth and the timing of non-GAAP EPS accretion), our acquisitions of Teneobio, Inc. , ChemoCentryx, Inc. , or Horizon Therapeutics plc (including the prospective performance and outlook of Horizon's business, performance and opportunities, any potential strategic benefits, synergies or opportunities expected as a result of such acquisition, and any projected impacts from the Horizon acquisition on our acquisition-related expenses going forward), as well as estimates of revenues, operating margins, capital expenditures, cash, other financial metrics, expected legal, arbitration, political, regulatory or clinical results or practices, customer and prescriber patterns or practices, reimbursement activities and outcomes, effects of pandemics or other widespread health problems on our business, outcomes, progress, and other such estimates and results. Forward-looking statements involve significant risks and uncertainties, including those discussed below and more fully described in the Securities and Exchange Commission reports filed by Amgen , including our most recent annual report on Form 10-K and any subsequent periodic reports on Form 10-Q and current reports on Form 8-K. Unless otherwise noted, Amgen is providing this information as of the date of this news release and does not undertake any obligation to update any forward-looking statements contained in this document as a result of new information, future events or otherwise. No forward-looking statement can be guaranteed and actual results may differ materially from those we project. Discovery or identification of new product candidates or development of new indications for existing products cannot be guaranteed and movement from concept to product is uncertain; consequently, there can be no guarantee that any particular product candidate or development of a new indication for an existing product will be successful and become a commercial product. Further, preclinical results do not guarantee safe and effective performance of product candidates in humans. The complexity of the human body cannot be perfectly, or sometimes, even adequately modeled by computer or cell culture systems or animal models. The length of time that it takes for us to complete clinical trials and obtain regulatory approval for product marketing has in the past varied and we expect similar variability in the future. Even when clinical trials are successful, regulatory authorities may question the sufficiency for approval of the trial endpoints we have selected. 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来源：小药说药 前言 人类基因组的破译加上生物技术的进步，特别是单克隆抗体（mAbs）的里程碑式发现，使得生物治疗极大地改善了病人的生存时间和生存状态。目前，已经有超过300种生物疗法获得美国食品和药物管理局（FDA）批准，其中许多被批准用于治疗免疫和炎症性疾病。 2022年全球TOP100畅销药合计实现了4868亿美元的销售收入，自免疾病领域已经是仅次于肿瘤的第二大药物市场。跻身TOP100榜单的自免产品共18款，总金额达861.7亿美元。如今，自免领域已成为重磅炸弹的密集诞生地，也成为各大制药巨头业绩贡献的主要来源。 治疗靶点与开发药物 下表列出了经FDA批准用于自身免疫疾病适应症，以及处于关键3期临床试验或阳性的2期临床试验中的生物疗法。 白细胞介素-1 IL-1α和IL-1β定位于对无菌状态下和微生物介导的炎症反应的迅速响应。当上皮细胞、内皮细胞和血小板对组织损伤作出反应时，IL-1α作为一种报警素发挥作用。相反，髓系来源的亚型IL-1β是作为一种非活性蛋白合成的，需要炎症小体驱动的蛋白水解过程才能发挥活性。IL-1α/β属于较大的IL-1细胞因子家族，它利用IL-1受体辅蛋白（IL-1RAcP）与IL-1R1亚基配对产生MyD88依赖性信号。IL-1α/β功能也受天然拮抗剂IL-1Ra、sIL-1RAcp和诱饵受体IL-1R2的调控。IL-1α/β表达失调与以发热、皮疹、关节炎和器官特异性炎症为特征的多种全身性自身炎症性疾病（SAID）有关。 FDA已经批准了三种不同性质的生物疗法，但都是针对IL-1的。Anakinra是一种天然拮抗剂IL-1Ra的改良版本，它同时抑制IL-1α和IL-1β。Anakinra被批准用于治疗RA和CAPS，其半衰期短，为5-6小时，因此需要每天皮下注射。Anakinra对痛风也有效，尿酸单钠晶体刺激NLRP3激活和IL-1β产生。Canakinumab是一种IL-1β中和抗体，每4-8周皮下给药一次，被批准用于治疗全身性青少年特发性关节炎（SJIA）和SAIDs。Rilonacept编码IL-1R和IL-1AcP的胞外结构域，与IgG的Fc部分相连，优先中和IL-1β，批准用于SAIDs的每周皮下给药。 白细胞介素-6 IL-6是gp130细胞因子家族的一员，是许多稳态和炎症过程的中心组成部分。IL-6最初被鉴定为促进B细胞分化的T细胞衍生因子，现在因其在适应性免疫中的多效性活性而受到重视。它有助于Th17和T滤泡辅助细胞（Tfh）的分化，驱动髓样细胞分化，并与Th2细胞因子协同促进巨噬细胞极化为促纤维化表型。IL-6在肝脏急性期反应中起重要作用，增加包括C反应蛋白（CRP）在内的炎症蛋白，增强补体与病原体或死亡细胞的结合，对内皮细胞功能和上皮细胞完整性也有重要影响。 IL-6的广泛生物活性源于其调节多个细胞靶点的复杂性质。IL-6由多种细胞合成，并通过三种不同的细胞表面信号机制（即经典信号、反式信号和反式呈递）激活靶细胞，最终产生JAK/STAT信号。 Tocilizumab和sarilumab是FDA批准的两种IL-6R阻断性单抗，许多其他药物正在临床开发中。Tocilizumab和sarilumab被FDA批准用于治疗中重度RA，其中受影响关节滑液中IL-6水平升高，血清IL-6水平与疾病活动相关。这两种药物都能改善RA患者的炎症症状并减少影像学进展。 细胞因子释放综合征（CRS）是一种急性全身炎症性疾病，与许多基于抗体的治疗、化疗和T细胞参与的免疫治疗（如CAR-T细胞）以及严重感染相关。与T细胞参与疗法相关的CRS被认为是由活化的T细胞产生TNF-α，进而触发单核细胞和活化的巨噬细胞产生IL-6和IL-1β。CRS症状（例如发烧和低血压）的缓解通常在单剂量的Tocilizumab后实现。给药tocilizumab似乎并不影响T细胞参与疗法的抗肿瘤效果。 肿瘤坏死因子 TNF-α主要由免疫细胞和内皮细胞产生，并通过促炎信号和细菌产物显著上调；TNF-β(LTα)主要由淋巴细胞产生。TNF-α以三聚体膜结合形式（mTNF）表达并经历蛋白水解裂解产生可溶性三聚体sTNF。TNFR1广泛表达，而TNFR2主要表达于神经元、免疫细胞和内皮细胞。TNF-α具有多效性功能。TNF-α对病原体的最佳防御、淋巴器官的正常发育以及在神经元再髓鞘化、心脏重塑和软骨再生中的重要修复作用都是必需的。 目前有五种TNF抑制剂被FDA批准用于临床，全部都靶向TNF-α，其中依那西普另外抑制TNF-β。肿瘤坏死因子拮抗剂的分子类型反映了近二十年来生物治疗药物的发展。依那西普（TNFR2-Fc）是FDA批准的第一个Fc融合蛋白；infliximab是第一代嵌合单抗；adalimumab是来源于噬菌体展示的人源单抗；golimumab是来源于表达人IgG的转基因小鼠的人源单抗；certolizumab-pegol是一种从小鼠杂交瘤中分离的人源化Fab片段，经聚乙二醇化可延长其体内半衰期。 大多数肿瘤坏死因子拮抗剂显示出共同的临床疗效。然而，依那西普在克罗恩病（CD）的随机双盲安慰剂对照试验中无效，可能反映了TNF抑制剂治疗机制的差异。除了中和sTNF-α外，抗TNF抗体和certolizumab-pegol(而不是依那西普)可通过结合mTNF或阻断抗凋亡信号诱导固有层T细胞凋亡。此外，抗TNF单抗（而非依那西普或certolizumab-pegol）可通过Fc依赖机制诱导M2型创伤愈合巨噬细胞应答。因此，TNF拮抗剂之间的机制差异可能是导致其在CD中不同临床效果的原因。 CD20 CD20是一种B细胞标志物，其表达始于早期的前B细胞，但在向浆细胞的终末分化过程中丢失。它是一种四肽蛋白，是B细胞发挥最佳功能和免疫反应所必需的。 Rituximab是一种嵌合单抗，是FDA批准的第一种治疗B细胞非霍奇金淋巴瘤的抗CD20单抗。基于其在肿瘤学中令人惊讶的良好安全性，研究人员开始探索其在严重自身免疫性疾病患者中的应用。Rituximab目前被FDA批准用于治疗多种自身免疫性疾病。由于CD20既不在HSC上表达，也不在终末分化的浆细胞上表达，因此抗CD20单抗选择性靶向CD20+B细胞与先天性B细胞缺乏具有不同的免疫学后果。例如，用抗CD20抗体治疗后，血清IgG水平没有显著影响，而严重的X连锁无丙种球蛋白血症（其中B细胞不发育）则观察到缺乏免疫球蛋白。 最近的一项2期研究使用了obinutuzumab，一种具有增强ADCC和诱导B细胞凋亡能力的II型抗CD20单抗，已报道狼疮性肾炎患者的临床获益（NCT 02550652）。需要对obinutuzumab进行进一步的研究，以确认额外的B细胞消耗是否对狼疮性肾炎有益。 BAFF/APRIL肿瘤坏死因子超家族成员 BAFF和APRIL是TNF配体超家族的两种II型跨膜蛋白，它们的受体BAFFR、BCMA和TACI在B系细胞的存活和成熟以及功能中起着重要作用。 血清BAFF和APRIL水平在许多自身免疫性疾病中升高，包括SLE、Sjögren综合征和RA。Belimumab是一种人IgG1λ单抗，被批准用于治疗活动性自身抗体阳性的SLE。它抑制sBAFF三聚体，但不与mBAFF或APRIL结合。在关键的临床试验中，与SOC组相比，belimumab在SLE应答指数和健康相关生活质量终点方面有更大的改善。此外，belimumab降低了循环中原始B细胞、活化B细胞和浆细胞的数量；抗dsDNA水平降低，补体水平正常化。与对循环记忆B和T细胞缺乏影响一致，治疗一年后，先前存在的抗肺炎、破伤风和甲型流感抗体没有受到影响。 Atacicept是融合TACI胞外区的Fc融合蛋白，结合BAFF、APRIL和BAFF/APRIL异源聚体。在系统性红斑狼疮患者中应用Atacicept治疗后，血清IgM（∼70%）、IgG（∼30–40%）和IgA（∼50–60%）迅速下降，抗双链DNA抗体下降了∼40%。终止治疗后，抗体和自身抗体水平恢复到预处理水平。 整合素家族 整合素通过调节白细胞与血管的粘附来调节免疫细胞的运输，并促进白细胞向组织中的外渗。整合素异二聚体由18个α亚单位和8个β亚单位之间的配对组成，形成24种不同的受体复合物，它们在表达模式、配体特异性和功能上存在差异。 在MS中，α4β1（CD49d/CD29，VLA4）在T和B细胞上表达，并通过VCAM1与血脑屏障内皮细胞的结合促进淋巴细胞向中枢神经系统（CNS）的外渗。在胃肠道中，表达于T细胞上的α4β7可与Peyer氏斑高内皮小静脉和固有层小静脉上的MADCAM-1结合，促进炎症性肠病（IBD）致病性T细胞的外渗。 Natalizumab是一种α4阻断性单抗，被批准用于治疗CD和RMS患者。然而，RMS抑制淋巴细胞进入中枢神经系统的有效性的机制基础也为进展性多灶性白质脑病（PML）的罕见病例的发展提供了基础。第二代抗体，包括vedolizumab（对α4β7复合物有选择性）和etrolizumab（抗β7），通过针对IBD的肠道特异性整合素降低PML的可能性。Vedolizumab可诱导临床反应和缓解，FDA已批准用于溃疡性结肠炎（UC）和CD。除了阻断α4β7:MADCAM1相互作用外，etrolizumab还干扰E-钙粘蛋白+肠上皮细胞对αEβ7+IELs的保留。在一项2期临床试验中，与对照组相比，对UC患者使用etrolizumab治疗导致临床病情缓解的可能性更大。由于αEβ7+IELs是UC患者炎症细胞因子的重要贡献者，因此阻断α4β7和αEβ7整合素可能有额外的临床益处。 抗αL抗体Efalizumab阻断T细胞和B细胞表达的αLβ2（LFA1）与ICAM1的相互作用。除了阻断整合素外，Efalizumab还下调LFA-1的表达，LFA-1是T细胞与抗原呈递细胞（APC）形成突触所必需的。Efalizumab被FDA批准用于治疗中度至重度斑块型银屑病。然而，4名使用Efalizumab治疗3年以上的患者出现了PML，该药物已退出市场。 白细胞介素-12和-23及其下游效应物 IL-12和IL-23是两种密切相关的APC衍生的异二聚体细胞因子，分别由p35和p19亚单位组成，它们与一个共同的p40亚单位配对。这两种细胞因子，主要的应答细胞是T细胞和固有淋巴细胞（ILCs），在不同的细胞类型中，IL-12上调Th1主转录因子T-bet的表达并诱导IFN-γ的产生。以类似的方式，IL-23刺激诱导转录因子RORγt的表达和下游细胞因子IL-17A、IL-17F、IL-22和GM-CSF的表达。疾病的临床前模型和全基因组关联研究表明IL-12/23通路参与炎症性肠病和银屑病。 设计用于干扰IL-12/23通路各种成分的多种疗法已进入临床。两种单抗（ustekinumab和briakinumab）靶向p40亚单位，从而中和IL-12和IL-23。最近，效应细胞因子的IL-17家族引起了广泛关注，有5种单抗选择性中和IL-17A；2种单抗中和IL-17A和F；brodalumab靶向IL-17RA，一种IL-17A、B、C、E和F成员的共同受体。然而，虽然IL-17B-E的不同功能已被描述，但这些细胞因子不受IL-23的调节，它们在人类疾病中的作用仍未被充分研究。 此外，对阻断IL-22（fezakinumab）、IFN-γ（fontolizumab）和GM-CSF（namilumab和mavrilimumab）治疗的研究将提供进一步的见解，尽管它们还处于早期研究。 自免疾病的全球和中国市场 经统计，全球自身免疫疾病治疗药物处于稳定增长的趋势。弗若斯特沙利文数据显示，全球自身免疫疾病药物市场预计将由2021年的1,277亿美元，增长至2030年的1760亿美元，复合年增长率为3.6%。2021年，自身免疫疾病生物制剂市场规模为891亿美元，预计到2030年将增至1421亿美元，分别占2021年及2030年全球自身免疫疾病药物市场的69.8%及80.8%。 来源：弗若斯特沙利文报告 鉴于中国庞大的患者群体及自身免疫疾病创新疗法的进步，中国自身免疫疾病药物市场有望快速增长，由2017年的17亿美元增长至2021年的30亿美元，复合年增长率为15.2%，估计2030年将达到231亿美元，2021年至2030年复合年增长率为25.5%。估计生物药在中国自身免疫疾病中的份额将由2021年的32.9%增加至2030年的71.8%。 来源：弗若斯特沙利文报告 虽然中国的自免市场在快速增长，但潜力仍未完全发掘。一方面是由于中国自免药物市场仍以传统小分子为主导，而进口自免新药已进入中国，但众多的自免患者由于分布在经济欠发达地区，支付能力仍有限。另一方面，则由于自免疾病作为慢性病并不致死，导致患者认知程度不高，因此，该领域许多疾病的诊断和治疗率一直很低。 不过，随着治疗手段的升级，疗效更好的生物制剂逐渐将被医生和患者所接受。而中国创新药的崛起也将凭借价格优势覆盖更广泛的患者群体。此外，银屑病、特应性皮炎、系统性红斑狼疮等自免疾病主要影响年轻群体，这类新生代人群更注重个人生活品质的提高，对身体、形象的受损容忍度低，因此有更强的支付意愿。多种有利因素将促进中国自免市场规模的快速增长。 参考文献： 1.30 Years of Biotherapeutics Development-What Have We Learned? Annu Rev Immunol. 2020 Apr 26;38:249-287     2. 弗若斯特沙利文报告