New Data Show Oral Ferric Maltol (FERACCRU®) May Be a Cost-effective Alternative to Intravenous (IV) Carboxymaltose With at Least as Great Benefits in the Quality of Life of Patients With Iron Deficiency Anaemia and Inflammatory Bowel Disease

Amsterdam (ots/PRNewswire) - Norgine B.V. highlighted new data from three post hoc analyses of the randomised controlled, open label, phase 3b non-inferiority study of oral ferric maltol vs intravenous ferric carboxymaltose (NCT02680756), presented at the 15th European Crohn's and Colitis Organisation (ECCO) Congress in Vienna. Ferric maltol, a novel oral iron replacement therapy, was found to be a cost-saving alternative to intravenous (IV) ferric carboxymaltose (FCM) by reducing drug administration costs[1]andproductivityloss,[2]withatleastasgreatbenefittothehealth-relatedqualityoflife(HRQoL)ofpatientswithirondeficiencyanaemia(IDA)andinflammatoryboweldisease(IBD).[3]

-Ferricmaltol(FM)wasassociatedwithsubstantiallyloweruseofhealthcareresourcesthanIVferriccarboxymaltose(FCM)

-IVFCMwaslinkedtogreaterproductivitylossanddisruptiontopatients'workandfamilylifeduetotheneedforclinic-basedIVadministration

-50%ofpatientsonIVFCMlostatleastonefulldayduetotreatmentwith43%losinguptoEUR387.51,asquantifiedforaGermansetting

-Meantotalperpatientdrugcostswereapproximately1.6timeshigherfortreatmentwithIVFCMcomparedtoFM

Dr.StefanieHowaldtfromtheHamburgResearchInstituteforIBD,HaFCEDe.K.,GermanypresentedthenewresearchfindingsatECCOandcommented,"Irondeficiencyanaemiaisverycommonininflammatoryboweldiseaseandcansignificantlyimpairthequalityoflifeofpatients.Duetoverycommonintolerancetostandardoralironproducts,IVironiscurrentlythemaintreatmentalternativeforIBDpatientswithIDA.Thesenewdatademonstratethatferricmaltolisnotonlyawell-toleratedandeffectivetherapy,whichwepreviouslyknew,butalsoacost-savingtreatmentforthehealthcaresystem,representinganalternativeoraltreatmentoptionwithsubstantialhealth-relatedqualityoflifebenefitforIBDpatientswithIDA.''

IDAcanbeaseriouscomplicationofIBDresultingfrominflammation,chronicmucosalbloodlossandironmalabsorption.[4]TreatmentofIDAinvolvesiron-replacementtherapyoftenwithoralironsupplementationinthefirstinstance.[4]However,useoforalferrousironmedicationsmaybelimitedbypoorabsorptionandadverseevents[4,5]whichcanleadtomanyunwellpatientshavingtoreceiveIVironinhospital.

Patient-reportedoutcomesareanimportantwaytomeasurehealthandwellbeing.MeasuresofHRQoLinIDAhavethepotentialtoreflectbothIDAsymptomsandtreatment-relatedissuessuchasadverseeffects,soareausefultooltocaptureadditionaltreatmentbenefitsbeyondthosetypicallyreportedinclinicalstudies.[3]

Inthequalityoflifeposthocanalysis,theHRQoLbenefitsofFMandIVFCMandtheirrelationshiptohaematologicalparameterswereanalysedusingdatafromarandomisedcontrolledtrial.TheanalysisshowedthatimprovementsinSF-36PCSandMCSscoreswereslightlygreaterwithFMthanwithIVFCM(differencenotstatisticallysignificant).FMpatientsexperiencedatleastasgreatbenefitinallSF-36domainssuchasgeneralandmentalhealth,bodilypain,vitality,physical,socialandemotionalfunctioning.[3]

IDAimposesasubstantialeconomicburdenonthehealthcarepayersystemresultingprimarilyfromincreasedmedicalcostsandhospitaladmissions.ThesecondposthocanalysislookedattheimpactonproductivitycomparingtheassociatedproductivitylossoforalFMvs.IVFCM.Thestudyfoundthat50%ofpatientstreatedwithIVFCMlostatleastonefulldayduetotreatment,with1in15losing4-6days.Productivitylosswasquantified,withIVFCMtreatmentassociatedwithlossesbetweenEUR0.00andEUR107.21in50%ofpatients,EUR129.17andEUR387.51in43%ofpatientsandEUR516.68andEUR775.02in7%ofpatients.AsFMwasadministeredorallybythepatientanddidnotrequireanyin-hospitaltreatmentadministration,therewasnotreatmentlinkedproductivityloss.FMdidnothavetheindirectcostsassociatedwithIVFCMandassuchmayprovideanoralalternativetoIVironinpatientswithIBD,enablingthemtoavoidthedisruptionofeverydaylifeactivitiesduetotheneedforin-hospitalIVadministration.[2]

Thethirdposthocanalysiscomparedthehealthcareresourceuse(HCRU)associatedwithoralFMandIVFCM.Thedatashowedthattotalperpatientdrugcosts(acquisitionandadministration)wereapproximately1.6timeshigherfortreatmentwithIVFCMthanFM.ThetotalcostofIVFCMisnotonlyinfluencedbythehigherdrugcost,butadditionalcostsassociatedwithIVadministrationwhichwasrequiredtobecarriedoutinahospitaloroutpatientsetting.FMhasnoadditionalcostsorresourceuseassociatedwithadministrationandisthereforelessofaburdenonlocalhealthcaresystems.[1]

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Abouttheposthocanalyses

PatientswithIBDandIDA(haemoglobin[Hb] >=8.0 g/dL and <=11.0 g/dL for women or >=8.0 g/dL and <=12.0 g/dL for men, and ferritin <30 ng/mL or ferritin <100 ng/mL with transferrin saturation <20%) were randomised to FM (30 mg b.d.) or IV FCM (as per local Summary of Product Characteristics [SmPC] or prescribing information) in an open-label, Phase 3b non-inferiority study. The primary endpoint was Hb responder rate (proportion of patients achieving a >=2 g/dL increase or normalisation of Hb at week 12). 250 patients were randomised: 125 to FM (per-protocol [PP] n=86) and 125 to IV FCM (PP n=93). The Hb responder rate for oral FM was non-inferior to IV FCM in the PP population (74% vs 83%); risk difference was -0.1 (two-sided p=0.017; 95% CI -0.2, 0.0), within the pre-defined non-inferiority margin of 20% difference.

For the post hoc analysis 'Impact of oral ferric maltol and IV iron on health-related quality of life in patients with iron deficiency anaemia and inflammatory bowel disease, and relationship with haemoglobin and serum iron', patients with IBD and IDA were randomised to FM (30 mg b.d) or IV FCM (as per local SmPC) with primary endpoint Hb responder rate [proportion of patients with >=2 g/dL increase or normalisation of Hb at week 12; non-inferiority margin 20%]. HRQoL was assessed via the Short Form Health Survey (SF-36). In the post hoc analysis of patient-level data, Hb, serum iron and HRQoL at baseline and week 12 were summarised descriptively and correlations between HRQoL and haematological parameters were assessed via Pearson's correlation coefficient (PCC). Hb, serum iron and HRQoL all improved following both treatments at Week 12. Improvements in SF-36 physical component summary (PCS) and mental component summary (MCS) scores were slightly greater with FM (difference not statistically significant). HRQoL improved across all SF-36 domain scores with both FM and FCM, with no statistically significant differences between treatments. HRQoL (MCS and PCS) improvements were positively associated with increases in Hb and serum iron. [3]

For the post hoc analysis 'Productivity loss in patients with inflammatory bowel disease receiving treatment for iron deficiency anaemia: a comparison of ferric maltol and IV iron' Productivity loss was calculated based on the number of days lost due to iron therapy during the initial 12-week study period. The costs associated with lost productivity were calculated using the human capital approach and based on the average gross income from Germany. IV FCM treatment resulted in a loss of patient time because IV administration was limited to an outpatient setting: 50% of patients treated with IV FCM lost at least one full day due to treatment, with 1 in 15 losing 4-6 days. Productivity loss was quantified, with IV FCM treatment associated with losses between EUR0.00 and EUR107.21 in 50% of patients, EUR129.17 and EUR387.51 in 43% of patients and EUR516.68 and EUR775.02 in 7% of patients. FM was administered orally by the patient and did not require any in-clinic treatment, there was no treatment linked productivity loss. [2]

For the post hoc analysis 'Health care resource use associated with ferric maltol and IV iron treatment for iron deficiency anaemia in patients with inflammatory bowel disease', pHCRU was assessed based on the total costs of iron therapy (including drug costs and administration), and the number of clinic visits during the initial 12-week study period. Costs of IV FCM and FM were applied to a German setting. Mean (standard deviation; SD) total treatment costs per patient in the FM and IV FCM arms were EUR302.27 (EUR80.68) and EUR489.37 (EUR147.19) respectively. 87% of FM patients were still receiving treatment at week 12, and 45% and 36% of IV FCM patients required a repeat course of IV iron at weeks 4 and 12 respectively. The mean (SD) number of hospital/outpatient visits during the study period for patients receiving IV FCM was 2.30 (0.88) and the total dose of IV FCM received was 1621 mg (491 mg). The study showed that the total per patient drug costs were approximately 1.6 times higher for treatment with IV FCM than FM. The total cost of IV FCM is not only influenced by the higher drug cost, but additional costs associated with IV administration which was required to be carried out in an outpatient setting. FM had no additional costs or resource use associated with administration and was therefore less of a burden on local health care systems. FM was associated with and substantially lower HCRU than IV FCM, and may provide a cost-effective oral alternative to IV iron in patients with IBD. [1]

About oral ferric maltol (FERACCRU®)

Ferric maltol is a novel oral ferric iron therapy for the treatment of iron deficiency (ID) in adults. The recommended dose is one capsule (30mg) taken twice a day, morning and evening, on an empty stomach. Treatment duration depends on the severity of the iron deficiency (ID), but generally at least 12 weeks of treatment are required.[6] For further information, please refer to the product Summary of Product Characteristics, available at: https://www.ema.europa.eu/en/documents/product-information/feraccru-epar-product-information_en.pdf

About Norgine

Norgine is a leading European specialist pharmaceutical company that has been bringing transformative medicines to patients for over a century. Our commitment to transforming people's lives drives everything we do and our European experience, fully integrated infrastructure and exceptional partnership approach enables us to quickly apply creative solutions to bring life-changing medicines to patients that they may not otherwise be able to access. Norgine is proud to have helped 22 million patients around the world in 2019 and generated EUR419 million in net product sales, a growth of 6% over 2018.

Norgine has a direct presence in 12 European countries, as well as Australia and New Zealand. We also have a strong global network of partnerships in non-Norgine markets. We are a flexible and fully integrated pharmaceutical business, with manufacturing (Hengoed, Wales and Dreux, France), third party supply networks and significant product development capabilities, in addition to our sales and marketing infrastructure. This enables us to acquire, develop and commercialise specialist and innovative products that make a real difference to the lives of patients around the world.

In 2012, Norgine established Norgine Ventures, a complementary business which supports innovative healthcare companies through the provision of debt-like financing in Europe and the US. For more information, please visit http://www.norgineventures.com/

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References

  1. Howaldt S, et al. P685, presented at ECCO 2020
  2. Howaldt S, et al. P331, presented at ECCO 2020
  3. Howaldt S, et al. P567, presented at ECCO 2020
  4. Howaldt S, et al. Presented at UEGW 2019, abstract number OP195
  5. Lugg et al. 2014 Journal of Crohn's and Colitis 8, 876-880
  6. FERACCRU® UK Summary of Product Characteristics, Norgine B.V. January 2020. Available at https://www.ema.europa.eu/en/documents/product-information/feraccru-epar-product-information_en.pdf Accessed February 2020

GL/COR/0220/0231, Date of preparation February 2020

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