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LA JOLLA PHARMACEUTICAL ANNOUNCES RESULTS
OF PHASE III TRIAL OF RIQUENT
SAN DIEGO, February 18, 2003 -- La
Jolla Pharmaceutical Company (Nasdaq:
LJPC) today announced preliminary findings
from a Phase III clinical trial evaluating
Riquent, previously known as LJP
394, for the treatment of lupus renal
disease. The Company continues to analyze
the results from the trial.
The objective of the study was to determine
Riquent's ability to delay the following:
renal flare, treatment with HDCC (high-dose
corticosteroids and/or cyclophosphamide)
or other immunosuppressive drugs, hospitalization,
or death due to lupus (Major SLE flare);
reduce antibodies to double-stranded
DNA (dsDNA); and to assess safety compared
with placebo in the intent-to-treat
population and in patients with impaired
renal function at baseline. The intent-to-treat
population was defined as patients with
high-affinity antibodies to Riquent.
The trial was designed to compare the
effect of drug or placebo treatment
in two well-balanced groups of lupus
patients with a history of renal disease.
Additional information follows in the
section titled Trial Design.
Summary of Results
Intent-to-treat analysis:
Riquent appeared to be well tolerated
with no apparent differences in the
overall incidence of serious adverse
events or adverse events between Riquent-treated
and placebo-treated patients. However,
an initial assessment of the trial data
indicates that treatment with Riquent
did not increase length of time to renal
flare, the primary endpoint, in a statistically
significant manner when compared with
placebo through the end of the study.
There were 298 patients in the intent-to-treat
population, 145 on Riquent and 153 on
placebo. Patients were treated for as
long as 92 weeks with a median of 46
weeks.
There was a statistically significant
reduction in antibodies to dsDNA in
the Riquent-treated group compared with
the placebo-treated group (p<0.001).
Antibodies to dsDNA are believed to
result in renal flares and other clinical
manifestations of lupus. Riquent was
designed to reduce antibodies to dsDNA
and this effect has been demonstrated
in all clinical studies of Riquent.
In this study, changes in antibodies
to dsDNA strongly correlated with changes
in complement levels in an inverse relationship
(p < 0.001). Complement C3 levels
below normal at baseline (hypocomplementemia)
strongly correlated with an increased
risk of renal flare (p< 0.001). Similar
correlations between antibody levels
and complement C3 were observed in the
previous Phase II/III study. Together,
these data confirm the pathogenic nature
of these antibodies to dsDNA in lupus
patients.
In the intent-to-treat population,
there were fewer renal flares, treatments
with HDCC and Major SLE (systemic lupus
erythematosus) flares in Riquent-treated
patients compared with placebo-treated
patients. The estimated median time
to renal flare was 123 months in the
Riquent-treated group and 89 months
in the placebo-treated group. There
were 41 renal flares, 17 (12%) in Riquent-treated
patients and 24 (16%) in placebo-treated
patients. There were 68 treatments with
HDCC, 32 (22%) in the Riquent-treated
group and 36 (24%) in the placebo-treated
group. There were 82 Major SLE flares
in the trial, 35 (24%) in patients on
Riquent and 47 (31%) in patients on
placebo. None of these differences were
statistically significant.
Reviewing a graph of the results showed
that the Riquent and placebo lines for
time to renal flare and for the changes
in antibody levels were separating until
weeks 46 to 48. In the first 46 weeks,
90% or 22 of 24 renal flares occurred
in the study in the placebo patients
compared with 59% or 10 of 17 in the
Riquent-treated patients. At weeks 44,
46, and 48, the incidence of renal flares
was 20:10 (p = 0.085), 22:10 (p = 0.041)
and 22:11 (p = 0.067), respectively,
in favor of Riquent. At weeks 44, 46
and 48, the incidence of renal and/or
Major SLE flares was 43:27 (p=0.057),
46:28 (p=0.033) and 46:29 (p=0.061),
respectively, in favor of Riquent. More
discussion follows in the section titled
Other Observations.
In addition, the results from this
trial appear to support the use of the
Company's high-affinity assay to identify
patients who may respond to Riquent
and also to confirm the high-affinity
analysis approach used in the previous
Phase II/III study. As the baseline
affinity of patients' antibodies for
Riquent increased, the number of renal
flares declined in the Riquent-treated
group compared with the placebo-treated
group.
Patients with Impaired Renal Function
analysis: In a prospectively defined
subpopulation with impaired renal function
at baseline, defined as a serum creatinine
> 1.5 mg/dl at baseline, there were
43 patients, 20 on Riquent and 23 on
placebo. Riquent-treated patients had
fewer renal flares, treatments with
HDCC and Major SLE flares compared with
patients on placebo, but the number
of patients was small and the differences
were not statistically significant.
There were 8 renal flares, 2 (10%) in
patients on Riquent and 6 (26%) in patients
on placebo. There were 9 treatments
with HDCC, 3 (15%) in patients on Riquent
and 6 (26%) in patients on placebo.
There were 11 Major SLE flares, 4 (20%)
in patients on Riquent and 7 (30%) in
patients on placebo. There were 14 renal
flares and/or Major SLE flares, 5 (25%)
in patients on Riquent and 9 (39%) in
patients on placebo. Similar results
in the same group were observed for
renal flares in a previous Phase II/III
study: no renal flares (0%) were observed
in the 11 Riquent-treated high-affinity
patients compared with 6/11 (55%) of
the placebo-treated high-affinity patients.
Experts believe a delay in time to or
a decrease in the incidence of renal
flares and/or Major SLE flares in this
high-risk population would be considered
medically meaningful.
Next Steps
The Company plans to complete its analysis
of the Phase III data and meet with
regulatory agencies. The analysis of
data from the health-related quality
of life survey and patient self-assessment
is ongoing. The Company will continue
to collect data in the ongoing open-label
follow-on trial. Based on the observed
reduction in antibodies to dsDNA, which
the Company believes confirms LJP's
Tolerance Technology® approach,
the Company plans at this time to continue
its antibody-mediated thrombosis program
and evaluate the use of the technology
for other diseases, which will depend
on the availability of additional funding.
Other Observations
Several observations may help to explain
the results from the study. These observations
are preliminary and they will all require
review by appropriate regulatory agencies
and medical experts.
Changes in medical practice: There
appears to have been changes in medical
practice since the completion of the
Phase II/III study as evidenced by a
difference in prescribing regimens for
immunosuppressive drugs. In particular,
it appears there were differences in
baseline treatments in the patient population
in the Phase III study compared with
the previous trial. A higher percentage
of patients were receiving immunosuppressive
treatments at study entry: 73/145 (50%)
in the Riquent-treated group versus
63/153 (41%) in the placebo-treated
group in the Phase III study, compared
with 35/114 (31%) in the Riquent-treated
group versus 40/116 (34%) in the placebo-treated
group in the Phase II/III trial. The
sample size selected for the Phase III
study was based on the Phase II/III
study.
The definition of HDCC may not have
captured all of the potential events
in this study, as HDCC did not include
some of the newer immunosuppressive
drugs that are increasingly used instead
of cyclophosphamide. While these newer
drugs have a better side effect profile
than cyclophosphamide, they are still
broadly immunosuppressive. The definition
of Major SLE flare included increases
in corticosteroid doses as well as any
new or increased dose of immunosuppressive
agents, hospitalization or death, provided
they were associated with active SLE.
To account for these observed changes
in medical practice, a combined analysis
of all patients with either a renal
flare and/or a Major SLE flare was performed.
In this combined analysis, there were
88 events, 37 (26%) in Riquent-treated
patients and 51 (33%) in placebo-treated
patients. Thus, changes in medical practice
may have resulted in fewer renal flares
because patients were being treated
before a renal flare could have been
observed or documented.
Depletion of susceptible patients in
placebo group: It appears that "sicker"
patients in the Riquent group stayed
in the trial longer than "sicker"
patients in the placebo group even though
a comparable number of patients discontinued
in each group before they met a predefined
endpoint in the study (a depletion of
susceptible patients). Reviewing a graph
of the results showed that the Riquent
and placebo lines for time to renal
flare and for the changes in antibody
levels were separating until weeks 46
to 48. Upon reviewing patient laboratory
values, placebo patients remaining in
the study past weeks 44 to 48 appeared
to have better renal function than the
placebo group who dropped out or flared
prior to these weeks, as measured by
creatinine clearance at baseline (p
= 0.024 at week 48). In the placebo-treated
group, those who remained in the study
after weeks 44 to 48 showed no mean
changes in antibodies to dsDNA from
baseline.
Trial Design
Treatment: Patients were
treated with weekly doses of 100 mg
of Riquent or with placebo. Patients
were also permitted to receive other
treatments including immunosuppressive
drugs. This randomized, double-blind,
placebo-controlled study was conducted
at more than 70 major medical centers
in North America and Europe. Patients
could remain in the study for up to
92 weeks.
Analysis groups: The
prospectively defined analysis groups
were the intent-to-treat population
and patients with impaired renal function.
Patients with impaired renal function
were defined as having a serum creatinine
level of 1.5 mg/dL to 3.5 mg/dL at baseline.
In general, patients with impaired renal
function are at greater risk of progressing
to renal flare, kidney failure, and
dialysis.
Endpoints: The primary
endpoint was time to renal flare. A
renal flare was defined as a significant,
reproducible increase in serum creatinine,
urine protein or blood in the urine.
The secondary endpoint was time to treatment
with HDCC. HDCC was defined as any dose
of cyclophosphamide or an increase in
prednisone of 15 mg/day or higher resulting
in a final dose greater than 20 mg/day.
Other prospectively defined secondary
outcomes included time to Major SLE
flare, treatment associated maintenance
and/or improvement in health-related
quality of life, decreases in antibodies
to dsDNA and associated increases in
complement C3 levels. A Major SLE flare
was defined as the occurrence of any
one of the following due to manifestations
of active SLE: treatment with HDCC or
initiation or increase in treatment
with other immunosuppressive agents,
including azathioprine, mycophenolate
mofetil, methotrexate, cyclosporin and
leflunomide; or hospitalization or death.
This definition of Major SLE flare was
designed to capture serious events where
patients were treated for manifestations
of active SLE as well as renal disease
or where treatment, hospitalization
or death could have preceded the occurrence
of a documented renal flare.
Complement changes were evaluated by
determining the mean change from baseline
in the complement protein C3 that indicates
overall complement consumption due to
active inflammation. Antibody changes
were evaluated by determining the mean
percent change of antibodies to dsDNA
from baseline. Patients' assessments
of disease activity and health-related
quality of life were measured on a regular
basis as well as at the time of, and
30 days following, a documented renal
flare
Discussion of Preliminary Results
"Based on preliminary results,
Riquent appears to be well tolerated
in patients over a relatively long study
period of up to 92 weeks and LJP plans
to continue the ongoing open-label follow-on
study to collect additional information,"
said Steve Engle, CEO of La Jolla Pharmaceutical
Company. "Although the prospectively
defined primary efficacy analysis in
the intent-to-treat population did not
demonstrate the level of efficacy expected,
we believe the study shows a clear correlation
between treatment with drug and improvements
in complement that are associated with
a reduced risk of renal flares in the
trial. Lupus trials conducted with Riquent
have consistently demonstrated the ability
to reduce these pathogenic antibodies."
"Many of the preliminary results
in this trial appear consistent with
the previous Phase II/III study,"
said Engle. "We observed a larger
difference between Riquent- and placebo-
treated patients earlier in the trial,
at weeks 44 to 48, and we still see
this treatment difference in patients
with impaired renal function who remained
on treatment during the entire study.
We believe the statistically significant
reduction in antibodies to dsDNA seen
in Riquent-treated patients compared
with placebo further demonstrates Riquent's
mechanism of action, confirms our core
Tolerance Technology® platform and
supports its potential application in
other autoimmune diseases with disease-causing
antibodies."
"It appears that several issues
may have prevented us from attaining
statistical significance," said
Engle. "Unfortunately, changes
in medical practice and interference
from concomitant medications are difficult
issues in drug development. Moving forward,
our clinical development pathway cannot
be fully defined until the study results
are completely analyzed and we discuss
the results with regulatory agencies."
"We appreciate the patients, physicians
and others who helped make this trial
possible and remain dedicated to the
search for less harmful therapies for
lupus patients," said Engle. "We
appreciate our investors' critical support.
We will continue to analyze the data
from the trial and then we plan to discuss
these results with the regulatory agencies.
Our guidance to investors and others
will be limited during this time."
La Jolla Pharmaceutical Company is
a biotechnology company developing therapeutics
for antibody-mediated autoimmune diseases
afflicting several million people in
the United States and Europe. The Company
is developing Riquent for the
treatment of lupus kidney disease, a
leading cause of sickness and death
in patients with lupus. The Company
is also developing LJP 1082 for the
treatment of antibody-mediated thrombosis,
a condition in which patients suffer
from recurrent stroke, deep-vein thrombosis
and other thrombotic events. The Company's
common stock is traded on The Nasdaq
Stock Market under the symbol LJPC.
For more information about the Company,
visit our Web site: http://www.ljpc.com.
Except for historical statements, this
press release contains forward-looking
statements involving significant risks
and uncertainties, and a number of factors,
both foreseen and unforeseen, could
cause actual results to differ materially
from our current expectations. Forward-looking
statements include those, which express
a plan, belief, expectation, estimation,
anticipation, intent, contingency, future
development or similar expression. Although
we expect to meet with the U.S. Food
and Drug Administration ("FDA")
to discuss the results of our Phase
III trial of Riquent, there is no guarantee
that a meeting with the FDA can be held
in a timely manner, or at all, or that
our meetings with them will result in
us being able to continue to develop
Riquent. Our analyses of clinical results
of Riquent, previously known as
LJP 394, our drug candidate for the
treatment of systemic lupus erythematosus
("lupus"), and LJP 1082, our
drug candidate for the treatment of
antibody-mediated thrombosis ("thrombosis"),
are ongoing and could result in a finding
that these drug candidates are not effective
in large patient populations, do not
provide a meaningful clinical benefit
or may reveal a potential safety issue
requiring us to develop new candidates.
Our blood test to measure the binding
affinity for Riquent is experimental,
has not been validated by independent
laboratories, may require regulatory
approval, and may be necessary for the
approval and the commercialization of
Riquent. Our other potential drug
candidates are at earlier stages of
development and involve comparable risks.
Analysis of our clinical trials could
have negative or inconclusive results.
Any positive results observed to date
may not be indicative of future results.
In any event, the FDA may require additional
clinical trials, or may not approve
our drugs. Our ability to develop and
sell our products in the future may
be affected by the intellectual property
rights of third parties. Additional
risk factors include the uncertainty
of: obtaining required regulatory approvals,
including delays associated with any
approvals that we may obtain; FDA approval
of our manufacturing facilities and
processes; the increase in capacity
of our manufacturing capabilities for
possible commercialization; successfully
marketing and selling our products;
our lack of manufacturing, marketing,
and sales experience; generating future
revenue from product sales or other
sources such as collaborative relationships;
future profitability; our need for additional
financing; and our dependence on patents
and other proprietary rights. Readers
are cautioned to not place undue reliance
upon forward-looking statements, which
speak only as of the date hereof, and
we undertake no obligation to update
forward-looking statements to reflect
events or circumstances occurring after
the date hereof. Interested parties
are urged to review the risks described
in our Registration Statement on Form
S-3, filed December 10, 2002, our Annual
Report on Form 10-K for the year ended
December 31, 2001, and in other reports
and registration statements that we
file with the Securities and Exchange
Commission from time to time.
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