CoLucid Pharmaceuticals, Inc. (Nasdaq:CLCD), a biopharmaceutical
company that is developing lasmiditan oral tablets for the acute
treatment of migraine in adults, with or without aura, provided
additional data regarding onset of action demonstrated as soon as
30 minutes after dosing for 100 mg and 200 mg of lasmiditan from
its Phase 3 pivotal trial evaluating lasmiditan, the SAMURAI study.
In addition, CoLucid had presented non-clinical data at the 5th
European Headache and Migraine Trust International Congress
(EHMTIC) in Glasgow, Scotland, U.K., supporting the mechanism of
action of lasmiditan through central nervous system (CNS)
penetration, distribution into areas of the brain relevant to
migraine pathophysiology, expression of the 5-HTIF receptor mRNA in
relevant regions of the brain, inhibition of trigeminal nociceptive
responses, and lack of any vasoconstrictive activity in
non-clinical models.
Data from the SAMURAI study were collected using electronic
diaries during the treated attack. Beginning pre-dose, patients
indicated their degree of headache pain on a 4-point scale: 0, no
pain; 1, mild pain; 2, moderate pain; or 3, severe pain. Migraine
headache relief was defined as moderate or severe headache pain at
baseline reduced to mild or no headache pain at the time point
assessment. Lasmiditan was effective at both the 100 mg dose and
the 200 mg dose in relieving migraine headache pain as soon as 30
minutes (p ≤ 0.004) as compared to placebo. The
following table sets forth the number and percentage of patients in
the intent to treat (ITT) population who experienced headache pain
relief during the two hours following dosing and a comparison of
each to dose to placebo.
HEADACHE PAIN RELIEF (ITT) |
Lasmiditan 100mg(N=562) |
Lasmiditan 200mg(N=555) |
Placebo(N=554) |
Number (%) of patients migraine headache pain relief at 30
minutes |
106 (18.9%) |
106 (19.1%) |
70 (12.6%) |
Odds Ratio (95% confidence interval) |
1.6 (1.2, 2.3) |
1.7 (1.2, 2.4) |
|
p-value |
p = 0.004 |
p = 0.002 |
|
|
|
|
|
Number (%) of patients migraine headache pain relief at 1 hour |
232 (41.3%) |
241 (43.4%) |
164 (29.6%) |
Odds Ratio (95% confidence interval) |
1.8 (1.3, 2.3) |
2.1 (1.6, 2.7) |
|
p-value |
p < 0.001 |
p < 0.001 |
|
|
|
|
|
Number (%) of patients migraine headache pain relief at 1 ½
hours |
303 (53.9%) |
296 (53.3%) |
216 (39.0%) |
Odds Ratio (95% confidence interval) |
2.0 (1.6, 2.6) |
2.1 (1.6, 2.8) |
|
p-value |
p < 0.001 |
p < 0.001 |
|
|
|
|
|
Number (%) of patients migraine headache pain relief at 2
hours |
334 (59.4%) |
330 (59.5%) |
234 (42.2%) |
Odds Ratio (95% confidence interval) |
2.4 (1.8, 3.1) |
2.5 (1.9, 3.3) |
|
p-value |
p < 0.001 |
p < 0.001 |
|
Patients also indicated the presence or absence of nausea,
phonophobia or photophobia, and at the pre-dose time point
identified the associated symptom present that was “most
bothersome.” At each time point assessment, patients were asked to
indicate the degree of headache pain and the presence or absence of
each associated symptom. The MBS endpoint was patient-centric and
measured treatment effect of study drug on associated symptoms.
Lasmiditan treated patients were more likely to achieve MBS freedom
as soon as 30 minutes after dosing (p ≤ 0.015) as compared to
patients treated with placebo. The following table sets forth
the number of patients in the modified ITT (mITT) population who
recorded a MBS at the time of dosing and the number and percentage
of those patients who experienced MBS freedom during the two hours
following dosing, as well as a comparison of each dose to
placebo.
MBS FREE (mITT) |
Lasmiditan 100mgN=503 |
Lasmiditan 200mgN=518 |
PlaceboN=524 |
MBS recorded at time of dosing |
469 |
481 |
488 |
|
|
|
|
Number (%) of patients MBS free at 30 minutes |
59 (12.6%) |
61 (12.7%) |
38 (7.8%) |
Odds Ratio (95% confidence interval) |
1.7 (1.1, 2.6) |
1.7 (1.1, 2.6) |
|
p-value |
p = 0.015 |
p = 0.013 |
|
|
|
|
|
Number (%) of patients MBS free at 1 hour |
129 (27.5%) |
130 (27.0%) |
84 (17.2%) |
Odds Ratio (95% confidence interval) |
1.8 (1.3, 2.5) |
1.8 (1.3, 2.4) |
|
p-value |
p < 0.001 |
p < 0.001 |
|
|
|
|
|
Number (%) of patients MBS free at 1 ½ hours |
162 (34.5%) |
161 (33.5%) |
117 (24.0%) |
Odds Ratio (95% confidence interval) |
1.7 (1.3, 2.2) |
1.6 (1.2, 2.1) |
|
p-value |
p < 0.001 |
p = 0.001 |
|
|
|
|
|
Number (%) of patients MBS free at 2 hours |
192 (40.9%) |
196 (40.7%) |
144 (29.5%) |
Odds Ratio (95% confidence interval) |
1.7 (1.3, 2.2) |
1.6 (1.3, 2.1) |
|
p-value |
p < 0.001 |
p < 0.001 |
|
The onset of action of lasmiditan as soon as 30 minutes after
dosing in SAMURAI is consistent with findings presented at EHMTIC
on September 15-18, 2016. In a poster presentation by Joseph
Kovalchin, Ph.D. (CoLucid), in vivo non-clinical models
demonstrated that lasmiditan was able to cross the blood brain
barrier as early as 30 minutes after oral or IV dosing.
Lasmiditan was also shown to distribute to areas of the brain
relevant to migraine.
In a poster presented by Marta Vila-Pueyo from Dr. Philip
Holland’s laboratory at King’s College London, U.K., IV lasmiditan
significantly inhibited trigeminal nociceptive responses in rats as
early as 30 minutes after dosing, which is indicative of acute
anti-migraine therapeutic efficacy. Moreover, 5-HT1F receptor
mRNA was found widely expressed in cortical, diencephalic and
brainstem regions of the human brain known to be of importance to
migraine pathophysiology. Together, the data suggests that,
unlike triptan therapies, lasmiditan likely acts directly in brain
regions involved in the pathophysiology of migraine that express
5-HT1F receptor mRNA.
- A copy of the Kovalchin poster is available on CoLucid’s
website at:
http://www.colucid.com/wp-content/uploads/2016/10/CoLucid-Kovalchin-Poster-90x120-13-Sep-16.pdf
- A copy of the Vila-Pueyo poster is available at:
http://www.colucid.com/wp-content/uploads/2016/10/Vila-Pueyo-poster.pdf
Lasmiditan was also shown to be devoid of vasoconstrictive
activity in the coronary and carotid arteries in non-clinical
models. In a poster presented by Elíosa Rubio-Beltran from Dr.
Antoinette Maassen van den Brink’s laboratory at Erasmus University
Medical Center, Rotterdam, The Netherlands, lasmiditan was
evaluated for vasoconstrictive activity using in vitro assays with
either human internal mammary or human coronary arteries.
Under normal and/or pre-contractile conditions, the latter achieved
by using threshold concentrations of the thromboxane A2 analogue
U46619, lasmiditan had no vasoconstrictive activity even at
supratherapeutic concentrations. Sumatriptan, the most widely
prescribed triptan in 2015, according to IMS Analytics, was shown
to induce vasoconstriction of human coronary arteries, already at
clinically relevant concentrations. The distal coronary arteries
were shown to have had greater vasoconstriction in response to
sumatriptan than the proximal coronary arteries. In an in vivo
model conducted by CorDynamics (Chicago, IL), lasmiditan showed no
vasoconstrictive activity in the coronary and carotid arteries,
even at supratherapeutic doses. Sumatriptan, used as positive
control, induced significant vasoconstriction of both the coronary
and carotid arteries, at doses calculated to be clinically
relevant. A copy of the Rubio-Beltran poster is available on
CoLucid’s website
at: http://www.colucid.com/wp-content/uploads/2016/10/Rubio-Beltran-poster.pdf
“One of the greatest unmet needs in the acute treatment of
migraine is speed of relief for patients suffering from an attack,”
said Thomas P. Mathers, President and CEO of CoLucid. “The SAMURAI
trial provides important data regarding onset of action of
lasmiditan in treating migraine headache pain as well as the most
bothersome associated symptom to the patient. We know that rapid
relief is clinically meaningful to the patients during a migraine
attack - patients want to feel better, and fast. We will continue
to analyze the data and study lasmiditan, with the hope that it can
provide relief utilizing a novel mechanism of action that does not
have the vasoconstrictive effects of other acute treatments such as
triptans.”
About LasmiditanLasmiditan has been designed
for the acute treatment of migraine headaches in adults without the
vasoconstrictor activity associated with previous generations of
migraine therapies. It selectively targets 5-HT1F receptors
expressed in the trigeminal pathway. Lasmiditan has been
given the generic stem name “ditan,” which distinguishes it from
other drug classes, including triptans, the current standard of
care for migraine.
CoLucid has completed its first pivotal Phase 3 clinical trial
of lasmiditan oral tablets, SAMURAI, which was a randomized,
double-blind, placebo-controlled parallel group study designed to
evaluate the efficacy and safety of lasmiditan (100 mg and 200 mg)
in comparison to placebo. Both the 100 mg and 200 mg doses of
lasmiditan were efficacious on headache pain freedom, the primary
endpoint, and most bothersome symptom freedom, the key secondary
endpoint, at the two-hour time point (p < 0.001). Both the
primary and key secondary endpoints of SAMURAI conform to the FDA’s
draft Guidance for Industry, Migraine: Developing Drugs for Acute
Treatment, issued in October 2014. Both the 100 mg and 200 mg
doses of lasmiditan demonstrated onset of action as soon as 30
minutes on headache pain relief (p ≤ 0.004) and the most bothersome
symptom (p ≤ 0.015). Both the 100 mg and 200 mg doses of lasmiditan
were also efficacious on headache pain relief at the two-hour time
point (p < 0.001), efficacious as a rescue medication on
headache pain freedom at the two-hour time point (p < 0.001 and
p < 0.012), and effective in reducing migraine related
disability at the two-hour time point (p < 0.001) and improving
Patient Global Impression of Change (p < 0.001). Lasmiditan was
well tolerated with no significant difference in cardiovascular
adverse events in patients dosed with lasmiditan versus placebo.
SAMURAI is the first of two Phase 3 pivotal trials of lasmiditan,
each being conducted under a Special Protocol Assessment agreement
(“SPA”) with the U.S. Food and Drug Administration (“FDA”).
CoLucid is currently enrolling patients in a second pivotal
Phase 3 clinical trial of lasmiditan oral tablets, SPARTAN. The
objective of SPARTAN is to evaluate the safety and efficacy of
lasmiditan (50 mg, 100 mg and 200 mg) in comparison to placebo two
hours after dosing on freedom from migraine headache pain, which is
the primary endpoint, and on freedom from the most bothersome
associated symptom of migraine (nausea, phonophobia or
photophobia), which is the key secondary endpoint. SPARTAN is a
randomized, double-blind, placebo-controlled parallel group
study. The study is expected to treat a single migraine in up
to 2,226 migraine patients with lasmiditan at approximately 140
sites in the United States, United Kingdom and Germany.
CoLucid expects that migraine patients enrolled in SPARTAN will
include those who also have one or more cardiovascular risk
factors, stable cardiovascular disease or known coronary artery
disease (“CAD”). CoLucid has obtained an SPA agreement from the FDA
for SPARTAN. Top-line results from SPARTAN are expected in the
second half of 2017.
CoLucid is also currently enrolling patients in GLADIATOR, a
Phase 3 long-term, open-label trial of lasmiditan. GLADIATOR’s
objective is to evaluate the safety and efficacy of lasmiditan,
(both the 100 mg and 200 mg dose) as well as resource utilization,
functional outcomes and disability. Based on the results of
GLADIATOR, CoLucid intends to build an appropriate safety database
to support a New Drug Application (“NDA”) for lasmiditan. At the
time of the NDA submission, it is anticipated that there will be
more than 15,000 patient exposures to lasmiditan in the entire
clinical program.
About MigraineMigraine is the leading cause of
disability among neurological disorders in the United States
according to the American Migraine Foundation. An estimated
36 million Americans suffer from migraine. Migraine can be
extremely disabling and costly, accounting for more than an
estimated $20 billion in direct (e.g., doctor visits, medications)
and indirect (e.g., missed work, lost productivity) expenses each
year in the United States.
About CoLucid Pharmaceuticals, Inc.CoLucid was
founded in 2005 and is developing lasmiditan oral tablets for the
acute treatment of migraine headaches in adults and intravenous
lasmiditan for the acute treatment of headache pain associated with
migraine in adults in emergency room and other urgent care
settings.
Forward-Looking Statements
Certain of the statements made in this press release are forward
looking, such as those, among others, relating to CoLucid’s
expectations for lasmiditan’s efficacy, anticipated marked demand,
anticipated physician prescribing patterns, clinical trial
enrollment goals and the timing of future clinical trials. Actual
enrollment results, market demand, use of cash and other
developments may occur that differ materially from those projected
or implied in these forward-looking statements. Factors that may
cause such a difference include risks that enrollment goals will
not be met, trials may not be commenced or successful or may take
longer to complete than anticipated, regulatory approval may not be
obtained, physicians may not prescribe lasmiditan, and projected
cash needs and expected financial results may be different. More
information about the risks and uncertainties faced by CoLucid are
contained in its periodic reports filed with the Securities and
Exchange Commission. CoLucid disclaims any intention or obligation
to update or revise any forward-looking statements, whether as a
result of new information, future events or otherwise.
CONTACT
Thomas Mathers
Chief Executive Officer
CoLucid Pharmaceuticals, Inc.
(857) 285-6494
Hans Vitzthum
Managing Director
LifeSci Advisors, LLC.
(212) 915-2568
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