TIDMNOVN 
 
 
   -- Sickle cell pain crises are unpredictable, severe events associated with 
      life-threatening complications1 
 
   -- Adakveo reduced the annual rate of sickle cell pain crises by 45% 
      compared to placebo (1.63 vs 2.98) and the annual rate of days 
      hospitalized (4 vs 6.87) in a 52-week study2 
 
   -- Approximately 100,000 people in the United States, most of whom are of 
      African descent, have sickle cell disease3 
 
   -- Approval comes approximately two months ahead of FDA's priority review 
      action date, allowing Adakveo to be available to patients more quickly 
 
 
   Basel, November 15, 2019 -- Novartis announced today that the US Food 
and Drug Administration (FDA) approved Adakveo(R) (crizanlizumab), 
previously known as SEG101, to reduce the frequency of vaso-occlusive 
crises (VOCs), or pain crises, in adult and pediatric patients aged 16 
years and older with sickle cell disease.(4) Adakveo represents the 
first FDA-approved medicine in sickle cell disease that binds to 
P-selectin --a cell adhesion protein that plays a central role in the 
multicellular interactions that can lead to vaso-occlusion.(5,6) The 
medicine is expected to be available to patients in the coming weeks. 
 
   The FDA's decision to approve Adakveo 5 mg/kg is based on results of the 
52-week, randomized, placebo-controlled SUSTAIN trial, which showed that 
Adakveo significantly lowered the median annual rate of VOCs to 1.63 vs 
2.98 compared to placebo (P=.010), which is equivalent to a 45% 
reduction. Reductions in the frequency of VOCs were observed among 
patients regardless of sickle cell disease genotype and/or hydroxyurea 
use.(2,4) 
 
   "We know this drug can decrease the frequency of sickle cell pain crises 
in a significant and clinically meaningful way," said Kenneth Ataga, MD, 
Director, Center for Sickle Cell Disease, University of Tennessee Health 
Science Center at Memphis, and Principal Investigator of the SUSTAIN 
trial. "The approval of crizanlizumab is an important advancement for 
people living with this very difficult condition." 
 
   Additional results from the SUSTAIN study include:(4) 
 
 
   -- A decrease in the median annual rate of days hospitalized to 4 vs 6.87 
      days when compared with placebo (a 42% reduction) 
 
   -- Thirty-six percent of patients treated with Adakveo did not experience a 
      VOC, compared to 17% of placebo-treated patients 
 
   -- The median time to first VOC was 4.1 for Adakveo vs 1.4 months for 
      placebo 
 
 
   The most common adverse reactions (incidence > 10%) were nausea (18%), 
arthralgia (18%), back pain (15%) and pyrexia (11%).(4) 
 
   "The approval of Adakveo marks a new era in the treatment of sickle cell 
disease, a genetic condition that places an extraordinary burden of 
unpredictable pain crises on patients and their families," said Susanne 
Schaffert, PhD, President, Novartis Oncology. "The stories we have heard 
from patients about their sickle cell pain crises are devastating. We 
are pleased to help reimagine medicine together with the sickle cell 
community and offer new hope for fewer VOCs." 
 
   Considered the clinical hallmark of the disease, sickle cell pain crises 
are triggered, in part, by multicellular interactions that form clusters 
of cells, which can block or reduce the blood flow to organs.(1,7) 
Sickle cell pain crises can be frequent and sudden, and are associated 
with an increased risk of life-threatening complications.(1) They also 
are the main reason why individuals living with sickle cell disease go 
to the emergency room and are admitted to the hospital.(7) 
 
   "Patients with sickle cell disease often face unique challenges, and 
have long suffered silently through unimaginable pain crises," said 
Beverley Francis-Gibson, President and CEO of the Sickle Cell Disease 
Association of America. "We are excited to have a new medicine that may 
help many of the thousands of people living with sickle cell disease by 
reducing the frequency of these potentially dangerous and painful 
episodes." 
 
   About Sickle Cell Disease 
 
   Sickle cell disease is a complex and debilitating, genetic blood 
disorder that goes beyond sickle-shaped red blood cells. The disease is 
associated with chronic inflammation, causing higher levels of cell 
adhesion proteins, including P-selectin, which make both the blood 
vessels and certain blood cells stickier and prone to multicellular 
interactions, or clusters, in the bloodstream. This environment can lead 
to the acute episodes of pain known as sickle cell pain crises, or VOCs, 
as well as life-threatening complications.(1,7,8) VOCs are the main 
reason why individuals living with sickle cell disease seek medical care 
in hospitals,(7) leading to approximately 200,000 ER visits in the US 
every year.(9,10) 
 
   Approximately 100,000 people in the US have sickle cell disease.(3) 
People of African ancestry make up 90% of the population with sickle 
cell disease in the US. However, sickle cell disease is also prevalent 
among people of Hispanic, South Asian, Southern European, and Middle 
Eastern ancestry. Sickle cell disease occurs in about 1 in 365 and 1 in 
16,300 African-American and Hispanic-American births, respectively.(3) 
 
   About Adakveo 
 
   Adakveo(R) (crizanlizumab) -- previously known as SEG101 -- is indicated 
to reduce the frequency of VOCs, or pain crises, in adults and pediatric 
patients aged 16 years and older with sickle cell disease. It is the 
first and only targeted biologic that works by binding to P-selectin, a 
cell adhesion protein that plays a central role in the multicellular 
interactions that can lead to vaso-occlusion in sickle cell disease. 
 
   By binding to P-selectin on the surface of the activated endothelium and 
platelets, Adakveo blocks interactions between endothelial cells, 
platelets, red blood cells, and leukocytes.(4) 
 
   About SUSTAIN 
 
   SUSTAIN is a randomized, multicenter, placebo-controlled, double-blind 
study. A total of 198 patients with any genotype of sickle cell disease 
(HbSS, HbSC, HbS/beta(0) -thalassemia, HbS/beta(+) -thalassemia, and 
others) and a history of 2-10 VOCs in the previous 12 months were 
eligible for inclusion. Patients were randomized 1:1:1 to Adakveo 5 
mg/kg (N = 67), Adakveo 2.5 mg/kg (N = 66), or placebo (N = 65) 
administered over a period of 30 minutes by intravenous infusion on Week 
0, Week 2, and every 4 weeks thereafter, for a treatment duration of 52 
weeks. 
 
   The primary efficacy outcome was the annual rate of VOCs leading to a 
healthcare visit. A VOC leading to a healthcare visit was defined as an 
acute episode of pain with no cause other than a vaso-occlusive event 
that required a medical facility visit and treatment with oral or 
parenteral opioids, or parenteral NSAIDs. Acute chest syndrome, hepatic 
sequestration, splenic sequestration, and priapism (requiring a visit to 
a medical facility) were also considered VOCs. Key secondary and other 
efficacy endpoints include annual rate of days hospitalized, time to 
first VOC leading to healthcare visit, and number of patients that did 
not experience a VOC. 
 
   Patient Access and Support 
 
   Novartis is committed to helping ensure that our medicines are 
accessible to as many patients as possible. With the approval of Adakveo 
in the United States, we now offer resources and support to address a 
range of needs. Adakveo Support at PANO (Patient Assistance Now 
Oncology) is a support center staffed by insurance specialists and case 
managers who can help eligible patients start and stay on treatment. 
Dedicated support specialists are available to help direct callers to 
services that best fit their needs. Patients or providers can call 
800-282-7630 or visit Patients.NovartisOncology.com or 
HCP.Novartis.com/Access to learn more about eligibility and to enroll. 
 
   Novartis Commitment to Sickle Cell Disease in Africa 
 
   Sickle cell is a global disease and is most widespread in sub-Saharan 
Africa. Unfortunately, we can see a clear disparity when comparing 
Africa with other parts of the world, where sickle cell is often managed 
as a chronic disease. Building on years of engagement in Africa, working 
to reduce the impact of malaria and other conditions, Novartis is taking 
steps to help address the needs of sickle cell patients as well, 
beginning in Ghana. Our partnership with the Ghana Ministry of Health, 
the Ghana Health Service, and the Sickle Cell Foundation of Ghana aims 
to improve the diagnosis and treatment of people with sickle cell 
disease through a comprehensive approach to screening and diagnosis, 
treatment and disease management, training and education, and elevating 
basic and clinical research and scientific capabilities. These 
activities include facilitating access to high-quality hydroxyurea and 
other basic medicines to enhance the standard of care. 
 
   To date, Novartis has delivered more than 20,000 hydroxyurea treatments 
to Ghana, with plans to deliver a total of 60,000 treatments by the end 
of the year. In addition, Novartis is developing a child-friendly 
formulation of hydroxyurea and is committed to implementing two clinical 
trials with crizanlizumab in Ghana and Kenya -- an important step to 
bringing this innovative medicine to patients. Crizanlizumab trials in 
Africa are expected to start in 2020. 
 
   Indication 
 
   Adakveo(R) (crizanlizumab-tmca) is used in people 16 years of age and 
older, who have sickle cell disease, to help reduce how often certain 
episodes of pain (crises) happen. It is not known if Adakveo is safe and 
effective in children under 16 years of age. 
 
   Important Safety Information 
 
   Adakveo may cause serious side effects, including infusion reactions. 
Infusion reactions may happen within 24 hours of receiving an infusion 
of Adakveo. Patients should tell their health care provider right away 
if they get any of the following signs and symptoms of an infusion 
reaction such as fever, chills or shivering, nausea, vomiting, tiredness, 
dizziness, sweating, hives, itching, or shortness of breath or wheezing. 
Health care providers may monitor their patients for signs and symptoms 
of infusion reactions. 
 
   Adakveo may interfere with automated platelet counts (platelet 
clumping). Patients should tell their health care provider that they are 
receiving Adakveo before having any blood tests. Health care providers 
should run blood samples as soon as possible or use tubes containing 
citrate. 
 
   Before receiving Adakveo, patients should tell their health care 
provider if they are pregnant or plan to become pregnant. It is not 
known if Adakveo may harm an unborn baby. 
 
   The most common side effects (incidence >=10%) include nausea, back pain, 
joint pain, and fever. 
 
   Please see full Prescribing Information for Adakveo at 
https://www.pharma.us.novartis.com/sites/www.pharma.us.novartis.com/files/adakveo.pdf. 
 
 
   Disclaimer 
 
   This press release contains forward-looking statements within the 
meaning of the United States Private Securities Litigation Reform Act of 
1995. Forward-looking statements can generally be identified by words 
such as "potential," "can," "will," "plan," "expect," "anticipate," 
"look forward," "believe," "committed," "investigational," "pipeline," 
"launch," or similar terms, or by express or implied discussions 
regarding potential marketing approvals, new indications or labeling for 
the investigational or approved products described in this press release, 
or regarding potential future revenues from such products. You should 
not place undue reliance on these statements. Such forward-looking 
statements are based on our current beliefs and expectations regarding 
future events, and are subject to significant known and unknown risks 
and uncertainties. Should one or more of these risks or uncertainties 
materialize, or should underlying assumptions prove incorrect, actual 
results may vary materially from those set forth in the forward-looking 
statements. There can be no guarantee that the investigational or 
approved products described in this press release will be submitted or 
approved for sale or for any additional indications or labeling in any 
market, or at any particular time. Nor can there be any guarantee that 
such products will be commercially successful in the future. In 
particular, our expectations regarding such products could be affected 
by, among other things, the uncertainties inherent in research and 
development, including clinical trial results and additional analysis of 
existing clinical data; regulatory actions or delays or government 
regulation generally; global trends toward health care cost containment, 
including government, payor and general public pricing and reimbursement 
pressures and requirements for increased pricing transparency; our 
ability to obtain or maintain proprietary intellectual property 
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breaches, or disruptions of our information technology systems, and 
other risks and factors referred to in Novartis AG's current Form 20-F 
on file with the US Securities and Exchange Commission. Novartis is 
providing the information in this press release as of this date and does 
not undertake any obligation to update any forward-looking statements 
contained in this press release as a result of new information, future 
events or otherwise. 
 
   About Novartis 
 
   Novartis is reimagining medicine to improve and extend people's lives. 
As a leading global medicines company, we use innovative science and 
digital technologies to create transformative treatments in areas of 
great medical need. In our quest to find new medicines, we consistently 
rank among the world's top companies investing in research and 
development. Novartis products reach more than 750 million people 
globally and we are finding innovative ways to expand access to our 
latest treatments. About 109,000 people of more than 140 nationalities 
work at Novartis around the world. Find out more at 
 
   www.novartis.com. 
 
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   References 
 
 
   1. Steinberg M. Management of sickle cell disease. N Engl J Med. 
      1999;340(13):1021-1030. 
 
   2. Ataga KI, Kutlar A, Kanter J et al. Crizanlizumab for the prevention of 
      pain crises in sickle cell disease. N Engl J Med. 2017;376(5):429-439. 
 
   3. American Society of Hematology. State of sickle cell disease 2016 report. 
      http://www.scdcoalition.org/pdfs/ASH%20State%20of%20Sickle%20Cell%20Disease%202016%20Report.pdf. 
      Accessed October 24, 2019. 
 
   4. Adakveo (crizanlizumab) prescribing information. East Hanover, New Jersey, 
      USA. Novartis Pharmaceuticals Corporation; November 2019. 
 
   5. Rees DC, Williams TN, Gladwin MT. Sickle-cell disease. Lancet. 
      2010;376(9757):2018-2031. 
 
   6. Lawrence MB, Springer TA. Leukocytes roll on a selectin at physiologic 
      flow rates: distinction from and prerequisite for adhesion through 
      integrins. Cell. 1991;65(5):859-873. 
 
   7. Gutsaeva D, Parkerson J, Yerigenahally S, et al. Inhibition of cell 
      adhesion by anti--P-selectin aptamer: a new potential therapeutic agent 
      for sickle cell disease. Blood. 2011;117(2):727-735. 
 
   8. Sparkenbaugh E, Pawlinski R. Interplay between coagulation and vascular 
      inflammation in sickle cell disease. Br J Haematol. 2013;162(1):1-22. 
 
   9. Ballas SK, Gupta K, Adams-Graves P. Sickle cell pain: a critical 
      reappraisal. Blood. 2012;120(18):3647-3656. 
 
  10. Yusuf HR, Atrash HK, Grosse SD, Parker CS, Grant AM. Emergency department 
      visits made by patients with sickle cell disease: a descriptive study, 
      1999-2007.Am J Prev Med. 2010;38(Suppl):S536-S541. 
 
 
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