Anavex Life Sciences Corp. (“Anavex” or the “Company”) (Nasdaq:
AVXL), a clinical-stage biopharmaceutical company developing
differentiated therapeutics for the treatment of neurodegenerative
and neurodevelopmental disorders including Alzheimer’s disease,
Parkinson’s disease, Rett syndrome and other central nervous system
(CNS) disorders, today reported that the predictive biomarker of
response established with SIGMAR1 mRNA expression correlates
significantly with responses in primary and secondary clinical
efficacy endpoints from the proof-of-concept randomized,
double-blind, placebo-controlled Phase 2 trial that randomized 132
patients with Parkinson’s disease dementia equally (ratio of 1:1:1)
to target doses of 30mg, 50mg ANAVEX®2-73 or placebo, respectively.
ANAVEX®2-73 activates the sigma-1 receptor
(SIGMAR1). Data suggests that activation of SIGMAR1 results in the
restoration of complete housekeeping function within the body and
is pivotal to restoring neural cell homeostasis and promoting
neuroplasticity.1 Recent independent findings strengthen the
understanding of the beneficial effect of SIGMAR1 activation as
compensatory mechanism to chronic CNS diseases.2
Parkinson’s disease (PD) is a chronic CNS
disease and the second largest age-related disorder after
Alzheimer’s disease.3 This study demonstrates for the first-time
that a drug-specific biomarker correlates with clinical efficacy
endpoints in Parkinson’s disease.
ANAVEX®2-73 treatment resulted in significant (p
= 0.035) mRNA expression increase of SIGMAR1, the gene encoding for
the receptor targeted by ANAVEX®2-73, which correlated with
clinical efficacy as measured by primary cognitive efficacy
endpoints, CDR system Continuity of Attention (CoA) (p = 0.029) and
CDR system Power of Attention (PoA) (p = 0.015), and secondary
Parkinson’s efficacy endpoints Movement Disorder Society-Unified
Parkinson's Disease Rating Scale (MDS-UPDRS)4, MDS-UPDRS Part III
(p = 0.024) and MDS-UPDRS Total (p = 0.038).
Parkinson’s Disease-related Scores
ANAVEX®2-73 high dose demonstrated statistically
significant improvements compared to placebo (ITT population) for
MDS-UPDRS Total score (p = 0.034). From baseline to end of trial at
14 weeks, MDS-UPDRS Total score improved by -10.98 points in the
ANAVEX®2-73 high dose group and worsened by 3.53 points in the
placebo group, an adjusted mean difference of -14.51 points (p =
0.034). This corresponds to a relative improvement of 18.9 % over
14 weeks.
This far exceeds an empirically established
cutoff score of -7.1 for detecting meaningful clinical change.5 For
reference, the observed worsening of MDS-UPDRS Total score in
patients with Parkinson’s disease in the literature is estimated in
the range of 3.99 to 7.45 points per year.6
Treatment with ANAVEX®2-73 not only slows the
progression of motor and non-motor symptoms in moderately advanced
patients with Parkinson’s. ANAVEX®2-73 also resulted in clinically
meaningful improvements as measured by the global composite score
of Parkinson’s disease symptom severity, MDS-UPDRS Total score on
top of standard of care including dopaminergic therapy, levodopa
and other anti-PD medications after 14 weeks of treatment,
suggesting ANAVEX®2-73’s global capability of slowing and reversing
symptoms that progress in Parkinson’s disease, an urgent unmet
medical need.
Sleep was a tracked variable both subjectively
and objectively including sleep continuity or incidence of sleep
disorders symptoms. ANAVEX®2-73 does not impair sleep and has a
positive effect on REM sleep behavior disorder.
Dementia-related Scores
Previously reported cognitive outcome measures
from this study relevant to Alzheimer’s disease presented at CTAD
2020 observed statistically significant improvement of CDR system
Episodic Memory of +42.22 between ANAVEX®2-73 high dose and
placebo, which was dose-dependent (p = 0.003).7 CDR system Episodic
Memory has been shown to be highly correlated (70%) with the
ADAS-Cog score (r = 0.7).8 The calculated corresponding ADAS-Cog
mean change from baseline score is -1.9 (improvement) for patients
in the high dose group, an 8% mean improvement from baseline to 14
weeks. The difference between the ANAVEX®2-73 group and the placebo
group in the change from baseline at 14 weeks was a 4.0-point
improvement of calculated corresponding ADAS-Cog score (p =
0.015).9
ANAVEX®2-73 is currently being tested in
late-stage placebo-controlled ANAVEX®2-73 Phase 2b/3 clinical
Alzheimer’s disease study, which recently completed enrollment, and
is utilizing the same dosing regimen as in the above-described
completed Parkinson’s disease dementia (ANAVEX®2-73-PDD-001) study
with differentiated patient selection criteria.10
Summary and Next Steps
“This is now the second independent
placebo-controlled clinical ANAVEX®2-73 Phase 2 study to confirm
the predictive biomarker of response established with SIGMAR1 mRNA
expression. Both ANAVEX®2-73-PDD-001 Parkinson’s disease dementia
study and the recently reported ANAVEX®2-73-RS-001 U.S. Rett
syndrome study are persuasively consistent with the proposed
mechanism for ANAVEX®2-73,” said Christopher U. Missling, PhD,
President & Chief Executive Officer of Anavex. “We believe that
the easily accessible predictive biomarker combined with the
observed efficacy is a consistent explanation of the efficacy in
this second largest CNS indication with unmet medical need. This
data further strengthens the foundation of ANAVEX®2-73 as a
cross-platform CNS drug.”
Michael J. Fox Foundation (MJFF) recently
awarded Anavex a research grant for an imaging-focused Parkinson’s
disease clinical trial with ANAVEX®2-73.11 MJFF previously awarded
Anavex a research grant, which fully funded a preclinical study
that established ANAVEX®2-73 as a potentially disease-modifying
treatment for Parkinson’s disease.12
With this convincing biomarker-correlating
efficacy data of this proof-of-concept Phase 2
(ANAVEX®2-73-PDD-001)13 study in patients with Parkinson’s disease
dementia, data will be submitted to the U.S. Food and Drug
Administration to seek regulatory guidance.
Data from this study will be submitted later
this year for presentation at a scientific medical meeting.
Anavex Life Sciences’ product portfolio platform
includes orally available small molecule drug lead candidate
ANAVEX®2-73 for the treatment of Alzheimer’s disease, Parkinson’s
disease and Rett syndrome and ANAVEX®3-71 for frontotemporal
dementia.
About Parkinson’s Disease (PD)
Parkinson’s disease is a chronic and progressive
neurological disorder that is characterized by well-known motor
symptoms including tremors, stiffness of limbs, slowness of
movements, and difficulties with posture and balance, as well as by
non-motor symptoms. It is the second most common neurological
disorder and approximately one million people in the United States,
and more that 10 million people worldwide, live with this disease.
Parkinson’s disease is more common in people over 60 years of age
and its prevalence is expected to increase significantly as the
average age of the population increases. Current Parkinson’s
treatments are only effective in managing symptoms of the disease,
mainly through the use of levodopa and dopamine agonists. As the
disease progresses and dopaminergic neurons continue to be lost,
these drugs eventually become less effective at treating the
symptoms.
About Parkinson’s Disease Dementia (PDD)
Parkinson’s disease is a fairly common
neurological disorder in older adults, estimated to affect nearly 2
percent of those older than age 65. The Parkinson’s Foundation
estimates that 1 million Americans have Parkinson’s disease. It is
estimated that up to 80 percent of those with Parkinson’s disease
eventually experience Parkinson’s disease dementia. The brain
changes caused by Parkinson’s disease begin in a region that plays
a key role in movement. As Parkinson’s brain changes gradually
spread, they often begin to affect mental functions, including
memory and the ability to pay attention, make sound judgments and
plan the steps needed to complete a task.14
About ANAVEX®2-73-PDD-001 Clinical Study
(NCT03774459)
The ANAVEX®2-73-PDD-001 study was an
international, double-blind, multicenter, placebo-controlled proof
of concept Phase 2 clinical study that randomized 132 patients with
Parkinson’s disease dementia (PDD) equally (ratio of 1:1:1) to
target doses of 30mg, 50mg ANAVEX®2-73 or placebo, respectively. In
addition to prespecified ANAVEX®2-73-related biomarker of response,
SIGMAR1, safety and cognitive efficacy, MDS-UPDRS, actigraphy and
sleep function was assessed during the study duration of 14
weeks.
Study inclusion required diagnosis of idiopathic
Parkinson's disease (PD) consistent with the UK Parkinson's Disease
Society Brain Bank diagnostic criteria and diagnosis of probable PD
dementia (PDD) according to the Movement Disorder Society Task
Force clinical diagnostic criteria as well as Montreal Cognitive
Assessment (MoCA) score of 13 to 23. DNA and RNA from blood samples
were analyzed using NGS.
Study participants were allowed to be on stable
regimen of anti-Parkinson's disease medications (including
levodopa, dopamine agonists, MAO-B inhibitors, or entacapone).
Treatment with cholinesterase inhibitors, rivastigmine, donepezil
and galantamine (Exelon®, Aricept®, or Reminyl®) were also
permitted.
The study found that ANAVEX®2-73 was well
tolerated in oral doses up to 50 mg once daily. The results showed
clinically meaningful, dose-dependent, and statistically
significant improvements in the Cognitive Drug Research (CDR)
computerized assessment system analysis. The study validated the
precision medicine approach of targeting SIGMAR1 as a genetic
biomarker of response to ANAVEX®2-73, confirming that ANAVEX®2-73
acts through SIGMAR1 activation.
Broad and statistically significant improvements
in CDR system Cognitive Domain of Attention assessed by Choice
Reaction Time (p = 0.039) and Digital Vigilance (p = 0.008) and CDR
system Episodic Memory (p = 0.047), representing complex cognitive
tasks with impact on quality of life such as making a choice
between similar objects and remembering daily personal experiences,
which are mostly impaired in both PD and AD.15Statistically
significant dose-dependent (p = 0.003) improvement of Episodic
Memory, which has been shown to be highly correlated (70%) with the
Alzheimer’s Disease Assessment Scale–Cognitive score (ADAS-Cog; r =
0.7).16ANAVEX®2-73 does not impair sleep and has a positive effect
on REM sleep behavior disorder.ANAVEX®2-73 was generally safe, well
tolerated, and improved safety profile compared to dementia drugs
associated with typical adverse effects.
After completing the ANAVEX®2-73-PDD-001 trial,
participants were able to enroll in a voluntary 48-week open-label
extension study, ANAVEX®2-73-PDD-EP-001, which continues to assess
safety, long term efficacy and changes in gut microbiota.17
About Anavex Life Sciences Corp.
Anavex Life Sciences Corp. (Nasdaq: AVXL) is a
publicly traded biopharmaceutical company dedicated to the
development of differentiated therapeutics for the treatment of
neurodegenerative and neurodevelopmental disorders including
Alzheimer’s disease, Parkinson’s disease, Rett syndrome and other
central nervous system (CNS) diseases, pain and various types of
cancer. Anavex’s lead drug candidate, ANAVEX®2-73 (blarcamesine),
successfully completed a Phase 2a clinical trial for Alzheimer’s
disease and recently a Phase 2 proof-of-concept study in
Parkinson’s disease dementia and a Phase 2 study in adult patients
with Rett syndrome. ANAVEX®2-73 is an orally available drug
candidate that restores cellular homeostasis by targeting sigma-1
and muscarinic receptors. Preclinical studies demonstrated its
potential to halt and/or reverse the course of Alzheimer’s disease.
ANAVEX®2-73 also exhibited anticonvulsant, anti-amnesic,
neuroprotective and anti-depressant properties in animal models,
indicating its potential to treat additional CNS disorders,
including epilepsy. The Michael J. Fox Foundation for Parkinson’s
Research previously awarded Anavex a research grant, which fully
funded a preclinical study to develop ANAVEX®2-73 for the treatment
of Parkinson’s disease. ANAVEX®3-71, which targets sigma-1 and
muscarinic receptors, is a promising clinical stage drug candidate
demonstrating disease-modifying activity against the major
hallmarks of Alzheimer’s disease in transgenic (3xTg-AD) mice,
including cognitive deficits, amyloid and tau pathologies. In
preclinical trials, ANAVEX®3-71 has shown beneficial effects on
mitochondrial dysfunction and neuroinflammation. Further
information is available at www.anavex.com. You can also connect
with the company on Twitter, Facebook, Instagram and LinkedIn.
Forward-Looking Statements
Statements in this press release that are not
strictly historical in nature are forward-looking statements. These
statements are only predictions based on current information and
expectations and involve a number of risks and uncertainties.
Actual events or results may differ materially from those projected
in any of such statements due to various factors, including the
risks set forth in the Company’s most recent Annual Report on Form
10-K filed with the SEC. Readers are cautioned not to place undue
reliance on these forward-looking statements, which speak only as
of the date hereof. All forward-looking statements are qualified in
their entirety by this cautionary statement and Anavex Life
Sciences Corp. undertakes no obligation to revise or update this
press release to reflect events or circumstances after the date
hereof.
For Further Information:
Anavex Life Sciences Corp.Research &
Business DevelopmentToll-free: 1-844-689-3939Email:
info@anavex.com
Investors:Andrew J.
BarwickiInvestor RelationsTel: 516-662-9461Email:
andrew@barwicki.com
1 Advances in Experimental Medicine and Biology Volume 964
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10.1016/j.arr.2014.01.004. Epub 2014 Feb 3. PMID: 24503004; PMCID:
PMC3989046; Mhyre TR, Boyd JT, Hamill RW, Maguire-Zeiss KA.
Parkinson's disease. Subcell Biochem. 2012;65:389-455. doi:
10.1007/978-94-007-5416-4_16. PMID: 23225012; PMCID: PMC43723874
The Movement Disorder Society-Unified Parkinson Disease Rating
Scale (MDS-UPDRS) is a commonly used tool to measure Parkinson
disease (PD) progression5 Makkos A, Kovács M, Aschermann Z, Harmat
M, Janszky J, Karádi K, Kovács N. Are the MDS-UPDRS-Based Composite
Scores Clinically Applicable? Mov Disord. 2018 May;33(5):835-839.
doi: 10.1002/mds.27303. Epub 2018 Feb 28. PMID: 294883186 Holden
SK, Finseth T, Sillau SH, Berman BD. Progression of MDS-UPDRS
Scores Over Five Years in De Novo Parkinson Disease from the
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Sep 22; Simuni T, Siderowf A, Lasch S, Coffey CS, Caspell-Garcia C,
Jennings D, Tanner CM, Trojanowski JQ, Shaw LM, Seibyl J, Schuff N,
Singleton A, Kieburtz K, Toga AW, Mollenhauer B, Galasko D, Chahine
LM, Weintraub D, Foroud T, Tosun D, Poston K, Arnedo V, Frasier M,
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Markers Initiative Cohort. Mov Disord. 2018 May;33(5):771-782. doi:
10.1002/mds.273617
https://www.anavex.com/wp-content/uploads/2020/11/CTAD-Anavex-PDD-001-Topline-data-Presentation-2020.pdf8
Wesnes K. et al., Computerized cognition assessment during
acetylcholinesterase inhibitor treatment in Alzheimer’s disease.
Acta Neurol Scand 2010; 122:270–79
https://www.anavex.com/anavex-life-sciences-reports-anavex2-73-blarcamesine-featured-as-a-disease-modifying-small-molecule-in-phase-3-clinical-trials-in-a-new-publication-in-medical-journal-titled-future-av/10
ClinicalTrials.gov Identifier: NCT0379070911
https://www.anavex.com/anavex-life-sciences-receives-michael-j-fox-foundation-grant-for-clinical-study-of-anavex2-73-blarcamesine-in-people-with-parkinsons-disease/12
https://www.anavex.com/parkinsons-disease-data-mjf-conference/;
https://www.anavex.com/anavex-awarded-grant-from-the-michael-j-fox-foundation-for-parkinsons-research/13
ClinicalTrials.gov Identifier: NCT0377445914 Source:
https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/parkinson-s-disease-dementia15
Mahurin, R. K., & Pirozzolo, F. J. (1993). Application of
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cognition assessment during acetylcholinesterase inhibitor
treatment in Alzheimer’s disease. Acta Neurol Scand 2010;
122:270–717 ClinicalTrials.gov Identifier: NCT04575259
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