ENHANCE Data Suggest Safety of Higher-Dose Ublituximab and Shorter Infusion Time
The data showed only a small number of infusion-related reactions among patients with MS transitioning from other disease-modifying therapies.
New data from the ongoing phase 3 ENHANCE study (NCT05877963) of patients with multiple sclerosis (MS) suggest that a 450-mg dose of ublituximab-xiiy (Briumvi; TG Therapeutics) can be administered in 1 hour as the initial infusion for those individuals who are B-cell depleted without additional safety concerns, and a shorter infusion time of 30 minutes was similarly well tolerated.1 Currently, the therapy is approved by the FDA in a dose of 150 mg (25 mg/mL) in a single-dose vial.2
Among those evaluated for the higher-dose infusion, the most frequently reported symptoms of Grade 1 IRRs were throat irritation (n = 7) and headache (n = 5), with the single Grade 2 IRR—minor throat itchiness—resolving without modification to the infusion. In total, 16% of those who were B-cell depleted (n = 86) reported an IRR after the day 1 dosing, and 8% of those who were not depleted (n = 40) reported an IRR. Notably, all patients had an antipyretic at each infusion.
The data were presented in a poster by John F. Foley, MD, a neurologist and the founder of the Rocky Mountain Multiple Sclerosis Clinic, and colleagues, at the the
There were 3 infusion times assessed in the study of the 450-mg dose: 60 minutes (n = 13), 45 minutes (n = 13), and 30 minutes (n = 12). Of note, only the 45-minute infusion group reported any infusion slowing or interruption (92% completed without any such interruption), while the 60-minute and 30-minute groups reported 100% completion rates. In total, 82% of patients received a nondrowsy antihistamine for this week 24 infusion. There were no IRRs reported in the 60-minute group, but 1 and 2 patients reported IRRs in the 45-minute and 30-minute groups, respectively. All of these were Grade 1 (itching, throat irritation, and headache), and all resolved completely.
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In ENHANCE, patients were assessed in 3 cohorts: those who were already B-cell depleted from prior anti-CD20 therapy transition to ublituximab and treated with a full dose of 450 mg over 2 hours (cohort 1; n = 13) or 1 hour (cohort 2; n = 21); and those being treated with another disease-modifying therapy (DMT), but not meeting inclusion criteria for cohorts 1 or 2, who transitioned to ublituximab at the labeled dose of 150 mg over 4 hours. This analysis included patients from cohorts 1 and 2, as patients are still being enrolled in the second and third groups.
Patients in the study transitioned to ublituximab from a number of other therapies, including ocrelizumab, natalizumab (Tysabri; Biogen), dimethyl fumarate (Vumerity; Biogen), glatiramer acetate, ofatumumab (Kesimpta Novartis), fingolimod (Gilenya; Novartis), ozanimod (Zeposia; Bristol Myers Squibb), evobrutinib (Merk), teriflunomide (Aubagio; Sanofi), rituximab, and interferon beta-1a. Among the B-cell depleted patients, the vast majority (94%) transitioned from ocrelizumab, while the remaining 6% transitioned from ofatumumab. All told, of the 34 patients included in the analysis who had transitioned to ublituximab from ocrelizumab (Ocrevus; Genentech), 20 (59%) had reported a wearing-off effect on their prior therapy.
Ultimately, the goal of the study was to determine if the elimination of the initial 150-mg dose would affect safety and efficacy, and if faster, higher-dose infusions of 30 minutes at week 24 were safe and tolerable. The data showed a low incidence of infusion-related reactions (IRRs) among patients in the study, regardless of B-cell depletion status, with only a single incidence of a Grade 2 IRR.
These data build upon those presented earlier this year at the2024
REFERENCES
1. Foley J, Miller T, Wray S, et al. Efficacy and tolerability of ublituximab after transitioning from a different disease modifying therapy: Updates from the ENHANCE study. Presented at: ECTRIMS Congress; September 18-20, 2024; Copenhagen, Denmark. Poster P329
2. Briumvi (ublituximab-xiyy) prescribing information. FDA. Revised December 2022. Accessed September 18, 2024. https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/761238s000lbl.pdf
3. Foley J, Wray S, Miller T, et al. Evaluating the Maintenance of Efficacy and Tolerability of Transitioning From IV Anti-CD20 Therapy to Ublituximab: ENHANCE Study Interim Data. Presented at ACTRIMS Forum 2024; February 29 to March 2; West Palm Beach, Florida. P109
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