Merck KGaA announced today that the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA) has issued a negative opinion regarding the marketing authorization application (MAA) for Cladribine Tablets as a treatment for relapsing-remitting multiple sclerosis (MS). The CHMP is of the opinion that based on currently available data the benefits of Cladribine Tablets do not outweigh its risks. Merck is committed to making Cladribine Tablets available to MS patients in Europe and is evaluating all options to gain approval in the European Union, including a potential appeal to request re-examination of the submission by the CHMP, in accordance with the current European regulatory legislation.
"We are disappointed by the CHMP opinion but remain fully committed to the potential of Cladribine Tablets to meet an unmet medical need as an oral short-course, disease-modifying drug for multiple sclerosis," said Elmar Schnee, Member of the Executive Board and Head of the Merck Serono division. "With the considerable support of the multiple sclerosis community and backed by the recent approvals in Australia and Russia, we will continue to work with the CHMP to address the committee's concerns and pursue a way forward to make Cladribine Tablets available to patients from the European Union."
"Multiple sclerosis is a heterogeneous disease and currently available treatments do not meet the medical needs of all patients with active disease," said Professor Gavin Giovannoni, Blizard Institute of Cell and Molecular Science, Barts and The London School of Medicine and Dentistry, London, United Kingdom, and principal investigator of the CLARITY study. "As a clinician, I hope that a way forward will be found to allow people suffering from this devastating disease to have the option of benefiting from Cladribine Tablets therapy."
Cladribine Tablets were recently approved in Australia and Russia as a treatment of relapsing-remitting MS under the trade name Movectro® and are under regulatory review in other countries, including the United States where the application has been granted Priority Review by the FDA. Cladribine Tablets registration applications are supported by the results from the CLARITY study, the largest placebo-controlled Phase III clinical trial in relapsing-remitting MS completed to date, involving over 1,300 patients with relapsing-remitting multiple sclerosis. Ongoing clinical trials with Cladribine Tablets will continue as planned.
CLARITY study design
The CLARITY study was a two-year (96-week), randomized, double-blind, placebo-controlled, international trial. It randomized 1,326 patients with relapsing-remitting MS according to the revised McDonald criteria. Study participants were randomized to one of three different treatment groups consisting of two different dose regimens of Cladribine Tablets or matching placebo tablets (1:1:1 ratio). Cladribine Tablets were given in two (3.5 mg/kg total dose) or four (5.25 mg/kg total dose) treatment courses in the first year, with each course consisting of once daily administration for four to five consecutive days (depending on patient weight), which means study patients took Cladribine Tablets for 8 to 20 days during the year. In the second year, two treatment courses were administered to all patient groups, meaning that patients took Cladribine Tablets for 8 to 10 days during the year.
The primary endpoint of the CLARITY study was the relapse rate over 96 weeks. Secondary endpoints included MRI endpoints, proportion of subjects relapse-free and disability progression at 96 weeks.
About Cladribine Tablets
Merck Serono's oral formulation of cladribine (Cladribine Tablets) is an investigational treatment for patients with relapsing forms of multiple sclerosis (MS). Cladribine is a small molecule that may interfere with the behavior and the proliferation of certain white blood cells, particularly lymphocytes, which are thought to be involved in the pathological process of MS. Merck Serono initiated global filings for Cladribine Tablets in mid-2009 and, to date has submitted regulatory applications for Cladribine Tablets covering about 40 countries. Cladribine Tablets was granted its first marketing approval in July 2010, in Russia.
About multiple sclerosis
Multiple sclerosis (MS) is a chronic, inflammatory condition of the central nervous system and is the most common, non-traumatic, disabling neurological disease in young adults. It is estimated that approximately two million people have MS worldwide. While symptoms can vary, the most common symptoms of MS include blurred vision, numbness or tingling in the limbs and problems with strength and coordination. The relapsing forms of MS are the most common.
About Merck KGaA
Merck is a global pharmaceutical and chemical company with total revenues of EUR 7.7 billion in 2009, a history that began in 1668, and a future shaped by approximately 40,000 employees (including Merck Millipore) in 64 countries. Its success is characterized by innovations from entrepreneurial employees. Merck's operating activities come under the umbrella of Merck KGaA, in which the Merck family holds an approximately 70% interest and free shareholders own the remaining approximately 30%. In 1917 the U.S. subsidiary Merck & Co. was expropriated and has been an independent company ever since.