FDA Advisory Committee votes unanimously to support use of teprotumumab to treat thyroid eye disease

Horizon Therapeutics announced that the Dermatologic and Ophthalmic Drugs Advisory Committee (DODAC) of the US Food and Drug Administration (FDA) voted unanimously that the potential benefits of teprotumumab, a fully human monoclonal antibody (mAb), outweigh the potential risks for the treatment of Thyroid Eye Disease (TED).

TED is a rare, serious, progressive and vision-threatening autoimmune disease, and is associated with proptosis (eye bulging), diplopia (double vision), blurred vision, pain and facial disfigurement that can significantly impact patients’ quality of life. If approved, teprotumumab would be the first FDA-approved medicine for TED. Teprotumumab is an investigational medicine and its safety and efficacy have not been established.

"Today’s unanimously positive vote marks a significant step towards the first FDA-approved treatment for patients with TED, a vision-threatening autoimmune disease," said Timothy Walbert, chairman, president and chief executive officer, Horizon.

"Our comprehensive set of data presented today on teprotumumab’s efficacy and safety is a testament to the extraordinary efforts of the physicians who partnered with us on the clinical development program, the TED patients who enrolled in our studies, and Horizon’s research and development team. We believe that teprotumumab has the potential to address a significant unmet need for these patients and we look forward to working with the FDA as it completes its review of our application."

"TED can affect patients both physically and emotionally, limiting their ability to perform everyday activities like driving, working, reading, sleeping and participating in social activities," said Jeff Todd, president and chief executive officer, Prevent Blindness. "As an organization dedicated to helping patients with vision impairment, and those who are at significant risk, we are extremely encouraged by today’s vote and hopeful this will change the future of TED treatment by giving patients an option that has been shown to improve the painful and vision-threatening aspects of the disease."

The FDA is currently evaluating a Biologics License Application (BLA) for teprotumumab for the treatment of TED. Teprotumumab is one of less than five medicines ever to receive Priority Review, Orphan Drug, Fast Track and Breakthrough Therapy designations from the FDA. The Prescription Drug User Fee Act (PDUFA) action date is March 8, 2020. The FDA will consider today’s vote as it reviews the BLA, although it is not obligated to follow the Committee’s recommendation.

The efficacy and safety of teprotumumab for the treatment of TED is supported by a robust body of clinical evidence. The BLA submission is based on positive results from the Phase 3 confirmatory clinical trial, called OPTIC (Treatment of Graves’ Orbitopathy (Thyroid Eye Disease) to Reduce Proptosis with Teprotumumab Infusions in a Randomized, Placebo-Controlled, Clinical Study), as well as positive Phase 2 results.

The OPTIC study found that significantly more patients treated with teprotumumab had a meaningful improvement in proptosis, or bulging of the eye, as compared with placebo (82.9% of teprotumumab patients compared to 9.5% of placebo patients). These results were achieved within a six-month course of therapy.

All secondary endpoints were also met, including reduced diplopia (double vision), improved quality of life (QoL) and reductions in Clinical Activity Score (CAS), which measures the degree of inflammation, including pain, swelling and redness. As previously reported, the majority of adverse events experienced with teprotumumab treatment were graded as mild to moderate and were managed in the trials, with few discontinuations.

The OPTIC study was initiated after the Phase 2 study demonstrated clinically meaningful and highly statistically significant results in reducing proptosis and in the symptoms of TED as measured by Overall Treatment Response. The Phase 2 study was published in The New England Journal of Medicine in May 2017. The Phase 2 and Phase 3 studies form a robust body of clinical evidence on the use of teprotumumab in people living with TED.

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