Pharmaceutical A US Food and Drug Administration advisory committee has voted unanimously to recommend UK drugs giant GlaxoSmithKline and Valeant Pharmaceuticals' Potiga (ezogabine) as adjunctive treatment for adults with partial-onset seizures.
After a review of the safety data, including urinary retention, infection and kidney stones, the majority of Committee members voted that urinary retention could be mitigated by patient monitoring and discussed how this could be addressed. The Committee also voted unanimously that monitoring should not be instituted for infection and kidney stones.
"We are encouraged by the Advisory Committee's assessment of the efficacy and safety of ezogabine and await a decision by the FDA," said Atul Pande, senior vice president, Neurosciences Medicines Development Center, North America Pharmaceuticals, GSK, adding: "For appropriate patients, we believe ezogabine could offer an important adjunctive treatment option for partial-onset seizures that are not well-controlled."
Sales forecasts range from $200 million to $800 million
Global sales of drugs to treat epilepsy reached nearly $13 billion last year, according to health care data firm IMS Health. Analysts have forecast peak annual sales for Potiga ranging from $200 million to $800 million. Valeant, which is in the process of a merger with Canada's Biovail, will receive up to 50% of US sales revenues under a development deal with GSK signed in 2008, which generated an upfront $125 million for Valeant.
'We think (Potiga) will be a good growth driver in neurology,' said Morningstar analyst Meera Venu, reported by Reuters. She has forecast $600 million in annual sales for the drug by 2019. Valeant shares declined 1.3% to $57.89 on the news, while GSK's stock fell 2.4% to $36.51 in US trading yesterday.
Clinical data
The Peripheral and Central Nervous System Drugs Advisory Committee reviewed efficacy data from three pivotal studies of ezogabine and an integrated safety data base including all patients who had at least one dose of the drug. Overall, ezogabine, as adjunctive therapy at a daily dose of 600mg, 900mg or 1,200mg, reduced the median number of partial-onset seizures in adults with epilepsy not adequately controlled on one to three concomitant anti-epileptic drugs compared to placebo (standard therapy).
The FDA specifically asked the Committee to comment on risks associated with urinary retention. In the pivotal trials, urinary retention occurred at a rate of 0.9% in patients receiving ezogabine compared to 0.5% on placebo. In all studies of patients with partial-onset seizures, including open-label studies, five patients required catheterization (four on ezogabine and one on placebo). The Committee recommended that patient monitoring for these events would be appropriate, with special attention given to specific groups that may be predisposed to urinary retention.
In the pivotal trials, the most frequently reported adverse events with the use of ezogabine in combination with other AEDs (occurring in at least 5% of subjects and at least twice the placebo rate) were dizziness (23%), fatigue (15%), confusion (9%), vertigo (8%), tremor (8%), abnormal coordination (7%), double vision (7%, disturbance in attention (6%), memory impairment (6%) and visual blurring (5%). In addition, somnolence occurred in 22% of patients on ezogabine compared to 12% on placebo.
The FDA, which usually follows advisory panel advice, is expected to make a final decision by August 30. About 3 million Americans have epilepsy, and 50 million globally, with partial-onset seizures accounting for 57% of seizure cases. Seizures can be controlled with medicines, but an estimated 30% of patients do not find adequate relief with current drugs.
The product, known as retigabine outside the USA, is also under review by the European Medicines Agency, Valeant noted in a press statement. 12 August 2010