NICE RECOMMENDS LILLY’S MIRIKIZUMAB (OMVOH ®▼) FOR THE TREATMENT OF ELIGIBLE ADULTS WITH MODERATELY TO SEVERELY ACTIVE ULCERATIVE COLITIS.1 22nd September 2023
Eli Lilly and Company announced today that the National Institute for Health and Care Excellence (NICE) have recommended mirikizumab for the treatment of adults with moderately to severely active Ulcerative Colitis (UC) in adults when conventional or biological treatment cannot be tolerated, or the condition has not responded well enough or lost response to treatment, only if:
– a tumour necrosis factor (TNF)-alpha inhibitor has not worked (that is the condition has not responded well enough or has lost response to treatment), or
– a (TNF)-alpha inhibitors cannot be tolerated or is not suitable1,2
“Ulcerative colitis is a chronic, relapsing inflammatory disorder affecting the large intestine. It is characterised by symptoms of diarrhoea, bleeding and urgency, with multidimensional, and often negative effects on patients’ personal, psychological, professional and social well-being. Our understanding of the aetio-pathogenesis is improving, but our treatment options remain limited,” said Professor Jimmy Limdi, Consultant Gastroenterologist/Head of IBD Section at Northern Care Alliance NHS Foundation Trust and Professor of Gastroenterology at University of Manchester. “The recent authorisation and subsequent NICE recommendation of mirikizumab, the first IL-23p19 inhibitor, is positive news for eligible people living with ulcerative colitis and I am delighted it will now be available on the NHS. It is a significant scientific advance welcomed by the medical community.”
Sarah Sleet, Chief Executive of Crohn’s & Colitis UK, welcomes the news: “Over 500,000 people in the UK are living with Crohn’s Disease and Ulcerative Colitis. They are lifelong conditions for which there is no known cure, and the symptoms are painful and debilitating. Existing medications may not work for some people, or indeed stop working for others. Expanding the treatment options for eligible people living with Colitis is a promising step forward and we welcome the NICE’s decision to recommend mirikizumab.”
“The NICE recommendation establishes mirikizumab as the first IL-23p19 antagonist to be made available in the NHS for the treatment of adults with moderate to severe Ulcerative Colitis and reflects our commitment to immunological diseases with high unmet need,” said Laura Steele, President & General Manager, Northern Europe, Eli Lilly and Company. “This is encouraging news for patients making Great Britain one of the first countries in the world to provide nationally reimbursed access; and national access should now be implemented within 30 days.”
The NICE recommendation was based on results from the LUCENT program, which included twoThe NICE recommendation was based on results from the LUCENT program, whichincluded two randomised, double-blind, placebo-controlled Phase 3 clinical trials, consisting of one 12-week induction study (LUCENT-1) and one 40-week maintenance study (LUCENT-2) for 52 weeks of continuous treatment.
In the LUCENT-1 induction study, 1,162 patients were included in the primary efficacy population. Patients were randomised 3:1 to receive mirikizumab (300 mg) intravenous (IV) orplacebo IV every 4 weeks for 12 weeks. After 12 weeks of treatment with mirikizumab 24.2% (n=210/868) of patients achieved the primary endpoint of clinical remission compared to 13.3% (n=39/294) of placebo.2
544 patients who achieved a clinical response with mirikizumab in LUCENT-1 (63.5%, n=551/868) were re-randomised 2:1 to receive mirikizumab (200 mg) subcutaneous injection or placebo subcutaneous injection every 4 weeks for another 40 weeks in LUCENT-2. Of the LUCENT-1 patients who achieved clinical response at 12 weeks, 49.9% (n=182/365) achieved clinical remission (primary end point) and 43.3% (n=158/365) achieved histologic-endoscopic mucosal remission (secondary end point) at one year, compared to placebo (25.1%, n=45/179 and 21.8%, n=39/179 for clinical remission and histologic-endoscopic mucosal remission, respectively).2
Patients treated with mirikizumab achieved a greater reduction in rectal bleeding and stool frequency subscores as early as two weeks. The LUCENT studies also investigated endpoints such as bowel urgency remission and bowel urgency severity using the validated Urgency Numeric Rating Scale (NRS) of 0-10, with zero being no urgency and 10 being worst possible urgency. Decreases in bowel urgency severity were observed as early as two weeks in patients treated with mirikizumab. After treatment with mirikizumab, 42.9% (n=144/336) of patients achieved bowel urgency remission at one year, compared to 25% (n=43/172) of placebo.2
The Phase 3 LUCENT clinical program also evaluated the safety profile of mirikizumab. The most frequently reported adverse reactions are upper respiratory tract infections (7.9 %, mostfrequently nasopharyngitis), headache (3.3 %), rash (1.1 %) and injection site reactions (8.7 %, subcutaneous injection, LUCENT-2). 2
Adverse reactions from clinical studies (Table 1) are listed by MedDRA system organ class. The frequency category for each reaction is based on the following convention: very common (≥1/10); common (≥ 1/100 to < 1/10); uncommon (≥ 1/1 000 to < 1/100); rare (≥ 1/10 000 to < 1/1 000); very rare (< 1/10 000).
Table 1 : Adverse Reactions
|MedDRA System organ class||Frequency||Adverse reaction|
|Infections and infestations||Common||Upper respiratory tract infectionsa|
|Immune system disorders||Uncommon||Infusion-related hypersensitivity reactions|
|Musculoskeletal and Connective
|Nervous system disorders||Common||Headache|
|Skin and subcutaneous tissue
|General disorders and administration
|Common||Injection site reactionsc|
|Uncommon||Infusion site reactionsd|
|Investigations||Uncommon||Alanine aminotransferase increased|
|Uncommon||Aspartate aminotransferase increased|
a Includes: acute sinusitis, nasopharyngitis, oropharyngeal discomfort, oropharyngeal pain, pharyngitis, rhinitis, sinusitis, tonsillitis, upper respiratory tract infection, and viral upper respiratory tract infection.
b Includes: rash, rash macular, rash maculo-papular, and rash papular and rash pruritic.
c Reported in the mirikizumab LUCENT-2 study where mirikizumab treatment is administered as subcutaneous injection.
d Reported in the mirikizumab LUCENT-1 study where mirikizumab treatment is administered as intravenous infusion2