ROCKLAND, Mass, April 16, 2021 – EMD Serono, the biopharmaceutical business of Merck KGaA, Darmstadt, Germany, in the U.S. and Canada, will present data from a Phase II placebo-controlled randomized trial at the 2021 American Academy of Neurology (AAN) Annual Meeting showing that the investigational Bruton’s tyrosine kinase (BTK) inhibitor evobrutinib significantly reduced blood neurofilament light chain (NfL) levels, a key biomarker of neuronal damage and inflammation, in patients with multiple sclerosis (MS). Elevated blood NfL levels have been shown to be associated with damage to neurons and inflammation and may predict future brain atrophy and disease progression.
“Blood NfL is a biomarker that may allow monitoring of disease activity and treatment response, which could be less burdensome and more sensitive than other standard clinical measures for MS patients,” said Prof. Jens Kuhle, MD, PhD, Head Multiple Sclerosis Centre, University Hospital Basel. “These data provide key insights into the role evobrutinib may play in modulating the clinical course of MS and further suggest that BTK inhibition with evobrutinib may reduce tissue damage associated with MS.”
A post-hoc analysis of the Phase II placebo-controlled trial of evobrutinib in patients with relapsing MS (RMS) evaluated 166 patients with NfL values at baseline and at least one post-baseline. The largest relative reductions of NfL levels were observed with evobrutinib 75mg twice daily (BID) at weeks 12 and 24 compared to placebo. Twice daily dosing with an exposure equivalent to 75mg twice daily is being carried through to the Phase III program which is on track to complete enrollment this year. Primary results from the Phase II study were previously published in the New England Journal of Medicine in 2019. As elevated NfL is associated with clinical disability and brain atrophy in MS, these results, combined with the previous clinical trial data that demonstrated a reduction in T1 Gd+ lesion and ARR, further support the hypothesis that BTK inhibition with evobrutinib may impact both inflammatory and progressive aspects of MS within the central nervous system (CNS).
Further supporting the impact of evobrutinib on CNS pathology in MS, a second oral presentation at AAN examined BTK and activated (phosphorylated) BTK (pBTK) levels in B cells isolated from RMS patients. pBTK was highly expressed in subsets of B cells of RMS patients, including T-bet and CXCR3 expressing memory B cells. Evobrutinib decreased CXCR3+ memory B cell transmigration through human CNS endothelial cell monolayers, suggesting evobrutinib may impact the activity of pathogenic B cells and modulate the progressive course of MS.
“Taken together, the presented pre-clinical and clinical data suggest that evobrutinib inhibits MS mechanisms involved in disease activity and progression,” said Danny Bar-Zohar, MD, Global Head of Development for the Healthcare business sector of Merck KGaA, Darmstadt, Germany. “Coupled with the already published and presented attributes of CNS penetration as well as very high BTK occupancy, these findings further substantiate the strong potential for evobrutinib to lead to a paradigm shift in the treatment of people living with MS.”
Separately, an exploratory analysis to be presented at the upcoming triMS.online conference on May 27 evaluated evobrutinib distribution into cerebrospinal fluid (CSF) relative to plasma concentration in patients with RMS. Plasma and CSF samples were collected from a subset of MS patients in the Phase II open-label extension (OLE) study receiving 75mg BID. Evobrutinib was detected in the CSF of all patients included in the analysis (n=9). CSF concentrations were generally consistent with free plasma concentrations. This suggests that evobrutinib, in addition to inhibiting BTK on peripheral cells, may also inhibit BTK-expressing B cells and myeloid cells in the CNS, which may impact MS disease progression.
Evobrutinib (M2951) is in clinical development to investigate its potential as a treatment for multiple sclerosis (MS). It is an oral, highly selective inhibitor of Bruton’s tyrosine kinase (BTK) which is important in the development and functioning of various immune cells including B lymphocytes and macrophages. Evobrutinib is designed to inhibit primary B cell responses such as proliferation and antibody and cytokine release, without directly affecting T cells. BTK inhibition is thought to suppress autoantibody-producing cells, which preclinical research suggests may be therapeutically useful in certain autoimmune diseases. Evobrutinib is currently under clinical investigation and not approved for any use anywhere in the world.
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 2.8 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.
EMD Serono, Inc. and Multiple Sclerosis
For more than 20 years, EMD Serono has been relentlessly focused on understanding the journey people living with MS face in order to create a meaningful, positive experience for them and the broader MS community. However, there is still much that is unknown about this complex and unpredictable disease. EMD Serono is digging deeper to advance the science.
About EMD Serono, Inc.
EMD Serono - the biopharmaceutical business of Merck KGaA, Darmstadt, Germany, in the U.S. and Canada - is engaged in the discovery, research and development of medicines for patients with difficult to treat diseases. The business is committed to transforming lives by developing and delivering meaningful solutions that help address the therapeutic and support needs of individual patients. Building on a proven legacy and deep expertise in neurology, fertility and endocrinology, EMD Serono is developing potential new oncology and immuno-oncology medicines while continuing to explore potential therapeutic options for diseases such as psoriasis, lupus and MS. Today, the business has approximately 1,500 employees around the country with commercial, clinical and research operations based in the company's home state of Massachusetts. www.emdserono.com.