POS0828 CONSISTENT EFFICACY WITH APREMILAST IN MEN AND WOMEN TO TREAT ORAL ULCERS ASSOCIATED WITH BEHÇET’S SYNDROME: PHASE 3 RELIEF STUDY RESULTS

Background:

Painful, recurring oral ulcers (OU) associated with Behçet’s syndrome negatively affect quality of life (QoL). Differences across sexes were reported in the frequency of disease manifestations, disease course, and response to colchicine. The phase 3, randomized, double-blind, placebo (PBO)-controlled RELIEF study showed overall efficacy of apremilast (APR) for OU associated with Behçet’s syndrome, including improvements in OU pain, disease activity, and QoL.

Objectives:

To evaluate the consistency of efficacy with APR in men and women with Behçet’s syndrome.

Methods:

Adults with active Behçet’s syndrome and ≥3 OU at randomization or ≥2 OU at screening and randomization, without active major organ involvement, were randomized to APR 30 mg BID or PBO during the 12-wk PBO-controlled phase. Randomization was stratified by sex. The primary endpoint was area under the curve for the number of OU through Wk 12 (AUCWk0-12) to assess continued efficacy over the time period in a symptom that waxed and waned. Key secondary endpoints included OU pain, complete response (OU-free), maintenance of complete response, and QoL at Wk 12. Disease activity was also assessed using Behçet’s Syndrome Activity Score (BSAS) and Behçet’s Disease Current Activity Index Form (BDCAF). QoL was assessed using Behçet’s Disease QoL (BDQoL). Prespecified subgroup analyses in men and women were performed to assess treatment effect in primary and secondary endpoints.

Results:

Eighty men and 127 women were randomized and received ≥1 dose of study medication. Mean age was 38.7 yrs (men) and 40.8 yrs (women). Mean (SD) OU count at baseline was 3.4 (1.4) (PBO) and 3.7 (1.5) (APR) for men and 4.3 (3.2) (PBO) and 4.5 (4.5) (APR) for women. Greater improvements in favor of APR vs PBO were observed in AUCWk0-12 in men and women (Figure 1). Consistency in efficacy with APR was observed between men and women, with greater reduction in pain and achievement of OU complete response (OU-free) and maintenance of response at Wk 12 vs PBO (Table 1). In men and women, consistent treatment effects in favor of APR vs PBO were observed for disease activity and QoL measures, although moderate treatment differences were observed in BDCAI (men/women) and BDQoL (men) (Table 1).

Conclusion:

Consistent treatment effects in favor of APR vs PBO in clinically relevant outcomes, including OU number and pain, OU complete response, and disease activity measures, were observed in men and women with OU associated with Behçet’s syndrome.

Key Secondary Efficacy Outcomes at Wk 12MenWomenPBO(n = 40)APR(n = 40)Tx Difference[95% CI]PBO(n = 63)APR(n = 64)Tx Difference[95% CI]OU CR, n/N (%)8/40 (20.0)21/40 (52.5)32.6 [12.8, 52.4]15/63 (23.8)34/64 (53.1)29.3 [13.2, 45.4]OU CR 6 + 6*, n/N (%)1/40 (2.5)10/40 (25.0)22.8 [8.8, 36.8]4/63 (6.3)21/64 (32.8)26.5 [13.6, 39.3]Pain (VAS)†-12.0 (4.8)-37.6 (4.9)-25.6 [-37.2, -14.1]-17.4 (4.4)-41.5 (4.3)-24.1 [-34.9, -13.3]BSAS†-1.3 (2.4)-14.4 (2.4)-13.1 [-18.8, -7.3]-7.7 (2.4)-19.7 (2.4)-12.0 [-18.0, -6.0]BDCAF†BDCAI-0.1 (0.3)-0.5 (0.3)-0.4 [-1.1, 0.4]-0.7 (0.3)-1.3 (0.3)-0.6 [-1.2, 0.0]Patient’s Perception of Disease Activity-0.2 (0.3)-1.4 (0.3)-1.2 [-1.9, -0.5]-1.0 (0.2)-1.8 (0.2)-0.9 [-1.4, -0.3]Clinician’s Overall Perception of Disease Activity-0.2 (0.3)-1.5 (0.3)-1.3 [-1.9, -0.7]-1.0 (0.2)-1.7 (0.2)-0.7 [-1.3, -0.2]BDQoL†-0.7 (1.0)-2.2 (1.0)-1.5 [-3.8, 0.8]-0.3 (0.9)-4.4 (0.9)-4.1 [-6.3, -2.0]

LOCF analyses. *Proportion of patients achieving an OU CR by Wk 6, and remaining OU-free for ≥6 additional wks during the 12-wk PBO-controlled treatment phase. †LS mean (SE) change from baseline. BSAS = Behçet’s Syndrome Activity Scores; BDCAF = Behçet’s Disease Activity Form; CR = complete response; n = number of patients randomized to treatment; Tx = treatment.

Acknowledgements:

This study was funded by Celgene. Additional analyses were funded by Amgen Inc. Writing support was funded by Amgen Inc. and provided by Kristin Carlin, RPh, MBA, of Peloton Advantage, LLC, an OPEN Health company.

Disclosure of Interests:

Gulen Hatemi Speakers bureau: AbbVie, Novartis, and UCB, Grant/research support from: Celgene, Alfred Mahr Speakers bureau: Chugai and Roche, Consultant of: Celgene and Chugai, Mitsuhiro Takeno Speakers bureau: AbbVie, Esai, and Mitsubishi-Tanabe, Consultant of: Celgene, Grant/research support from: Novartis, Doyoung Kim: None declared, Melike Melikoglu: None declared, Sue Cheng Employee of: Amgen Inc., Sven Richter Employee of: Amgen Inc., Shauna Jardon Employee of: Amgen Inc., Maria Paris Employee of: Amgen Inc., Mindy Chen Employee of: Amgen Inc., Yusuf Yazici Consultant of: Bristol-Myers Squibb, Celgene, Genentech, and Sanofi

OP0108 LORECIVIVINT (SM04690), AN INTRA-ARTICULAR, SMALL-MOLECULE CLK2/DYRK1A INHIBITOR THAT MODULATES THE WNT PATHWAY, PROVIDED CARTILAGE-PROTECTIVE EFFECTS IN AN ANIMAL MODEL OF POST-TRAUMATIC OA

Background:

Osteoarthritis (OA) is characterized by increased cartilage thinning, bone remodeling, and inflammation. Post-traumatic OA, which develops after acute direct trauma to the joints, accounts for approximately 12% of all OA cases.1 Current therapeutic options focus on alleviating symptoms and pain rather than disease modification. Lorecivivint (LOR; SM04690), an intra-articular (IA), small-molecule CLK2/DYRK1A inhibitor that modulates the Wnt pathway, has been shown in animal studies to induce chondrogenesis, protect cartilage, and reduce inflammation and, thereby, improve joint health.2

Objectives:

A single IA LOR injection was evaluated in a rat model of knee instability to determine its protective and regenerative effects when injected at different timepoints after induction of post-traumatic OA.

Methods:

Knee instability/post-traumatic OA was surgically induced in rats by combining anterior cruciate ligament transection with partial medial meniscus transection (ACLT+pMMx). LOR (0.3 ug) or vehicle was injected into the IA space of the damaged knee at 2, 3, or 4 weeks after induction of OA. OA-induced (n=10/group) or sham-operated (surgery without ACLT+pMMx; n=5/group) rats were sacrificed at the injection timepoint (baseline) or 12 weeks following LOR/vehicle injection (study conclusion). Histological grades were evaluated using the summed OARSI scores (stage and grade of cartilage damage)3 of the anterior and posterior medial femoral condyle (MFC) and medial tibial plateau (MTP). Weight distribution analysis was performed using an incapacitance meter at several timepoints. Statistical analysis was performed using one-way ANOVA with Dunnett’s multiple comparison test.

Results:

ACLT+pMMx surgeries led to increased OARSI scores in rats compared with sham surgeries by 2 weeks. LOR treatment at Weeks 2, 3, and 4 led to significant decreases (P<0.05) in total joint OARSI scores (Table 1) at the end of the study compared with vehicle treatment. Rats treated with LOR for 12 weeks and rats at injection baseline had similar OARSI scores, suggesting that LOR treatment arrested the progression of cartilage damage. Significant improvements (P<0.05) were also observed in the weight distribution of LOR-treated rats in the 3- and 4-week groups at 6 and 12 weeks after their respective IA injections compared with vehicle-treated rats.

Table 1.

OARSI scores

Week-2 injectionSham-operated(14 weeks after surgery)Baseline (BL)(2 weeks after surgery)Vehicle(12 weeks after injection)LOR(12 weeks after injection)Total score5.9919.1731.3619.19SEM1.071.552.481.81P value versus BL0.9999P value versus vehicle0.0004Week-3 injectionSham-operated(15 weeks after surgery)Baseline (BL)(3 weeks after surgery)Vehicle(12 weeks after injection)LOR(12 weeks after injection)Total score6.0923.1730.4521.20SEM1.251.361.421.00P value versus BL0.4522P value versus vehicle0.0001Week-4 injectionSham-operated(16 weeks after surgery)Baseline (BL)(4 weeks after surgery)Vehicle(12 weeks after injection)LOR(12 weeks after injection)Total score6.9716.8824.9518.63SEM1.321.041.741.61P value versus BL0.6257P value versus vehicle0.0111

Conclusion:

LOR exhibited cartilage-protective effects and slowed disease progression in the ACLT+pMMx model in vivo and, therefore, has potential as a structure-modifying treatment for OA.

References:

[1]Brown TD, et al. J Orthop Trauma. 2006.

[2]Deshmukh V, et al. Osteoarthr Cartil. 2019.

[3]Pritzker KPH, et al. Osteoarthr Cartil. 2006.

Disclosure of Interests:

Tim Seo Shareholder of: Samumed, LLC, Employee of: Samumed, LLC, Vishal Deshmukh Shareholder of: Samumed, LLC, Employee of: Samumed, LLC, Yusuf Yazici Shareholder of: Samumed, LLC, Employee of: Samumed, LLC

POS0372 LORECIVIVINT (SM04690), AN INTRA-ARTICULAR, SMALL-MOLECULE CLK2/DYRK1A INHIBITOR THAT MODULATES THE WNT PATHWAY, AS A POTENTIAL TREATMENT FOR MENISCAL INJURIES

Background:

Meniscal injuries are the most common pathology of the knee and are associated with pain, stiffness, and localized swelling. Meniscal damage is a frequent finding on MRI images of knee osteoarthritis (OA).1 Efforts to repair meniscal damage have been largely unsuccessful and do not prevent the progression of degenerative changes that lead to knee OA.2 The Wnt signaling pathway has been shown to be regulated during meniscal development,3 suggesting that manipulation of this pathway may influence the regenerative capacity of the meniscus. Lorecivivint (LOR; SM04690) is an intra-articular (IA), small-molecule CLK2/DYRK1A inhibitor that modulates the Wnt pathway.4

Objectives:

LOR was evaluated in preclinical studies to determine its protective and anabolic effects in ex vivo explants and in a rat model of chemically induced inflammatory meniscal degeneration.

Methods:

Effects of LOR (30 nM) on matrix metalloproteinase (MMP) expression in cultured rat menisci treated with IL-1B were measured by qRT-PCR. In vivo, LOR activity was evaluated in a rat model of monosodium iodoacetate (MIA) injection-induced inflammatory meniscal degeneration. A single IA injection of MIA was immediately followed by a single IA injection of LOR (0.3 ug) or vehicle. Knees were harvested on Days 1, 4, and 11 and menisci were isolated. Anti-inflammatory effects were evaluated by qRT-PCR for TNFA and IL6 expression. Meniscal protection was evaluated by qRT-PCR for MMPs and aggrecanase. Anabolic effects were evaluated by qRT-PCR for collagens.

Results:

In ex vivo meniscal explants, LOR inhibited expression of MMP1, MMP3, and MMP13 compared with DMSO (P<0.01). In vivo, LOR significantly decreased expression of MMPs and aggrecanase (P<0.05) and reduced expression of inflammatory cytokines TNFA and IL6 compared with vehicle in the rat model of inflammatory meniscal degeneration at Day 4 after MIA injection. Additionally, LOR increased expression of collagen types I, II, and III at Day 11 after MIA injection (Figure 1).

Conclusion:

LOR exhibited protective effects in the meniscus ex vivo and in vivo by reducing catabolic enzyme expression compared with control. Anti-inflammatory effects of LOR were demonstrated by inhibition of inflammatory cytokine expression. Compared with vehicle, LOR increased collagen expression in vivo, indicating potential meniscal anabolic effects. These data support further investigation of LOR as a potential structure-modifying treatment for meniscal injuries.

References:

[1]Englund M, et al. Rheum Dis Clin North Am. 2009.

[2]Collins JE, et al. Arthritis Care Res (Hoboken). 2019.

[3]Pazin DE, et al. Dev Dyn. 2012.

[4]Deshmukh V, et al. Osteoarthr Cartil. 2019.

Disclosure of Interests:

Tim Seo Shareholder of: Samumed, LLC, Employee of: Samumed, LLC, Vishal Deshmukh Shareholder of: Samumed, LLC, Employee of: Samumed, LLC, Yusuf Yazici Shareholder of: Samumed, LLC, Employee of: Samumed, LLC

POS0278 A MULTICENTER, OBSERVATIONAL, EXTENSION STUDY EVALUATING THE SAFETY, TOLERABILITY, AND EFFICACY OF A SINGLE LORECIVIVINT INJECTION IN KNEE OA SUBJECTS

Background:

Lorecivivint (LOR), a novel intra-articular (IA) CLK2/DYRK1A inhibitor that modulates the Wnt pathway, is in development as a knee osteoarthritis (OA) treatment.

Objectives:

Subjects from two consecutive Phase 2 trials were followed up in a 5-year, pooled, observational study that evaluated the safety and exploratory efficacy of a single LOR injection that was previously administered into the target knee joint of subjects with moderate to severe knee OA. The study was terminated in its third year, as relevant long-term safety information became limited in the absence of repeated LOR administration. The primary objective evaluated the incidence of serious adverse events (SAEs). Safety data for all doses and a post hoc efficacy analysis for the pivotal dose (0.07 mg LOR) are reported.

Methods:

This was a Phase 3, multicenter, observational, extension study of completer subjects (OA-05; NCT02951026) from two Phase 2 trials of LOR: a 12-month Phase 2a trial (OA-02; NCT02536833)1 and a 6-month Phase 2b trial (OA-04; NCT03122860)2. Subjects received a single LOR or control (placebo or vehicle) injection at their parent-study baseline visit (OA-02 or OA-04 Visit 0 in this analysis). Pooled data from clinic visits at 6, 12, 24, and 36 months contributed to the extension-study (OA-05) analysis. SAEs, knee-related adverse events (AEs), and AEs of newly diagnosed conditions requiring treatment were collected as safety outcomes. Efficacy was assessed by target knee WOMAC Pain and Function subscores and radiographic medial joint space width (mJSW). A post hoc analysis was performed for 0.07 mg LOR versus control to assess responses in a subject subgroup (unilateral symptoms, no widespread pain, 18-month post-injection radiograph at study termination). Baseline-adjusted ANCOVA was performed using data from both the current and parent studies at 0, 3, 6, 12, and 18 months.

Results:

Of 703 subjects, 119 (17%) subjects discontinued prior to study termination. Subjects had a mean age of 60.7 years and mean BMI of 29.1 kg/m2, and 61% were female. The majority of subjects had KL 3 (61.2%) OA. The safety analysis set included 495 LOR-treated subjects and 208 control subjects. There were 169 AEs reported by 110 [15.6%] subjects. Four AEs were considered to be related to study drug and were reported by 3 (0.6%) subjects across LOR groups; no subjects withdrew from the study due to a treatment-related AE. The most common AEs were osteoarthritis (28 [4.0%] subjects) and arthralgia (25 [3.6%] subjects); incidence was similar between LOR and control groups. During the study, 68 SAEs were reported by 38 (5.4%) subjects, and no SAEs were considered to be related to treatment by investigator. One death occurred in the control group. Post hoc efficacy analyses demonstrated that subjects in the 0.07 mg LOR group (n=59) showed greater improvements from baseline in both WOMAC Pain and Function at 6 and 12 months versus subjects in the control group (n=70) (Figure 1; Day 0):

6 months:Pain: -8.16, 95% CI [-15.60, -0.71], P=0.032

Function: -9.47, 95% CI [-17.09, -1.84], P=0.015

12 months:Pain: -8.51, 95% CI [-15.17, -1.85], P=0.013

Function: -9.62, 95% CI [-16.83, -2.42], P=0.009

No mJSW progression was observed in any group over 18 months.

Limitations to this analysis include 1) subjects from LOR and control groups were “completers,” therefore, more likely to be responders, and 2) subjects could have been on any medication or treatment in the extension study.

Conclusion:

From these data, LOR appeared to be safe and well tolerated. A post hoc-analyzed subset of completer subjects treated with a single 0.07 mg LOR injection reported durable symptom improvements in WOMAC Pain and Function for up to at least 12 months versus control subjects.

References:

[1]Yazici Y, et al. Arthritis Rheumatol. 2020.

[2]Yazici Y, et al. ACR meeting. 2019. Abstract L03.

Disclosure of Interests:

Ismail Simsek Shareholder of: Samumed, LLC, Employee of: Samumed, LLC, Christopher Swearingen Shareholder of: Samumed, LLC, Employee of: Samumed, LLC, Heli Ghandehari Shareholder of: Samumed, LLC, Employee of: Samumed, LLC, Sarah Kennedy Shareholder of: Samumed, LLC, Employee of: Samumed, LLC, Jeyanesh Tambiah Shareholder of: Samumed, LLC, Employee of: Samumed, LLC, Yusuf Yazici Shareholder of: Samumed, LLC, Employee of: Samumed, LLC, Nebojsa Skrepnik Consultant of: Pfizer, Regeneron, Orthofix, Grant/research support from: Samumed, LLC

POS0254 EFFICACY OF APREMILAST IN THE TREATMENT OF ORAL ULCERS OF BEHÇET’S SYNDROME: RESULTS FROM THE EUROPEAN SUBGROUP OF RELIEF

Background:

Behçet’s syndrome, a chronic, multi-system variable vessel vasculitis, is often characterized by painful oral ulcers (OU) affecting quality of life (QoL). Apremilast (APR), an oral PDE4 inhibitor, demonstrated efficacy in OU treatment in the phase 3 multinational RELIEF study.

Objectives:

To evaluate APR efficacy in OU treatment in patients with active Behçet’s syndrome in a prespecified subgroup of patients enrolled in 13 European RELIEF sites (France, Germany, Greece, and Italy).

Methods:

patients were adults with active Behçet’s syndrome and ≥3 OU at randomization or ≥2 OU at screening and randomization, without active major organ involvement. Patients were randomized (1:1) to APR 30 mg BID or PBO during a 12-week double-blind phase. The primary endpoint was area under the curve for the number of OU through Week 12 (AUCWk0-12). Other outcomes were OU pain visual analog scale (VAS); achievement of OU complete response (ie, OU-free) and maintenance of OU complete response (ie, complete response at Week 6 and remaining OU-free for ≥6 additional weeks); OU partial response (ie, OU reduction ≥50%); disease activity (Behçet’s Syndrome Activity Score [BSAS]; Behçet’s Disease Current Activity Form [BDCAF], including Behçet’s Disease Current Activity Index [BDCAI], and Patient’s and Clinician’s Perception of Disease Activity); and QoL (BDQoL; Short Form Health Survey version 2 [SF-36v2], including Physical Functioning [PF] scale and Physical and Mental Component Summary [PCS, MCS]).

Results:

Of 207 patients randomized and treated in RELIEF, 52 were in the European subgroup. Mean (±SD) age in the subgroup was 39 (±12) years; 54% were women. Baseline disease characteristics were similar between treatment groups (Table 1). Patients receiving APR achieved lower AUCWk0-12 for OU vs PBO (Figure 1) and greater reduction in pain. A greater proportion of patients receiving APR achieved complete, maintained, or partial OU responses at Week 12 vs those receiving PBO (Table 1). Consistent treatment effects favoring APR vs PBO were observed in disease activity, as shown by BSAS and BDCAF component scores at Week 12 (Table 1). Greater improvement in SF-36v2 MCS was observed favoring APR vs PBO at Week 12, and moderate treatment differences were seen for other QoL measures (BDQoL, SF-36v2 PF, and SF-36v2 PCS).

Conclusion:

In the European subgroup of patients with Behçet’s syndrome and OU in RELIEF, APR resulted in greater reduction in OU count, OU pain, and disease activity as well as favorable treatment effect on QoL measures than PBO. These results are consistent with the efficacy of APR treatment in the overall RELIEF population.

Baseline Disease Characteristics, Mean*PBO (n = 27)APR (n = 25)Duration of BD, years9.08.2OU count3.84.0OU pain (VAS 0-100)60.664.2BSAS (0-100)38.741.4BDCAI (0-12)3.53.6BDQoL (0-30)10.59.0Efficacy Outcomes at 12 Weeks*PBO (n = 27)APR (n = 25)Treatment Difference [95% CI]OU pain (VAS 0-100), mean†–17.7–48.7–31.0 [–44.7, –17.3]OU complete response, n (%)‡4 (14.8)16 (64.0)51.5 [29.8, 73.3]OU maintained response, n (%)‡1 (3.7)8 (32.0)26.7 [7.4, 46.0]OU partial response, n (%)‡11 (40.7)21 (84.0)46.0 [23.9, 68.0]BSAS (0-100)†,§–5.23–20.68–15.5 [–22.6, –8.3]BDCAI (0-12)†,§–0.0–1.4–1.4 [–2.2, –0.6]Patient’s Perception of Disease Activity†,§–0.4–1.6–1.2 [–2.1, –0.4]Clinician’s Overall Perception of Disease Activity†,§−0.6−1.7–1.0 [–1.7, –0.4]BDQoL (0-30)†,§–1.25–2.37–1.12 [–3.8, 1.5]SF-36v2 MCS (0-100)†,§–2.14.26.3 [2.2, 10.4]

*ITT population.†LS mean of the change from baseline at Week 12.‡Non-responder imputation for missing data.§LOCF approach. All efficacy endpoints (except BDQoL) were significant at the level of P<0.05.

Acknowledgements :

This study was funded by Celgene. Additional analyses were funded by Amgen Inc. Writing support was funded by Amgen Inc. and provided by Kristin Carlin, RPh, MBA, of Peloton Advantage, LLC, an OPEN Health company.

Disclosure of Interests:

Alfred Mahr Speakers bureau: Chugai; Roche, Consultant of: Celgene; Chugai, Gulen Hatemi Speakers bureau: AbbVie, Novartis, and UCB, Grant/research support from: Celgene, Mitsuhiro Takeno Speakers bureau: AbbVie, Esai, and Mitsubishi-Tanabe, Consultant of: Celgene, Grant/research support from: Novartis, Doyoung Kim: None declared, Melike Melikoglu: None declared, david Saadoun Consultant of: AbbVie, Celgene, Janssen, and Roche, Grant/research support from: AbbVie and Roche, Christos C. Zouboulis Speakers bureau: Amgen, Galderma, Pierre Fabre, PPM and Sobi, Consultant of: AbbVie, AccureAcne, Almirall, Bayer Healthcare, GSK/Stiefel, Incyte, Inflarx, Janssen, Novartis, PPM, Regeneron, and UCB, Grant/research support from: Celgene, NAOS-BIODERMA, and Relaxera, Sue Cheng Employee of: Amgen Inc, Sven Richter Employee of: Amgen Inc, Shauna Jardon Employee of: Amgen Inc, Maria Paris Employee of: Amgen Inc, Mindy Chen Employee of: Amgen Inc, Yusuf Yazici Consultant of: Bristol-Myers Squibb, Celgene, Genentech, and Sanofi

POS1320 DIFFERENCES IN CLINICAL MANIFESTATION AND DISEASE ACTIVITY OF PEDIATRIC BEHÇET DISEASE: A CROSS-SECTIONAL COHORT COMPARISON BETWEEN TURKEY AND UNITED STATES

Background:

Behçet disease (BD) is a systemic inflammatory disease which is rare in children. It is also known a higher prevalence along the ancient Silk Road and the eastern Mediterranean, especially in Turkey. Despite the presence of diagnostic criteria, the diagnosis of pediatric BD is still difficult due to atypical findings and the heterogeneity of the disease. While descriptive cohort studies in pediatric BD exist, direct comparison studies of clinical manifestations and disease activity between patients from different countries are scarce.

Objectives:

We aimed to compare the main clinical features and activity of pediatric BD patients from Turkey versus United States (US).

Methods:

The BD was diagnosed before 18 years of age and based on expert opinion. Disease activity was assessed with Physician Global Assessment (PhGA), Parents/Patient Global Assessment (PWPGA) and Behçet’s Syndrome Activity Scale (BSAS) were administered to patients from both countries.

Results:

A total of 161 patients were included (61 from Turkey; 100 from US). Males were more prevalent among patients from Turkey than among patients from US (63.9% vs. 32%, respectively, p < 0.001). Disease duration at the diagnosis was significantly longer in US p=0.002). Oral aphthosis was the most common symptom in both groups (96.7% for Turkey and 73% for US), however a significant difference was found (p<0.001). Genital ulcers were documented in 47% of US patients and in 41.4% of Turkish patients (p=0.5). There were significant difference between two groups with regards to the ocular involvement: uveitis and posterior uveitis were more frequently in Turkish patients (p=<0.001 respectively) while retinal vasculitis was no seen in US patients (p<0.001). Erythema nodosum occurred more frequently in Turkish group (p<0.001). The pathergy test was reported as positive in 22 (37.3%) patients in Turkey and 2 (2.3%) in USA in our study (p<0.001). Gastrointestinal and neurological involvement did not differ between cohorts. The rate of colchicine and oral steroids was similar. Azathioprine, cyclosporine and methotrexate usage was more frequent in Turkey (p=0.005, p=0.007, p=0.033, respectively) and infliximab was administered just in the US cohort (p = 0.002). PhGA and BSAS scores were higher in patients from Turkey (p=0.003 and p=0.017 respectively) and no significant differences were seen in PWPGA scores.

Conclusion:

Disease activity and clinical features seem to be different between the two countries which may be linked to the environmental factors, referral patterns and immune system responses in the expression of this disease. The diagnosis of BD in the US was based on both fulfilling the ISBD criteria and in cases when criteria were not met, based on treating physician assessment, which can explain some of the differences in disease presentation. In addition, there were differences in regard to clinical practice and treatment patterns between two countries. Increasing knowledge about heterogeneity of BD will improve the ability of diagnosis, development of new diagnostic criteria, and management of BD.

References:

[1]Butbul Aviel Y et al, Semin Arthritis Rheum. 2020

Disclosure of Interests:

None declared

A Phase 2b randomized trial of lorecivivint, a novel intra-articular CLK2/DYRK1A inhibitor and Wnt pathway modulator for knee osteoarthritis

OBJECTIVE

Lorecivivint (LOR; SM04690), an investigational Wnt pathway modulator, previously demonstrated patient-reported and radiographic outcome improvements vs placebo in clinically relevant subjects with moderate to severe knee osteoarthritis (OA). This study's objective was to identify effective LOR doses.

DESIGN

Subjects in this 24-week, Phase 2b, multicenter, randomized, double-blind, placebo (PBO)-controlled trial received an intra-articular injection of 2 mL LOR (0.03, 0.07, 0.15, or 0.23 mg), PBO, or dry-needle sham. The primary efficacy endpoints were changes in Pain NRS [0-10], WOMAC Pain [0-100], WOMAC Function [0-100], and radiographic mJSW outcomes, which were measured using baseline-adjusted analysis of covariance at Week 24. Multiple Comparison Procedure-Modeling (MCP-Mod) was performed for dose modeling.

RESULTS

In total, 695/700 subjects were treated. Pain NRS showed significant improvements vs PBO after treatment with 0.07 mg and 0.23 mg LOR at Weeks 12 (-0.96, 95% CI [-1.54, -0.37], P = 0.001; -0.78 [-1.39, -0.17], P = 0.012) and 24 (-0.70 [-1.34, -0.06], P = 0.031; -0.82 [-1.51, -0.12], P = 0.022). Additionally, 0.07 mg LOR significantly improved WOMAC Pain and Function subscores vs PBO at Week 12 (P = 0.04, P = 0.021), and 0.23 mg LOR significantly improved both WOMAC subscores at Week 24 (P = 0.031, P = 0.017). No significant differences from PBO were observed for other doses. No radiographic progression was observed in any group at Week 24. MCP-Mod identified 0.07 mg LOR as the lowest effective dose.

CONCLUSION

This 24-week Phase 2b trial demonstrated the efficacy of LOR on PROs in knee OA subjects. The optimal dose for future studies was identified as 0.07 mg LOR.

OP0188 INTEGRATED SAFETY SUMMARY OF THE NOVEL, INTRA-ARTICULAR AGENT LORECIVIVINT (SM04690), A CLK/DYRK1A INHIBITOR THAT MODULATES THE WNT PATHWAY, IN SUBJECTS WITH KNEE OSTEOARTHRITIS

Background:

Concerns over the safety of available osteoarthritis (OA) treatments have led to revision of treatment guidelines and highlight the need for new therapies. Lorecivivint (LOR; SM04690) is an intra-articular (IA), small-molecule CLK/DYRK1A inhibitor that modulates the Wnt pathway and is in development as a potential disease-modifying treatment for knee OA.1,2

Objectives:

To evaluate pooled early-phase LOR clinical data for safety, including bone health-related adverse events (AEs).

Methods:

Safety data were pooled from 3 randomized controlled trials (one Phase 1, two Phase 2) evaluating 4 doses (0.03 mg, 0.07 mg, 0.15 mg, 0.23 mg) of a single IA injection of LOR in subjects with moderately to severely symptomatic knee OA. Two trials (NCT02095548;NCT03122860) evaluated subjects for 24 weeks and one trial (NCT02536833) for 52 weeks. AEs, serious AEs (SAEs), and bone health AEs were categorized by Medical Dictionary for Regulatory Activities (MedDRA) classification. Incidences of AEs and SAEs were compared between the combined LOR-treated group (subjects who received any dose of LOR) and a control group (subjects not treated with LOR).

Results:

This analysis includes 848 LOR-treated and 360 control subjects. The incidence of AEs was similar in LOR-treated (350/848 [41.3%]) and control subjects (138/360 [38.3%]). Incidence of SAEs was 20/848 (2.4%) in LOR-treated and 4/360 (1.1%) in control subjects. The most commonly reported AE in LOR-treated subjects was arthralgia (treated 7.6%, control 7.2%) and was the only AE reported at >5% in either group (Fig. 1). Target-knee arthralgia was the most common joint-specific AE (treated 6.5%, control 5.3%) (Fig. 2). No AEs in other joints exceeded an incidence of 2% in either group. In all categories, individual AEs were reported at similar rates between groups and no SAEs were deemed related to LOR by investigators.

Figure 1.

Adverse event summary for events occurring in at least 1% of the treated population (N=1208).

Figure 2.

Joint-specific adverse event summary, subcategorized by affected joint, for events occurring in at least 1% of the treated population (N=1208).

There were 16 bone health-related AEs in 9/848 (1.1%) LOR-treated and 3/360 (0.8%) control subjects. Of the bone health AEs, 2 were osteopenia/osteoporosis in 2 LOR-treated postmenopausal women and 14 were fractures in 10 subjects (7 LOR-treated, 3 control). All fractures (3 patellar [1 target knee, 2 non-target knee], 3 vertebral, 2 foot, 2 wrist, 2 rib, 1 fibula, 1 hand) were adjudicated and determined to be caused by trauma; all healed uneventfully within the expected time frame.

Conclusion:

In exposure to date of 848 subjects, IA LOR for the treatment of knee OA appeared to be safe and well tolerated. These data support the continued evaluation of LOR as a potential treatment for knee OA.

References:

[1]Deshmukh V, et al.Osteoarthritis Cartilage. 2017.

[2]Deshmukh V, et al.Osteoarthritis Cartilage. 2019.

Disclosure of Interests:

Ismail Simsek Shareholder of: Samumed, LLC, Employee of: Samumed, LLC, Christopher Swearingen Shareholder of: Samumed, LLC, Employee of: Samumed, LLC, Sarah Kennedy Shareholder of: Samumed, LLC, Employee of: Samumed, LLC, Jeyanesh Tambiah Shareholder of: Samumed, LLC, Employee of: Samumed, LLC, Cristina Damatarca Shareholder of: Samumed, LLC, Employee of: Samumed, LLC, Yusuf Yazici Shareholder of: Samumed, LLC, Grant/research support from: Bristol-Myers Squibb, Celgene, and Genentech, Consultant of: Celgene and Sanofi, Employee of: Samumed, LLC, Nancy Lane Consultant of: Samumed, LLC, Marc Hochberg: None declared

THU0056 SM04755, A POTENTIAL DISEASE-MODIFYING TREATMENT FOR TENDINOPATHY, MODULATES THE WNT PATHWAY VIA INHIBITION OF CLKS AND DYRK1A

Background:

Tendinopathy is an inflammatory and degenerative disorder of tendons caused by injuries and/or overuse. Left untreated, tendinopathy can lead to pain and rupture. Current therapeutic options only treat symptoms. Stem cell- and growth factor-based treatments are under investigation but have not established safety or efficacy, leaving considerable unmet need. The Wnt pathway is upregulated in chronic tendinopathy, affecting inflammation and tenocyte differentiation. SM04755, a novel, topical, small-molecule Wnt pathway inhibitor, has previously been shown to inhibit inflammation, protect tenocytes, and increase tenocyte differentiation in nonclinical models.1

Objectives:

To identify molecular targets of SM04755 and its associated mechanism of action.

Methods:

Wnt pathway inhibition was measured using a cell-based luciferase reporter assay controlled by a β-catenin/TCF-responsive promoter in SW480 colon cancer cells. A kinome screen (318 kinases) and kinase assays were performed. Effects of SM04755 on phosphorylation of proteins, including serine/arginine-rich splicing factor (SRSF) proteins in rat tendon-derived stem cells (rTDSCs) and peripheral blood mononuclear cells (PBMCs), were measured using western blot. SiRNA-mediated knockdown of CDC-like kinases (CLKs) and dual-specificity tyrosine kinase (DYRK1A) were performed in human mesenchymal stem cells (hMSCs), rTDSCs, and rat tenocytes. Effects of SM04755 and siRNA knockdowns on Wnt pathway gene expression and catabolic enzymes (MMPs) were measured using qPCR. SM04755 and siRNA effects on tenocyte marker expression were assessed by qPCR and immunostaining. Effects of SM04755 on LPS-induced expression of inflammatory cytokines in PBMCs were measured by MSD-based ELISA. Statistical analyses used one-way ANOVA for multiple group comparisons and t-tests for comparison between two groups.

Results:

SM04755 was a potent inhibitor (EC50=156 nM) of Wnt signaling. Biochemical assays identified CLKs and DYRK1A as molecular targets of SM04755. SM04755 potently inhibited CLK-mediated phosphorylation of SRSF proteins compared with DMSO controls. Knockdowns of CLKs and DYRK1A led to inhibition of Wnt pathway genes (AXIN2,LEF1,TCF4,TCF7, etc.) compared with siRNA controls (siCtrl). CLK1, 2, and 4 and DYRK1A knockdowns also induced expression of tenocyte markers in rTDSCs and inhibited IL-1β-induced expression of catabolic enzymes (MMP1, 3, 9, 13) in tenocytes compared with siCtrl. SM04755 treatment of LPS-stimulated PBMCs resulted in reduced phosphorylation of NF-kB and STAT3 and inhibited production of inflammatory cytokines compared with DMSO.

Conclusion:

SM04755 inhibited CLKs and DYRK1A, which led to Wnt pathway modulation. Knockdowns of CLKs and DYRK1A, compared with control siRNA, induced tenocyte differentiation and reduced tendon-destroying proteases in tenocytes. This supports the potential disease modification of tendinopathy with SM04755. Furthermore, the anti-inflammatory effects of SM04755 are mechanistically supported by the decreased phosphorylation of STAT3 and NF-kB. These data support that SM04755, as a single agent, may potentially improve symptoms and provide disease modification in tendinopathy. Human tendinopathy trials are planned.

References:

[1]Deshmukh et al.Arthritis and Rheum. 2016

Acknowledgments:

Brian Hofilena for chemistry, Josh Stewart for pharmacokinetics, and Luis Dellamary for formulation.

Disclosure of Interests:

Vishal Deshmukh Shareholder of: Samumed, LLC, Employee of: Samumed, LLC, Alyssa O’Green Shareholder of: Samumed, LLC, Employee of: Samumed, LLC, Tim Seo Shareholder of: Samumed, LLC, Employee of: Samumed, LLC, Yusuf Yazici Shareholder of: Samumed, LLC, Grant/research support from: Bristol-Myers Squibb, Celgene, and Genentech, Consultant of: Celgene and Sanofi, Employee of: Samumed, LLC

AB0481 EFFICACY OF APREMILAST FOR THE TREATMENT OF GENITAL ULCERS ASSOCIATED WITH ACTIVE BEHÇET’S SYNDROME: A COMBINED ANALYSIS OF TWO RANDOMIZED CONTROLLED TRIALS

Background:

Behçet’s syndrome is a chronic, multi-system inflammatory disorder characterized by painful, recurrent oral ulcers (OU) and genital ulcers (GU).1The GU associated with Behçet’s syndrome can contribute to difficulties with sexual activity, walking, and sitting2; may cause scarring1; and may impair quality of life.1,2Apremilast (APR), an oral phosphodiesterase 4 inhibitor, has demonstrated efficacy in the treatment of the OU associated with Behçet’s syndrome in the phase III, randomized RELIEF study (BCT-002).3

Objectives:

To describe the efficacy of APR for the treatment of GU associated with active Behçet’s syndrome in the RELIEF study and in a pooled data analysis of RELIEF and the phase II study.

Methods:

Adult patients (≥18 years of age) with active Behçet’s syndrome and ≥3 OU at randomization or ≥2 OU at screening and randomization, without active major organ involvement, were randomized (1:1) to APR 30 mg twice daily or placebo (PBO). In RELIEF, clinical improvement in GU was assessed by evaluating the time to the first GU recurrence after loss of complete response, the mean number of GU in patients without GU at baseline, and the proportion of patients who were GU-free (complete response) at Week 12 (regardless of baseline GU status). A pooled analysis of patients in RELIEF and a randomized, phase II study4were conducted to assess achievement of GU complete response in patients with GU at baseline. In patients with GU complete response before Week 12, the median time to the first GU recurrence after loss of complete response was based on Kaplan-Meier estimates. The mean number of GU was summarized descriptively using data as observed. Between-group differences in the proportion of patients who were GU-free at Week 12 were analyzed by Cochran-Mantel-Haenszel test using non-responder imputation to handle missing data. Statistical tests were 2 sided (α=0.05).

Results:

A total of 207 patients were randomized and received ≥1 dose of study medication (APR: n=104; PBO: n=103). In all, 17 patients in the APR group and 17 in the PBO group had GU at baseline, with mean GU counts of 2.9 (APR) and 2.6 (PBO). Among patients with GU at baseline in RELIEF, 12/17 (70.6% [APR]) and 7/17 (41.2% [PBO]) achieved GU complete response at Week 12 (P=0.110). The median time to first GU recurrence in these patients occurred earlier with PBO (6.1 weeks) vs. APR (not calculable). In the pooled analysis of RELIEF and the phase II study, a significantly greater proportion of patients with GU at baseline achieved GU complete response at Week 12 with APR vs. PBO (21/27 [77.8%] vs. 9/23 [39.1%];P=0.011) (Figure 1). The proportion of patients who were GU-free was significantly greater with APR (92/104 [88.5%]) vs. PBO (72/101 [71.3%]), regardless of baseline number of GU (P=0.002) (Figure 2).

Conclusion:

The number of patients with GU was low, but the totality of the data shows a favorable trend in the treatment effect of APR on GU. Greater proportions of APR-treated patients were GU-free at Week 12 vs. patients receiving PBO, and the time to the first GU recurrence occurred earlier with PBO vs. APR.

References:

[1]Kokturk A. Patholog Res Int. 2012;2012:690390. 2. Senusi A, et al. Orphanet J Rare Dis. 2015;10:117. 3. Hatemi G, et al. N Engl J Med. 2019;381:1918-1928. 4. Hatemi G, et al. N Engl J Med. 2015;372:1510-1518.

Disclosure of Interests:

Gulen Hatemi Grant/research support from: BMS, Celgene Corporation, Silk Road Therapeutics – grant/research support, Consultant of: Bayer, Eli Lilly – consultant, Speakers bureau: AbbVie, Mustafa Nevzat, Novartis, UCB – speaker, Alfred Mahr Consultant of: Celgene, Speakers bureau: Roche, Chugai, Mitsuhiro Takeno Speakers bureau: Esai, Tanabe-Mitsubishi – speaker; Celgene Corporation – advisory board, Doyoung Kim: None declared, Melike Melikoglu: None declared, Sue Cheng Employee of: Amgen Inc. – employment; Celgene Corporation – employment at the time of study conduct, Shannon McCue Employee of: Amgen Inc. – employment; Celgene Corporation – employment at the time of study conduct, Sven Richter Employee of: Amgen Inc. – employment; Celgene Corporation – employment at the time of study conduct, Michele Brunori Employee of: Amgen Inc. – employment; Celgene Corporation – employment at the time of study conduct, Maria Paris Employee of: Amgen Inc. – employment; Celgene Corporation – employment at the time of study conduct, Mindy Chen Employee of: Amgen Inc. – employment; Celgene Corporation – employment at the time of the conduct, Yusuf Yazici Consultant of: BMS, Celgene Corporation, Genentech, Sanofi – consultant, Consultant of: BMS, Celgene Corporation, Genentech, Sanofi – consultant

AB0069 LORECIVIVINT (SM04690), AN INTRA-ARTICULAR, SMALL-MOLECULE CLK/DYRK1A INHIBITOR THAT MODULATES THE WNT PATHWAY, AS A POTENTIAL TREATMENT FOR MENISCAL INJURIES

Background:

Meniscal injuries, associated with pain, stiffness, and localized swelling, are the most common pathology of the knee with a prevalence of 61 per 100,000.1Meniscal damage is a frequent finding on MRI images of knee osteoarthritis (OA)2; while a meniscal tear can lead to knee OA, knee OA can also lead to a spontaneous meniscal tear.3Efforts to repair meniscal damage have been largely unsuccessful and do not prevent the progression of degenerative changes that lead to knee OA.4The Wnt signaling pathway has been shown to be regulated during meniscal development,5,6suggesting that manipulation of this pathway may influence the regenerative capacity of the meniscus. Lorecivivint (LOR; SM04690) is an intra-articular (IA), small-molecule CLK/DYRK1A inhibitor that modulates the Wnt pathway.

Objectives:

LOR was evaluated in preclinical studies to determine its protective and anabolic effects in ex vivo explants and in a rat model of chemically induced inflammatory meniscus degeneration.

Methods:

Effects of LOR (30 nM) on expression of matrix metalloproteinases (MMPs) in cultured rat menisci treated with IL-1B were measured by qPCR. In vivo, LOR activity was evaluated in a rat model of monosodium iodoacetate (MIA) injection-induced inflammatory meniscus degeneration. A single IA injection of MIA was immediately followed by a single IA injection of LOR (0.3 ug) or vehicle. Knees were harvested on Days 1, 4, and 11 and menisci were isolated. Anti-inflammatory effects were evaluated by measuringTNFAandIL6expression by qPCR. Meniscus protection was evaluated by qPCR for MMPs and aggrecanase and anabolic effects by qPCR for collagens.

Results:

In ex vivo meniscal explants, LOR inhibited expression ofMMP1,MMP3, andMMP13compared to DMSO (P<0.01). In vivo, LOR significantly decreased expression of these MMPs and aggrecanase (P<0.05) compared to vehicle in the rat model of inflammatory meniscus degeneration at Day 4 after MIA injection. In addition, LOR reduced expression of inflammatory cytokinesTNFAandIL6at Day 4 compared to vehicle. Finally, LOR increased expression of collagen types I, II, and III at Day 11 after MIA injection.

Conclusion:

LOR exhibited protective effects in the meniscus ex vivo and in vivo by reducing the expression of catabolic enzymes compared to control. Anti-inflammatory effects of LOR were demonstrated by inhibition of inflammatory cytokine expression. Compared to vehicle, LOR increased expression of collagens in vivo, indicating potential meniscal anabolic effects. These data support further investigation of LOR as a potential disease-modifying therapy for meniscal injuries.

References:

[1]Logerstedt D and Snyder-Mackler L.J Orthop Sports Phys Ther. 2010

[2]Englund M, et al.Rheum Dis Clin North Am. 2009

[3]Englund M, et al.Radiol Clin North Am. 2009

[4]von Lewinski, et al.Knee Surg Sports Traumatol Arthrosc. 2007

[5]Pazin DE, et al.ORS 2012 Annual Meeting. Paper No. 0221

[6]Pazin DE, et al.Dev Dyn. 2012

Disclosure of Interests:

Tim Seo Shareholder of: Samumed, LLC, Employee of: Samumed, LLC, Vishal Deshmukh Shareholder of: Samumed, LLC, Employee of: Samumed, LLC, Yusuf Yazici Shareholder of: Samumed, LLC, Grant/research support from: Bristol-Myers Squibb, Celgene, and Genentech, Consultant of: Celgene and Sanofi, Employee of: Samumed, LLC

SAT0260 PENTOXYFILLINE GEL FOR ORAL ULCERS IN PATIENTS WITH BEHÇET’S SYNDROME

Background:

Oral ulcers, the hallmark lesion of Behçet’s syndrome (BS) can be disabling and impair eating, drinking and speaking. Despite recent advances in systemic medications for the treatment of oral ulcers, some patients do not achieve complete remission. Topical agents may help such patients by decreasing the pain and duration of oral ulcers. Pentoxyfilline (PTX) is a methylxanthine derivative that inhibits phosphodiesterase and is thought to have immunomodulatory effects in addition to improving blood flow which is its main reason for use in peripheral vascular disorders.

Objectives:

The aim of this study is to assess the efficacy and safety of PTX gel for oral ulcers in patients with BS. We also aimed to explore the best tools for the assessment of treatment response to topical agents in randomized controlled trials (Clinicaltrial.gov ID: NCT 03888846).

Methods:

This was an open-label, randomized, parallel group study comparing PTX gel in addition to colchicine (PTX-COL) with colchicine alone (COL). Patients with BS who were treated with colchicine and not using any other systemic medications for BS, having at least one oral ulcer that appeared during the last 48 hours were included. PTX 5% gel with a dose of 1000 mg/day was applied in 4 divided doses per day for 14 days. Patients were contacted daily for 14 consecutive days. Photographs were taken every 24 - 48 hours and graphical processing software was used to calculate the area of the index ulcer. Duration of the index ulcer, time to start of index ulcer shrinkage, time to 50% reduction in oral ulcer pain on a 10 mm visual analog scale (VAS), change from baseline in the area of the index ulcer over time, total number of oral ulcers and adverse events were evaluated.

Results:

A total of 41 patients were randomized, 39 patients (18 in the PTX-COL group and 21 in the COL group) completed the study and 2 patients in PTX-COL group withdrew from the study due to unacceptable dysgeusia and nausea. Mean duration of index ulcer, time to start of index ulcer shrinkage, time to 50% reduction in oral ulcer pain, and number of patients with no detectable ulcers on day 4 in each group were lower in the PTX-COL group as presented in the Table. Change from baseline in the area of index ulcer and pain score over time is shown in the Figure. There were no serious adverse events. Fifteen (75%) patients reported nausea, 11 (55%) reported dysgeusia and 2 reported vomitting in the PTX-COL group, while 2 patients (10%) reported nausea in the COL group.

Conclusion:

This pilot phase 2 open label, randomized controlled study supports the hypothesis that topical PTX in addition to colchicine accelerates the healing of BS oral ulcers compared to colchicine alone. A phase 3 controlled study with a higher number of patients is planned with improving the taste for tolerability of the product.

Disclosure of Interests:

Gulen Hatemi Grant/research support from: BMS, Celgene Corporation, Silk Road Therapeutics – grant/research support, Consultant of: Bayer, Eli Lilly – consultant, Speakers bureau: AbbVie, Mustafa Nevzat, Novartis, UCB – speaker, Berna Yurttas: None declared, Zekayi Kutlubay: None declared, Tim Cote Employee of: Silk Road Therapeutics is in Washington, DC, USA, Şemsi Burak Derkunt Employee of: Silk Road Therapeutics is in Washington, DC, USA, Yusuf Yazici: None declared, Hasan Yazici: None declared

AB0536 EFFECT OF HYDROXYCHLOROQUINE TREATMENT IN MUCOCUTANEOUS MANIFESTATIONS IN PATIENTS WITH BEHÇET’S SYNDROME

Background:

Behçet syndrome (BS) is a rare multisystemic vasculitis, most commonly seen in regions along the ancient Silk Road. It runs a relapsing and remitting course. Mucocutaneous disease, consisting of oral ulcers, genital ulcers and skin lesions is often reported. EULAR recommendations advise colchicine and topical agents for the treatment of these lesions.1Not all patients respond adequately, thus, it is important to explore alternative treatment options.

Objectives:

To study the efficacy of hydroxychloroquine (HCQ) 400 mg daily in patients with mucocutaneous BS.

Methods:

Data on all patients who presented at the outpatient Behçet clinic in New York were recorded. Patients with a first prescription with HCQ and a follow-up of 3 months (range: 2.75-41.2 months) were included. Patient reported outcomes BSAS and RAPID3 were used to evaluate the effect of HCQ. Results of all patients and of International Study Group (ISG) positive patients were analyzed separately using Wilcoxon rank tests.

Results:

We included 94 patients with a first prescription of HCQ. 72 patients (76.6%) fulfilled ISG criteria. Mean age was 36.1 years (SD 12.5), 76 patients (80.9%) were female and 11 patients (11.7%) were from Silk Road countries.

Mean duration until follow-up was 6.5 months (SD 5.7). Median BSAS scores in ISG+ patients at baseline did not differ significantly from ISG- patients, except for skin lesions (5.0 in ISG+ vs. 0.5 in ISG- p=0.005). BSAS scores at follow-up did not differ significantly (ISG+ vs. ISG-).

Median BSAS scores were significantly lower at follow-up compared to baseline for oral ulcers (p=0.010), skin lesions (p=0.018) and overall activity (p=0.019). Regarding genital ulcers there was no significant result, due to only 37 patients reporting complaints of genital ulcers. Performing these analyses in ISG+ patients only did not change these results, except for BSAS overall activity, which lost significance (p=0.057).

RAPID3 scores were not statistically different between baseline and follow-up (9.67 vs. 8.75, p=0.145), nor were its separate components function (p=0.67 vs. 0.67, 0.713), pain (4.0 vs. 4.0, p=0.157) and patient global (5.0 vs. 4.5, p=0.095).

The majority of patients used prednisone at baseline (58.5%) and at follow-up (57.4%). In 15 patients, prednisone was stopped at follow up, in 13 patients it was started.

Table 1.

Median BSAS scores of patients treated with HCQ.

Baseline(median, IQR)Follow-up 3 months(median, IQR)P-valuesAll patients (n=94)Oral ulcers5.0 (2.00-7.88)3.0 (1.00-6.00)0.010Genital ulcers0.0 (0.00-3.88)0.0 (0.00-3.00)0.371Skin lesions5.0 (1.25-7.00)2.5 (0.00-7.00)0.018Overall activity5.5 (4.00-8.00)5.0 (2.00-7.25)0.019ISG+ patients (n=72)Oral ulcers5.25 (2.00-7.63)3.25 (1.00-6.00)0.007Genital ulcers0.5 (0.00-4.00)0.0 (0.00-3.00)0.684Skin lesions5.0 (2.00-7.13)3.0 (0.00-7.00)0.015Overall activity6.0 (4.00-8.00)5.0 (2.00-7.50)0.057

Conclusion:

HCQ improves median BSAS scores for oral ulcers, skin lesions and overall activity at 3 months follow-up compared to baseline. These results were similar in ISG+ patients (except for overall activity). Additional research is needed to assess the effect of HCQ in more patients and over multiple time points.

References:

[1]Hatemi G et al. 2018 update of the EULAR recommendations for the management of Behçet’s syndrome. Ann Rheum Dis 2019;77:808-818

Disclosure of Interests:

Floor Kerstens: None declared, Shreen Mohamed: None declared, Ingrid Visman: None declared, Franktien Turkstra: None declared, Christopher Swearingen: None declared, Yusuf Yazici Consultant of: BMS, Celgene Corporation, Genentech, Sanofi – consultant, Consultant of: BMS, Celgene Corporation, Genentech, Sanofi – consultant

AB0070 LORECIVIVINT (SM04690), A POTENTIAL DISEASE-MODIFYING TREATMENT FOR KNEE OSTEOARTHRITIS, DEMONSTRATED CARTILAGE-PROTECTIVE EFFECTS ON HUMAN OSTEOARTHRITIC EXPLANTS

Background:

Wnt pathway upregulation contributes to knee osteoarthritis (OA) through osteocyte differentiation, cartilage thinning, and inflammation. Lorecivivint (LOR; SM04690), a novel, small-molecule CLK/DYRK1A inhibitor that modulates the Wnt pathway, demonstrated disease-modifying potential for knee OA in preclinical studies.1However, the specific mechanisms by which LOR protects cartilage in knee OA are unclear.

Objectives:

To evaluate the cartilage-protective effects of LOR on human OA explants from total knee replacement (TKR) donors.

Methods:

Knee joint tissue from 22 TKR donors was obtained. IRB approval was obtained from Scripps Health. Cartilage was scored using the Outerbridge classification system based on gross appearance (grade 1=least-damaged tissue, grade 4=most-damaged tissue). Cartilage explants (4 mm in diameter) with Outerbridge grades 2–3 were harvested and cultured for 48 hours to reach metabolic stability. They were then treated with LOR (10 nM, 30 nM) or DMSO and stimulated with either IL-1β (10 ng/ml) or TNF-α (20 ng/ml)+oncostatin M (OM) (10 ng/ml) or left unstimulated. After 72 hours, supernatants and explants were collected. Gene expression of matrix metalloproteinases (MMPs) 1, 3, and 13 was measured by qPCR and protein levels of MMP-1, MMP-3, MMP-13, and thrombospondin-motif-containing disintegrins/metalloproteinases ADAMTS-4 and ADAMTS-5 were measured in supernatants by ELISA. Glycosaminoglycan (GAG) and nitric oxide (NO) levels were measured in supernatants using the dimethylmethylene blue assay and Griess assay, respectively. One-way ANOVA was used for multiple group comparisons.

Results:

Treatment with IL-1β or TNF-α+OM led to statistically significant increases in gene expression ofMMP1,MMP3, andMMP13and increased secretion of GAG, MMP-1, MMP-3, MMP-13, ADAMTS-4, ADAMTS-5, and NO in supernatants compared to unstimulated control. Treatment with LOR decreased both IL-1β-stimulated and TNF-α+OM-stimulated gene expression ofMMP1,MMP3, andMMP13and secretion of GAG, MMP-1, MMP-3, MMP-13, ADAMTS-4, ADAMTS-5, and NO in supernatants compared to treatment with DMSO.

Conclusion:

LOR demonstrated potent inhibition of cartilage catabolism enzyme production in human OA explants compared to controls. These cartilage-protective effects support the development of LOR as a potential disease-modifying treatment for knee OA. Human trials are ongoing.

References:

[1]Deshmukh V, et al.Osteoarthr Cartil. 2019.

Disclosure of Interests:

Vishal Deshmukh Shareholder of: Samumed, LLC, Employee of: Samumed, LLC, Shawn Grogan: None declared, Tim Seo Shareholder of: Samumed, LLC, Employee of: Samumed, LLC, Deepti Bhat Shareholder of: Samumed, LLC, Employee of: Samumed, LLC, William Bugbee: None declared, Darryl D’Lima: None declared, Yusuf Yazici Shareholder of: Samumed, LLC, Grant/research support from: Bristol-Myers Squibb, Celgene, and Genentech, Consultant of: Celgene and Sanofi, Employee of: Samumed, LLC

OP0028 EFFICACY OF APREMILAST FOR THE PAIN OF ORAL ULCERS ASSOCIATED WITH ACTIVE BEHÇET’S SYNDROME: 12-WEEK RESULTS FROM THE RANDOMIZED, PHASE III RELIEF STUDY

Background:

Oral ulcers (OU) associated with Behçet’s syndrome are often painful, may interfere with the ability to eat and can negatively affect quality of life.1,2Apremilast (APR), an oral phosphodiesterase 4 inhibitor, demonstrated efficacy in the treatment of OU associated with Behçet’s syndrome in a phase III, multicenter, randomized, double-blind, placebo (PBO)-controlled study (RELIEF; BCT-002).3

Objectives:

To describe the efficacy of APR treatment in improving OU pain associated with Behçet’s syndrome in RELIEF.

Methods:

Patients were randomized (1:1) to APR 30 mg twice daily (APR 30 BID) or PBO twice daily for a 12-week PBO-controlled phase, followed by a 52-week active treatment extension. Eligible patients were ≥18 years of age and had active Behçet’s syndrome with ≥3 OU at randomization or ≥2 OU at screening and randomization and without active major organ involvement. Clinical improvement in OU was evaluated by the area under the curve for the number of OU through Week 12 (AUCWk0-12; primary efficacy endpoint) and by assessments of OU number. Patient-reported OU pain was evaluated by the 100-mm visual analogue scale (VAS). The statistical tests were 2-sided (α=0.05). The proportions of patients achieving the minimal clinically important difference (MCID) and higher rates of improvement, defined as ≥10-mm,4≥30-mm (3-fold MCID), ≥50-mm (5-fold MCID) improvements in OU pain VAS scores, respectively, were analyzed through Week 12. An ANCOVA model was used to analyze the primary endpoint and assessments of OU number and OU pain (VAS). The proportion of patients achieving improvement in OU pain VAS scores at Week 12 were summarized descriptively.

Results:

A total of 207 patients were randomized and received ≥1 dose of study medication (APR: n=104; PBO: n=103). At baseline, the mean (SD) number of OU was 4.2 (3.7) in the APR 30 BID group and 3.9 (2.7) in the PBO group, and the mean (SD) OU pain VAS scores were 61.2 (27.6) and 60.8 (26.9), respectively. At Week 12, significantly greater improvements were observed with APR 30 BID vs. PBO in AUCWk0-12(least-squares [LS] mean [SE]: 129.5 [15.9] vs. 222.1 [15.9];P<0.0001), number of OU (LS mean [SE]: 1.1 [0.2] vs. 2.0 [0.3];P=0.0003) and OU pain VAS scores (LS mean [SE] change from baseline: −40.7 [3.3] vs. −15.9 [3.3];P<0.0001). The proportion of patients who achieved the MCID of ≥10-mm improvement in OU pain VAS scores at Week 12 was greater with APR 30 BID vs. PBO; this pattern was also observed for the higher 3- and 5-fold improvements in MCID (Figure 1). Greater proportions of APR 30 BID vs. PBO patients achieved ≥10-mm and ≥30-mm improvements in OU pain VAS scores over 12 weeks. Notably, greater achievement of ≥50-mm improvement in OU pain VAS scores was observed with APR 30 BID vs. PBO as early as Week 1 and maintained up to Week 12 (Figure 2).

Conclusion:

For patients with active Behçet’s syndrome, APR 30 BID provided significantly greater improvements vs. PBO in OU number and OU pain at Week 12, including the greater proportion of patients achieving MCID and 3- and 5-fold MCID of OU pain in the APR 30 BID group vs. the PBO group. These results indicate a clinically meaningful treatment effect of APR 30 BID on the OU associated with Behçet’s syndrome.

References:

[1]Kokturk A.Patholog Res Int. 2012;2012:690390.

[2]Hatemi G, et al.Ann Rheum Dis. 2008;67:1656-1662.

[3]Hatemi G, et al.N Engl J Med. 2019;381:1918-1928. 4. Dworkin RH, et al.J Pain. 2008;9:105-121.

Disclosure of Interests:

Gulen Hatemi Grant/research support from: BMS, Celgene Corporation, Silk Road Therapeutics – grant/research support, Consultant of: Bayer, Eli Lilly – consultant, Speakers bureau: AbbVie, Mustafa Nevzat, Novartis, UCB – speaker, Alfred Mahr Consultant of: Celgene, Speakers bureau: Roche, Chugai, Mitsuhiro Takeno Speakers bureau: Esai, Tanabe-Mitsubishi – speaker; Celgene Corporation – advisory board, Doyoung Kim: None declared, Melike Melikoglu: None declared, Sue Cheng Employee of: Amgen Inc. – employment; Celgene Corporation – employment at the time of study conduct, Shannon McCue Employee of: Amgen Inc. – employment; Celgene Corporation – employment at the time of study conduct, Sven Richter Employee of: Amgen Inc. – employment; Celgene Corporation – employment at the time of study conduct, Michele Brunori Employee of: Amgen Inc. – employment; Celgene Corporation – employment at the time of study conduct, Maria Paris Employee of: Amgen Inc. – employment; Celgene Corporation – employment at the time of study conduct, Mindy Chen Employee of: Amgen Inc. – employment; Celgene Corporation – employment at the time of the conduct, Yusuf Yazici Consultant of: BMS, Celgene Corporation, Genentech, Sanofi – consultant, Consultant of: BMS, Celgene Corporation, Genentech, Sanofi – consultant

FRI0430 THE NOVEL, INTRA-ARTICULAR CLK/DYRK1A INHIBITOR LORECIVIVINT (LOR; SM04690), WHICH MODULATES THE WNT PATHWAY, IMPROVED RESPONDER OUTCOMES IN SUBJECTS WITH KNEE OSTEOARTHRITIS: A POST HOC ANALYSIS FROM A PHASE 2B TRIAL

Background:

Lorecivivint (LOR; SM04690) is a small-molecule, intra-articular (IA) CLK/DYRK1A inhibitor that modulates the Wnt pathway1and has demonstrated some beneficial effects on patient-reported outcomes (PROs) relative to placebo (PBO) in two Phase 2 knee OA trials. With subjective measures such as PROs, meaningful benefits may be better characterized by representation as discrete threshold responses rather than by changes in mean point estimates.

Objectives:

To conduct a post hoc analysis of subjects in a 24-week Phase 2b study by measuring the proportions of subjects treated with LOR and placebo (PBO) who achieved 30%, 50%, or 70% threshold responses of improvement over baseline in Pain Numeric Rating Scale (NRS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain, WOMAC Function, and Patient Global Assessment (PtGA) at Week 12. Results from the Phase 3-selected dose of 0.07 mg LOR are presented here.

Methods:

Subjects had ACR-defined knee OA, Kellgren-Lawrence (KL) grades 2–3, and Pain NRS scores ≥4 and ≤8 in the target knee and <4 in the contralateral knee. A single 2mL IA injection of 0.03 mg, 0.07 mg, 0.15 mg, or 0.23 mg LOR, or vehicle PBO was given in the target knee at baseline. The proportion of subjects meeting 30%, 50%, or 70% threshold responses over baseline in the weekly average of daily Pain NRS [0–10], WOMAC Pain [0–100], WOMAC Function [0–100], and PtGA [0–100] at Week 12 was determined. The odds ratios (OR [95% CI]) of achieving each threshold response level were calculated and compared between LOR and PBO.

Results:

In total, 635 subjects (91.4%) completed the study (mean age 59.0±8.5 years, BMI 29.0±4.0 kg/m2, female 58.4%, KL grade 3 57.3%). At Week 12, treatment with 0.07 mg LOR significantly (P<0.05) increased the odds of a 30% threshold response in Pain NRS (OR 2.47 [1.45, 4.19]) and WOMAC Function (OR 1.86 [1.10, 3.12]) and a 50% threshold response in WOMAC Pain (OR 1.79 [1.06, 3.03]) and PtGA (OR 2.28 [1.25, 4.16]). Numerically, more (not statistically significant) subjects achieved a 70% threshold response in all PROs. All improvements were maintained through Week 24.

Conclusion:

In this post hoc analysis, LOR-treated subjects reported greater improvements in PRO threshold responses versus PBO from Week 12 through Week 24. LOR demonstrated significantly higher odds of achieving and maintaining improvements in PROs at 30% and 50% thresholds. Phase 3 studies of 0.07 mg LOR are ongoing.

References:

[1]Deshmukh V, et al.Osteoarthr Cartil. 2019.

Disclosure of Interests:

Yusuf Yazici Shareholder of: Samumed, LLC, Grant/research support from: Bristol-Myers Squibb, Celgene, and Genentech, Consultant of: Celgene and Sanofi, Employee of: Samumed, LLC, Sarah Kennedy Shareholder of: Samumed, LLC, Employee of: Samumed, LLC, Christopher Swearingen Shareholder of: Samumed, LLC, Employee of: Samumed, LLC, Jeyanesh Tambiah Shareholder of: Samumed, LLC, Employee of: Samumed, LLC

Modulation of the Wnt pathway through inhibition of CLK2 and DYRK1A by lorecivivint as a novel, potentially disease-modifying approach for knee osteoarthritis treatment

OBJECTIVES

Wnt pathway upregulation contributes to knee osteoarthritis (OA) through osteoblast differentiation, increased catabolic enzymes, and inflammation. The small-molecule Wnt pathway inhibitor, lorecivivint (SM04690), which previously demonstrated chondrogenesis and cartilage protection in an animal OA model, was evaluated to elucidate its mechanism of action.

DESIGN

Biochemical assays measured kinase activity. Western blots measured protein phosphorylation in human mesenchymal stem cells (hMSCs), chondrocytes, and synovial fibroblasts. siRNA knockdown effects in hMSCs and BEAS-2B cells on Wnt pathway, chondrogenic genes, and LPS-induced inflammatory cytokines was measured by qPCR. In vivo anti-inflammation, pain, and function were evaluated following single intra-articular (IA) lorecivivint or vehicle injection in the monosodium iodoacetate (MIA)-induced rat OA model.

RESULTS

Lorecivivint inhibited intranuclear kinases CDC-like kinase 2 (CLK2) and dual-specificity tyrosine phosphorylation-regulated kinase 1A (DYRK1A). Lorecivivint inhibited CLK2-mediated phosphorylation of serine/arginine-rich (SR) splicing factors and DYRK1A-mediated phosphorylation of SIRT1 and FOXO1. siRNA knockdowns identified a role for CLK2 and DYRK1A in Wnt pathway modulation without affecting β-catenin with CLK2 inhibition inducing early chondrogenesis and DYRK1A inhibition enhancing mature chondrocyte function. NF-κB and STAT3 inhibition by lorecivivint reduced inflammation. DYRK1A knockdown was sufficient for anti-inflammatory effects, while combined DYRK1A/CLK2 knockdown enhanced this effect. In the MIA model, lorecivivint inhibited production of inflammatory cytokines and cartilage degradative enzymes, resulting in increased joint cartilage, decreased pain, and improved weight-bearing function.

CONCLUSIONS

Lorecivivint inhibition of CLK2 and DYRK1A suggested a novel mechanism for Wnt pathway inhibition, enhancing chondrogenesis, chondrocyte function, and anti-inflammation. Lorecivivint shows potential to modify structure and improve symptoms of knee OA.

A small-molecule inhibitor of the Wnt pathway (SM04690) as a potential disease modifying agent for the treatment of osteoarthritis of the knee

OBJECTIVES

Osteoarthritis (OA) is a degenerative disease characterized by loss of cartilage and increased subchondral bone within synovial joints. Wnt signaling affects the pathogenesis of OA as this pathway modulates both the differentiation of osteoblasts and chondrocytes, and production of catabolic proteases. A novel small-molecule Wnt pathway inhibitor, SM04690, was evaluated in a series of in vitro and in vivo animal studies to determine its effects on chondrogenesis, cartilage protection and synovial-lined joint pathology.

DESIGN

A high-throughput screen was performed using a cell-based reporter assay for Wnt pathway activity to develop a small molecule designated SM04690. Its properties were evaluated in bone-marrow-derived human mesenchymal stem cells (hMSCs) to assess chondrocyte differentiation and effects on cartilage catabolism by immunocytochemistry and gene expression, and glycosaminoglycan breakdown. In vivo effects of SM04690 on Wnt signaling, cartilage regeneration and protection were measured using biochemical and histopathological techniques in a rodent acute cruciate ligament tear and partial medial meniscectomy (ACLT + pMMx) OA model.

RESULTS

SM04690 induced hMSC differentiation into mature, functional chondrocytes and decreased cartilage catabolic marker levels compared to vehicle. A single SM04690 intra-articular (IA) injection was efficacious in a rodent OA model, with increased cartilage thickness, evidence for cartilage regeneration, and protection from cartilage catabolism observed, resulting in significantly improved Osteoarthritis Research Society International (OARSI) histology scores and biomarkers, compared to vehicle.

CONCLUSIONS

SM04690 induced chondrogenesis and appeared to inhibit joint destruction in a rat OA model, and is a candidate for a potential disease modifying therapy for OA.

A novel Wnt pathway inhibitor, SM04690, for the treatment of moderate to severe osteoarthritis of the knee: results of a 24-week, randomized, controlled, phase 1 study

OBJECTIVE

To assess the safety, pharmacokinetics, and exploratory efficacy of SM04690, a novel Wnt pathway inhibitor, as a potential disease modifying treatment for knee osteoarthritis (OA).

DESIGN

Subjects with Kellgren-Lawrence grade 2-3 knee OA were randomized in successive dose-escalation cohorts to receive a knee intra-articular (IA) injection with 0.03, 0.07, or 0.23 mg SM04690, or placebo (PBO) (4:1 ratio). Safety, pharmacokinetics, efficacy (WOMAC Total/Function/Pain, Pain VAS, Physician Global Assessment [MDGA], and OMERACT-OARSI Response), OA-related biomarker (P1NP, ß-CTX, and cartilage oligomeric matrix protein [COMP]), and radiographic/imaging data were collected at baseline and during 24-week follow-up.

RESULTS

61 subjects (SM04690 n = 50; PBO n = 11) enrolled. Two dose limiting toxicities (DLTs), increased pain following injection and paroxysmal tachycardia (also the single serious AE), were reported in the 0.07 mg cohort. A total of 72 AEs were reported; Sixteen (occurring in eight subjects) were considered related to study medication. There were three discontinuations; one due to an AE (0.03 mg cohort). Bone marrow edema (BME) remained constant for most subjects. No doses were excluded from further study due to DLT criteria. Plasma levels of SM04690 were below the limit of detection at all time points. At Week 24, improvements from baseline were seen in all cohorts for the exploratory measures WOMAC Total, WOMAC Function, WOMAC Pain, MDGA, Pain VAS, and OMERACT-OARSI response. Joint space width (JSW) improvement was observed in the 0.07 mg cohort (P = 0.02 vs PBO).

CONCLUSION

SM04690 appeared safe and well tolerated, with no evidence of systemic exposure. Exploratory efficacy analyses suggested positive trends for measurements of OA pain, function and disease-modifying osteoarthritis drug (DMOAD) properties. CLINICALTRIALS.

GOV REGISTRATION

NCT02095548.