COMUNICADO: CHMP Issues a Positive Opinion for Daiichi Sankyo's Once-Daily LIXIANA®▼ (edoxaban) in Patients with Atrial Fibrillation

 

COMUNICADO: CHMP Issues a Positive Opinion for Daiichi Sankyo's Once-Daily LIXIANA®▼ (edoxaban) in Patients with Atrial Fibrillation

Publicado 17/07/2017 9:01:58CET

MUNICH, July 17, 2017 /PRNewswire/ --

- Recommended label update for LIXIANA(R) provides guidance on its use in patients undergoing transoesophageal echocardiography (TEE)-guided and delayed cardioversion   - Update is based on data from ENSURE-AF, the largest prospective randomised clinical trial of anticoagulation for cardioversion of patients with non-valvular atrial fibrillation (NVAF), to date[1]   - LIXIANA is now the only non-vitamin K oral anticoagulant (NOAC) with specific label guidance for early cardioversion within two hours after LIXIANA intake in the TEE-guided approach  

Daiichi Sankyo Europe GmbH (hereafter, "Daiichi Sankyo") today announced that the European Committee for Medicinal Products for Human Use (CHMP) has recommended approval of a label update for the company's oral, once-daily direct factor Xa-inhibitor LIXIANA(R), to provide guidance on its use in patients undergoing transoesophageal echocardiography (TEE)-guided and delayed cardioversion (treatment to restore a normal heart rhythm).

The label update is based on results from the ENSURE-AF study, the largest, prospective randomised clinical trial of an anticoagulant for cardioversion in patients with NVAF. The study enrolled 2,199 patients, and compared once-daily LIXIANA with enoxaparin/warfarin with a median time in therapeutic range (INR 2-3) of 70.8 %.[1] These data support the use of LIXIANA as an effective and safe alternative to the best possible conventional treatment with enoxaparin and warfarin.[1] LIXIANA's rapid onset of action allows for prompt cardioversion in the TEE-guided approach as early as two hours after LIXIANA intake, helping to avoid delays or postponements of the procedure.

"ENSURE-AF provides important insight into the use of LIXIANA in the setting of TEE-guided and delayed cardioversion in NVAF patients," said Wolfgang Zierhut, MD, Executive Director, EU Cardiovascular Medical Affairs. "We are pleased that the CHMP has recognised the importance of the ENSURE-AF data for LIXIANA in this common procedure, by recommending this label update. Daiichi Sankyo is committed to supporting patients and physicians by advancing understanding of the efficacy and safety of LIXIANA in different clinical settings, through studies such as ENSURE-AF."

Cardioversion is a procedure used to restore normal, regular heart rhythm in AF patients. Due to an associated risk of thrombotic events such as stroke, guidelines recommend anticoagulation before and after the procedure.[2],[3],[4] The delayed onset of action and fluctuations in INR associated with VKA treatments such as warfarin, can result in costly and inconvenient delays to cardioversion in patients.[5] Initial treatment with enoxaparin (followed by overlapping VKA treatment) until the VKA reaches the therapeutic range of INR 2-3, represents the best possible conventional treatment.[5]

The primary efficacy endpoint of the ENSURE AF study was a composite of stroke, systemic embolic events, myocardial infarction and cardiovascular mortality, which occurred in five patients in the LIXIANA 60/30 mg arm versus 11 in the enoxaparin-warfarin arm. The primary safety endpoint was major and clinically relevant non-major bleedings (CRNM), which occurred in 16 patients in the LIXIANA arm versus 11 patients in the enoxaparin-warfarin arm.[1] The difference between the treatment arms was statistically non-significant.[1]

Event rates of thromboembolism and major and CRNM bleedings were low in the LIXIANA and exceptionally well-controlled warfarin arms. There was no difference between the TEE-guided approach and the delayed cardioversion setting.[1]

These data support the use of LIXIANA as an effective and safe alternative to the best possible conventional treatment with enoxaparin and warfarin, and allow for prompt cardioversion in the TEE-guided approach as early as two hours after LIXIANA intake.[1]

This label update makes LIXIANA the only NOAC with specific label guidance for early cardioversion within two hours after LIXIANA intake in the TEE-guided approach.

About ENSURE-AF   

(EdoxabaN vs. warfarin in subjectS UndeRgoing cardiovErsion of Atrial Fibrillation)

ENSURE-AF is a Prospective, Randomised, Open-Label, Blinded Endpoint evaluation (PROBE) , parallel-group phase 3b study, evaluating the efficacy and safety of once-daily edoxaban versus enoxaparin/warfarin in patients undergoing electrical cardioversion. The primary efficacy endpoint was the composite of stroke, systemic embolism, myocardial infarction and cardiovascular mortality. A total of 2,199 NVAF patients undergoing electrical cardioversion were enrolled at 239 clinical sites across North America and Europe. Patients were randomised to receive edoxaban 60 mg (or a reduced dose of edoxaban 30 mg for specific patients with renal impairment or low body weight or P-glycoprotein inhibitor use) or enoxaparin/warfarin for 28-49 days. Edoxaban demonstrated comparable efficacy and safety to well-managed enoxaparin/warfarin (mean time in therapeutic range on warfarin was 70.8%) for the prevention of stroke and other blood clot complications.[1]

About Atrial Fibrillation  

AF is a condition where the heart beats irregularly and rapidly. When this happens, blood can pool and thicken in the chambers of the heart causing an increased risk of blood clots. These blood clots can break off and travel through the blood stream to the brain (or sometimes to another part of the body), where they have the potential to cause a stroke.[6]

AF is the most common type of heart rhythm disorder, and is associated with substantial morbidity and mortality.[7] An estimated 8.8 million Europeans suffered from AF in 2010, and this figure is expected to at least double over the next 50 years.[8] Compared to those without AF, people with the arrhythmia have a 3-5 times higher risk of stroke.[9] One in five of all strokes are as a result of AF.[3]

About Edoxaban  

Edoxaban is an oral, once-daily, direct factor Xa (pronounced "Ten A") inhibitor. Factor Xa is one of the key components responsible for blood clotting, so inhibiting this makes the blood thin and less prone to clotting. Edoxaban is currently marketed by Daiichi Sankyo and its partners in more than 20 countries around the world.

The edoxaban Summary of Product Characteristics can be viewed here: http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/002629/WC500189045.pdf .

About Edoxaban Clinical Research Programme (ECRP)  

Daiichi Sankyo is committed to expanding scientific knowledge about edoxaban, as demonstrated through our research programmes evaluating its use in a broad range of cardiovascular conditions, patient types and clinical settings in atrial fibrillation (AF) and venous thromboembolism (VTE). The Edoxaban Clinical Research Programme includes multiple RCTs (randomised, controlled trials), registries and non-interventional studies, with the goal of generating new clinical and real-world-data regarding its use in AF and VTE populations. Daiichi Sankyo expects that more than 100,000 patients will participate in the Edoxaban Clinical Research Programme, including completed, ongoing and future research.

The RCTs include:

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