Positive CHMP opinion for momelotinib use in myelofibrosis patients with anaemia

20th November 2023

The Janus kinase (JAK) inhibitor momelotinib has received a positive opinion from the European Medicines Agency‘s Committee for Medicinal Products for Human Use (CHMP) for use in certain myelofibrosis patients, its manufacturer GSK has announced.

Momelotinib has been recommended for the treatment of disease-related splenomegaly or symptoms in adult patients with moderate-to-severe anaemia who have primary myelofibrosis, post polycythaemia vera myelofibrosis or post-essential thrombocythaemia myelofibrosis and who are JAK inhibitor naive or have been treated with ruxolitinib.

If approved, momelotinib (proposed brand name Omjjara) would be the only medicine in the European Union specifically indicated for both newly diagnosed and previously treated myelofibrosis patients with moderate-to-severe anaemia that addresses splenomegaly and symptoms.

Nina Mojas, senior vice president, oncology global product strategy at GSK, said: ‘Momelotinib has a differentiated mechanism of action that may address the significant medical needs of myelofibrosis patients, especially those with moderate to severe anaemia.

‘The vast majority of myelofibrosis patients will develop anaemia, causing them to require transfusions and leading a notable proportion to discontinue treatment.

‘This positive CHMP opinion is a significant step in bringing momelotinib to patients in the EU with this difficult-to-treat blood cancer.‘

Statistically significant response for momelotinib

The positive opinion was based on the results of the pivotal MOMENTUM trial, which evaluated the safety and efficacy of momelotinib versus danazol for the treatment and reduction of key manifestations of myelofibrosis in an anaemic, symptomatic, JAK inhibitor-experienced population.

All primary and key secondary endpoints were met, and momelotinib demonstrated a statistically significant response with respect to constitutional symptoms, splenic response and transfusion independence compared to danazol at Week 24.

Momelotinib was also associated with favourable safety at Week 48 in a follow-up analysis.

The CHMP recommendation was also supported by data from a subpopulation of adult patients with moderate-to severe-anaemia (haemoglobin <10 g/dL) from the SIMPLIFY-1 phase 3 trial.

This evaluated the efficacy and safety of momelotinib versus ruxolitinib in myelofibrosis patients who had not received a prior JAK-inhibitor therapy.

It found that in JAKi-naive patients with myelofibrosis, 24 weeks of momelotinib treatment was non-inferior to ruxolitinib for spleen response but not for symptom response. Momelotinib treatment was also associated with a reduced transfusion requirement.

In these clinical trials, the most common adverse reactions were diarrhoea, thrombocytopaenia, nausea, headache, dizziness, fatigue, asthenia, abdominal pain and cough.

A decision on EU marketing authorisation is expected for momelotinib by early 2024.

Momelotinib was approved by the US Food and Drug Administration in September 2023 under the brand name Ojjaara. It is currently not approved in any other market.

Risk of anaemia increased among elderly patients taking low-dose aspirin

26th June 2023

The risk of anaemia is higher among patients aged 70 years and older taking a daily dose of 100 mg of enteric-coated aspirin, according to a post hoc analysis of the ASPREE randomised controlled trial.

The Aspirin in Reducing Events in the Elderly (ASPREE) trial was designed to examine whether a daily dose of 100 mg of aspirin would prolong the healthy life span of older adults. While it is recognised that aspirin use in patients without cardiovascular disease lowers the risk of cardiac events but increases the risk of a major bleed, whether aspirin use also associated with anaemia is less certain.

Details of the ASPREE trial have been already published and revealed a higher all-cause mortality, largely due to cancer-related deaths, in those assigned to daily aspirin compared to placebo.

In the post hoc analysis of the ASPREE trial, published in the Annals of Internal Medicine, researchers investigated the effect of low-dose aspirin on incident anaemia, haemoglobin and serum ferritin concentrations.

Researchers assessed haemoglobin levels annually and ferritin levels at both baseline and after three years. The primary outcome was defined as incident anaemia but researchers also considered changes in haemoglobin and ferritin levels over time.

Aspirin use and anaemia

A total of 18,153 participants with a mean age of 74 years (44% male) were included, of whom 9,047 were randomised to a daily dose of 100 mg of enteric coated aspirin. Participants were followed for a median of 4.7 years after randomisation.

The incidence of anaemia was significantly higher in the aspirin group (hazard ratio, HR = 1.20, 95% CI 1.12 – 1.29). In addition, haemoglobin concentrations declined more steeply in those assigned to aspirin.

By year three, serum ferritin levels had reduced by an average of 11.5% in the aspirin group compared to those assigned to placebo. A higher proportion of patients assigned to aspirin experienced a major bleeding event compared to placebo (3% vs 2.1%). However, in sensitivity analysis, this difference did not account for the levels of anaemia seen between the two groups.

Overall the results suggested that the risk of developing anaemia within five years was 23.5% among those taking low dose aspirin.