RARE Daily

FDA approves Pharming’s Joenja for the treatment of APDS

March 31, 2023

Rare Daily Staff

The U.S. Food and Drug Administration has approved Pharming Group’s Joenja for the treatment of activated phosphoinositide 3-kinase delta syndrome (APDS) in adult and pediatric patients 12 years of age and older.

Activated phosphoinositide 3-kinase delta (PI3Kδ) syndrome (APDS) is a rare primary immunodeficiency that was first characterized in 2013 and is currently estimated to affect 1 to 2 people per million. It is caused by genetic variants in either one of two identified genes, known as PIK3CD or PIK3R1, which are vital to the normal development and function of immune cells in the body. While people with APDS may suffer from a wide variety of symptoms, the most common are frequent and severe infections of the ears, sinuses, and upper and lower respiratory tracts. Infections usually begin in infancy. People with APDS are susceptible to swollen lymph nodes or an enlarged spleen (splenomegaly), as well as autoimmunity and inflammatory symptoms. People with APDS may also be at higher risk for cancers like lymphoma.

Joenja (leniolisib), an oral, selective PI3Kδ inhibitor, is the first and only treatment approved in the U.S. for APDS, a rare and progressive primary immunodeficiency. The FDA evaluated the Joenja application for APDS under Priority Review, which is granted to therapies that have the potential to provide significant improvements in the treatment, diagnosis or prevention of serious conditions. Joenja is expected to launch in the U.S. in early April and will be available for shipment in mid-April.

“This FDA approval of Joenja is an important milestone for people living with APDS who will now have access to the first approved treatment option specifically for this debilitating disease,” said Sijmen de Vries, CEO of Pharming. “Until now, management of APDS has relied on the treatment of the diverse symptoms associated with APDS.

FDA approval was based on findings from a multinational, triple-blind, placebo-controlled, randomized phase 2/3 clinical trial, which evaluated efficacy and safety in 31 patients diagnosed with APDS aged 12 years and older. Also submitted as part of the application were data from a long term, open-label extension clinical trial in which 38 patients received Joenja for a median of two years.

Results from the 12-week randomized, placebo-controlled study in 31 patients with APDS aged 12 years and older demonstrated clinical efficacy of Joenja 70mg twice daily over placebo, and was significant in the co-primary endpoints which evaluated improvement in lymphoproliferation as measured by the reduction in lymph node size and increase in naïve B cells, reflecting the impact on immune dysregulation and normalization of immunophenotype in these patients, respectively.

The adjusted mean change between Joenja and placebo for lymph node size was -0.25 and for percentage of naïve B cells was 37.30; The most common adverse reactions in the clinical trial (incidence >10 percent) were headache, sinusitis, and atopic dermatitis.

With the approval of Joenja as a treatment for a rare pediatric disease, the FDA granted Pharming a priority review voucher. Pursuant to the terms of Pharming’s 2019 exclusive license agreement with Novartis for leniolisib, Novartis has the right to purchase the PRV from Pharming for a small minority share of the value of the PRV. Pursuant to the agreement, Pharming will make milestone payments to Novartis and another party for the approval and first commercial sale for APDS totaling $10.5 million and to make certain additional milestone payments to Novartis in an aggregate amount of up to $190 million upon the achievement of certain leniolisib sales milestones, plus tiered royalty payments calculated as low double-digit to high-teen double-digit percentage of net sales of leniolisib.

The Marketing Authorisation Application for leniolisib with the European Medicines Agency’s Committee for Human Medicinal Products (CHMP) is currently under review. Pharming expects that CHMP will issue its opinion on the MAA in the second half of 2023.

Leniolisib is also being evaluated in a phase 3 clinical trial in children aged 4 to 11 with APDS, with a further trial planned in children aged 1 to 6 years with APDS.

Photo: Sijmen de Vries, CEO of Pharming

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