SAT0303 DESIGN OF PHASE 3 STUDY OF LENABASUM FOR THE TREATMENT OF DERMATOMYOSITIS
Authors: Victoria Werth, Chester V. Oddis, Ingrid E. Lundberg, David Fiorentino, Caitlin Cornwall, Nancy Dgetluck, Scott Constantine, Barbara White
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> To date, there has not been a Phase 3 study evaluating efficacy and safety of a new chemical entity solely in subjects with dermatomyositis (DM). There is no precedence for design of such a pivotal study, including selection of patients or efficacy outcomes. <h3>Objectives:</h3> Develop a Phase 3 study design for testing efficacy and safety of lenabasum in DM that would be acceptable to experts and for registration purposes. <h3>Methods:</h3> Lenabasum is a synthetic, non-immunosuppressive, selective cannabinoid receptor type 2 agonist that activates resolution of innate immune responses. Lenabasum had acceptable safety and tolerability and improved multiple physician-reported and patient-reported efficacy outcomes in a 16-week double-blinded, randomized, placebo-controlled Phase 2 trial in DM subjects with refractory, skin-predominant involvement, as well as in the open-label extension of that study. The Phase 3 trial design was based on Phase 2 data, input from a steering committee of experts in DM clinical trials, and recommendations made by regulatory authorities in the US, EU, Sweden, and Japan. <h3>Results:</h3> A global, double-blind, randomized, interventional design was chosen to provide an unbiased assessment of the efficacy, safety and tolerability of lenabasum 20 mg bid and 5 mg bid compared to placebo in the treatment of DM. A 52-week treatment duration was selected to provide safety and efficacy data adequate to support chronic treatment. Subjects with DM were classified by Peter and Bohan criteria or the 2017 EULAR/ACR classification criteria for DM (both amyopathic DM and classic DM). Subjects will be required to have active disease, as assessed by an expert and based on a range of muscle, skin, and other disease manifestations. Subjects must be on stable doses of current DM treatments with any background immunosuppressive medications allowed except prednisone ≥ 20 mg per day or equivalent. This inclusivity allows testing of efficacy and safety of lenabasum in the setting of current treatment practice and reduces risk of disease flare early in the study. The primary efficacy outcome is change from baseline in 2016 ACR/EULAR Total Improvement Score (TIS) for DM and polymyositis. This composite outcome has six domains that broadly capture improvement in disease activity, is relevant to the range of manifestations in DM, and is applicable to the assessment of efficacy in the target patient population. Secondary efficacy outcomes were chosen to assess how the subject functions (Short Form – 36 physical functioning domain), major organ involvement (MMT-8, CDASI activity score, and a new Investigator Global Assessment scale of skin activity designed specifically for this study), and lung function (FVC). Change in oral corticosteroid dose also will be captured. <h3>Conclusion:</h3> To our knowledge, this is the first Phase 3 study in DM with a new molecular entity. As such, agreement with experts and regulatory authorities on design represents a step forward in the development pathway of new treatments for DM. <h3>Disclosure of Interests:</h3> Victoria Werth: None declared, Chester V Oddis Grant/research support from: Support of clinical research from Roche/Genentech and BMS, Consultant for: Corbus: Previous Steering Committee consultation; No longer being paid as a Corbus consultant, Ingrid E. Lundberg Grant/research support from: Dr. Lundberg has received honoraria from Bristol Myers Squibb and MedImmune and is currently receiving a research grant from Bristol Myers Squibb and from Astra Zeneca., Consultant for: She is a scientific advisor for Bristol Myers Squibb, and aTyr, David Fiorentino Grant/research support from: Pfizer - to support analysis of human tissue from patients with dermatomyositis, Consultant for: Pfizer—design and operation of clinical trial in DM Corbus—design of clinical trial in DM 23 and me—ad hoc consulting Admiryx—ad hoc consulting Janssen—SAB for PSOLAR database Beigene—paid consultant, Caitlin Cornwall Shareholder of: Corbus Pharmaceuticals, Inc., Employee of: Corbus Pharmaceuticals, Inc., Nancy Dgetluck Employee of: Corbus Pharmaceuticals, Inc., Scott Constantine Shareholder of: Corbus Pharmaceuticals, Inc., Employee of: Corbus Pharmaceuticals, Inc., Barbara White Shareholder of: Corbus Pharmaceuticals, Inc., Employee of: Corbus Pharmaceuticals, Inc.