- Only anticoagulant proven to show superior risk reductions versus warfarin in three important outcomes: stroke, major bleeding and all-cause death
- First approval in any market worldwide of ELIQUIS for preventing strokes and systemic embolism in patients with nonvalvular atrial fibrillation
Bristol-Myers Squibb (NYSE: BMY) and Pfizer (NYSE: PFE) announced today
that the European Commission has approved ELIQUIS® (apixaban)
for prevention of stroke and systemic embolism in adult patients with
nonvalvular atrial fibrillation (NVAF) with one or more risk factors.
ELIQUIS is the only oral anticoagulant that has demonstrated superior
risk reduction versus warfarin in the three important outcomes of stroke
and systemic embolism, major bleeding, and all-cause mortality. ELIQUIS
is an oral direct Factor Xa inhibitor, part of a novel therapeutic
class. This is the first regulatory approval in any market for ELIQUIS
for stroke prevention in patients with nonvalvular atrial fibrillation.
“Patients with atrial fibrillation have a five times greater risk of
stroke and there remains a critical public health need for improved
treatment options to reduce this risk,” said Lars Wallentin, Director
and Professor of Cardiology, Uppsala Clinical Research Centre and
University Hospital, Sweden. “The approval of ELIQUIS represents an
important new treatment option for health care professionals, who now
have an oral anticoagulant with superior outcomes versus warfarin in the
reduction of stroke, major bleeding and death in patients with
nonvalvular atrial fibrillation.”
The marketing authorization for ELIQUIS is supported by the pivotal
Phase 3 trials ARISTOTLE and AVERROES, which evaluated approximately
24,000 patients with NVAF in the largest completed clinical trial
program conducted to date in this patient population. The ELIQUIS
clinical program is the only Phase 3 clinical program among the new oral
anticoagulants to evaluate the safety and efficacy of ELIQUIS versus
aspirin in patients who were unsuitable for vitamin K antagonist (VKA)
therapy.
“Today’s approval of ELIQUIS in the EU is the result of a strong
collaboration between Bristol-Myers Squibb and Pfizer to help address
the unmet need for improved treatment options versus warfarin to reduce
the burden of stroke in patients with nonvalvular atrial fibrillation,”
said Lamberto Andreotti, Chief Executive Officer, Bristol-Myers Squibb.
“With its compelling clinical profile, ELIQUIS represents the commitment
of our partnership with Pfizer to scientific innovation and our shared
vision of bringing innovative and meaningful medicines to patients.”
“We are confident in ELIQUIS and its differentiated profile and believe
it has the potential to transform the standard of care in stroke
prevention in nonvalvular atrial fibrillation,” said Ian Read, Chairman
and Chief Executive Officer, Pfizer. “With our combined cardiovascular
leadership and expertise, we believe that we will successfully introduce
this important medicine to patients and physicians in the EU.”
ELIQUIS 5 mg is indicated as a twice-daily oral medication for
prevention of stroke and systemic embolism in adult patients with NVAF
with one or more risk factors, such as prior stroke or transient
ischaemic attack (TIA); age ≥ 75 years; hypertension; diabetes mellitus;
symptomatic heart failure (NYHA Class ≥ II). ELIQUIS does not require
International Normalized Ratio (INR) monitoring and there are no known
dietary restrictions.
The first-line use of ELIQUIS and other new oral anticoagulants (NOACs)
is recommended in The European Society of Cardiology Guidelines for the
management of AF where oral anticoagulation is recommended, recognizing
the important benefits that ELIQUIS offers in preventing NVAF-related
stroke.
CLINICAL TRIAL PROGRAMME
ARISTOTLE
As described in the SmPC, in the ARISTOTLE Apixaban for Reduction in
Stroke and Other Thromboembolic Events in Atrial Fibrillation) trial,
ELIQUIS achieved statistically significant superiority in the primary
endpoint of prevention of stroke (haemorrhagic or ischaemic) and
systemic embolism compared with warfarin. ELIQUIS was superior to
warfarin in the primary efficacy endpoint of stroke/systemic embolism,
with a 21% relative risk reduction beyond warfarin (1.27% vs. 1.60%,
HR=0.79, CI=0.66, 0.95, P=0.0114). ELIQUIS was superior to warfarin for
the primary safety endpoint of major bleeding, with a 31 percent
relative risk reduction (2.13% vs. 3.09%, HR=0.69, CI=0.60, 0.80,
P<0.0001). Intracranial hemorrhage, a subset of major bleeding, occurred
with lower incidence with ELIQUIS compared to warfarin (0.33% vs. 0.80%,
HR=0.42, CI=0.30, 0.58, P<0.0001). ELIQUIS was superior to
warfarin in the key secondary endpoint of all-cause death, with an 11%
relative risk reduction (3.52% vs. 3.94%, HR=0.89; CI=0.80, 1.00, P=
0.0465). The use of ELIQUIS did not result in an increase in
myocardial infarction in the ARISTOTLE trial. The efficacy results for
prespecified subgroups, including CHADS2 score, age, body
weight, gender, renal function, prior stroke or TIA and diabetes were
consistent with the primary efficacy results for the overall population
studied in the trial.
The overall discontinuation rate due to adverse reactions was 1.8% for
ELIQUIS and 2.6% for warfarin in the ARISTOTLE study.
AVERROES
As described in the SmPC, the AVERROES (Apixaban Versus Acetylsalicylic
Acid to Prevent Strokes) trial was designed to demonstrate the efficacy
and safety of ELIQUIS versus aspirin for the prevention of stroke or
systemic embolism in patients who were unsuitable for VKA therapy.
AVERROES was stopped early based on the recommendation of the trial’s
independent Data Monitoring Committee due to clear evidence of reduction
of stroke and systemic embolism with an acceptable safety profile. In
AVERROES, ELIQUIS was statistically superior to acetyl salicylic acid
(ASA) in the primary endpoint of prevention of stroke (hemorrhagic or
ischemic) and systemic embolism compared to ASA (1.62% vs. 3.63%,
HR=0.45; CI=0.32, 0.62, P<0.0001), as well as in the key secondary
composite endpoint of stroke, systemic embolism, MI or vascular death
(4.21% vs. 6.35%, HR=0.66; CI=0.53, 0.83, P = 0.003). While not
significant, there was an increase in the incidence of major bleeding
with ELIQUIS compared to aspirin (1.41%/year vs. 0.92%/year). The
incidence of fatal bleeding (0.16%/year vs. 0.16%/year) and intracranial
bleeding (0.34%/year vs. 0.35%/year) bleeding were similar in the
ELIQUIS and ASA treatment groups.
The safety of ELIQUIS has been investigated in 11,886 patients in NVAF
studies treated for an average total exposure of 1.7 years. In ARISTOTLE
and AVERROES, 24.4% (ELIQUIS vs. warfarin) and 9.6% (ELIQUIS vs.
aspirin) of the patients treated with ELIQUIS (5 mg or 2.5 mg) twice
daily experienced adverse reactions. Common adverse reactions were
epistaxis, contusion, haematuria, haematoma, eye haemorrhage, and
gastrointestinal haemorrhage. The overall incidence of adverse reactions
related to bleeding with ELIQUIS was 24.3% in the ELIQUIS vs. warfarin
study and was 9.6% in the ELIQUIS vs. aspirin study. In ARISTOTLE study,
the incidence of ISTH major gastrointestinal bleeds (including upper GI,
lower GI, and rectal bleeding) with ELIQUIS was .76%/year. The incidence
of ISTH major intraocular bleeding with ELIQUIS was 0.18%/year.
About Atrial Fibrillation
Atrial fibrillation is the most common cardiac arrhythmia (irregular
heart beat). It is estimated that approximately 6 million individuals in
Europe have atrial fibrillation. The lifetime risk of developing atrial
fibrillation is estimated to be approximately 25% for individuals 40
years of age or older. One of the most serious medical concerns for
individuals with atrial fibrillation is the increased risk of stroke,
which is five times higher in people with atrial fibrillation than those
without atrial fibrillation. In fact, atrial fibrillation is responsible
for 15-20% of all ischaemic strokes and 45 percent of all embolic
strokes in Europe. Atrial fibrillation-related strokes are more severe
than other strokes, with an associated 30-day mortality of 24% and a 50%
likelihood of death within one year in patients who are not treated with
an antithrombotic.
About ELIQUIS
ELIQUIS is an oral direct Factor Xa inhibitor, part of a new therapeutic
class. By inhibiting Factor Xa, a key blood clotting protein, ELIQUIS
prevents thrombin generation and blood clot formation. ELIQUIS is the
approved trade name for apixaban in Europe and the proposed trade name
in the U.S. ELIQUIS is not yet approved for the prevention of stroke or
systemic embolism in patients with atrial fibrillation outside of the
EU. In May 2011, Bristol-Myers Squibb and Pfizer announced the first
regulatory approval for ELIQUIS in the 27 countries of the European
Union for the prevention of venous thromboembolic events (VTE) in adult
patients who have undergone elective hip or knee replacement surgery, at
a dose of 2.5 mg twice daily.
ELIQUIS is also being investigated in Phase 3 trials for the acute and
extended treatment of VTE.
About the Bristol-Myers Squibb/Pfizer Collaboration
In 2007, Pfizer and Bristol-Myers Squibb entered into a worldwide
collaboration to develop and commercialize ELIQUIS, an investigational
oral anticoagulant discovered by Bristol-Myers Squibb. This global
alliance combines Bristol-Myers Squibb's long-standing strengths in
cardiovascular drug development and commercialisation with Pfizer’s
global scale and expertise in this field.
About Bristol-Myers Squibb
Bristol-Myers Squibb is a global biopharmaceutical company whose mission
is to discover, develop and deliver innovative medicines that help
patients prevail over serious diseases. For more information, please
visit http://www.bms.com
or follow us on Twitter at http://twitter.com/bmsnews.
Pfizer Inc.: Working together for a healthier world™
At Pfizer, we apply science and our global resources to improve health
and well-being at every stage of life. We strive to set the standard for
quality, safety and value in the discovery, development and
manufacturing of medicines for people and animals. Our diversified
global health care portfolio includes human and animal biologic and
small molecule medicines and vaccines, as well as nutritional products
and many of the world’s best-known consumer products. Every day, Pfizer
colleagues work across developed and emerging markets to advance
wellness, prevention, treatments and cures that challenge the most
feared diseases of our time. Consistent with our responsibility as the
world’s leading biopharmaceutical company, we also collaborate with
health care providers, governments and local communities to support and
expand access to reliable, affordable health care around the world. For
more than 150 years, Pfizer has worked to make a difference for all who
rely on us. To learn more about our commitments, please visit us at www.pfizer.com.
Bristol-Myers Squibb Forward-Looking Statement
This press release contains "forward-looking statements" as that term
is defined in the Private Securities Litigation Reform Act of 1995
regarding product development. Such forward-looking statements are based
on current expectations and involve inherent risks and uncertainties,
including factors that could delay, divert or change any of them, and
could cause actual outcomes and results to differ materially from
current expectations. No forward-looking statement can be guaranteed.
Among other risks, there can be no guarantee that ELIQUIS will become a
commercially successful product in the EU or that it will receive
regulatory approval in the U.S. or other markets. Forward-looking
statements in this press release should be evaluated together with the
many uncertainties that affect Bristol-Myers Squibb's business,
particularly those identified in the cautionary factors discussion in
Bristol-Myers Squibb's Annual Report on Form 10-K for the year ended
December 31, 2011, in our Quarterly Reports on Form 10-Q and our Current
Reports on Form 8-K. Bristol-Myers Squibb undertakes no obligation to
publicly update any forward-looking statement, whether as a result of
new information, future events or otherwise.
PFIZER DISCLOSURE NOTICE:
The information contained in this release is as of November 20, 2012.
Pfizer assumes no obligation to update forward-looking statements
contained in this release as the result of new information or future
events or developments.
This release contains forward-looking information about various
indications and potential indications for ELIQUIS (apixaban), including
their potential benefits, that involves substantial risks and
uncertainties. Such risks and uncertainties include, among other things,
(i) the uncertainties inherent in research and development; (ii) the
uncertainties regarding the commercial success of ELIQUIS in the EU for
the prevention of stroke and systemic embolism in patients with
nonvalvular atrial fibrillation; (iii) decisions by the U.S. Food and
Drug Administration and regulatory authorities in various other
jurisdictions regarding whether and when to approve drug applications
that have been or may be filed for potential indications for ELIQUIS as
well as their decisions regarding labeling and other matters that could
affect the availability or commercial potential of such indications; and
(iv) competitive developments.
A further description of risks and uncertainties can be found in
Pfizer’s Annual Report on Form 10-K for the fiscal year ended December
31, 2011 and in its reports on Form 10-Q and Form 8-K.

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