Idorsia’s JERAYGO (aprocitentan) approved in Europe as first and
only ERA for the treatment of resistant hypertension
- Idorsia receives approval from the European Commission (EC) for
JERAYGO™ (aprocitentan) as the first and only endothelin
receptor antagonist (ERA) for the treatment of resistant
hypertension.
- JERAYGO is a new oral antihypertensive therapy – the first in
almost 40 years – that is working via a new therapeutic
pathway.
Allschwil, Switzerland – July 1, 2024
Idorsia Ltd (SIX: IDIA) announced today that the European
Commission (EC) has approved JERAYGO™ (aprocitentan) for
the treatment of resistant hypertension in adult patients in
combination with at least three antihypertensive medicinal
products.1 The recommended dose is 12.5 mg orally once
daily. The dose can be increased to 25 mg once daily for patients
tolerating the 12.5 mg dose and in need of tighter blood pressure
(BP) control.1
Hypertension is one of the leading causes of cardiovascular
disease worldwide, impacting an estimated 1.3 billion people
globally.2 Approximately 10% of these people have
uncontrolled BP, despite receiving at least three antihypertensive
medications from different classes, at optimal doses and they are
categorized in hypertension guidelines as having resistant
hypertension.3,4
Prof. Krzysztof Narkiewicz, MD, PhD, Head of the
Department of Hypertension and Diabetology, Medical University of
Gdansk, Poland, commented:
“JERAYGO is an oral antihypertensive therapy that is tackling a new
therapeutic pathway – the endothelin system. JERAYGO has
demonstrated clinically meaningful rapid and long-term reduction in
blood pressure. What I was particularly impressed with, this effect
was shown in patients with resistant hypertension, whose blood
pressure remained uncontrolled despite receiving at least three
antihypertensive medications as background therapy. In Europe,
there are millions of patients with resistant hypertension, and
they are at a higher risk of heart attack, heart failure, stroke,
end-stage renal disease and death due to their high blood pressure.
With JERAYGO, doctors now a have an effective new treatment option
to help control blood pressure in these patients.”
Alberto Gimona, MD, Head of Global Clinical Development
& Medical Affairs, commented:
“We are very proud to have gained approval for JERAYGO, the first
innovative anti-hypertensive drug in 40 years, acting on the
endothelin pathway, which we believe is a key player in patients
with resistant hypertension. We have seen a clinically meaningful
and consistent blood pressure lowering across blood pressure
measurement methodologies and in subgroups of patients with serious
comorbidities – for example in patients with chronic kidney
disease. We also saw a marked reduction in albuminuria with JERAYGO
as evidenced by a decrease in baseline UACR. I’m very pleased that
the wealth of data we have generated with JERAYGO is well reflected
in the label. We will now work to expand marketing authorization by
also applying for JERAYGO approval in the UK, Canada, and
Switzerland.”
André Muller, Chief Executive Officer of Idorsia
commented:
“With aprocitentan, we have a largely unencumbered asset approved
in the US and Europe. We continue to carefully evaluate all our
funding options including potential collaborations for the
commercialization of aprocitentan, while preparing to make
aprocitentan available in these two key markets.”
About the Phase 3 PRECISION
study1,5
The efficacy of aprocitentan was evaluated in one randomized,
double-blind (DB), placebo-controlled Phase 3 multicenter
study. Patients with uncontrolled blood pressure (systolic blood
pressure [SBP] ≥140 mmHg) despite the use of at least three
antihypertensive medicinal products and following exclusion of
pseudo-resistant hypertension (e.g., white coat effect,
inappropriate blood pressure measurement, secondary causes of
hypertension) were considered to have resistant hypertension. The
patients were switched to standardized background antihypertensive
therapy consisting of an angiotensin receptor blocker (valsartan
160 mg), a calcium channel blocker (amlodipine 5 or 10 mg), and a
diuretic (hydrochlorothiazide 25 mg) throughout the study. Patients
with concomitant use of beta-blockers continued this treatment
throughout the study, in addition to the standardized background
antihypertensive therapy and study treatment. A total of 730
patients received either aprocitentan 12.5 mg, aprocitentan 25 mg,
or placebo once daily during the initial 4-week DB treatment (part
1). Thereafter, patients received aprocitentan 25 mg once daily
during the 32-week single-blind treatment (part 2). At the end of
the 32 weeks, patients were re-randomized to receive either
aprocitentan 25 mg or placebo, once daily, during the 12-week
double-blind withdrawal (DB-WD) treatment (part 3).
The primary efficacy endpoint was the change in sitting SBP
(SiSBP) from baseline to Week 4 during DB treatment (part 1),
measured at trough by unattended automated office blood pressure
(uAOBP). The key secondary endpoint was the change in SiSBP
measured at trough by uAOBP from DB-WD baseline (Week 36) to Week
40 (part 3).
Patients had a mean age of 61.7 years (range 24 to 84 years;
34.1% were ≥ 65 and < 75 years; 9.9% were ≥ 75 years) and 59.5%
were male. Patients were White (82.9%), African American (11.2%) or
Asian (5.2%). The mean body weight was 97.6 kg (range 46 to 196 kg)
and mean BMI was 33.7 kg/m2 (range 18 to 64 kg/m2). Patients had a
medical history of type 2 diabetes mellitus (54.1%), ischemic heart
disease (30.8%), central nervous system vascular disorders (23.0%),
chronic kidney disease stages 3 and 4 (22.2%; 19.3% of patients had
eGFR 30–59 mL/min/1.73 m2 and 2.9% had eGFR 15–29 mL/min/1.73 m2),
congestive heart failure (19.6%), and sleep apnea syndrome (14.1%).
63.0% of patients had four or more antihypertensive medicinal
products.
Key PRECISION
findings1,5
Doses of aprocitentan 12.5 and 25 mg showed a statistically
significant reduction vs placebo on SiSBP at Week 4. The treatment
effect was consistent for sitting diastolic blood pressure (SiDBP).
The persistence of the BP-lowering effect of aprocitentan was shown
in DB-WD treatment (part 3). In patients re-randomized to placebo,
the mean SiSBP increased, whereas in patients re-randomized to
aprocitentan 25 mg the mean effect on SiSBP was stable, resulting
in a statistically significant difference. The treatment effect was
consistent for SiDBP. The effect was also consistent across SBP and
DBP measured by ambulatory BP monitoring (ABPM) and assessed as
daytime, night-time, and 24h periods at Week 4 and Week 40. A
substantial proportion (i.e., at least 90%) of the BP-lowering
effect was observed within the first two weeks of treatment with
aprocitentan. The effect of aprocitentan was consistent across
subgroups of age (including patients ≥ 75 years), sex, race
(including patients with Black or African American origin), BMI,
baseline urine albumin-to-creatinine ratio (UACR), baseline eGFR
and medical history of diabetes.
The most frequently reported adverse reactions with aprocitentan
were edema/fluid retention (mostly peripheral edema) (9.1%, 12.5
mg; 18.4%, 25 mg) and hemoglobin decreased (3.7%, 12.5 mg; 1.2%, 25
mg). JERAYGO is contraindicated for use in women who are pregnant,
breast-feeding and in women of childbearing potential who are not
using reliable contraception, and patients with severe hepatic
impairment.
For more information on the marketing authorization of JERAYGO
in the European Union, please review the Summary of Product
Characteristics (SmPC).
Notes to the editor
About aprocitentan
The team at Idorsia has been working on the research and
development of endothelin receptor antagonists for more than 30
years, successfully bringing three other molecules from this class
to patients in different indications. Endothelin (ET)-1, via its
receptors (ETA and ETB), mediates a variety
of effects such as vasoconstriction, fibrosis, cell proliferation,
and inflammation and is upregulated in hypertension. Aprocitentan
is a dual ERA that inhibits the binding of ET-1 to ETA
and ETB receptors and hence the effects mediated by
these receptors.1
References
- JERAYGO™ Summary of Product Characteristics.
2024.
- NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in
hypertension prevalence and progress in treatment and control from
1990 to 2019: a pooled analysis of 1201 population-representative
studies with 104 million participants. Lancet 2021;
398:957-80.
- Noubiap JJ, et al. Global prevalence of resistant hypertension:
a meta-analysis of data from 3·2 million patients. Heart 2019; 105:
98–105.
- Williams B, et al. 2018 ESC/ESH guidelines for the management
of arterial hypertension. Eur Heart J 2018; 39: 3021–104.
- Schlaich MP, et al. A randomized controlled trial of the dual
endothelin antagonist aprocitentan for resistant hypertension. The
Lancet, 2022; Dec 3;400(10367):1927-1937.
About Prof. Krzysztof Narkiewicz, MD, PhD
Professor Krzysztof Narkiewicz is the Head of the Department of
Hypertension and Diabetology, Medical University of Gdansk, Gdansk,
Poland. His research has been focused on the role of the
sympathetic nervous system and metabolic factors in regulation of
cardiovascular function in physiological and pathological states,
and on prevention and treatment of cardiometabolic diseases
including hypertension, diabetes, coronary artery disease,
congestive heart failure and obstructive sleep apnea. He has
published over 700 full-text publication; (> 39 000 citations;
h-index: 69). He was the President of the Scientific Council of the
European Society of Hypertension (2009-2011). He was a member of
the Task Force for the Management of Arterial Hypertension of the
European Society of Hypertension (ESH) and of the European Society
of Cardiology (ESC) preparing the 2007, 2013 and 2018 Guidelines
for the Management of Arterial Hypertension. He also contributed to
the 2023 ESH hypertension guidelines. Prof. Krzysztof Narkiewicz
serves as a consultant to Idorsia.
About Idorsia
Idorsia Ltd is reaching out for more – We have more ideas, we see
more opportunities and we want to help more patients. In order to
achieve this, we will develop Idorsia into a leading
biopharmaceutical company, with a strong scientific core.
Headquartered near Basel, Switzerland – a European biotech-hub –
Idorsia is specialized in the discovery, development and
commercialization of small molecules to transform the horizon of
therapeutic options. Idorsia has a 25-year heritage of drug
discovery, a broad portfolio of innovative drugs in the pipeline,
an experienced team of professionals covering all disciplines from
bench to bedside, and commercial operations in Europe and North
America – the ideal constellation for bringing innovative medicines
to patients.
Idorsia was listed on the SIX Swiss Exchange (ticker symbol:
IDIA) in June 2017 and has over 750 highly qualified specialists
dedicated to realizing our ambitious targets.
For further information, please contact
Investors & Media
Andrew C. Weiss
Senior Vice President, Head of Investor Relations & Corporate
Communications
Idorsia Pharmaceuticals Ltd, Hegenheimermattweg 91, CH-4123
Allschwil
+41 58 844 10 10
investor.relations@idorsia.com • media.relations@idorsia.com •
www.idorsia.com
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