NASHVILLE—Two doses of ozanimod provide greater benefits on annualized relapse rate and MRI end points than interferon beta-1a does, according to research described at the 2018 CMSC Annual Meeting. Together with safety and tolerability results, the data indicate that oral ozanimod has a favorable risk–benefit profile in patients with relapsing-remitting multiple sclerosis (MS), said the investigators.
Ozanimod is an oral immunomodulator that selectively targets sphingosine 1-phosphate receptors 1 and 5. The drug is administered once daily. Bruce A. C. Cree, MD, PhD, Associate Professor of Neurology at the University of California, San Francisco, and colleagues examined data for patients with relapsing-remitting MS in the SUNBEAM and RADIANCE Part B trials to compare the efficacy and safety of ozanimod with those of interferon beta-1a. Patients received 1 mg or 0.5 mg of ozanimod HCl (with a seven-day dose escalation) or 30 μg of interferon beta-1a.
Ozanimod Decreased Annualized Relapse Rate
Dr. Cree and colleagues analyzed 12-month efficacy data from SUNBEAM, 24-month efficacy data from RADIANCE, and pooled safety data.
In all, 1,346 patients were treated in SUNBEAM, and 1,313 patients were treated in RADIANCE. Ozanimod 1 mg and 0.5 mg reduced participants’ adjusted annualized relapse rate by 48% (0.181) and 31% (0.241), respectively, versus interferon beta-1a (0.350) in SUNBEAM, and by 38% (0.172) and 21% (0.218), respectively, versus interferon beta-1a (0.276) in RADIANCE.
The adjusted mean number of new or enlarging T2 lesions was reduced by 48% and 25% versus interferon beta-1a for ozanimod 1 mg and 0.5 mg, respectively, in SUNBEAM, and by 42% and 34%, respectively, in RADIANCE. The adjusted mean number of gadolinium-enhancing lesions was reduced by 63% for the 1-mg dose of ozanimod and by 34% for the 0.5-mg dose of ozanimod versus interferon beta-1a in SUNBEAM. In RADIANCE, ozanimod 1 mg reduced this outcome by 53% and ozanimod 0.5 mg reduced this outcome by 47%, compared with interferon beta-1a.
Fewer Adverse Events With Ozanimod
Confirmed three-month pooled disability progression was low in the ozanimod 1 mg (0.102), ozanimod 0.5 mg (0.080), and interferon beta-1a (0.099) groups. In SUNBEAM, whole brain volume loss was 33% lower with ozanimod 1 mg and 12% lower with ozanimod 0.5 mg, compared with interferon beta-1a. In RADIANCE, whole brain volume loss was 27% lower with ozanimod 1 mg and 25% lower with ozanimod 0.5 mg, compared with interferon beta-1a. Ozanimod was associated with greater slowing of cortical gray matter and thalamic volume loss in both studies, compared with interferon beta-1a.
Compared with interferon beta-1a, ozanimod-treated patients had fewer adverse events (ozanimod 1 mg, 67.1%; ozanimod 0.5 mg, 65.6%; interferon beta-1a, 79.2%) and adverse events leading to study drug discontinuation (ozanimod 1 mg, 2.9%; ozanimod 0.5 mg, 2.4%; interferon beta-1a, 3.8%). Serious adverse events, including infections, were balanced and infrequent across groups (ozanimod 1 mg, 4.6%; ozanimod 0.5 mg, 5.3%; interferon beta-1a, 4.4%); no serious opportunistic infections were reported.
No second degree or higher atrioventricular block was observed. Researchers observed one death due to drowning (ozanimod 0.5 mg) deemed unrelated to the study drug.