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Message complété le 07/01/2014 17:57:30 par son auteur.
je vous retrouve le lien
en attendant j'ai un lien sur l'asthme severe avec le prix des tablettes des concurrents
Re: étude de phase III dans l’asthme sévère_ autorisation FDA pour les USA 14/09/2011
par Admin le Sam 23 Fév - 12:55
Nouveau Document datant d'aujourdui.
le 23/02/2013
http://euroscan.org.uk/technologies/technology/view/2033
Source agency:
NHSC
Date of Submission:
08/10/2012
Date of Printing:
23/02/2013
Disclaimer:
This report is work in progress and should not be used for external distribution without permission from the originating agency. Users should be aware that reports are based on information available at the time of research and often on a limited literature search.
Technology, Company & Licensing
Technology name:
Masitinib (AB-101)
Technology - description:
Masitinib (AB-101) is an orally active, protein tyrosine kinase inhibitor, which selectively inhibits c-kit. Inhibition of c-kit may lead to a reduction in the number or activity of mast cells, which play a key role in inflammation. It is intended for the treatment of severe, persistent, corticosteroid-dependent asthma. In the phase III clinical trial masitinib is administered orally at 6mg/kg per day.
Company or developer:
AB Science.
Reason for database entry:
If licensed, masitinib may offer an additional treatment option for patients with severe, persistent, corticosteroid-dependant asthma.
Technology - stage in early warning process:
Assessment in progress
Technology - stage of development:
Investigational - phase III
Licensing, reimbursement and other approval:
No information available.
Technology - type(s):
Drug
Technology - use(s):
Therapeutic
Patient Indication & Setting
Patient indications:
Asthma: severe, persistent, corticosteroid-dependant.
Disease description and associated mortality and morbidity:
Asthma is a chronic disorder of the airways caused primarily by inflammatory processes and constriction of the smooth muscle in airway walls (bronchoconstriction)(1). It is characterised by airflow obstruction and increased responsiveness of the airways to various stimuli. Symptoms include recurring episodes of wheezing, breathlessness, chest tightness and coughing(1).
Asthma usually develops in childhood but may start at any age. There is no cure for asthma, although people may experience long periods of remission. Poorly controlled asthma can have a significant impact on the quality of life of the affected person and their family, though there may be variation in an individuals perception of the symptoms and how they adapt to the condition over time (1,2). Clinical measures such as lung function may not correlate well with an individuals quality of life, but if asthma is well controlled, near maximal scores on quality of life instruments can be achieved . The diagnosis of asthma is a clinical one; there is no standardised definition of the type, severity or frequency of symptoms, nor of the findings on investigation(3).
It is estimated that there are 5.2 million people with asthma in the UK, of whom approximately 2.9 million are women and girls, 2.3 million are men and boys, 0.7 million people are older than 65 years, and 0.6 million are teenagers. The Health Survey for England (2010) estimated the lifetime prevalence of diagnosed asthma to be 17% in women and 16% in men(4). NICE estimates the prevalence of severe persistent asthma to be 47 per 100,000 population(1,2). Mortality from asthma is rare, with 999 asthma-related deaths reported in 2010(5). Although mortality from asthma is rare, expert opinion suggests that it still accounts for nearly 3 potentially eminently preventable deaths, sometimes in young persons, every day.
Number of Patients:
In 2010-11, there were 62,961 hospital admissions for asthma (ICD-10 J45) in England, resulting in 148,497 bed-days and 82,253 finished consultant episodes(6).
Technology - specialities(s):
Respiratory disease & thoracic surgery
Technology - setting(s):
General hospital and ambulatory care
Setting - further information:
Impact
Alternative and/or complementary technology:
Additive or complementary technology
Current Technology:
The management of asthma aims to control the disease; this includes no daytime symptoms, no night-time awakening due to asthma, no need for rescue medication, no exacerbations, and no limitations on activity including exercise(1,2). The SIGN/BTS(7) guideline recommends a stepwise approach to treatment in both adults and children. Treatment is started at the step most appropriate to the initial severity of the asthma with the aim of achieving early control of symptoms and optimising respiratory function. Control is maintained by stepping up treatment as necessary and stepping down when control is good(1,2).
The following stepwise and additive approach is recommended(6):
Inhaled short-acting beta2-agonist (step 1).
Inhaled corticosteroid (ICS) 200-400µg/day (children aged 5-12), 200-800µg/day (adults) or other preventer drug if inhaled steroid cannot be used (step 2).
Inhaled long-acting beta2-agonist (LABA) (step 3).
- Benefit from LABA but inadequate control increase ICS dose to 400µg/day (children aged 5-12), 800µg/day (adults).
- No response to LABA - stop use and increase ICS dose to 400µg/day (children aged 5-12), 800µg/day (adults).
- Control still inadequate - consider leukotriene receptor agonist or modified release theophylline.
Increase ICS up to 800µg/day (children aged 5-12), or trials of increasing ICS up to 2000µg/day, or addition of a fourth drug e.g leukotriene receptor antagonist, modified release theophylline, β2 agonist tablet (adults) (step 4).
Daily oral, corticosteroids (lowest dose) and ICS at 800µg/day (step 5)
NICE guidelines also recommend the use of omalizumab for severe persistent allergic asthma(.
Health Impact:
No information available.
Diffusion:
No information available.
Cost, infrastructure and economic consequences:
The cost of masitinib is unknown. The cost of selected inhaled corticosteroids and other treatments for the treatment of asthma is (8,9):
Drug: Beclometasone dipropionate
Dose: 100 - 400µg twice daily; children under 12 years, 100-200µg twice daily.
Cost: 200µg/metered inhalation (100-dose unit): £9.89
Drug: Budesonide
Dose: 100 - 400µg twice daily; children under 12 years, 100-200µg twice daily.
Cost: 200µg/metered inhalation (200-dose unit): £17.71
Drug: Ciclesonide
Dose: 160µg daily as a single dose.
Cost: 160µg/metered inhalation (60-dose unit): £19.31
Drug: Fluticasone propionate (Flixotide; Accuhaler)
Dose: 50 - 200µg twice daily; children aged 4-12yrs, 50100µg twice daily.
Cost: 100µg/blister with Accuhaler: £8.93
Drug: Mometasone fuorate (Asmanex; Twisthaler)
Dose: 400µg as a single dose in the evening or in 2 divided doses. Not recommended for children under 12.
Cost: 200µg/metered inhalation (30-dose unit): £15.70
Drug: Omalizumab (Xolair)
Dose: Subcutaneous injection. The appropriate dose and frequency of omalizumab is determined by baseline IgE (IU/ml), measured before the start of treatment, and body weight (kg). The maximum recommended dose is 600 mg every two weeks(10).
Cost: £15,400 per patient, per year.
Ethical, social, legal, political and cultural impact:
No information available.
Evidence & Policy
Clinical evidence and safety:
Trial: NCT01449162, AB07015; masitinib vs placebo; phase III.
Sponsor: AB Science.
Status: Ongoing.
Source of information: Trial registry(11).
Location: France.
Design: Randomised, placebo-controlled.
Participants: n=300 (planned); aged 18 years and older; severe persistent asthma despite treatment.
Schedule: Randomised to masitinib, oral, 6mg/kg once a day vs placebo, oral, both for 36 weeks.
Follow-up: Active treatment period 36 weeks.
Primary outcome/s: Asthma exacerbation rate.
Secondary outcome/s: Asthma control questionnaire (ACQ) score, moderate and severe asthma exacerbation rate.
Key results: -
Adverse effects (AEs): -
Expected reporting date: Primary completion date reported as Dec 2013.
Trial: NCT00842270, AB04026; masitinib vs placebo; phase II.
Sponsor: AB Science.
Status: Completed and published.
Source of information: Trial registry(12) and publication(13).
Location: France.
Design: Randomised, placebo-controlled.
Participants: n=44; aged 18 years and older; severe persistent asthma; disease duration >1 year.
Schedule: Randomised to masitinib, oral, 3mg/kg, 4.5mg/kg, 6mg/kg, or placebo, all once a day for 16 weeks.
Follow-up: Active treatment period 16 weeks, follow-up 3 months.
Primary outcome/s: Decrease in oral corticosteroid therapy.
Secondary outcome/s: Asthma control improvement assessed by the ACQ (asthma exacerbation rate).
Key results: Patients weaned from oral corticosteroids: 35.7% (masitinib group), 27.3% (placebo group); number of patients experiencing at least one exacerbation during the study: 42.4% (masitinib group), and 54.5% (placebo group); improvement in asthma control score (assessed by ACQ), 0.56, 1.57 and 0.89 units in patients treated with 3, 4.5 and 6mg/kg masitinib respectively, improvement of 0.43 units in the placebo group.
Adverse effects (AEs): Common AEs include nausea (30.3%), skin rash (30.3%), peripheral oedema (18.2%), diarrhoea (18.2%), vomiting (12.1%), fatigue (12.1%) and pruritus (12.1%).
Expected reporting date: -
Economic evaluation:
No further information available.
Ongoing research:
None.
Ongoing or planned HTA:
No further information available.
Web link:
References and sources:
1) National Institute for Health and Clinical Excellence. Inhaled corticosteroids for the treatment of chronic asthma in children under the age of 12 years. Technology appraisal TA131. London: NICE; Nov 2007.
2) National Institute for Health and Clinical Excellence. Inhaled corticosteroids for the treatment of chronic asthma in children aged 12 years and over. Technology appraisal TA138. London: NICE; March 2008.
3) National Institute for Health and Clinical Excellence. Guidance on the use of inhaler systems (devices) in children under the age of 5 years with chronic asthma. Technology appraisal TA10. London: NICE; August 2000.
4) The Health Survey for England. Respiratory Health: Summary of key findings. Leeds: The NHS information centre. 2010.
5) Office for National Statistics. Mortality statistics: deaths registered in England and Wales (Series DR) 2010. http://www.ons.gov.uk
6) NHS Hospital episode statistics. NHS Englnad 2010-11. 2011. www.hesonline.co.uk
7) Scottish Intercollegiate Guidelines Network. Managing asthma in adults: A booklet for patients and their families and carers. Edinburgh: SIGN; Dec 2011.
National Institute for Health and Clinical Excellence. Omalizumab for the treatment of severe persistent allergic asthma in children ages 6 to 11 years. Technology appraisal TA201. London: NICE; Oct 2010.
9) British Medical Association and Royal Pharmaceutical Society of Great Britain. British National Formulary. BNF. London: BMJ Group and RPS Publishing, Mar 2012.
10) The electronic Medicines Compendium (eMC). Summary of Product Characteristics, Xolair. Novartis Pharmaceuticals UK Ltd. Accessed 24 Sept 2012.
11) ClinicalTrials.gov. A prospective, multicentre, randomised, double-blind, placebo-controlled, 2-parallel groups, phase 3 study to compare the efficacy and the safety of masitinib at 6mg/kg/day versus placebo in the treatment of patients with severe persistent asthma treated with oral corticosteroids. http://clinicaltrials.gov/ct2/show/NCT01449162?term=masitinib&rank=9 Accessed 24 July 2012
12)ClinicalTrials.gov A multicentre, double-blind, placebo-controlled, randomised, parallel-group study to evaluate the efficacy of oral AB1010 in adult patients with severe persistent corticosteroid dependent asthma. http://clinicaltrials.gov/ct2/show/NCT00842270?term=masitinib&rank=5 Accessed 24 July 2012.
13) Humbert M, De Blay F, Garcia G et al. Masitinib, a c-kit/PDGF receptor tyrosine kinase inhibitor, improves disease control in severe corticosteroid-dependent asthmatics. Allergy 2009;64(:1194-201.
je pars a la recherche du lien
Message complété le 07/01/2014 18:05:22 par son auteur.
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Message complété le 07/01/2014 17:43:25 par son auteur.
on s'est barré de bourso car on y'est censuré dans la minute.
on derange dans nos analyses et nos contenus car le ver est dans la pomme laba et il a tres tres faim
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Message complété le 07/01/2014 17:37:18 par son auteur.
Oh Bouli tu vas trop vite pour moi....
Message complété le 07/01/2014 17:40:55 par son auteur.
Et Greg Pépin est plus jeune que toi.
Mais il est Suisse, c'est plus facile pour bosser dans la finances.
Cela dit, vu qu'il semble avoir renforcé pour son fond le 20 ou 21 novembre, il doit quand même serrer les fesses en ce moment. Heureusement qu'il a eu un parcours inverse avec OXBT.
Et puis un gars qui suit le PSG ne peut pas être parfait. Hein, marseillais ?
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Message complété le 07/01/2014 17:34:53 par son auteur.
donc pour la partie sur les impuretés :
- Un problème sur la notion d'impureté :
J'ai cru comprendre que de nombreuses idées reçues ont été écrites à ce sujet. Tout d'abord, il faut savoir que au dernières nouvelles AB science produit son médicament en Allemagne de mémoire et non en Chine ou un quelconque pays exotique. Ensuite, en générale lorsque les autorités évoquent la notion d'impureté il s'agit juste dans le cadre de méthodologie de calcul pour savoir quand est ce que les impuretés du principe actif (qui vit sur la durée du médicament) atteint un niveau supérieur au seuil de tolérance (et donc devient impropre à la consommation). En d'autres termes, quel est la méthode de calcul pour retenir une date de péremption du produit. Ceci ne devient un problème que lorsque le produit sera commercialisé donc on peut toujours voir le silver lining derrière cette remarque : l'EMA a donc considéré l'autorisation pour avoir évoqué la méthodologie de calcul de l'impureté pour la date de péremption. Ensuite ceci est donc à mon avis qu'un détail puisqu'il s'agit juste de définir proprement la bonne date de péremption en cas d'autorisation. Je ne pense pas que ce soit même un élément matériel qui puisse empêcher une autorisation (que ce soit le GIST, le pancréas ou d'autres).
En résumé, je pense que les arguments en réponse aux objections de l'EMA sont totalement raisonnables et de qualités. De quoi avoir une relative confiance en un possible succès de l'appel et au pire ceci ne remet en aucun cas en cause la réussite à moyen terme dans le GIST (contrairement aux aneries de l'analyste de SocGen mais passons) bien au contraire.
Bref je voulais juste donner une perspective sérieuse des moyens de réponses à mon sens de AB science face à l'appel à venir.
Je pense qu'AB Science peut convaincre les autorités par rapport à leur profil de safety vis à vis d'un sutent très toxique et une efficacité au pire similaire (au vue de la variable PFS) et au mieux significativement meilleur (si la variable survie rentre une nouvelle fois en ligne de compte pour les experts).
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Forum de discussion Ab Science
201401081143 384196