Network meta-analysis for indirect comparison of lanadelumab and berotralstat for the treatment of hereditary angioedema
Publication: Journal of Comparative Effectiveness Research
Abstract
Aim: With no head-to-head studies comparing the effectiveness of lanadelumab and berotralstat for prevention of hereditary angioedema (HAE) attacks, this network meta-analysis (NMA) aimed to indirectly compare the effectiveness of these treatments. Materials & methods: The NMA, using the published data from Phase III trials, was performed using a frequentist weighted regression-based approach following Rücker et al. Efficacy outcomes of interest were HAE attack rate per 28 days and ≥90% reduction in monthly HAE attacks. Results & conclusion: In this NMA, lanadelumab 300 mg administered every 2 weeks or every 4 weeks was associated with statistically significantly higher effectiveness versus berotralstat 150 mg once daily (q.d.) or 110 mg q.d. for both efficacy outcomes assessed.
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References
Papers of special note have been highlighted as: • of interest; •• of considerable interest
1.
Bernstein JA. Severity of hereditary angioedema, prevalence, and diagnostic considerations. Am. J. Manag. Care 24(Suppl. 14), S292–S298 (2018).
2.
Busse PJ, Christiansen SC. Hereditary angioedema. N. Engl. J. Med. 382(12), 1136–1148 (2020).
3.
Busse P, Kaplan A. Specific targeting of plasma kallikrein for treatment of hereditary angioedema: a revolutionary decade. J. Allergy Clin. Immunol. Pract. 10(3), 716–722 (2022).
4.
Banerji A, Davis KH, Brown TM et al. Patient-reported burden of hereditary angioedema: findings from a patient survey in the United States. Ann. Allergy Asthma Immunol. 124(6), 600–607 (2020).
5.
Mendivil J, Murphy R, de la Cruz M et al. Clinical characteristics and burden of illness in patients with hereditary angioedema: findings from a multinational patient survey. Orphanet. J. Rare Dis. 16(1), 94 (2021).
6.
Kaplan AP, Joseph K. Pathogenesis of hereditary angioedema: the role of the bradykinin-forming cascade. Immunol. Allergy Clin. North Am. 37(3), 513–525 (2017).
7.
Maurer M, Magerl M, Betschel S et al. The international WAO/EAACI guideline for the management of hereditary angioedema-the 2021 revision and update. Allergy 77(7), 1961–1990 (2022).
• The most recent international guidelines on the management of hereditary angioedema.
8.
Busse PJ, Christiansen SC, Riedl MA et al. US HAEA Medical Advisory Board 2020 guidelines for the management of hereditary angioedema. J. Allergy Clin. Immunol. Pract. 9(1), 132–150.e3 (2021).
9.
Betschel S, Badiou J, Binkley K et al. The international/Canadian hereditary angioedema guideline. Allergy Asthma Clin. Immunol. 15, 72 (2019).
10.
Kenniston JA, Faucette RR, Martik D et al. Inhibition of plasma kallikrein by a highly specific active site blocking antibody. J. Biol. Chem. 289(34), 23596–23608 (2014).
11.
Takeda Pharmaceuticals International AG Ireland Branch. Summary of product characteristics. Takhzyro, INN-lanadelumab. (2023). https://www.ema.europa.eu/en/documents/product-information/takhzyro-epar-product-information_en.pdf
12.
Takeda Pharmaceutical Company Limited. Highlights of prescribing information. TAKHZYRO® (lanadelumab-flyo) injection, for subcutaneous use. (2023). https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/761090s010lbl.pdf
13.
Banerji A, Riedl MA, Bernstein JA et al. HELP Investigators. Effect of lanadelumab compared with placebo on prevention of hereditary angioedema attacks: a randomized clinical trial. J. Am. Med. Assoc. 320(20), 2108–2121 (2018).
•• The primary manuscript reporting results from the HELP study.
14.
Hwang JR, Hwang G, Johri A, Craig T. Oral plasma kallikrein inhibitor BCX7353 for treatment of hereditary angioedema. Immunotherapy 11(17), 1439–1444 (2019).
15.
BioCryst Pharmaceuticals, Inc. Highlights of prescribing information. Orladeyo™ (berotralstat) capsules, for oral use. (2023). https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/214094s000lbl.pdf
16.
BioCryst Ireland Limited. Summary of product characteristics. Orladeyo, berotralstat. (2023). https://www.ema.europa.eu/en/documents/product-information/orladeyo-epar-product-information_en.pdf
17.
Zuraw B, Lumry WR, Johnston DT et al. Oral once-daily berotralstat for the prevention of hereditary angioedema attacks: a randomized, double-blind, placebo-controlled Phase III trial. J. Allergy Clin. Immunol. 148(1), 164–172.e9 (2021).
•• The primary manuscript reporting results from the APeX-2 study.
18.
Takeda Manufacturing Austria AG. Summary of product characteristics. Cinryze, INN-Human C1-esterase inhibitor. (2023). https://www.ema.europa.eu/en/documents/product-information/cinryze-epar-product-information_en.pdf
19.
Takeda Pharmaceuticals U.S.A. Inc. Highlights of prescribing information. CINRYZE (C1 Esterase Inhibitor [Human]) for intravenous use, freeze-dried powder for reconstitution. (2023). https://www.fda.gov/media/75907/download
20.
Zuraw BL, Busse PJ, White M et al. Nanofiltered C1 inhibitor concentrate for treatment of hereditary angioedema. N. Engl. J. Med. 363(6), 513–522 (2010).
21.
Jansen JP, Fleurence R, Devine B et al. Interpreting indirect treatment comparisons and network meta-analysis for health-care decision making: report of the ISPOR task force on indirect treatment comparisons good research practices: part 1. Value Health 14(4), 417–428 (2011).
• An introduction to network meta-analyses.
22.
Song F, Altman DG, Glenny AM, Deeks JJ. Validity of indirect comparison for estimating efficacy of competing interventions: empirical evidence from published meta-analyses. Brit. Med. J. 326(7387), 472 (2003).
23.
Mendivil J, Malmenäs M, Haeussler K, Hunger M, Jain G, Devercelli G. Indirect comparison of lanadelumab and intravenous C1-INH using data from the HELP and CHANGE studies: bayesian and frequentist analyses. Drugs R D 21(1), 113–121 (2021).
• Reports indirect treatment comparison between lanadelumab and C1-INH for the long-term prophylaxis of hereditary angioedema attacks.
24.
Rücker G. Network meta-analysis, electrical networks and graph theory. Res. Synth. Methods 3(4), 312–324 (2012).
•• Methodology paper describes the approach to network meta-analysis used in this analysis.
25.
Bucher HC, Guyatt GH, Griffith LE, Walter SD. The results of direct and indirect treatment comparisons in meta-analysis of randomized controlled trials. J. Clin. Epidemiol. 50(6), 683–691 (1997).
26.
Banerji A, Busse P, Shennak M et al. Inhibiting plasma kallikrein for hereditary angioedema prophylaxis. N. Engl. J. Med. 376(8), 717–728 (2017).
27.
Rücker G, Krahn U, König J et al. Package ‘Netmeta’. Network Meta-Analysis Using Frequentist Methods. Springer (2022).https://cran.r-project.org/web/packages/netmeta/netmeta.pdf
28.
Wedner HJ, Aygören-Pürsün E, Bernstein J et al. Randomized trial of the efficacy and safety of berotralstat (BCX7353) as an oral prophylactic therapy for hereditary angioedema: results of APeX-2 through 48 weeks (part 2). J. Allergy Clin. Immunol. Pract. 9(6), 2305–2314.e4 (2021).
29.
Cochrane. Chapter 10: analyzing data and undertaking meta-analyses. In: Cochrane Handbook for Systematic Reviews of Interventions, Version 6.3. Deeks JJ, Higgins JPT, Altman DG (Eds). John Wiley & Sons, Chichester, UK (2022).
30.
Day S, Jonker AH, Lau LPL et al. Recommendations for the design of small population clinical trials. Orphanet J. Rare Dis. 13(1), 195 (2018).
31.
Banerji A, Bernstein JA, Johnston DT et al. Long-term prevention of hereditary angioedema attacks with lanadelumab: The HELP OLE Study. Allergy 77(3), 979–990 (2022).
32.
Kinaciyan T, Sheridan WP, Desai B, Tomita D, Panovska VG. P053 Sustained reduction in hereditary angioedema (HAE) attack rates following switch to berotralstat: subgroup analysis from APeX-2. Ann. Allergy Asthma Immunol. 127(Suppl. 5), S29 (2021).
33.
Lumry WR, Miller DP, Newcomer S, Fitts D, Dayno J. Quality of life in patients with hereditary angioedema receiving therapy for routine prevention of attacks. Allergy Asthma Proc. 35(5), 371–376 (2014).
34.
Bernstein JA, Li HH, Craig TJ et al. Indirect comparison of intravenous vs. subcutaneous C1-inhibitor placebo-controlled trials for routine prevention of hereditary angioedema attacks. Allergy Asthma Clin Immunol 15, 13 (2019).
35.
European Medicines Agency Committee for Medicinal Products for Human Use (CHMP). TAKHZYRO: EPAR – Public Assessment Report European Medicines Agency (2018). https://www.ema.europa.eu/en/documents/assessment-report/takhzyro-epar-public-assessment-report_en.pdf
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© 2023 Takeda Pharmaceuticals International AG. This work is licensed under the Attribution-NonCommercial-NoDerivatives 4.0 Unported License
History
Received: 31 October 2022
Accepted: 31 March 2023
Published online: 23 May 2023
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Takeda Development Center Americas, Inc.
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Network meta-analysis for indirect comparison of lanadelumab and berotralstat for the treatment of hereditary angioedema. (2023) Journal of Comparative Effectiveness Research. DOI: 10.57264/cer-2022-0188
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