ECE2021 Oral Communications Oral Communications 13: Pituitary and Neuroendocrinology (6 abstracts)
A Phase 3 Large International Noninferiority Trial (MPOWERED): Assessing Maintenance of Response to Oral Octreotide Capsules in Comparison to Injectable Somatostatin Receptor Ligands
Maria Fleseriu 2 , Alexander V. Dreval 3 , Yulia Pokramovich 3 , Irina Bondar 4 , Elena Isaeva 5 , Mark E. Molitch 6 , Djuro P. Macut 7 , Nina Leonova 8 , Gerald Raverot 9 , Elena Grineva 10 , Yury E. Poteshkin 11 , Yossi Gilgun-Sherki 12 , William H. Ludlam 13 , Gary Patou 13 , Asi Haviv 12 , Murray B. Gordon 14 , Nienke Biermasz 15 , Shlomo K. Melmed 16 & Christian J. Strasburger 17
1Oregon Health & Science University, United States; 1Oregon Health & Science University, United States; 3M.F. Vladimirsky Moscow Regional Research Clinical Institute, Russian Federation; 4Novosibirsk State Medical University, Russian Federation; 5 Interregional Clinical Diagnostic Center, Russian Federation; 6Northwestern University Feinberg School of Medicine, United States; 7University of Belgrade, Serbia; 8Antrium Multidisciplinary Medical Clinic, Russian Federation; 9Hospices Civils de Lyon, France; 10Federal State Institution Federal Center of Heart, Blood and Endocrinology, Russian Federation; 11Pirogov Russian National Research Medical University, Russian Federation; 12Chiasma Inc., Israel; 13Chiasma Inc., United States; 14Allegheny General Hospital, United States; 15Leiden University Medical Center (LUMC), Netherlands; 16Cedars-Sinai Medical Center Heliport, United States; 17Charité–Campus Mitte (Berlin), Germany
Background
MPOWERED, a large phase 3 trial, assessed maintenance of response to oral octreotide capsules (OOC; MYCAPSSA) compared to injectable somatostatin receptor ligands (iSRLs) in patients with acromegaly who responded to OOC and iSRLs (octreotide or lanreotide). OOC were recently approved in the US for patients with acromegaly who responded to and tolerated iSRLs.
Methods
Eligibility criteria included age 18 – 75 years at screening, acromegaly diagnosis, disease evidence, biochemical control (insulin-like growth factor I [IGF-I] < 1.3 × upper limit of normal [ULN] and mean integrated growth hormone [GH] < 2.5 ng/ml) at screening, and ≥6 months’ iSRL treatment. Effective OOC dose was determined in a 26-week Run-in phase. Eligible patients (IGF-I < 1.3 × ULN and mean integrated GH < 2.5 ng/ml, week 24) were randomized to a 36-week controlled treatment phase (RCT), receiving OOC or iSRLs starting at week 26. The primary end point was a noninferiority assessment of proportion of patients biochemically controlled in the RCT (IGF-I < 1.3 × ULN using time-weighted average). Other end points included nonresponse imputation of the primary end point, landmark analysis using proportion of responders based on average of last 2 IGF-I values at end of RCT, and change from baseline RCT (week 26) IGF-I and GH levels.
Results
Of 146 enrolled patients, 92 entered the RCT (OOC, n = 55; iSRLs, n = 37). Both arms were well balanced for age, sex, and acromegaly duration. OOC demonstrated noninferiority to iSRLs in maintaining biochemical response, with 91% (CI, 80% – 97%) of OOC and 100% (CI, 91% – 100%) of iSRL groups maintaining control during the RCT. Of those responding at end of Run-in, 96% of patients on OOC maintained response during RCT. Using nonresponse imputation, 89% of OOC and 95% of iSRL groups were biochemically controlled in RCT. Landmark analysis of those responding at end of Run-in showed that 94% of patients in each group maintained response at RCT end. In both groups, IGF-I levels were stable in the RCT, average IGF-I at baseline and RCT end being 0.9 × ULN (OOC) and 0.8 × ULN (iSRL). Mean change in GH from RCT start to RCT end was -0.03 ng/ml (OOC) and +0.29 ng/ml (iSRL). Safety data were mostly similar between groups; the OOC group did not experience injection site reactions.
Conclusion
In this noninferiority trial in patients with acromegaly, OOC demonstrated maintenance of biochemical response compared to iSRLs. Results support the efficacy of OOC as a possible iSRL alternative.
Volume 73
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Endocrine Abstracts
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