Incyte has announced results from the Phase 3 DEVENT study evaluating the efficacy and safety of ruxolitinib (5mg and 15mg) plus standard of care (SoC) versus SoC in patients on mechanical ventilation with COVID-19 associated Acute Respiratory Distress Syndrome (ARDS), a type of respiratory failure characterised by rapid onset of widespread inflammation in the lungs.
While results indicate a trend towards an improvement in mortality in the overall study population (N=211), the DEVENT study did not meet its primary endpoint – mortality due to any cause through day 29—adjusted for ARDS severity between the two treatment arms versus placebo (55.2% vs. 74.3% [Odds Ratio (OR): 0.42 (95% CI: 0.171-1.023)], P=0.0280 in the 5mg arm and 51.8% vs. 69.6% [OR: 0.46 (95% CI: 0.201-1.028)], P=0.0292 in the 15mg arm). In the US study population (N=191), which accounts for the majority (91%) of the DEVENT study patients, there was a clinically and statistically significant improvement in mortality in each of the 5mg (46.7% vs. 69.1% [OR: 0.39 (95% CI: 0.157-0.948)], P=0.0189) and 15mg treatment arms (47.1% vs. 66.7% [OR: 0.43 (95% CI: 0.188-0.974)], P=0.0215) versus placebo, respectively.
Additionally, a post-hoc analysis of the overall study population pooling both the 5mg and 15mg ruxolitinib arms together versus placebo, showed a statistically significant improvement in mortality (53.6% vs. 70.7% [OR: 0.47 (95% CI: 0.219-0.996)], P=0.0244). More than half of study patients (55%) received remdesivir and 90% of study patients received corticosteroids prior to or during the study.
The safety profile was generally consistent with hospitalized patients with COVID-19 and consistent with treatment with ruxolitinib. The most common adverse events on the ruxolitinib arms, regardless of dose, compared to placebo were anaemia (20.7% vs. 22.2%), increased alanine aminotransferase (ALT, 14.6% vs. 13.3%), increased aspartate transaminase (AST, 14.0% vs. 8.9%) and hypertension (11.6% vs. 11.1%), respectively.
“There remains a significant unmet medical need for treatments that may potentially improve survival outcomes for patients suffering from severe COVID-19 related complications, specifically those requiring mechanical ventilation,” said Dr Steven Stein, chief medical officer, Incyte. “We hope the results of this study, and the potential utility of ruxolitinib for treatment of patients with severe COVID-19 associated ARDS, will contribute to the advances being made across the scientific community to alleviate the burden this pandemic has placed on patients, as well as the healthcare system. We look forward to discussing the results of the DEVENT study with regulatory authorities in the US.”
Given the urgent nature of the COVID-19 pandemic, Incyte plans to make ruxolitinib available to eligible patients in the US at no cost via an Expanded Access Programme (EAP) pending agreement with the US Food and Drug Administration. The protocol will allow eligible patients with severe COVID-19 associated ARDS with disease severity requiring mechanical ventilation to receive ruxolitinib.
At present, there is ample commercial and clinical supply of ruxolitinib in the US to meet the needs of US patients receiving ruxolitinib in its approved indications and those participating in clinical trials or the COVID-19 EAP.
About DEVENT (NCT04377620) Trial
A Phase 3 randomised, double-blind, placebo-controlled, multicentre clinical trial, the DEVENT study evaluated the efficacy and safety of ruxolitinib 5mg and 15mg plus standard of care (SoC) compared to SoC plus placebo in patients with COVID-19 associated acute respiratory distress syndrome (ARDS) on mechanical ventilation.
At initiation, the study aimed to enrol 500 patients; in December 2020, enrolment was stopped and the final analysis was conducted at the time of the planned interim analysis.
The primary endpoint of the study evaluated the mortality rate at day 29 of ruxolitinib 5mg twice daily (BID) plus SoC therapy and ruxolitinib 15mg BID plus SoC compared with placebo plus SoC, in participants with COVID-19 associated ARDS who required mechanical ventilation.
Secondary outcomes measures included number of days patients were ventilator free, did not receive supplemental oxygen, did not use vasopressor therapy, as well as the number of days patients were out of the hospital, clinical status at Day 15 and 29 using the COVID-19 ordinal scale, change in organ function or rate of failure (as measured by Sequential Organ Failure Assessment or SOFA Score) and safety.
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[link url="https://www.clinicaltrials.gov/ct2/show/NCT04377620"]DEVENT study details[/link]