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Prevention of Thromboembolism after Knee Replacement Surgery:
Rivaroxaban is First Oral Anticoagulant to Achieve Superior Efficacy over the Twice-Daily Injection of Enoxaparin while Maintaining Low Major Bleeding Rates / RECORD4 Confirms Results of RECORD1, 2 and 3 / U.S. Submission Planned for mid 2008 / Prof. Turpie: "Rivaroxaban has the potential to revolutionize the way we prevent the formation of dangerous blood clots"
Nice, May 30, 2008 - Phase III clinical trial results demonstrate that
rivaroxaban (Xarelto®), a one tablet/once-daily, oral investigational
anticoagulant, showed superior efficacy in preventing venous blood clots in
patients following total knee replacement (TKR), whilst maintaining low major
bleeding rates. The RECORD4 study compared rivaroxaban with the U.S.-approved
treatment regimen for injectable enoxaparin, a current standard of care.
Data from RECORD4 were presented today at the 9th Annual Meeting of the
European Federation of National Associations of Orthopaedics & Traumatology
(EFORT) in Nice, France. Rivaroxaban is being jointly developed by Bayer
HealthCare AG and Johnson & Johnson Pharmaceutical Research & Development,
L.L.C.
The RECORD4 data show that rivaroxaban (10mg tablet once-daily) provided TKR
surgery patients with a statistically significant reduction of total venous
thromboembolism (VTE) event rates over twice-daily injectable enoxaparin (6.9%
and 10.1%, respectively; p = 0.012). This corresponds to a 31% relative risk
reduction (RRR) over enoxaparin (30mg injection twice-daily). The rate of major
bleeding in the rivaroxaban-treated patients was low and not statistically
different to the rate of major bleeding in the enoxaparin-treated patients
(0.7% and 0.3%, respectively; p=0.110).
While the RECORD1, 2 and 3 studies compared rivaroxaban against enoxaparin 40
mg injected once-daily to reduce blood clots after major orthopaedic surgery,
RECORD4 is the first trial to evaluate rivaroxaban against enoxaparin 30 mg
injected subcutaneously twice-daily, which is the U.S. Food and Drug
Administration (FDA)-approved treatment regimen for enoxaparin. RECORD4
provides additional head-to-head trial evidence demonstrating superior efficacy
of rivaroxaban compared to enoxaparin together with a similar low rate of major
bleeding, and establishes rivaroxaban as the first oral anticoagulant to show
superiority over this regimen of enoxaparin.
"The superior efficacy and similar adverse event profile of rivaroxaban
demonstrated in RECORD4 are in line with the outstanding results of the earlier
RECORD studies," said Dr. A.G.G. Turpie, Professor of Medicine, McMaster
University, Canada and Principal Investigator for the RECORD program. "The
success of this trial strengthens my belief that direct Factor Xa inhibition
with rivaroxaban has the potential to revolutionize the way we prevent the
formation of dangerous blood clots."
RECORD4 is part of the RECORD program (REgulation of Coagulation in major
Orthopedic surgery reducing the Risk of DVT and PE), which involved more than
12,500 total hip or knee replacement surgery patients. The full RECORD data set
will be used to support the new drug application for rivaroxaban in the U.S.
which is planned for submission in mid 2008.
"We are very pleased that rivaroxaban has once again exceeded our
expectations", said Frank Misselwitz, MD, Head of Cardiovascular Development,
Bayer HealthCare AG. "RECORD4 is a testament to the outstanding, robust and
consistent results we have seen across the full RECORD program."
RECORD4 Study Details
RECORD4 compared rivaroxaban with enoxaparin for the prevention of VTE
following TKR surgery in 3,148 patients. Rivaroxaban (10mg tablet once-daily)
was administered
6-8 hours post surgery, compared to enoxaparin (30mg injection twice-daily)
which was administered 12-24 hours post surgery, in accordance with the
U.S.-approved regimen. The study demonstrated a 31% RRR in total VTE, the
primary endpoint of this trial (composite of deep vein thrombosis, non-fatal
pulmonary embolism and all-cause mortality), for patients treated with
rivaroxaban compared with those treated with enoxaparin (6.9% and 10.1%,
respectively; p=0.012). Event rates for secondary endpoints were consistently
lower in the rivaroxaban-treated patients, but did not reach statistical
significance.
Notes to editors:
Unmet Needs in Venous Thromboembolism (VTE)
In the EU, venous blood clots are associated with more than 1.5 million events
annually, and are responsible for killing 544,000 individuals each year - more
than breast cancer, prostate cancer, HIV/AIDS and road traffic accidents
combined.
VTE is a serious life-threatening condition. It includes deep vein thrombosis
(DVT) - a blood clot in a deep vein (usually in the leg) - and pulmonary
embolism (PE) - a blood clot in the lungs. These clots often break apart and
travel through the bloodstream, blocking blood flow to vital organs. During hip
or knee replacement procedures, the large veins of the leg that carry blood
back to the heart are damaged which significantly increases the VTE risk for
patients undergoing such major orthopedic surgery. In fact, venous blood clots
occur in 40-60% of patients undergoing major orthopedic surgery and not
receiving preventative care.
An estimated 815,000 hip replacement procedures were performed in the U.S. and
Europe in 2005, while the number of knee replacement procedures was estimated
to be 761,000. But the threat stretches beyond orthopedic surgeries: Blood
clots are one of the leading causes of global disease and death in many patient
populations, including those with atrial fibrillation at risk for stroke, those
at risk for acute myocardial infarction (heart attack) and acutely ill
hospitalized patients, such as those with cancer.
About the RECORD Study program
RECORD is a global program of clinical trials involving more than 12,500
patients, comparing rivaroxaban with injectable enoxaparin for the prevention
of VTE in patients undergoing either total knee or hip replacement surgery.
- In RECORD1, rivaroxaban demonstrated a 70% relative risk reduction (RRR) in
total VTE in patients undergoing total hip replacement (THR) surgery compared
with enoxaparin, with a similar safety profile. The duration of
thromboprophylaxis in both treatments was five weeks.
- In RECORD2, extended-duration rivaroxaban (35+/-4 days) demonstrated a 79%
RRR in total VTE and a similar rate of major bleeding in patients undergoing
THR surgery compared to patients dosed with short-duration therapy with
enoxaparin (10-14 days) followed by placebo.
- In RECORD3, rivaroxaban demonstrated a 49% RRR in total VTE in patients
undergoing total knee replacement (TKR) surgery compared to enoxaparin, with a
similar safety profile. Both treatments were dosed for 10-14 days.
- In RECORD4, 10mg once-daily rivaroxaban was compared to the U.S.-approved
regimen for enoxaparin of 30mg injected twice-daily. Rivaroxaban demonstrated a
31% RRR in total VTE in patients undergoing TKR surgery compared to enoxaparin,
with a similar safety profile. Both treatments were continued for 10-14 days.
About Rivaroxaban
Rivaroxaban is being jointly developed by Bayer HealthCare and Johnson &
Johnson Pharmaceutical Research & Development, L.L.C. The extensive clinical
trial program for rivaroxaban makes it the most studied oral, direct Factor Xa
inhibitor in the world today. Based on the clinical evidence in more than
20,000 patients, rivaroxaban has not been associated with compromised liver
function. A more definitive statement will be made once the data from long-term
exposure to rivaroxaban in the VTE treatment and stroke prevention in atrial
fibrillation (SPAF) programs is available. Almost 50,000 patients are expected
to be evaluated in the total clinical development program.
Bayer HealthCare submitted a regulatory filing to the European Agency for the
Evaluation of Medicinal Products (EMEA) at the end of October 2007 for approval
to market rivaroxaban in the EU for the prevention of VTE in patients
undergoing major orthopaedic surgery of the lower limbs. To date, the drug has
been filed in more than 10 countries, including Canada and China, and is also
expected to be filed for approval in the U.S. in mid 2008, where upon approval
it will be commercialized by Scios Inc. and Ortho-McNeil, Inc., both of which
are wholly-owned subsidiaries of Johnson & Johnson.
The trade name of rivaroxaban is expected to be Xarelto®, pending health
authority approval.
Please visit www.thrombosisadviser.com for more information on VTE.
About Bayer HealthCare
The Bayer Group is a global enterprise with core competencies in the fields of
health care, nutrition and high-tech materials. Bayer HealthCare, a subsidiary
of Bayer AG, is one of the world's leading, innovative companies in the
healthcare and medical products industry and is based in Leverkusen, Germany.
The company combines the global activities of the Animal Health, Consumer Care,
Diabetes Care and Pharmaceuticals divisions. The pharmaceuticals business
operates under the name Bayer Schering Pharma. Bayer HealthCare's aim is to
discover and manufacture products that will improve human and animal health
worldwide. Find more information at www.bayerhealthcare.com.
Bayer Schering Pharma is a worldwide leading specialty pharmaceutical company.
Its research and business activities are focused on the following areas:
Diagnostic Imaging, General Medicine, Specialty Medicine and Women's
Healthcare. With innovative products, Bayer Schering Pharma aims for leading
positions in specialized markets worldwide. Using new ideas, Bayer Schering
Pharma aims to make a contribution to medical progress and strives to improve
the quality of life. Find more information at www.bayerscheringpharma.de.