Catalyst Pharmaceuticals announced top-line results from CMS-001, a Phase 3 study evaluating amifampridine phosphate for the symptomatic treatment of genetically confirmed Congenital Myasthenic Syndromes (CMS) in adults and children aged 2 years and above. The Company’s lead product, Firdapse® (amifampridine phosphate), is currently approved for the treatment of Lambert-Eaton Myasthenic Syndrome (LEMS) in adults, and amifampridine phosphate is being investigated for the treatment of CMS and other neuromuscular and neurological disease to support applications to FDA for these indications.
CMS-001 is the first ever double-blind, placebo-controlled, clinical trial conducted in genetically confirmed CMS patients. In the trial, 20 subjects were enrolled and 16 randomized, in a 2 period, 2 treatment crossover study designed to evaluate the efficacy and safety of amifampridine phosphate in patients (aged 2 years and above) diagnosed with certain genetic subtypes of CMS. While individual patient improvements were observed in some patient sub-groups, the trial did not meet its primary endpoint of subject global impression (SGI) or the secondary endpoint of muscle function measure (MFM) across all tested subtypes. Due to the rarity of CMS, this trial took almost 4 years to recruit.
“While we are disappointed that this trial did not reach its primary or secondary endpoints in the evaluated CMS patient subtypes, we are pleased with the new valuable clinical information that these results will provide to the medical and scientific communities as we work to develop FDA-approved treatment options for patients with this disease” said Patrick J. McEnany, Chairman and Chief Executive Officer of Catalyst Pharmaceuticals. “We also remain committed to developing FDA-approved treatment options for other rare neuromuscular disorders.”
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Catalyst is scheduled to meet with the FDA before the end of the year to discuss the outcome of this clinical trial, and potential paths forward to seek approval of amifampridine phosphate for the symptomatic treatment of some subset of genetic subtypes of CMS. After receiving additional guidance, Catalyst will provide future updates on its plans for this potential indication.
The Company also reports that it remains on track to complete enrollment in its clinical trial of amifampridine phosphate in patients with anti-MuSK antibody positive myasthenia gravis (MuSK-MG) before the end of this year, and to report top-line data from this trial in the first half of 2020. We also expect to report top-line results from our SMA Type-3 proof of concept study in the first half of 2020. Both of these diseases have a much more homogeneous patient population than CMS and should not present the same challenges.
“We have made significant progress in genetically testing patients who were unable to previously get diagnosed,” said Steven Miller, Ph.D., Chief Operating Officer and Chief Scientific Officer of Catalyst Pharmaceuticals. “Due to the small patient prevalence, the low number of patients tested, and heterogeneity of the disease with a wide range of variation in clinical presentation across its more than 50 subtypes, it was challenging to demonstrate a statistically significant benefit across multiple subtypes.”
Congenital myasthenic syndromes, or CMS, are rare neuromuscular disorders comprising a spectrum of more than 50 genetic defects with some of the various mutations having as few as a handful of diagnosed patients. CMS patients are characterized by fatigable weakness of skeletal muscles with onset at or shortly after birth or early childhood; in rare cases, symptoms may not manifest themselves until later in childhood. The severity and course of the genetic disease types are variable, ranging from minor symptoms to progressive disabling weakness; symptoms may be mild, but sudden severe exacerbations of weakness or even sudden episodes of respiratory insufficiency also occur.
CMS is rare. Catalyst estimates that there are between 1,000 and 1,500 CMS patients in the United States.
About 15% of Myasthenia Gravis, or MG, patients test negative for the acetylcholine receptor antibody, and about 40-50% of these "seronegative MG" patients are test positive for the MuSK-MG antibody and are identified as MuSK-MG patients, representing about 4,500 patients in the United States. MuSK is a protein that is required for the maintenance of the neuromuscular junction. MuSK-MG is a clinically distinguishable, more severe form of MG. The disease is characterized by a predominance in females, a prevalent involvement of cranial and bulbar muscles, high incidence of respiratory crises and a resistance to treatment. Although many patients with MuSK-MG are presently treated with anticholinesterase inhibitors or immunosuppressants, such patients do not generally respond adequately to these treatments.