Lilly (LLY) Updates on EXPEDITION in Alzheimer's; Slowing Observed in Pooled Analysis
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Eli Lilly and Company (NYSE: LLY) announced its detailed results for the Phase 3, double-blind, placebo-controlled EXPEDITION studies in patients with mild-to-moderate Alzheimer's disease. This announcement follows the presentation of results from independent analyses of the EXPEDITION study data conducted by the Alzheimer's Disease Cooperative Study (ADCS), an academic research consortium, at the annual meeting of the American Neurological Association (ANA) by Rachelle Doody, M.D., Ph.D., professor of Neurology and the Effie Marie Cain Chair in Alzheimer's Disease Research, Baylor College of Medicine. Dr. Doody is a member of the steering committee for the ADCS.
Lilly provided the raw data (the full data set collected from the EXPEDITION studies) to the ADCS. The ADCS statisticians then performed independent analyses of these data. These results were presented at today's meeting.
Lilly Results from EXPEDITION1
The EXPEDITION1 study was designed with co-primary cognitive and functional endpoints (the Alzheimer's Disease Assessment Scale- Cognitive subscale [ADAS-Cog11] and the Alzheimer's Disease Cooperative Study-Activities of Daily Living [ADCS-ADL], respectively) in patients with mild-to-moderate Alzeimer's disease.
Lilly's pre-specified secondary analyses showed that results in patients with mild Alzheimer's disease taking solanezumab demonstrated a slowing of cognitive decline compared with placebo (p=.008), as measured by the ADAS- Cog11. This finding represented a 42 percent reduction in decline at the endpoint of the 18-month study. The difference in functional decline (ADCS-ADL) was not statistically significant.
Lilly Results from EXPEDITION2
Based on the results of EXPEDITION1, Lilly modified the statistical analysis plan (SAP) for EXPEDITION2, prior to database lock, to specify a single primary endpoint of cognition in patients with mild Alzheimer's disease as measured by the ADAS-Cog14, a 14-item scale, which includes three additional items considered relevant for patients with mild Alzheimer's disease.1 At the conclusion of EXPEDITION2, there was a 20 percent reduction in cognitive decline in patients with mild Alzheimer's disease taking solanezumab; however, the treatment difference was not statistically significant (p=.120). In the pre-specified secondary endpoint of ADCS-ADL, there was a 19 percent reduction in functional decline in patients with mild Alzheimer's disease treated with solanezumab, as compared with placebo; this difference was not statistically significant (p=.076).
Lilly Results from Pooled Analyses of EXPEDITION1 and EXPEDITION2
A pre-specified secondary analysis of pooled data in patients with mild Alzheimer's disease showed a slowing of cognitive decline (p=.001) compared with placebo, as measured by the ADAS-Cog14; this finding represented a 34 percent reduction in decline. In addition, the secondary analysis of the pooled data in patients with mild Alzheimer's disease showed a 17 percent reduction of functional decline as measured by the ADCS-ADL; however, the treatment difference was not statistically significant compared with placebo (p=.057).
A number of different biomarkers were assessed in the EXPEDITION studies. Some, but not all, of these biomarkers showed an effect of solanezumab. These additional data will be presented by the ADCS at the Clinical Trials on Alzheimer's Disease (CTAD) meeting in Monte Carlo, Monaco, on October 29, 2012, or at subsequent medical meetings and in appropriate scientific venues.
In the EXPEDITION studies, the only adverse event with an incidence of at least 1 percent that occurred statistically significantly more in the solanezumab group than in the placebo group was angina (1.1 percent versus 0.2 percent). The incidence of vasogenic edema (ARIA-E) was approximately 1 percent, occurring in 11 patients treated with solanezumab and 5 patients on placebo, which was not statistically significant.
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Lilly provided the raw data (the full data set collected from the EXPEDITION studies) to the ADCS. The ADCS statisticians then performed independent analyses of these data. These results were presented at today's meeting.
Lilly Results from EXPEDITION1
The EXPEDITION1 study was designed with co-primary cognitive and functional endpoints (the Alzheimer's Disease Assessment Scale- Cognitive subscale [ADAS-Cog11] and the Alzheimer's Disease Cooperative Study-Activities of Daily Living [ADCS-ADL], respectively) in patients with mild-to-moderate Alzeimer's disease.
Lilly's pre-specified secondary analyses showed that results in patients with mild Alzheimer's disease taking solanezumab demonstrated a slowing of cognitive decline compared with placebo (p=.008), as measured by the ADAS- Cog11. This finding represented a 42 percent reduction in decline at the endpoint of the 18-month study. The difference in functional decline (ADCS-ADL) was not statistically significant.
Lilly Results from EXPEDITION2
Based on the results of EXPEDITION1, Lilly modified the statistical analysis plan (SAP) for EXPEDITION2, prior to database lock, to specify a single primary endpoint of cognition in patients with mild Alzheimer's disease as measured by the ADAS-Cog14, a 14-item scale, which includes three additional items considered relevant for patients with mild Alzheimer's disease.1 At the conclusion of EXPEDITION2, there was a 20 percent reduction in cognitive decline in patients with mild Alzheimer's disease taking solanezumab; however, the treatment difference was not statistically significant (p=.120). In the pre-specified secondary endpoint of ADCS-ADL, there was a 19 percent reduction in functional decline in patients with mild Alzheimer's disease treated with solanezumab, as compared with placebo; this difference was not statistically significant (p=.076).
Lilly Results from Pooled Analyses of EXPEDITION1 and EXPEDITION2
A pre-specified secondary analysis of pooled data in patients with mild Alzheimer's disease showed a slowing of cognitive decline (p=.001) compared with placebo, as measured by the ADAS-Cog14; this finding represented a 34 percent reduction in decline. In addition, the secondary analysis of the pooled data in patients with mild Alzheimer's disease showed a 17 percent reduction of functional decline as measured by the ADCS-ADL; however, the treatment difference was not statistically significant compared with placebo (p=.057).
A number of different biomarkers were assessed in the EXPEDITION studies. Some, but not all, of these biomarkers showed an effect of solanezumab. These additional data will be presented by the ADCS at the Clinical Trials on Alzheimer's Disease (CTAD) meeting in Monte Carlo, Monaco, on October 29, 2012, or at subsequent medical meetings and in appropriate scientific venues.
In the EXPEDITION studies, the only adverse event with an incidence of at least 1 percent that occurred statistically significantly more in the solanezumab group than in the placebo group was angina (1.1 percent versus 0.2 percent). The incidence of vasogenic edema (ARIA-E) was approximately 1 percent, occurring in 11 patients treated with solanezumab and 5 patients on placebo, which was not statistically significant.
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