Novartis drug Signifor® LAR recommended by CHMP for EU approval to treat patients with rare hormonal disorder acromegaly

Novartis drug Signifor® LAR recommended by CHMP for EU approval to treat patients with rare hormonal disorder acromegaly

Acromegaly is an endocrine disorder caused by elevated growth hormone (GH) and insulin-like growth factor-1 (IGF-1) levels[1]

Signifor LAR (pasireotide) represents a potential new option for acromegaly patients lacking disease control, as measured by both GH and IGF-1 levels[2]

Positive CHMP opinion marks critical milestone for Signifor LAR in acromegaly; worldwide regulatory filings are under review by health authorities

Basel, September 26, 2014 - The Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA) adopted a positive opinion for Signifor® (pasireotide) long acting release (LAR) formulation to treat adult patients with acromegaly for whom surgery is not an option or has not been curative and who are inadequately controlled on treatment with a first-generation somatostatin analogue (SSA)[2]. If approved in the EU, this next-generation SSA could fill a current unmet need, providing a new therapeutic option for the approximately 45% of acromegaly patients whose growth hormone (GH) or insulin-like growth factor-1 (IGF-1) levels remain inadequately controlled despite treatment with currently available SSAs[2],[3].

Affecting an estimated one to two patients per 10,000 people in the EU, acromegaly is a rare, debilitating endocrine disorder caused by the excess production of GH and IGF-1[1],[4]. The disease is caused by a non-cancerous tumor in the pituitary gland[1]. Prolonged exposure to excess GH and IGF-1 may cause patients to experience extreme physical changes including the enlargement of hands, feet, facial features, and internal organs as well as serious health consequences such as heart disease, diabetes and an increased risk of death[1].

"This positive CHMP opinion for Signifor LAR formulation represents a significant step towards our goal of being able to offer adult patients with inadequately controlled acromegaly in the EU a much-needed alternative treatment option," said Alessandro Riva, MD, Global Head, Novartis Oncology Development and Medical Affairs. "Our continued investment in acromegaly research reflects the strong commitment Novartis has to the pituitary community as we work to help address unmet medical needs and ensure that patients receive the best therapeutic options for individualized care."

In the EU, the European Commission generally follows the recommendations of the CHMP and delivers its final decision within three months of the CHMP recommendation. The decision will be applicable to all 27 EU member states plus Iceland and Norway. In the EU, Signifor LAR formulation has orphan drug designation for acromegaly[5]. Orphan drugs are those that treat a condition which affects no more than five in 10,000 people in the EU[6]. Global regulatory applications for Signifor LAR in acromegaly are currently ongoing, and further regulatory filings are under review by health authorities.

The CHMP recommendation was based on two multicenter Phase III studies, C2402 and C2305. Both studies showed Signifor LAR formulation to have superior efficacy in providing biochemical control, as measured by both GH and IGF-1 levels, compared to a first generation SSA. The incidence and severity of adverse events was similar to other SSAs, except for a higher frequency and degree of hyperglycemia-related adverse events with Signifor LAR formulation[2]. Results of the C2402 study were published recently in The Lancet Diabetes & Endocrinology[7].

About study C2402

The Phase III multicenter, randomized, three-arm, parallel-group study C2402 evaluated the efficacy and safety of double-blind pasireotide LAR 40 mg and 60 mg versus maximal doses of Sandostatin LAR or Somatuline Autogel* in patients with inadequately controlled acromegaly treated for at least 6 months with first generation SSAs. The primary efficacy objective was to compare the proportion of patients achieving biochemical control (defined as mean GH levels <2.5 Mu g/L and normalization of sex- and age-adjusted IGF-1) with pasireotide LAR formulation, 40 and 60 mg, separately, versus active control represented by Sandostatin LAR and Somatuline Autogel. The primary endpoint was met in both pasireotide LAR dose groups with 15.4% (P=.0006) and 20.0% (P<.0001) of patients receiving pasireotide LAR 40 mg and 60 mg achieving biochemical control, respectively, compared with zero in the active control arm. In patients treated with pasireotide LAR formulation in whom reductions in GH and IGF-1 were observed, these changes occurred during the first 3 months of treatment and were maintained at week 24. A higher proportion of patients on pasireotide LAR formulation (18.5% and 10.8% for 40 and 60 mg, respectively) achieved a reduction in tumor volume of at least 25% versus 1.5% on active control[2].

The most common adverse reactions observed (frequency >=20%) in either of the pasireotide LAR formulation arms were hyperglycemia and diabetes mellitus. Common Toxicity Criteria (CTC) Grade 3 and 4 adverse reactions were mostly related to hyperglycemia[2].

About study C2305

In the Phase III multicenter, randomized and blinded study, medical treatment naïve patients with active acromegaly received either pasireotide LAR formulation (starting dose of 40 mg with possibility to up titrate to 60 mg) or Sandostatin LAR (starting dose of 20 mg with possibility to up titrate to 30 mg) for 12 months. Medical treatment naïve patients enrolled in the trial included those who were post-surgery, or newly diagnosed patients for whom surgery was contraindicated. The primary endpoint was met, showing superiority of pasireotide LAR formulation over Sandostatin LAR in providing biochemical control, as defined by the proportion of patients with a reduction of mean GH level to <2.5 Mu g/l and the normalization of IGF-1 to within normal limits. Specifically, 31.3% and 19.2% of patients achieved biochemical control on pasireotide LAR formulation and Sandostatin LAR, respectively, demonstrating a statistically significant superior result that favored Signifor LAR formulation (P=.007). In addition, 80.8% of patients achieved a tumor volume reduction greater than 20% with Signifor LAR formulation compared with 77.4% with Sandostatin LAR[2].

The most common adverse reactions observed (frequency >=20%) with the pasireotide LAR formulation were diarrhea, cholelithiasis, hyperglycemia and diabetes mellitus. Common Toxicity Criteria (CTC) Grade 3 and 4 adverse reactions were mostly related to hyperglycemia[2].

About acromegaly

Worldwide, the prevalence of acromegaly is estimated to be 60 cases per million, with an annual incidence of 3 to 4 new cases per million[1]. However, recent studies suggest that pituitary adenomas may be more prevalent than previously thought, and that the prevalence of acromegaly may be between 115 and 295 cases per million globally. Acromegaly most commonly presents in middle-aged men and women[8]. This debilitating disease can be difficult to detect because it can develop gradually and/or individual symptoms may be mistaken for another medical condition, with the average delay from disease onset to diagnosis between 6 to 10 years[1],[9]. Acromegaly is also associated with two- to three-fold increased mortality rates and serious health complications, including heart disease, hypertension, diabetes, arthritis and colon cancer[2],[10],[11]. In fact, heart disease is responsible for approximately 60% of deaths among people with acromegaly[12].

About Signifor LAR formulation

Signifor LAR formulation is available for patients with acromegaly through carefully controlled and monitored clinical trials which are designed to better understand the potential benefits and risks of the compound. For various reasons, including the uncertainty of clinical trials, there is no guarantee that Signifor LAR formulation will become commercially available for acromegaly or any other indication.

Important safety information about Signifor (pasireotide) injection

Signifor is contraindicated in patients with severe hepatic impairment (Child Pugh C).

Hyperglycemia and diabetes occurs with initiation of Signifor therapy. Acromegaly patients with poor glycemic control (as defined by hemoglobin A1c (HbA1c) values >8% while receiving anti-diabetic therapy) may be at a higher risk of developing severe hyperglycemia and associated complications, e.g., ketoacidosis. Intensive glucose monitoring is recommended and may require initiation or adjustment of anti-diabetic treatment. 

Treatment with Signifor may lead to bradycardia and QT prolongation. Caution should be used in at-risk patients. ECG testing is recommended prior to dosing and during treatment. Hypokalemia and hypomagnesemia must be corrected prior to Signifor administration and should be monitored periodically during therapy.

Mild transient elevations in aminotransferases are commonly observed in patients treated with pasireotide. Liver tests are recommended prior to and after the first 2 to 3 weeks on treatment, then monthly for 3 months, and as clinically indicated thereafter.

Cholelithiasis is associated with Signifor. Gallbladder ultrasounds should be performed before and at 6- to 12- month intervals.

Inhibition of pituitary hormones may occur with Signifor treatment. Monitoring of pituitary function should occur prior to initiation of therapy and periodically during treatment with Signifor.

Treatment with Signifor may lead to a decrease in circulating levels of cortisol resulting in biochemical and/or clinical hypocortisolism. Signifor dose of reduction or interruption and/or adding low-dose short-term glucocorticoid therapy may be necessary.

Caution is required when co-administering Signifor with anti-arrhythmics and drugs that prolong QT. The following drugs may require monitoring and possible dose adjustments when used with Signifor: cyclosporine, bromocriptine.

The most common adverse reactions (>=10%) occurring in patients in acromegaly clinical trials are hyperglycemia, diabetes mellitus, diarrhea, abdominal pain, cholelithiasis and alopecia.


Please see full Prescribing Information at

About Sandostatin LAR

Sandostatin LAR, a long-acting, injectable depot formulation of octreotide acetate, is approved in the EU for Treatment of patients with acromegaly in whom surgery is inappropriate or ineffective, or in the interim period until radiotherapy becomes fully effective as per recently finalized label harmonization. In the US, Sandostatin LAR is available as Sandostatin® LAR® Depot for long-term maintenance therapy in patients with acromegaly who have had an inadequate response to surgery and/or radiotherapy, or for whom surgery and/or radiotherapy is not an option. The goal of treatment in acromegaly is to reduce GH and IGF-1 levels to normal. Outside the EU and US, acromegaly indications vary by country.

Sandostatin LAR is available from Novartis for different uses and not all indications are available in every country.

Important safety information about Sandostatin LAR (octreotide/IM injection)

Treatment with Sandostatin LAR may affect gallbladder function, sugar metabolism, thyroid and heart function and nutritional absorption, which may require monitoring.

Caution is to be exercised for those with a history of heart disease or taking other medications, including cyclosporine, insulin, oral hypoglycemic agents, beta-blockers and bromocriptine.

Common side effects include diarrhea, gallstones, abdominal pain and flatulence.

Please see full Prescribing Information at

The foregoing release contains forward-looking statements that can be identified by words such as "recommended," "potential," "under review," "positive opinion," "could," "goal," "continued," "commitment," "will," "ongoing," "recommendation," "suggest," "may," or similar terms, or by express or implied discussions regarding potential new indications or labeling for Signifor LAR, or regarding potential future revenues from Signifor LAR or Sandostatin LAR. You should not place undue reliance on these statements. Such forward-looking statements are based on the current beliefs and expectations of management regarding future events, and are subject to significant known and unknown risks and uncertainties. Should one or more of these risks or uncertainties materialize, or should underlying assumptions prove incorrect, actual results may vary materially from those set forth in the forward-looking statements. There can be no guarantee that Signifor LAR will be submitted or approved for any additional indications or labeling in any market, or at any particular time. Nor can there be any guarantee that Signifor LAR or Sandostatin LAR will be commercially successful in the future. In particular, management's expectations regarding Signifor LAR and Sandostatin LAR could be affected by, among other things, the uncertainties inherent in research and development, including unexpected clinical trial results and additional analysis of existing clinical data; unexpected regulatory actions or delays or government regulation generally; the company's ability to obtain or maintain proprietary intellectual property protection; general economic and industry conditions; global trends toward health care cost containment, including ongoing pricing pressures; unexpected manufacturing issues, and other risks and factors referred to in Novartis AG's current Form 20-F on file with the US Securities and Exchange Commission. Novartis is providing the information in this press release as of this date and does not undertake any obligation to update any forward-looking statements contained in this press release as a result of new information, future events or otherwise.

About Novartis

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[1] Acromegaly. National Institutes of Health. National Institute of Diabetes and Digestive and Kidney Diseases. 2008 May; 8(3924): 1-10.

[2] Signifor® (pasireotide LAR) Summary of Product Characteristics. Basel, Switzerland: Novartis Pharma AG; September 2014.

[3] Carmichael J.D. et al. Acromegaly Clinical Trial Methodology Impact on Reported Biochemical Efficacy Rates of Somatostatin Receptor Ligan Treatments - a Meta-analysis. J Clin Endocrin Metab. 2014; 99:1825-1833.

[4] RI Health Solutions. "Epidemiology Report for an Orphan Drug Application in the European Union." 2012: 1-17.

[5] European Medicines Agency. "Orphan Designation." Available at: Accessed September 2014.

[6] European Medicines Agency. "Public Summary of Positive Opinion of Orphan Designation of Pasireotide for the Treatment of Acromegaly." Available at: Accessed September 2014.

[7] Gadelha M.R. et al. Superior Efficacy of Pasireotide Versus Continued Treatment with Octreotide or Lanreotide in Patients with Inadequately Controlled Acromegaly: Randomized, Prospective, Phase III Study. The Lancet Diabetes & Endocrinology. 2014 September;

[8] Rosario P.W. Frequency of Acromegaly in Adults with Diabetes or Glucose Intolerance and Estimated Prevalence in the General Population. Pituitary. 2011; 14: 217-221.

[9] Schneider H et al. A Novel Approach to the Detection of Acromegaly: Accuracy of Diagnosis by Automatic Face Classification. J Clin Endocrin Metab. 2011; 96: 2074-2080.

[10] Holdaway M et al. Factors Influencing Mortality in Acromegaly. J Clin Endocrin Metab. 2004; 89(2): 667-674.

[11] Holdaway I.M. et al. A Meta-Analysis of the Effect of Lowering Serum Levels of GH and IGF-1 on Mortality in Acromegaly. European Journal of Endocrinology. 2009; 159: 89-95.

[12] Colao, et. al. Systemic Complications of Acromegaly: Epidemiology, Pathogenesis, and Management. Endocrine Reviews. 2004; 25:102-152.


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*Lanreotide Autogel (Somatuline®Autogel®) is a registered trademark of Ipsen.