Actelion receives Health Canada approval of Opsumit (macitentan) for the long-term treatment of pulmonary arterial hypertension


Source: Marketwatch

ALLSCHWIL, SWITZERLAND - 12 NOVEMBER 2013 - Actelion Ltd (six:ATLN) announced today that Health Canada has granted a Notice of Compliance (NOC) approving the orally available endothelin receptor antagonist OpsumitTM (macitentan) 10 mg once daily for the treatment of pulmonary arterial hypertension (PAH).

Opsumit (macitentan) is indicated in Canada, for the long-term treatment of pulmonary arterial hypertension (PAH, WHO Group l) to reduce morbidity in patients of WHO Functional Class II or III whose PAH is either idiopathic or heritable, or associated with connective tissue disease or congenital heart disease.

Opsumit is effective when used as monotherapy or in combination with phosphodiesterase-5 inhibitors.

Dr. Sanjay Mehta, MD, FRCPC, FCCP, Professor of Medicine at Western University, Director of the Southwest Ontario Pulmonary Hypertension Clinic at the London Health Sciences Center in London, Ontario and Chair of the Pulmonary Hypertension Association of Canada commented: "This new study represents a critical milestone in the treatment of PAH patients. We now have a new standard of excellence for clinical trials in PAH and the strongest evidence ever of hope for long-term improved quality of life and clinical stability for those affected by PAH in Canada."

Dr Mehta, who was also a SERAPHIN investigator and co-author of the published article in the New England Journal of Medicine continued: "Five years ago, global and Canadian experts in PAH proposed that future PAH clinical studies should assess the effects of treatment on long-term morbidity and mortality, a clinically more important primary endpoint compared to all previous studies, which only looked at very short-term outcomes, such as the six minute walk test. Today, thanks to Opsumit, we now have an answer to this critical question of long-term benefits of PAH treatment on clinical outcomes important to patients."

Jean-Paul Clozel, M.D. and Chief Executive Officer of Actelion commented: "The approval by Health Canada for Opsumit is another milestone for Actelion. In just a few short weeks we have seen the approval of Opsumit in both the US and Canada along with the positive CHMP decision in Europe showing Actelion's efficiency and expertise in managing the submissions for Opsumit."

The most common adverse reactions observed with Opsumit (>3% compared to placebo) are nasopharyngitis, headache, anemia, bronchitis, urinary tract infection, pharyngitis and influenza.
It is recommended that hemoglobin concentrations are measured prior to initiation of treatment with Opsumit, again after one month, and periodically thereafter as clinically indicated. Liver enzyme tests should be obtained prior to initiation of Opsumit. Subsequently, monthly testing during the first year of treatment is recommended. They may then be repeated less frequently during treatment as clinically indicated.

Actelion expects Opsumitto become available to patients by early 2014 in Canada.
Actelion continues to work with other health authorities worldwide to obtain regulatory approval for Opsumit.
Pulmonary arterial hypertension (PAH) is a chronic, life-threatening disorder characterized by abnormally high blood pressure in the arteries between the heart and lungs of an affected individual. The symptoms of PAH are non-specific and can range from mild breathlessness and fatigue during normal daily activity to symptoms of right heart failure and severe restrictions on exercise capacity and ultimately reduced life expectancy.


Opsumit (macitentan) is a novel dual endothelin receptor antagonist (ERA) that resulted from a tailored drug discovery process with the target of developing an ERA to address efficacy and safety [1].
SERAPHIN (Study with an Endothelin Receptor Antagonist in Pulmonary arterial Hypertension to Improve cliNical outcome) was the largest and longest randomized, controlled study in PAH patients to include a clearly defined morbidity/mortality primary endpoint [2]. The pivotal Phase III study was designed to evaluate the efficacy and safety of Opsumit (macitentan) - a novel dual endothelin receptor antagonist that resulted from a tailored drug discovery process - through the primary endpoint of time to first morbidity and all-cause mortality event in patients with symptomatic PAH.
Global enrolment was completed in December 2009 with a total of 742 patients. Patients were randomized 1:1:1 to receive two different doses of macitentan (3 mg and 10 mg once daily) or placebo. Patients were allowed to receive PAH background therapy throughout the study, either PDE-5 inhibitors or oral/inhaled prostanoids. This event-driven study was conducted in 151 centers from almost 40 countries in North America, Latin America, Europe, Asia-Pacific and Africa and was completed in the first half of 2012, with 287 patients having an adjudicated event.
Patients were randomized to placebo (n=250), macitentan 3 mg (n=250), or macitentan 10 mg (n=242). The primary end point occurred in 46.4%, 38.0%, and 31.4% of the patients in these groups, respectively. The hazard ratio for macitentan 3 mg versus placebo was 0.70 (97.5% CI, 0.52 to 0.96; p=0.0108) and the hazard ratio for macitentan 10 mg versus placebo was 0.55 (97.5% CI, 0.39 to 0.76; p<0.0001). Worsening of pulmonary arterial hypertension was the most frequent primary end point event. The effect of macitentan on this end point was observed irrespective of background therapy for pulmonary arterial hypertension. [3]

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