TY - JOUR
T1 - MPN-478 MOMENTUM
T2 - Phase 3 Randomized Study of Momelotinib (MMB) versus Danazol (DAN) in Symptomatic and Anemic Myelofibrosis (MF) Patients Previously Treated With a JAK Inhibitor
AU - Mesa, Ruben
AU - Gerds, Aaron
AU - Vannucchi, Alessandro
AU - Al-Ali, Haifa Kathrin
AU - Lavie, David
AU - Kuykendall, Andrew
AU - Grosicki, Sebastian
AU - Iurlo, Alessandra
AU - Goh, Yeow Tee
AU - Lazaroiu, Mihaela
AU - Egyed, Miklos
AU - Fox, Maria Laura
AU - McLornan, Donal
AU - Perkins, Andrew
AU - Yoon, Sung Soo
AU - Gupta, Vikas
AU - Kiladjian, Jean Jacques
AU - Donahue, Rafe
AU - Kawashima, Jun
AU - Verstovsek, Srdan
N1 - Publisher Copyright:
© 2022 Elsevier Inc.
PY - 2022/10
Y1 - 2022/10
N2 - Background: MMB, a JAK1/2 and ACVR1/ALK2 inhibitor, showed clinical activity in the MF SIMPLIFY trials. The pivotal phase 3 MOMENTUM study of MF patients previously treated with a JAK inhibitor (JAKi) tested MMB vs DAN on key symptom, anemia, and splenic endpoints. Methods: Eligibility: Primary or post- essential thrombocythemia (ET)/polycythemia vera (PV) MF; DIPSS High/Int-2/Int-1; MF symptom assessment form total symptom score (TSS) ≥10; hemoglobin <10 g/dL; prior JAKi ≥90 days, or ≥28 days if RBC transfusions ≥4 units in 8 weeks or grade 3/4 thrombocytopenia, anemia, or hematoma; palpable spleen ≥5 cm. Stratification: TSS, palpable spleen, and RBC units transfused. JAKi taper/washout ≥21 days. Randomization: 2:1 MMB 200 mg QD+DAN placebo or DAN 600 mg QD+MMB placebo for 24 weeks. Primary endpoint: TSS response (≥50% reduction from baseline) rate at week 24. Secondary endpoints, assessed sequentially at week 24: transfusion independence (TI) rate, splenic response rate (SRR; ≥25% volume reduction from baseline), TSS change from baseline, SRR (≥35% reduction) and rate of zero transfusions since baseline. Results: 94/130 (72%) MMB and 38/65 (58%) DAN patients completed randomized treatment (RT). Mean baseline TSS were 28 (MMB) and 26 (DAN), hemoglobin levels were 8.1 (MMB) and 7.9 (DAN) g/dL, and median platelets were 97 (MMB) and 94 (DAN) x109/L. Baseline TI was 13% (MMB) and 15% (DAN). Prior JAKi was ruxolitinib in 195 (100%) and fedratinib in 9 (5%) patients. All primary and key secondary endpoints were met: TSS response (24.6% vs 9.2%), TI (30.8% vs 20.0%), SRR25 (40.0% vs 6.2%), TSS change (-9.36 vs -3.13), SRR35 (23.1% vs 3.1%), and zero transfusions (35.4% vs 16.9%). Most common grade ≥3 TEAEs in RT were thrombocytopenia (MMB, 22%; DAN, 12%) and anemia (MMB, 8%; DAN, 11%). TEAEs led to study drug discontinuation in 18% of MMB and 23% of DAN patients in RT. Trend toward improved survival up to week 24 was seen with MMB vs DAN (HR=0.506, p=0.0719). Conclusions: In symptomatic and anemic MF patients, MMB was superior to DAN for symptom responses, transfusion requirements, and spleen responses with comparable safety and favorable survival. MMB may address a critical unmet need, particularly in MF patients with anemia.
AB - Background: MMB, a JAK1/2 and ACVR1/ALK2 inhibitor, showed clinical activity in the MF SIMPLIFY trials. The pivotal phase 3 MOMENTUM study of MF patients previously treated with a JAK inhibitor (JAKi) tested MMB vs DAN on key symptom, anemia, and splenic endpoints. Methods: Eligibility: Primary or post- essential thrombocythemia (ET)/polycythemia vera (PV) MF; DIPSS High/Int-2/Int-1; MF symptom assessment form total symptom score (TSS) ≥10; hemoglobin <10 g/dL; prior JAKi ≥90 days, or ≥28 days if RBC transfusions ≥4 units in 8 weeks or grade 3/4 thrombocytopenia, anemia, or hematoma; palpable spleen ≥5 cm. Stratification: TSS, palpable spleen, and RBC units transfused. JAKi taper/washout ≥21 days. Randomization: 2:1 MMB 200 mg QD+DAN placebo or DAN 600 mg QD+MMB placebo for 24 weeks. Primary endpoint: TSS response (≥50% reduction from baseline) rate at week 24. Secondary endpoints, assessed sequentially at week 24: transfusion independence (TI) rate, splenic response rate (SRR; ≥25% volume reduction from baseline), TSS change from baseline, SRR (≥35% reduction) and rate of zero transfusions since baseline. Results: 94/130 (72%) MMB and 38/65 (58%) DAN patients completed randomized treatment (RT). Mean baseline TSS were 28 (MMB) and 26 (DAN), hemoglobin levels were 8.1 (MMB) and 7.9 (DAN) g/dL, and median platelets were 97 (MMB) and 94 (DAN) x109/L. Baseline TI was 13% (MMB) and 15% (DAN). Prior JAKi was ruxolitinib in 195 (100%) and fedratinib in 9 (5%) patients. All primary and key secondary endpoints were met: TSS response (24.6% vs 9.2%), TI (30.8% vs 20.0%), SRR25 (40.0% vs 6.2%), TSS change (-9.36 vs -3.13), SRR35 (23.1% vs 3.1%), and zero transfusions (35.4% vs 16.9%). Most common grade ≥3 TEAEs in RT were thrombocytopenia (MMB, 22%; DAN, 12%) and anemia (MMB, 8%; DAN, 11%). TEAEs led to study drug discontinuation in 18% of MMB and 23% of DAN patients in RT. Trend toward improved survival up to week 24 was seen with MMB vs DAN (HR=0.506, p=0.0719). Conclusions: In symptomatic and anemic MF patients, MMB was superior to DAN for symptom responses, transfusion requirements, and spleen responses with comparable safety and favorable survival. MMB may address a critical unmet need, particularly in MF patients with anemia.
KW - JAK inhibitor
KW - MPN
KW - Phase III
KW - anemia
KW - momelotinib
KW - myelofibrosis
UR - http://www.scopus.com/inward/record.url?scp=85138160385&partnerID=8YFLogxK
U2 - 10.1016/S2152-2650(22)01463-X
DO - 10.1016/S2152-2650(22)01463-X
M3 - Article
C2 - 36164012
AN - SCOPUS:85138160385
VL - 22
SP - S339-S340
JO - Clinical Lymphoma, Myeloma and Leukemia
JF - Clinical Lymphoma, Myeloma and Leukemia
SN - 2152-2650
ER -