Fingolimod: 'Hint' of advantages in a small group of patients

The immunosuppressive drug fingolimod (trade name: Gilenya) is approved for the treatment of highly-active relapsing-remitting multiple sclerosis (RRMS) in adults. In an early benefit assessment pursuant to "Act on the Reform of the Market for Medicinal Products" (AMNOG), the German Institute for Quality and Efficiency in Health Care (IQWiG) assessed whether fingolimod offers an added benefit compared with the present standard therapy.

According to the findings of the assessment, with a rapidly progressive and severe course of disease who take fingolimod experience fewer -like symptoms. Under consideration of this advantage on the one hand and the uncertain evidence base on the other, IQWIG has concluded that the data provide a "hint" of a minor added benefit of fingolimod for this group of patients.

Due to a lack of evaluable data, an added benefit is not proven for two further groups of patients.

Separate assessment in three groups of patients

According to the different areas of application, IQWiG performed separate assessments of the drug in three groups of patients. Fingolimod was compared with glatiramer in patients with highly active RRMS who had not responded to a complete and appropriate (usually at least one-year) cycle with beta-interferon (IFN-β).

In patients with highly active RRMS who had not received sufficient IFN-β therapy and in those with rapidly progressive severe RRMS, fingolimod was in each case compared with IFN-β 1a.

Evaluable data only for one group of patients

One relevant study was available for the early benefit assessment, an approval study on fingolimod (TRANSFORMS), which compared treatment with fingolimod versus IFN β 1a in with RRMS. However, the study only provided data for one of the three patient groups specified by the Federal Joint Committee (G-BA), namely for those with rapidly progressive severe RRMS.

The manufacturer dossier did not contain evaluable data for a benefit assessment in the other two groups, that is, patients with highly active RRMS who had already received a complete pre-treatment with IFN-β and patients with RRMS who had not received sufficient pre-treatment with IFN-β. An added benefit of fingolimod is therefore not proven for these therapeutic indications.

Fewer flu-like symptoms in some patients

The study results in patients with rapidly progressive severe RRMS did not indicate significant differences between treatment groups for the outcomes "relapse", "progression of disability" and "health-related quality of life". No data were reported for the outcomes "fatigue" and "activities of daily living" for this patient group, even though such data were collected in the study. Likewise, no significant difference was shown between treatment groups regarding the overall rate of side effects (adverse events), serious adverse events, and study discontinuations due to adverse events.

However, for the outcome "frequency of flu-like symptoms" the data provided an indication of less harm: patients treated with fingolimod experienced fewer such symptoms.

Only "hint" of added benefit due to inadequate data

It should be noted that conclusions on the group of patients with rapidly progressive severe RRMS are somewhat uncertain. For example, according to the approval status, this patient group is defined by several disease criteria, but the study participants for whom the manufacturer had presented data did not fulfil all of these criteria and can only be identified indirectly as a patient group in the study pool.

Under consideration of this uncertain evidence base on the one hand and the potential advantage on the other, in summary IQWiG concludes that there is a "hint" of a minor added benefit of fingolimod in patients with rapidly progressive severe RRMS treated with fingolimod compared with those treated with beta-interferon.

G-BA decides on the extent of added benefit

The procedure for inferring the overall conclusion on the extent of added benefit is a proposal from IQWiG. The G-BA, which has opened a formal commenting procedure, decides on the extent of added benefit.

The following extract provides an overview of the results of the benefit assessment performed by IQWiG. The website gesundheitsinformation.de, which is issued by IQWiG, provides easily understandable brief information.

The G-BA website contains both general information on benefit assessments pursuant to §35a Social Code Book V and specific information on the assessment of fingolimod.

add to favorites email to friend print save as pdf

Related Stories

Cabazitaxel can offer an advantage in certain patients

May 29, 2012

Cabazitaxel (trade name: Jevtana) has been approved since March 2011 in men with metastatic prostate cancer who no longer respond to conventional therapy with hormone blockers and have already been pre-treated with the cytostatic ...

Added benefit of linagliptin is not proven

Jan 06, 2012

Linagliptin (trade name: Trajenta) has been approved since August 2011 to improve blood glucose control ("glycaemic control") in adults with type 2 diabetes mellitus whose elevated blood glucose levels are inadequately controlled ...

Pirfenidone: Extent of added benefit assessed

Jan 03, 2012

Pirfenidone inhibits the development of inflammation and scarring (fibrosis) in pulmonary tissue and has been approved for the treatment of mild to moderate idiopathic pulmonary fibrosis (IPF) since the beginning of 2011. ...

Boceprevir: Indication of added benefit for specific patients

Dec 09, 2011

The active ingredient boceprevir has been available since the middle of 2011 as a treatment for chronic hepatitis C of genotype 1. In an early benefit assessment pursuant to the "Act on the Reform of the Market for Medicinal ...

Recommended for you

Restrictions lifted at British bird flu farm

1 hour ago

Britain on Sunday lifted all restrictions at a duck farm in northern England after last month's outbreak of H5N8 bird flu, the same strain seen in recent cases across Europe.

Recorded Ebola deaths top 7,000

Dec 20, 2014

The worst Ebola outbreak on record has now killed more than 7,000 people, with many of the latest deaths reported in Sierra Leone, the World Health Organization said as United Nations Secretary-General Ban ...

Liberia holds Senate vote amid Ebola fears (Update)

Dec 20, 2014

Health workers manned polling stations across Liberia on Saturday as voters cast their ballots in a twice-delayed Senate election that has been criticized for its potential to spread the deadly Ebola disease.

Evidence-based recs issued for systemic care in psoriasis

Dec 19, 2014

(HealthDay)—For appropriately selected patients with psoriasis, combining biologics with other systemic treatments, including phototherapy, oral medications, or other biologic, may result in greater efficacy ...

User comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.