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RAPAMUNE ® TM I-1 RAPAMUNE ® WYETH-AYERST RESEARCH January 24, 2002 Subcommittee of the Antiviral Drugs Advisory Committee on Immunosuppressive Drugs January 24, 2002 Subcommittee of the Antiviral Drugs Advisory Committee on Immunosuppressive Drugs
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RAPAMUNE ® TM I-2 RAPAMUNE ® Introduction Randy Brenner, MS Senior Manager, Worldwide Regulatory Affairs Wyeth-Ayerst Research Randy Brenner, MS Senior Manager, Worldwide Regulatory Affairs Wyeth-Ayerst Research
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RAPAMUNE ® TM I-3 Randy Brenner, MS Introduction John Neylan, MD Overview Design of Clinical Studies Efficacy Review Safety Review James Zimmerman, PhDPharmacokinetics Concentration-Controlled Trials Therapeutic Drug Monitoring John Neylan, MDConcluding Remarks Randy Brenner, MS Introduction John Neylan, MD Overview Design of Clinical Studies Efficacy Review Safety Review James Zimmerman, PhDPharmacokinetics Concentration-Controlled Trials Therapeutic Drug Monitoring John Neylan, MDConcluding Remarks Agenda
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RAPAMUNE ® TM I-4 RAPAMUNE Approved Formulations Oral Solution –Dec 98:NDA priority review –Jul 99:FDA Advisory Committee recommendation –Sep 99:FDA approval Dosing Recommendations - in combination with cyclosporine and corticosteroids –2 mg fixed daily dose RAPAMUNE –5 mg fixed daily dose RAPAMUNE Tablets –Oct 99:NDA submitted –Aug 00:FDA approval of RAPAMUNE 1 mg Tablets Oral Solution –Dec 98:NDA priority review –Jul 99:FDA Advisory Committee recommendation –Sep 99:FDA approval Dosing Recommendations - in combination with cyclosporine and corticosteroids –2 mg fixed daily dose RAPAMUNE –5 mg fixed daily dose RAPAMUNE Tablets –Oct 99:NDA submitted –Aug 00:FDA approval of RAPAMUNE 1 mg Tablets
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RAPAMUNE ® TM I-5 1999 Advisory Committee Meeting Protocols 301 and 302 determined that the combination of RAPAMUNE + CsA was safe and well-tolerated Significantly lower rates of acute rejection RAPA + CsA: < 18% Excellent survival Patient: > 95% Graft: > 90% Unanimous recommendation Recommendation to further evaluate the impact of RAPAMUNE on renal function Protocols 301 and 302 determined that the combination of RAPAMUNE + CsA was safe and well-tolerated Significantly lower rates of acute rejection RAPA + CsA: < 18% Excellent survival Patient: > 95% Graft: > 90% Unanimous recommendation Recommendation to further evaluate the impact of RAPAMUNE on renal function
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RAPAMUNE ® TM I-6 RAPAMUNE + CsA (Studies 301, 302) Fixed Dose RAPA + CsA RAPAMUNE + CsA (Studies 301, 302) Fixed Dose RAPA + CsA RAPAMUNE Base Therapy (Studies 207, 210) Concentration- Controlled RAPA (without CsA) Key Concepts in Clinical Development CsA Elimination Trials Study 212 Study 310 Animal Data Effective agent when evaluated alone Non-nephrotoxic
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RAPAMUNE ® TM I-7 RAPAMUNE CsA Elimination Studies Equivalent patient and graft survival at 12 months –> 97% and > 95%, respectively, in all groups Significantly better renal function Significantly better blood pressure No difference in biopsy-confirmed acute rejection at 12 months Equivalent patient and graft survival at 12 months –> 97% and > 95%, respectively, in all groups Significantly better renal function Significantly better blood pressure No difference in biopsy-confirmed acute rejection at 12 months
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RAPAMUNE ® TM I-8 RAPAMUNE Current Application CsA Elimination –Apr 01: sNDA submitted Dosing Recommendations –6 mg loading dose of RAPAMUNE followed by 2 mg/day in combination with CsA and corticosteroids –2 to 4 months after transplantation, CsA elimination should be considered and RAPAMUNE dose selection based on trough levels with a recommended range Therapeutic Drug Monitoring CsA Elimination –Apr 01: sNDA submitted Dosing Recommendations –6 mg loading dose of RAPAMUNE followed by 2 mg/day in combination with CsA and corticosteroids –2 to 4 months after transplantation, CsA elimination should be considered and RAPAMUNE dose selection based on trough levels with a recommended range Therapeutic Drug Monitoring
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RAPAMUNE ® TM I-9 RAPAMUNE Current Indication RAPAMUNE is indicated for the prophylaxis of organ rejection in patients receiving renal transplants. It is recommended that RAPAMUNE be used in a regimen with cyclosporine and corticosteroids.
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RAPAMUNE ® TM I-10 RAPAMUNE Proposed Indication Cyclosporine withdrawal should be considered 2 to 4 months after transplantation. RAPAMUNE is indicated for the prophylaxis of organ rejection in patients receiving renal transplants. It is recommended that RAPAMUNE be used initially in a regimen with cyclosporine and corticosteroids.
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