Longeveron Announces the Result of its Phase 2b Trial of Lomecel-B for Aging Frailty Longeveron Announces the Result of its Phase 2b Trial of Lomecel-B...
Pharma Tech Outlook

Longeveron Announces the Result of its Phase 2b Trial of Lomecel-B for Aging Frailty

Pharma Tech Outlook | Tuesday, August 17, 2021

A primary analysis and a secondary analysis were used in the pre-specified statistical analysis strategy for the primary effectiveness outcome, change in six-minute walk test distance 180 days after infusion

FREMONT, CA: Longeveron, a clinical-stage biotechnology company developing cellular therapies for chronic aging-related and life-threatening conditions, recently announced the results of its Phase 2b trial, titled: A Phase 2b, Randomized, Blinded, and Placebo-Controlled Trial to Evaluate the Safety and Efficacy of Lomecel-B Infusion in Patients With Aging Frailty (the Phase 2b trial). Lomecel-B is a patented allogeneic product made up of medicinal signaling cells (MSCs) extracted from adult donors’ bone marrow and culture-expanded in Longeveron’s cell processing facilities under current good manufacturing practice (cGMP).

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The Phase 2b trial, which was partly funded by a Small Business Innovation Research (SBIR) grant from the National Institute on Aging (NIA), assessed the safety and effectiveness of a single peripheral intravenous infusion of four distinct doses of Lomecel-B cell therapy (25 million (n=37), 50 million (n=31), 100 million (n=34) and 200 million (n=16) cells; sample size exhibits any subject that was randomized and received an infusion) compared to placebo (n=30), on signs and symptoms of Aging Frailty, along with mobility and exercise tolerance.

“Improving physical function in older adults with frailty is one of the primary goals in geriatric medicine,” said Dr. Jorge G. Ruiz, MD, geriatrician at the Miami Veterans Affairs Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), the study site enrolling the largest number of subjects. “The fact that patients enrolled in this study, with an average age of 75 and with clear mobility limitations, showed 6-month and 9-month placebo-adjusted increases in walking distance of 40 meters and 63 meters, respectively (200 million cell dose), is significant for a number of reasons. Frailty is associated with poor clinical outcomes and high healthcare utilization and being able to improve and extend walking distance suggests preservation of function and potentially independence,” Dr. Ruiz continued. “I would consider these results clinically significant and relevant for the older veteran population since one third of American Veterans older than 65 years have frailty.”

A primary analysis and a secondary analysis were used in the pre-specified statistical analysis strategy for the primary effectiveness outcome, change in six-minute walk test distance 180 days after infusion:

Primary Analysis of The Primary Efficacy Endpoint:The initial analysis compared the change from baseline in 6MWT distance for the four Lomecel-B cohorts to the placebo cohort at Day 180. There were statistically significant advances in the highest 3 doses--50 million, 100 million and 200 million Lomecel-B cohorts--and no important changes in the placebo or lowest dose of Lomecel-B (25 million=7.8 meters, p=0.5040; 50 million=35.8 meters, p=0.0053; 100 million=24.9 meters p=0.0443; 200 million=49.3 meters, p=0.0065; placebo=8.0 meters, p=0.5371). However, after modifying for multiple comparisons using the Hochberg method (1988), the four Lomecel-B cohorts did not show a statistically vital placebo-adjusted difference (Δ) (25 million Δ=-0.2, p=0.9902; 50 million Δ=27.7, p=0.1279; 100 million Δ=16.8, p=0.3472; 200 million Δ=41.3, p=0.0635).

Secondary Analysis of The Primary Efficacy Endpoint:The secondary analysis was to discover whether a dose-response relationship exists using the many comparisons and modeling approach by Bretz et. al (2003). The results showed a clear, statistically notable dose-response curve at day 180. Among the various dose-response curves estimated (Emax, Linear, Exponential, Quadratic, and Sigmoid Emax), all had p-values of less than 0.05, with the Sigmoid Emax model having the most significant dose-response relationship (p=0.0170).

Despite not obtaining the statistical significance for the pairwise comparison to placebo at Day 180, significant deviations from placebo were observed at Day 270, which was a pre-specified exploratory endpoint (25 million Δ=27.5, p=0.1530; 50 million Δ=49.2, p=0.0122; 100 million Δ=31.0, p=0.1071; 200 million Δ=63.4, p=0.0077).

“We are very pleased to report a statistically significant dose response curve with our experimental cell therapy,” commented Geoff Green, CEO of Longeveron Inc. “One of the main objectives of this trial was to determine whether a dose response relationship could be demonstrated in the primary efficacy endpoint, so this finding is important for the research program,” Mr. Green continued. “Furthermore, the safety profile of Lomecel-B continues to look very good, with no Lomecel-B related Serious Adverse Events reported in this study, which is consistent with previous clinical trial data.”

The study’s key secondary endpoints were day 180 change in the patient-reported outcome questionnaire PROMIS—Physical Function—Short Form 20a (SF-20a) total score and day 180 change in serum levels of tumor necrosis factor-alpha (TNF-α), an inflammatory cytokine. Lomecel-B cohorts did not demonstrated a statistically significant difference compared to the placebo cohort in the SF-20a score, and the TNF-α analysis is pending. The remaining efficacy endpoints, such as physical function, sexual function, fear and risk of falling, depression, cognition, frailty status, pulmonary function, and clinical outcomes, were considered exploratory, and Lomecel-B-treated groups did not show significant differences versus placebo at most time points for any of the endpoints.

Subjects 70-85 years old, a screening 6MWT of 200 to 400 meters, a Canadian Health and Safety Assessment (CHSA) Clinical Frailty Scale score of 5 (mildly frail) to 6 (moderately frail), and a minimum serum TNF- of 2.5 pg/mL were the key inclusion criteria for the trial.

During an upcoming steering committee made of impartial frailty specialists, Longeveron plans to review the trial findings and lay out the program’s next stages. The company aims to provide clinical data from this research during a round table presentation at the 2021 International Conference on Frailty & Sarcopenia Research (ICFSR) on September 29th at 11:30 a.m. EDT.

Green said, “We look forward to engaging with our experts and potentially regulatory authorities to review the data and to advance into the next trial. I want to thank the subjects, their families, and physicians for their participation in this important study, and the NIH’s National Institute on Aging for its generous support. We are also expecting our Phase 1/2 “HERA” trial data this quarter, which is designed to evaluate Lomecel-B infusion’s effect on immune response to influenza vaccination in Aging Frailty subjects, and we anticipate initiating the Phase 2 Japanese Aging Frailty this year.”

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