Biohaven’s troriluzole study for generalised anxiety disorder misses primary endpoint

This eight-week trial randomized 402 adult patients equally at more than 45 centers in the United States. In this trial, troriluzole monotherapy at 100mg twice daily did not differentiate from placebo on the primary endpoint of the mean change from baseline on the Hamilton Anxiety Rating Scale (HAM-A) after eight weeks of treatment.

Vlad Coric, M.D., Chief Executive Officer of Biohaven, “While these efficacy results were disappointing and do not support continued development of troriliuzole as a monotherapy in GAD, we have multiple ongoing studies evaluating troriluzole in other disease indications and with different dosing paradigms. Since it is often difficult to predict clinical outcomes from preclinical and early clinical proof of concept studies, our strategy has been to test troriluzole in four distinct disorders where glutamate has been implicated in the underlying pathophysiology of the illnesses. We eagerly await topline data from our adjunctive therapy trial in OCD, and our symptomatic treatment trials in Alzheimer’s disease and Spinocerebellar Ataxia. We thank the patients and clinical investigators who participated in the GAD program and sincerely appreciate all that they have done to see this study through completion.”

After eight weeks of treatment, troriluzole treated subjects had a mean improvement change from baseline of -9.28 points [95% CI: -10.23 to -8.32] on the HAM-A total score versus -9.35 points [95% CI: -10.34 to -8.36] on placebo, p-value = 0.917. Troriluzole was well tolerated with a low discontinuation rate due to adverse events (troriluzole 4% versus placebo 4.5%).

Loren Aguiar, M.D., Vice President of Research and Development stated, “Although the efficacy results are disappointing, the team conducted a well-designed study that provided us with definitive data. We are grateful to the community of patients and researchers who participated in this trial and allowed us to efficiently enroll the study in under 10 months.”

Biohaven has a deep and broad portfolio of assets in development with five ongoing Phase 3 trials across it its calcitonin gene-related peptide (CGRP) antagonists, glutamate modulators and myeloperoxidase inhibitor platforms. Biohaven continues to prepare for potential launch with its upcoming 1Q2020 PDUFA date for rimegepant and expects topline data from the rimegepant prevention trial in 1Q2020.

Earlier this year, troriluzole dosed at 280mg successfully advanced past an interim futility analysis in its pivotal Phase 2/3 trial in Alzheimer’s disease study performed after 100 subjects completed 6 months of treatment.  Completion of the troriluzole in Alzheimer’s Disease trial is expected in 4Q2020, and topline data is anticipated from the troriluzole adjunctive therapy obsessive compulsive disorder (OCD) trial in 2Q2020 and from the troriluzole in SCA trial in 2021. Additionally, Biohaven’s verdiperstat trial in Multiple System Atrophy (MSA) is enrolling ahead of schedule with topline results expected in 2021.

Troriluzole is a third-generation prodrug and new chemical entity that modulates glutamate, the most abundant excitatory neurotransmitter in the human body. The primary mode of action of troriluzole is normalizing synaptic levels of glutamate. Troriluzole increases glutamate uptake from the synapse, by augmenting the expression and function of excitatory amino acid transporters (i.e., EAAT2) located on glial cells that play a key role in clearing glutamate from the synapse.

Source: Company Press Release