Constella® (linaclotide) Approved in Europe for the Treatment of Irritable Bowel Syndrome with Constipation (IBS-C)in Adults
BARCELONA, Spain and CAMBRIDGE, Massachusetts, November 28, 2012 /PRNewswire/ –
- Constella(R) (linaclotide) is the first and only medicine approved by the European Commission for the symptomatic treatment of moderate to severe IBS-C in adults, that improves abdominal pain/discomfort, bloating and constipation - First launches in Europe are expected in the first half of 2013 - IBS-C is a functional gastrointestinal disorder affecting approximately 15 million adults across the European Union
Almirall, S.A. (ALM:MC) and Ironwood Pharmaceuticals, Inc. (NASDAQ:IRWD) announced
today that the European Commission has granted marketing authorization to Constella(R)
(linaclotide 290mcg) for the symptomatic treatment of moderate to severe Irritable Bowel
Syndrome with Constipation (IBS-C) in adults. This approval follows the positive
recommendation received from the European Committee for Medicinal Products for Human Use
(CHMP) in September.
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Constella(R) is an oral, once-daily medication. Linaclotide, the active ingredient in
Constella(R), is a guanylate cyclase-C agonist (GCCA) with visceral analgesic and
secretory activities, as stated in the product label for European use. In non-clinical
studies, linaclotide has been shown to reduce visceral pain by decreasing pain-fiber
activity and to accelerate gastrointestinal transit by increasing intestinal fluid
secretion. Linaclotide acts locally in the intestine with minimal systemic exposure.
“Despite affecting more than 10% of the population in the EU there are few effective
treatment options for IBS. Approximately one third of IBS patients suffer from the IBS-C
form of the disease and the approval of Constella(R) provides physicians with an
innovative medication, for improving the lives of patients whose quality of life is
impaired, said Professor Jan Tack, Head of Clinic in the Department of Gastroenterology,
and Professor in Internal Medicine at the University Hospital Gasthuisberg of the
University of Leuven, Belgium.
IBS is a functional gastrointestinal disorder impacting over 10% of the European
population, and it is estimated that one-third of IBS patients suffer from IBS-C, which
means that approximately 15 million adults across the European Union might be affected.
Symptoms associated with IBS-C include abdominal pain and discomfort, bloating, and
constipation resulting in a significant impact on affected individuals. There are few
prescription treatment options for this condition approved in the European Union.
Constella(R) is the first and only prescription medicine approved by the European
Commission for the symptomatic treatment of moderate to severe Irritable Bowel Syndrome
with Constipation in adults.
“Almirall is delighted with the approval of Constella(R), the first prescription
medicine approved by the European Commission for the treatment of IBS-C in adults. This
new medicine has the potential to improve some of the hallmark symptoms of IBS-C patients
who up until now have had few treatment options. Furthermore the approval of Constella(R)
is an important growth opportunity for Almirall and will strengthen our gastrointestinal
franchise,” said Eduardo Sanchiz, Chief Executive Officer at Almirall.
Almirall expects to begin launching Constella(R) in Europe in the first half of 2013.
“Linaclotide was discovered by Ironwood scientists, and obtaining marketing
authorization for Constella(R) in Europe is important progress towards our goal of
translating knowledge into medicines that make a difference for patients,” said Peter
Hecht, Ironwood’s Chief Executive Officer. “We look forward to continuing to work closely
with our partner Almirall in their efforts to bring Constella(R) to adult IBS-C patients
in Europe, and we will continue collaborating with our global network of partners with the
goal of bringing this medicine to appropriate patients worldwide.”
In April 2009, Almirall signed a license agreement with Ironwood, under which Almirall
holds exclusive marketing rights for linaclotide in all European Union member states, plus
Russia, the CIS (Commonwealth of Independent States of the former USSR), Switzerland,
Norway and Turkey, as well as other countries in Europe, including the countries of former
Yugoslavia. In September 2012, Almirall also signed an agreement by which Forest
Laboratories sublicensed its commercialization rights for linaclotide in Mexico to
Notes to editors
About Constella(R) (linaclotide)
Linaclotide is a Guanylate Cyclase-C receptor agonist (GCCA) with visceral analgesic
and secretory activities.
Linaclotide is a 14-amino acid synthetic peptide structurally related to the
endogenous guanylin peptide family. Both linaclotide and its active metabolite bind to the
GC-C receptor, on the luminal surface of the intestinal epithelium. Through its action at
GC-C, linaclotide has been shown to reduce visceral pain and increase GI transit in animal
models and increase colonic transit in humans. Activation of GC-C results in an increase
in concentrations of cyclic guanosine monophosphate (cGMP), both extracellularly and
intracellularly. Extracellular cGMP decreases pain-fiber activity, resulting in reduced
visceral pain in animal models. Intracellular cGMP causes secretion of chloride and
bicarbonate into the intestinal lumen, through activation of the cystic fibrosis
transmembrane conductance regulator (CFTR), which results in increased intestinal fluid
and accelerated transit.
Constella(R) is a trademark owned by Ironwood Pharmaceuticals, Inc.
Clinical efficacy and safety
The efficacy of linaclotide was established in two randomised, double-blind,
placebo-controlled Phase 3 clinical studies in patients with IBS-C. In one clinical study
(study 1), 802 patients were treated with Constella 290 micrograms or placebo once daily
for 26 weeks. In the second clinical study (study 2), 800 patients were treated for 12
weeks, and then re-randomised for an additional 4 weeks treatment period. During the
2-weeks pre-treatment baseline period, patients had a mean abdominal pain score of 5.6
(0-10 scale) with 2.2% of abdominal pain-free days, a mean bloating score of 6.6 (0-10
scale), and an average of 1.8 spontaneous bowel movements (SBM)/week.
The characteristics of the patient population included in Phase 3 clinical trials were
as follows: mean age of 43.9 years [range 18 - 87 years with 5.3% greater than or equal to
65 years of age], 90.1% female. All patients met Rome II criteria for IBS-C and were
required to report a mean abdominal pain score of greater than or equal to 3 on a
0-to-10-point numeric rating scale (criteria that correspond to a moderate to severe IBS
population), <3 complete spontaneous bowel movements and less than or equal to 5 SBMs per
week during a 2-week baseline period.
The co-primary endpoints in both clinical studies were 12-week IBS degree of relief
responder rate and 12 week abdominal pain/discomfort responder rate. An IBS degree of
relief responder was a patient that was considerably or completely relieved for at least
50% of the treatment period; an abdominal pain/discomfort responder was a patient that had
an improvement of 30% or more for at least 50% of the treatment period.
For the 12 weeks data, study 1 shows that 39% of the patients treated with linaclotide
compared with 17% of the patients treated with placebo showed response to IBS degree of
relief (p<0.0001) and 54% of the patients treated with linaclotide compared with 39% of
the patients treated with placebo showed response to abdominal pain/discomfort (p<0.0001).
Study 2 shows that 37% of the patients treated with linaclotide compared with 19% of the
patients treated with placebo showed response to IBS degree of relief (p<0.0001) and 55%
of the patients treated with linaclotide compared with 42% of the patients treated with
placebo showed response to abdominal pain/discomfort (p=0.0002).
For the 26 weeks data, study 1 shows that 37% and 54% of the patients treated with
linaclotide compared with 17% and 36% of the patients treated with placebo showed response
to IBS degree of relief (p<0.0001) and abdominal pain/discomfort (p<0.0001) respectively.
In both studies, these improvements were seen by week 1 and sustained over the entire
treatment periods. Linaclotide has been shown not to cause rebound effect when the
treatment was stopped after 3 months continuous treatment.
Other signs and symptoms of IBS-C including bloating, complete spontaneous bowel
movement (CSBM) frequency, straining, stool consistency, were improved in linaclotide
treated patients vs. placebo (p<0.0001). These effects were reached at 1 week and
sustained over the entire treatment periods.
Treatment with linaclotide also resulted in significant improvements in validated and
disease-specific Quality of Life (QoL) measure (IBS-QoL; p<0.0001), and EuroQoL (p =
0.001). Clinically meaningful response in overall IBS-QoL (> 14 points difference) was
achieved in 54% of linaclotide treated patients vs. 39% in placebo treated patients.
The most frequently reported adverse reaction associated with linaclotide therapy was
diarrhoea, mainly mild to moderate in intensity, occurring in less than 20% of patients.
Other common adverse reactions (>1%) were abdominal pain, abdominal distension and
About Irritable Bowel Syndrome with Constipation (IBS-C)
IBS is defined as a functional bowel disorder in which abdominal pain or discomfort is
associated with defecation or a change in bowel function and with features of disordered
defecation. IBS-C is one of four clinically different subtypes of IBS. One-third of
patients with IBS are thought to have IBS-C and suffer chronically from both abdominal
pain and constipation.
The Rome III Diagnostic Criteria for Functional Gastrointestinal Disorders includes
criterion for the diagnosis of IBS as:
- Recurrent abdominal pain or discomfort at least three days/month, in the last three months with symptom onset at least 6 months prior to diagnosis, associated with two or more of the following: - improvement with defecation - onset associated with a change of frequency of stool - onset associated with a change in form (or appearance) of stool
The estimated prevalence of IBS at 10-15% of the European population puts it in line
with conditions such as migraine (12%) and asthma (11%). IBS can have a negative impact
on daily living with considerable socio-economic and psychological consequences, and
represents a major proportion of gastrointestinal workload in both primary and secondary
care. Due to the complex, multimodal nature of the condition there is no cure for IBS and
there are minimal therapeutic options.
Almirall is an international pharmaceutical company based on innovation and committed
to health. Headquartered in Barcelona, it researches, develops, manufactures and
commercialises its own R&D and licensed drugs with the aim of improving people’s health
and wellbeing. Almirall focuses its research resources on respiratory, gastrointestinal,
dermatology and pain. Almirall’s products are currently present in over 70 countries in
the five continents. With the opening of the Canadian affiliate, Almirall has now direct
presence in Europe, Mexico and Canada through 13 affiliates.
For further information please visit: http://www.almirall.com
About Ironwood Pharmaceuticals
Ironwood Pharmaceuticals (NASDAQ: IRWD) is an entrepreneurial pharmaceutical company
dedicated to the art and science of great drugmaking. Ironwood is located in Cambridge,
To learn more, visit http://www.ironwoodpharma.com.
This press release contains forward looking statements. Investors are cautioned not to
place undue reliance on these forward-looking statements, including, but not limited to,
the potential for Constella as a treatment option for the symptomatic treatment of
moderate to severe IBS-C in adult men and women, the anticipated launch timing of
Constella, and the potential for linaclotide to achieve marketing authorization approval
in countries outside of the European Union. Each forward-looking statement is subject to
risks and uncertainties that could cause actual results to differ materially from those
expressed or implied in such statement. Applicable risks and uncertainties include the
risks that Constella is priced at a point lower than anticipated, Almirall is unable to
secure sufficient reimbursement for Constella in any of the major E.U. countries,
physicians do not view Constella as an effective or safe treatment option for adult men or
women who suffer from moderate to severe IBS-C, or Almirall is unable to produce an
adequate commercial supply of Constella, as well as risks related to the difficulty of
predicting regulatory approvals, the acceptance of and demand for new pharmaceutical
products, the potential prescribing habits of doctors, the impact of competitive products
and pricing, and whether linaclotide will ever be commercialized successfully in a given
country. Applicable risks also include those that are listed in Ironwood Pharmaceuticals’
Quarterly Report on Form 10-Q for the quarter ended September 30, 2012, in addition to the
risk factors that are listed from time to time in Ironwood Pharmaceuticals’ Annual Reports
on Form 10-K, Quarterly Reports on Form 10-Q and any subsequent SEC filings. We undertake
no obligation to update these forward-looking statements to reflect events or
circumstances occurring after this press release. These forward-looking statements speak
only as of the date of this press release. All forward-looking statements are qualified in
their entirety by this cautionary statement.
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SOURCE Almirall, S.A. and Ironwood Pharmaceuticals, Inc