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Istesso's Leramistat Misses Primary Endpoint in Phase 2b Rheumatoid Arthritis Trial, Shows Promise in Bone Protection

5 months ago2 min read

Key Insights

  • Leramistat failed to meet its primary endpoint of improving tender and swollen joints in moderate-to-severe rheumatoid arthritis patients resistant to methotrexate treatment.

  • Secondary endpoints revealed promising results, including significant reduction in bone erosion and improvements in disability and fatigue scores, supporting the drug's tissue repair mechanism.

  • Despite the primary endpoint miss, IP Group maintains confidence in leramistat's potential, with plans for additional Phase 2 trials in RA and other conditions like idiopathic pulmonary fibrosis.

IP Group announced today that its majority-owned portfolio company Istesso's experimental drug leramistat (MBS2320) failed to achieve its primary endpoint in a Phase 2b clinical trial for rheumatoid arthritis (RA). The news triggered a 5% decline in IP Group's share price, though the company remains optimistic about the drug's potential based on encouraging secondary outcomes.
The 12-week IST-06 trial evaluated leramistat in patients with moderate-to-severe RA who had not adequately responded to methotrexate. While the study did not meet its primary objective of improving ACR20 response rates compared to placebo, significant positive findings emerged in key secondary endpoints.

Promising Secondary Outcomes

Most notably, leramistat demonstrated a reduction in bone erosion compared to placebo, providing validation for the drug's novel mechanism of action. As a mitochondrial complex 1 inhibitor, leramistat is designed to enhance the body's natural repair response without immunosuppression – a distinct approach from current RA therapies.
The trial also revealed improvements in disability and fatigue measures, addressing persistent symptoms that continue to affect many RA patients despite current treatment options. Safety data was encouraging, with reported adverse events being mild and self-resolving without intervention.

Strategic Path Forward

Greg Smith, IP Group's chief executive, expressed optimism about the results: "We are encouraged that these results are consistent with leramistat's unique mechanism of action, which supports and augments tissue repair. The impact on disability and fatigue, from which a large proportion of RA patients continue to suffer despite the widespread availability of current medications, is also highly promising."
Istesso plans to conduct additional Phase 2 trials of leramistat, with secured funding already in place. The company is also exploring the drug's potential in other chronic conditions characterized by autoimmunity, fibrosis, and bone loss, including idiopathic pulmonary fibrosis (IPF).

Market Context

The development of new RA treatments remains crucial, as the condition affects approximately 17.6 million people globally. While current therapies, including JAK inhibitors, have enabled many patients to achieve remission, a significant portion still struggle with persistent disease. IP Group, which holds a 56.5% stake in Istesso, believes leramistat could address this unmet need by offering a novel approach to tissue repair in combination with existing disease-modifying anti-rheumatic drugs (DMARDs).
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