Ipsen has achieved a significant milestone with the FDA's accelerated approval of Iqirvo (elafibranor), marking the introduction of the first dual PPAR alpha/delta agonist for primary biliary cholangitis (PBC). This approval represents the first therapeutic advancement for PBC patients in more than a decade.
The drug has been approved as a second-line therapy in combination with ursodeoxycholic acid (UDCA) for adult patients showing inadequate response to UDCA alone, and as monotherapy for those unable to tolerate UDCA.
Disease Impact and Market Significance
PBC, a chronic autoimmune disease affecting approximately 100,000 Americans, primarily women, leads to progressive destruction of bile ducts in the liver, potentially resulting in cirrhosis. The condition's prevalence is increasing, with patients experiencing debilitating symptoms including severe fatigue and pruritus. Without effective treatment, PBC can progress to require liver transplantation and may result in premature death.
Clinical Trial Results Demonstrate Significant Efficacy
The FDA's decision was based on compelling data from the ELATIVE trial. The study showed that 51% of patients receiving 80 mg of elafibranor achieved a cholestasis response, as measured by ALP (a biomarker of liver disease progression), compared to only 4% in the placebo group. Additionally, 15% of Iqirvo-treated patients achieved ALP normalization, while no patients in the placebo plus UDCA group reached this milestone.
Patient Advocacy Perspective
Carol Roberts, executive president of PBCers, emphasized the significance of this approval: "People with PBC may feel uncertainty around the disease progression and if, or when, their liver health may deteriorate. Earlier diagnosis and education about PBC, along with new treatment options, are important to meet the current needs of people living with PBC."
Market Position and Competition
Ipsen has positioned Iqirvo with a list price of $11,500 per month before discounts and rebates. The drug will compete with Intercept Pharma's Ocaliva (obeticholic acid), which has been on the market since 2016 and is priced at approximately $10,000 per month. Ocaliva generated $344 million in worldwide sales last year, with $286 million from the US market alone.
Development Journey and Future Outlook
Elafibranor's path to approval is particularly noteworthy, as it was initially developed by Genfit for non-alcoholic steatohepatitis (NASH) before being redirected to PBC following promising phase 2 results. Ipsen acquired the rights to the drug for €120 million upfront, with potential milestone payments of up to €360 million.
The PBC treatment landscape may see further evolution with Gilead Sciences' seladelpar, a PPAR delta agonist, awaiting FDA decision by August 14th. Analysts project the market for UDCA-refractory PBC treatments could exceed $1.5 billion annually.
Regulatory decisions for Iqirvo are pending in the EU and GB, with outcomes expected in the second half of this year, potentially expanding access to this innovative therapy for PBC patients globally.
