Janssen-Cilag International NV, a Johnson & Johnson company, has announced positive results from the Phase 2/3 Vibrance-MG study evaluating nipocalimab in adolescents aged 12-17 years with anti-AChRa positive generalized myasthenia gravis (gMG). The study demonstrated that participants treated with nipocalimab plus standard of care (SOC) achieved sustained disease control, as measured by a reduction in immunoglobulin G (IgG) from baseline over 24 weeks. The results also showed improvement in secondary endpoints, including MG-ADLb and QMGc scores.
The data were presented at the Myasthenia Gravis Foundation of America (MGFA) Scientific Session during the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) Annual Meeting. Johnson & Johnson presented a total of 25 abstracts at the meeting.
Jonathan Strober, M.D., Director of the Pediatric Neuromuscular Clinic at UCSF Benioff Children's Hospital, noted, "Findings from the Vibrance-MG study underscore the potential of this investigational therapy for young individuals aged 12 – 17 living with gMG. Results show a significant reduction in IgG of approximately 70 percent in adolescents and a clinical benefit that is consistent with the Vivacity-MG3 study in adults."
Key Findings from the Vibrance-MG Study
The Vibrance-MG study is an ongoing, open-label trial designed to assess the effect of nipocalimab in pediatric participants with gMG. The study enrolled seven participants aged 12-17 years with a confirmed diagnosis of gMG, reflected by a Myasthenia Gravis Foundation of America (MGFA) Class of II through IV at screening, and an insufficient clinical response to ongoing, stable SOC therapy. Participants were required to have a positive blood test for either anti-AChR or anti-MUSK autoantibodies.
The study's primary outcome was the effect of nipocalimab on total serum IgG, safety and tolerability, and pharmacokinetics in pediatric participants with gMG at 24 weeks. Secondary endpoints included changes in MG-ADL and QMG scores at 24 weeks.
Treatment with nipocalimab plus SOC met the study’s primary endpoint with a -69% reduction in total serum IgG. The treatment also met the two secondary endpoints of MG-ADL and QMG, which are measures of disease activity. Four of five patients achieved minimum symptom expression (MG-ADL score 0-1) by the end of their treatment phase. Nipocalimab was well-tolerated over the six-month period, with tolerability similar to that seen in adult participants in the Vivacity-MG3 study. There were no serious adverse events and no discontinuations due to an adverse event.
gMG in Adolescents
Myasthenia gravis (MG) is an autoantibody disease where the immune system mistakenly produces antibodies (e.g., anti-acetylcholine receptor [AChR], anti-muscle-specific tyrosine kinase [MuSK] or anti-low density lipoprotein-related protein 4 [LRP4]) that target proteins at the neuromuscular junction. This disrupts normal signaling from nerves to muscles, impairing or preventing muscle contraction.
Approximately 10-15% of new MG cases are diagnosed in adolescents (12-17 years). The severity of gMG in pediatric patients is often heightened, with 43% experiencing over five hospitalizations, 46% having at least one intensive care unit stay, and 68% having periods of exacerbated disease.
Nipocalimab's Potential Impact
Sindhu Ramchandren, M.D., Executive Medical Director, Neuroscience, Johnson & Johnson Innovative Medicine, stated, “The Vibrance-MG data add to the expanding clinical profile of nipocalimab and highlight its potential for adolescents living with gMG who are in need of new treatments. We are committed to developing innovations for autoantibody-driven neurological diseases, like gMG, with the aim of transforming the lives of people living with these conditions.”
Johnson & Johnson has submitted applications to the U.S. Food and Drug Administration (FDA) and the European Medicines Agency (EMA) seeking approval for nipocalimab for the treatment of gMG. If approved, nipocalimab would offer a novel approach to managing gMG by reducing levels of circulating IgG antibodies, potentially improving muscle function and quality of life for affected individuals.
