The European Medicines Agency's Committee for Medicinal Products for Human Use (CHMP) has adopted a positive opinion recommending label expansion of Novo Nordisk's Alhemo (concizumab) to include treatment of severe hemophilia A and moderate or severe hemophilia B without inhibitors. The decision, announced on July 25, 2025, positions the once-daily subcutaneous monoclonal antibody to enter a significant market segment representing approximately 12,000 EU patients.
Clinical Efficacy Drives Regulatory Decision
The CHMP's positive opinion is based on results from the phase 3 explorer8 trial, which met its primary endpoint demonstrating substantial reductions in bleeding episodes. Alhemo prophylaxis compared with no prophylaxis treatment led to an 86% reduction in treated spontaneous and traumatic bleeds for patients with hemophilia A without inhibitors and a 79% reduction for patients with hemophilia B without inhibitors.
The explorer8 study was a multicentre, open-label, randomised, phase 3a clinical trial involving 148 patients randomly assigned in a 1:2 ratio to receive no prophylaxis (n=21) or Alhemo prophylaxis (n=42), with an additional 85 patients nonrandomly assigned to receive Alhemo prophylaxis. The initial loading dose was 1 mg per kilogram of body weight, followed by 0.2 mg per kilogram daily, with potential individualisation based on concizumab plasma concentration measured at Week 4.
Patient-Reported Outcomes Show Treatment Preference
Patient-Reported Outcome data from the explorer8 study indicated improvements in health-related quality of life and reduction in treatment burden with Alhemo treatment compared with no prophylaxis. Trends favouring Alhemo over prophylaxis were observed in the short-form health survey (SF-36v2) and Haemophilia Quality of Life Questionnaire for Adults (Haem-A-QoL) results, including changes in "bodily pain" and "physical functioning" from baseline to week 24, and improvements in the Haem-A-QoL "total score" and "physical health" domain score.
Treatment preference results showed 70.9% of respondents indicating they prefer Alhemo over their previous haemophilia treatment. The drug's user-friendly, pre-filled, portable pen-injector device contributes to its appeal among patients and caregivers.
Market Impact and Commercial Potential
The label expansion extends Alhemo's reach to a patient population representing 79.2% of the hemophilia market without inhibitors. The European hemophilia market is valued at $5.16 billion and projected to grow at a 7.1% compound annual growth rate through 2030. Germany, the UK, and France—markets with high prophylaxis adoption—are expected to benefit most from this expansion, with Germany alone projected to reach $1.11 billion in hemophilia treatment revenue by 2030.
Analysts estimate Alhemo could generate $1-2 billion in annual sales by 2030, assuming 20-30% market penetration. This positions the drug as a potential competitor to existing treatments including Roche's Hemlibra and traditional factor replacement therapies.
Mechanism of Action and Safety Profile
Alhemo is an anti-tissue factor pathway inhibitor (TFPI) monoclonal antibody designed to block a protein in the body that stops blood from clotting. By blocking TFPI, Alhemo ensures the production of thrombin, which helps to clot the blood and prevent bleeding. In the explorer8 trial, Alhemo showed a favourable safety profile in patients with haemophilia A and B without inhibitors.
Regulatory Timeline and Current Approvals
Following the positive CHMP opinion, Novo Nordisk expects the European Commission to approve the label update within approximately two months. Alhemo is currently approved in Europe, the United States, India, Brazil and Switzerland for treating adolescents and adults (12 years or older) with haemophilia A and B with inhibitors. In Japan and Australia, it is approved for treating patients with haemophilia A and B both with and without inhibitors.
Martin Holst Lange, executive vice president and head of Development at Novo Nordisk, stated: "If approved by the European Commission, this label update would extend Alhemo's convenient once-daily, under-the-skin administration to patients living with haemophilia without inhibitors, providing an efficacious prophylactic choice. Each person living with haemophilia has individual and evolving needs. With its user-friendly, pre-filled, portable pen, we believe that Alhemo has the potential to offer even more patients an individualised and flexible treatment."
