Lucious Lim, M.D., M.P.H.
NDA 207795
Vyzulta (latanoprostene bunod ophthalmic solution) 0.024%
CDER Clinical Review Template 2015 Edition 1
Version date: June 25, 2015 for initial rollout (NME/original BLA reviews)
CLINICAL REVIEW
Application Type NDA Application Number(s) 207795
Priority or Standard Standard Submit Date(s) July 21, 2015 Received Date(s) July 21, 2015 PDUFA Goal Date July 21, 2016
Division/Office DTOP/OAP
Reviewer Name(s) Lucious Lim, M.D., M.P.H.
Review Completion Date April 14, 2016
Established Name Latanoprostene bunod ophthalmic solution 0.024%
(Proposed) Trade Name Vyzulta
Applicant Bausch & Lomb Inc.
Formulation(s) Topical ophthalmic solution
Dosing Regimen One drop in the affected eye(s) once daily in the evening Applicant Proposed
Indication(s)/Population(s) Reduction of intraocular pressure in patients with open-angle glaucoma or ocular hypertension
Recommendation on
Regulatory Action From a clinical perspective, it is recommended that NDA 207795 be approved.
Recommended Indication(s)/Population(s) (if applicable)
Reduction of intraocular pressure in patients with open-angle glaucoma or ocular hypertension
Reference ID: 3920623
Clinical Review
Lucious Lim, M.D., M.P.H.
NDA 207795
Vyzulta (latanoprostene bunod ophthalmic solution) 0.024%
CDER Clinical Review Template 2015 Edition 2
Version date: June 25, 2015 for initial rollout (NME/original BLA reviews) Table of Contents
Glossary ...9 1 Executive Summary ...11 1.1. Product Introduction...11 1.2. Conclusions on the Substantial Evidence of Effectiveness...11 1.3. Benefit-Risk Assessment ...11 2 Therapeutic Context...14 2.1. Analysis of Condition...14 2.2. Analysis of Current Treatment Options ...14 3 Regulatory Background ...15 3.1. U.S. Regulatory Actions and Marketing History...15 3.2. Summary of Presubmission/Submission Regulatory Activity ...15 3.3. Foreign Regulatory Actions and Marketing History ...16 4 Significant Issues from Other Review Disciplines Pertinent to Clinical Conclusions on
Efficacy and Safety ...16 4.1. Office of Scientific Investigations (OSI) ...16 4.2. Product Quality ...16 4.3. Clinical Microbiology...17 4.4. Nonclinical Pharmacology/Toxicology ...17 4.5. Clinical Pharmacology ...17 4.5.1. Mechanism of Action...17 4.5.2. Pharmacodynamics...17 4.5.3. Pharmacokinetics...17 4.6. Devices and Companion Diagnostic Issues ...17 4.7. Consumer Study Reviews...18 5 Sources of Clinical Data and Review Strategy ...18 5.1. Table of Clinical Studies ...18 5.2. Review Strategy ...22 6 Review of Relevant Individual Trials Used to Support Efficacy ...22
Clinical Review
Lucious Lim, M.D., M.P.H.
NDA 207795
Vyzulta (latanoprostene bunod ophthalmic solution) 0.024%
CDER Clinical Review Template 2015 Edition 3
Version date: June 25, 2015 for initial rollout (NME/original BLA reviews)
6.1. A Randomized, Multicenter, Double-Masked, Parallel-Group Study Comparing the Safety and Efficacy of BOL-303259-X 0.024% (Latanoprostene Bunod) Ophthalmic Solution with Timolol Maleate Ophthalmic Solution 0.5% in Subjects with Open-Angle Glaucoma or Ocular Hypertension (Study #770) ...22
6.1.1. Study Design ...22 6.1.2. Study Results ...29 6.2. A Randomized, Multicenter, Double-Masked, Parallel-Group Study Comparing the Safety and Efficacy of BOL-303259-X 0.024% (Latanoprostene Bunod) Ophthalmic Solution with Timolol Maleate Ophthalmic Solution 0.5% in Subjects with Open-Angle or Ocular Hypertension (Study #769)...36
6.2.1. Study Design ...36 6.2.2. Study Results ...44 7 Integrated Review of Effectiveness...51 7.1. Assessment of Efficacy Across Trials ...51 7.1.1. Primary Endpoints ...51 7.1.2. Secondary and Other Endpoints ...52 7.1.3. Subpopulations...52 7.1.4. Dose and Dose-Response ...52 7.1.5. Onset, Duration, and Durability of Efficacy Effects...52 7.2. Additional Efficacy Considerations...52 7.2.1. Considerations on Benefit in the Postmarket Setting...52 7.2.2. Other Relevant Benefits...52 7.3. Integrated Assessment of Effectiveness ...52 8 Review of Safety...53 8.1. Safety Review Approach ...53 8.2. Review of the Safety Database ...53 8.2.1. Overall Exposure...53 8.2.2. Relevant characteristics of the safety population: ...54 8.2.3. Adequacy of the safety database: ...54 8.3. Adequacy of Applicant’s Clinical Safety Assessments...55 8.3.1. Issues Regarding Data Integrity and Submission Quality...55 8.3.2. Categorization of Adverse Events...55
Reference ID: 3920623
Clinical Review
Lucious Lim, M.D., M.P.H.
NDA 207795
Vyzulta (latanoprostene bunod ophthalmic solution) 0.024%
CDER Clinical Review Template 2015 Edition 4
Version date: June 25, 2015 for initial rollout (NME/original BLA reviews)
8.3.3. Routine Clinical Tests...55 8.4. Safety Results...55 8.4.1. Deaths...55 8.4.2. Serious Adverse Events...56 8.4.3. Dropouts and/or Discontinuations Due to Adverse Effects...57 8.4.4. Significant Adverse Events...59 8.4.5. Treatment Emergent Adverse Events and Adverse Reactions ...59 8.4.6. Laboratory Findings ...59 8.4.7. Vital Signs...60 8.4.8. Electrocardiograms (ECGs) ...60 8.4.9. QT ...60 8.4.10. Immunogenicity...60 8.5. Analysis of Submission-Specific Safety Issues ...60 8.6. Specific Safety Studies/Clinical Trials ...60 8.7. Additional Safety Explorations...60 8.7.1. Human Carcinogenicity or Tumor Development ...60 8.7.2. Human Reproduction and Pregnancy...60 8.7.3. Pediatrics and Assessment of Effects on Growth ...60 8.7.4. Overdose, Drug Abuse Potential, Withdrawal, and Rebound...61 8.8. Safety in the Postmarket Setting ...61 8.8.1. Safety Concerns Identified Through Postmarket Experience ...61 8.8.2. Expectations on Safety in the Postmarket Setting...61 8.9. Additional Safety Issues From Other Disciplines...61 8.10. Integrated Assessment of Safety...61 9 Advisory Committee Meeting and Other External Consultations ...61 10 Labeling Recommendations ...62 10.1. Prescribing Information...62 10.2. Patient Labeling...62 10.3. Nonprescription Labeling ...62 11 Risk Evaluation and Mitigation Strategies (REMS) ...62
Clinical Review
Lucious Lim, M.D., M.P.H.
NDA 207795
Vyzulta (latanoprostene bunod ophthalmic solution) 0.024%
CDER Clinical Review Template 2015 Edition 5
Version date: June 25, 2015 for initial rollout (NME/original BLA reviews)
11.1. Safety Issue(s) that Warrant Consideration of a REMS ...62 11.2. Conditions of Use to Address Safety Issue(s) ...62 11.3. Recommendations on REMS ...62 12 Postmarketing Requirements and Commitments...62 13 Appendices...63 13.1. References...63 13.2. Financial Disclosure ...63 13.3. Labeling ...66
Reference ID: 3920623
Clinical Review
Lucious Lim, M.D., M.P.H.
NDA 207795
Vyzulta (latanoprostene bunod ophthalmic solution) 0.024%
CDER Clinical Review Template 2015 Edition 6
Version date: June 25, 2015 for initial rollout (NME/original BLA reviews) Table of Tables
Table 2.2.-1 Drug Products with Approved NDAs
Table 4.2.-1 Qualitative and Quantitative Composition of Latanoprostene Bunod Ophthalmic Solution 0.024%
Table 5.1.-1 List of Clinical Studies
Table 6.1.1.-1 Schedule of Visits and Parameters (Study #770)
Table 6.1.2.-1 Subject Disposition and Primary Reason for Discontinuation
Table 6.1.2.-2 Major Protocol Violations in the Efficacy Phase (Randomized Population) Table 6.1.2.-3 Demographics and Baseline Characteristics (ITT Population)
Table 6.1.2-4 Baseline Study Eye Characteristics (ITT Population) Table 6.2.1.-1 Schedule of Visits and Parameters (Study #769)
Table 6.2.2.-1 Subject Disposition and Primary Reason for Discontinuation
Table 6.2.2.-2 Major Protocol Violations in the Efficacy Phase (Randomized Population) Table 6.2.2.-3 Demographics and Baseline Characteristics (ITT Population)
Table 6.2.2-4 Baseline Study Eye Characteristics (ITT Population) Table 8.2.1.-1 Safety Population (All Exposed Subjects)
Table 8.2.1.-2 Summary of Duration of Exposure (All Exposed Subjects) Table 8.4.1.-1 Deaths in the Safety Population
Table 8.4.2.-1 Ocular Serious Adverse Events (Phase 2/3 Pooled) Table 8.4.2.-2 Nonocular Serious Adverse Events (Phase 2/3 Pooled) Table 8.4.3.-1 Discontinuations Due to Adverse Events (Phase 2/3 Pooled)
Clinical Review
Lucious Lim, M.D., M.P.H.
NDA 207795
Vyzulta (latanoprostene bunod ophthalmic solution) 0.024%
CDER Clinical Review Template 2015 Edition 7
Version date: June 25, 2015 for initial rollout (NME/original BLA reviews)
Table 8.4.5.-1 TEAEs Occurring in ≥ 2% of Subjects in Any Treatment Group (Phase 2/3 Pooled)
Reference ID: 3920623
Clinical Review
Lucious Lim, M.D., M.P.H.
NDA 207795
Vyzulta (latanoprostene bunod ophthalmic solution) 0.024%
CDER Clinical Review Template 2015 Edition 8
Version date: June 25, 2015 for initial rollout (NME/original BLA reviews) Table of Figures
Figure 6.1.2.-1 Study #770 - ITT Population Mean IOP by Visit and Time Figure 6.1.2.-2 Study #770 - ITT Population Mean Difference with 95% CI Figure 6.1.2.-3 Study #770 - PP Population Mean Difference with 95% CI Figure 6.2.2.-1 Study #769 - ITT Population Mean IOP by Visit and Time Figure 6.2.2.-2 Study #769 - ITT Population Mean Difference with 95% CI Figure 6.2.2.-3 Study #769 - PP Population Mean Difference with 95% CI
Clinical Review
Lucious Lim, M.D., M.P.H.
NDA 207795
Vyzulta (latanoprostene bunod ophthalmic solution) 0.024%
CDER Clinical Review Template 2015 Edition 9
Version date: June 25, 2015 for initial rollout (NME/original BLA reviews)
Glossary
AC advisory committee
AE adverse event
BID twice daily
BLA biologics license application
BPCA Best Pharmaceuticals for Children Act BRF Benefit Risk Framework
CBER Center for Biologics Evaluation and Research CDER Center for Drug Evaluation and Research CDRH Center for Devices and Radiological Health CDTL Cross-Discipline Team Leader
CFR Code of Federal Regulations
CMC chemistry, manufacturing, and controls
COSTART Coding Symbols for Thesaurus of Adverse Reaction Terms
CRF case report form
CRO contract research organization CRT clinical review template CSR clinical study report CSS Controlled Substance Staff DMC data monitoring committee
ECG electrocardiogram
eCTD electronic common technical document ETASU elements to assure safe use
FDA Food and Drug Administration
FDAAA Food and Drug Administration Amendments Act of 2007 FDASIA Food and Drug Administration Safety and Innovation Act GCP good clinical practice
GRMP good review management practice
ICH International Conference on Harmonization IND Investigational New Drug
IOP intraocular pressure
ISE integrated summary of effectiveness ISS integrated summary of safety
ITT intent to treat
MedDRA Medical Dictionary for Regulatory Activities mITT modified intent to treat
NCI-CTCAE National Cancer Institute-Common Terminology Criteria for Adverse Event NDA new drug application
Reference ID: 3920623
Clinical Review
Lucious Lim, M.D., M.P.H.
NDA 207795
Vyzulta (latanoprostene bunod ophthalmic solution) 0.024%
CDER Clinical Review Template 2015 Edition 10
Version date: June 25, 2015 for initial rollout (NME/original BLA reviews) NME new molecular entity
OCS Office of Computational Science OPQ Office of Pharmaceutical Quality
OSE Office of Surveillance and Epidemiology OSI Office of Scientific Investigation
PBRER Periodic Benefit-Risk Evaluation Report
PD pharmacodynamics
PI prescribing information
PK pharmacokinetics
PMC postmarketing commitment PMR postmarketing requirement
PP per protocol
PPI patient package insert PREA Pediatric Research Equity Act PRO patient reported outcome PSUR Periodic Safety Update report
QD once daily
REMS risk evaluation and mitigation strategy SAE serious adverse event
SAP statistical analysis plan
SGE special government employee
SOC standard of care
TEAE treatment emergent adverse event
Clinical Review
Lucious Lim, M.D., M.P.H.
NDA 207795
Vyzulta (latanoprostene bunod ophthalmic solution) 0.024%
CDER Clinical Review Template 2015 Edition 11
Version date: June 25, 2015 for initial rollout (NME/original BLA reviews)