23.05.2007 11:00:00
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Northfield Laboratories Reports Results of Pivotal Phase III Trauma Study
Northfield Laboratories, Inc. (NASDAQ: NFLD) reported today results of
its pivotal Phase III trauma trial with PolyHeme®,
its human hemoglobin-based oxygen-carrying red blood cell substitute.
The trial was designed to seek an indication for use in the treatment of
life-threatening red blood cell loss when transfusion is required and
red blood cells are not available, not for use interchangeably with
blood. This indication addresses a critical, unmet medical need.
The primary efficacy endpoint of the study was a dual
superiority-noninferiority assessment of mortality at 30 days after
injury. The margin to assess noninferiority, using the upper limit of
the confidence interval, was set at 7% more than control. In the primary
Modified Intent to Treat population, the upper limit was 7.65%. In the
As Treated population, the upper limit was 7.06%. In the Per Protocol
population, the upper limit was 6.29%.
Day 30 mortality was also a primary safety endpoint. Further analysis of
the mortality data indicates that the difference in mortality at 30 days
between patients who received PolyHeme beginning at the scene and
continuing for up to 12 hours following injury, and control patients who
received the standard of care, including early blood, was not
statistically significant.
"The results of this study are best understood
in the context of bleeding patients who do not have early access to
blood transfusion,” said Steven A. Gould,
M.D., Chairman and Chief Executive Officer. "47
million Americans live more than an hour away from a trauma center where
blood is available. Mortality rates in that scenario would be
considerably higher than those observed in the control patients in the
urban setting of this trial, where transit times were relatively short.
We believe that when our data are extrapolated to patients who need an
oxygen carrier and have delayed access to blood, PolyHeme can play an
important role in saving lives.” Conference Call
Northfield will hold a conference call today, Wednesday, May 23, 2007,
at 8:30 a.m. EDT to discuss the results of the study. To participate in
the call, investors may dial 866.770.7146 and reference the passcode
56877457. Investors may also access a live audio webcast at www.northfieldlabs.com;
this will be archived for two weeks. A telephone replay will also be
available for two weeks by dialing 888-286-8010 and entering the
passcode 14789842.
Analysis Populations
The study protocol pre-specified multiple patient populations for
analysis: the primary Modified Intent to Treat population (MITT); the As
Treated population (AT); and the Per Protocol population (PP).
Efficacy Analysis
The primary efficacy endpoint of the study was a dual
superiority-noninferiority assessment of mortality at 30 days after
injury. A noninferiority endpoint requires the establishment of a
relative margin around the control outcome. The margin to assess
noninferiority in this study, using the upper limit of the confidence
interval, was set at 7% more than control.
MITT Population
The MITT population is comprised of all 714 patients both randomized and
treated. In this population, patients were analyzed as randomized,
and not based on the actual treatment they received. There were 41
randomized patients in the study who received the incorrect treatment.
Therefore, the 21 patients randomized to PolyHeme who did not receive
any PolyHeme were analyzed in the PolyHeme group. Similarly, the 20
patients randomized to control who did receive PolyHeme were analyzed in
the control group.
AT Population
The AT population is also comprised of all 714 patients both randomized
and treated. However, in this population all patients were analyzed
according to the treatment they actually received.
Therefore, all patients who did receive PolyHeme were analyzed in the
PolyHeme group, and all patients who did not receive any PolyHeme were
analyzed in the control group. Although the AT population was
pre-specified for safety rather than efficacy, it provides a meaningful
opportunity to assess mortality as well.
PP Population
The PP population is comprised of the 586 patients both appropriately
randomized and correctly treated. The PP population does not include
128 patients who had major protocol violations related to eligibility or
treatment regimen. Since the PP patients were treated exactly as
specified in the protocol, Northfield believes the PP population
represents the clearest opportunity to assess a treatment effect.
In the primary MITT population, the upper limit of the confidence
interval was 7.65%. In the AT population, the upper limit was 7.06%. In
the PP population, the upper limit was 6.29%. The data are shown in
Table 1.
TABLE 1 DAY 30 MORTALITY
PolyHeme (deaths/N) % Control (deaths/N) % Upper Limit MITT
47/350
13.4
35/364
9.6
7.65%
AT
46/349
13.2
36/365
9.9
7.06%
PP
31/279
11.1
28/307
9.1
6.29%
Secondary efficacy endpoints of the study included Day 1 mortality
(Table 2), the incidence of multiple organ failure, the use of donated
blood through Day 1, and an analysis of mortality by the mechanism of
injury (blunt versus penetrating trauma). The incidence of transfusion
of donated blood was significantly lower in the PolyHeme group at 41%
than the control group at 51% (p(<=)0.05).
There was no statistically significant difference between PolyHeme and
control patients for the other efficacy endpoints.
TABLE 2 DAY 1 MORTALITY
PolyHeme (deaths/N) % Control (deaths/N) % MITT
34/350
9.7
27/364
7.4
AT
33/349
9.5
28/365
7.7
PP
20/279
7.2
21/307
6.8
Safety Analysis
The primary safety endpoints in the study were Day 1 mortality, Day 30
mortality, and durable serious adverse events (SAEs). Durable serious
adverse events were prospectively defined as SAEs which resulted in a "permanently
disabling” outcome. There were two durable
SAEs in each group. There was no statistically significant difference
between the PolyHeme and control groups for any of these endpoints.
Additional Safety Data
All adverse events (AEs), serious adverse events (SAEs), cardiac SAEs,
and myocardial infarction (MI) were also analyzed. The overall incidence
of AEs in the PolyHeme group of 93% (324 patients) was higher than that
in the control group of 88% (322 patients), (p(<=)0.05).
The most common AEs in both groups were: anemia, fever, and electrolyte
imbalances. The overall incidence of SAEs in the study was 40% (141
patients) in the PolyHeme group and 35% (126 patients) in the control
group (p>0.05). The most common SAEs in
both groups were: shock, pneumonia, and respiratory failure.
The incidence of cardiac AEs was 35% (123 patients) in the PolyHeme
group and 29% (105 patients) in the control group (p>0.05).
The incidence of cardiac SAEs was 7% (23 patients) in the PolyHeme group
and 4% (16 patients) in control (p>0.05).
The overall incidence of MI in the study as reported by investigators
was 2%: eleven PolyHeme patients and three control patients (p(<=)0.05).
Three PolyHeme patients and one control patient died.
The medical literature documents the difficulty of making an accurate
diagnosis of MI in trauma patients for multiple reasons, including
direct trauma to the chest. Myocardial infarction and myocardial
ischemia are traditionally assessed by EKGs and the cardiac enzymes
Troponin I and CK-MB, both of which can be altered by direct trauma.
Approximately 75% of the patients in this study had abnormal EKGs or
elevated cardiac enzymes. Because of the disparity between the low
number of reported MIs and the high incidence of abnormal EKGs and
elevated cardiac enzymes, Northfield has established an independent
panel of cardiac experts to review the cardiac profiles of all 720
randomized patients in a blinded fashion to categorize MIs in the study.
Summary "This was a seminal study. This summary
represents our initial opportunity to explore the data on safety and
efficacy in detail. We continue to believe there is a potential benefit
to using PolyHeme in patients with delayed access to blood, whose
expected mortality without oxygen-carrying replacement would be
considerably greater,” said Dr. Gould.
As the data have not been submitted to FDA, Northfield is preparing a
detailed summary of the study data for submission to FDA for review.
About the Study
This randomized, controlled open-label, multi-center, active control
pivotal Phase III study of 720 patients was designed to evaluate the
safety and efficacy of PolyHeme when used to treat patients in
hemorrhagic shock following traumatic injuries beginning in the
prehospital setting. Treatment began at the scene of injury, continued
in the ambulance during transport, and for up to 12 hours post-injury or
a total of 6 units. Patients then received donated blood if they
continued to bleed. Patients in the control group received the standard
of care: saline in the field and during transport, followed by blood
upon arrival at the hospital. Thirty-two Level I trauma centers
participated in the study, which was conducted to seek an indication for
the use of PolyHeme that addresses a critical, unmet medical need: the
unavailability of blood.
In December 2006, Northfield announced that it had received the
preliminary draft top-line data from its contract research organization.
Northfield indicated that due to certain discrepancies in the data
identified during its initial review, it became necessary to resolve the
discrepancies and unlock the study database to make any necessary
corrections. The process has now been completed, the study database
relocked, and the data reanalyzed. Northfield has also had the
opportunity to further analyze the study data, including additional
safety data. These data have not been submitted to or reviewed by FDA.
About Northfield Laboratories
Northfield Laboratories, Inc., is a leader in developing an
oxygen-carrying red blood cell substitute for the treatment of
life-threatening blood loss, when an oxygen-carrying fluid is required
and red blood cells are not available. PolyHeme®
is a solution of chemically modified human hemoglobin that requires no
cross matching and is, therefore, compatible with all blood types. It
has a shelf life in excess of 12 months. For further information, visit www.northfieldlabs.com. Forward Looking Statement This press release may contain forward-looking statements concerning,
among other things, Northfield’s future
business plans and strategies and clinical and regulatory developments
affecting our PolyHeme red blood cell substitute product. These
forward-looking statements are identified by the use of such terms as "intends,” "expects,” "plans,” "estimates,” "anticipates,” "should,” "believes”
and similar terms. These forward-looking statements involve inherent
risks and uncertainties. Our actual results may therefore differ
materially from those predicted by the forward-looking statements
because of various factors and possible events, including the
possibility that since the data from our Phase III clinical trial have
not been submitted to, or reviewed by, FDA, they may not be
sufficient to demonstrate the safety or effectiveness of PolyHeme, our
ability to obtain FDA approval to market PolyHeme commercially, our
ability to obtain priority review, the availability of capital to
finance our clinical trials and ongoing business operations, our ability
to obtain adequate supplies of raw materials and to manufacture PolyHeme
in commercial quantities, our ability to market PolyHeme successfully,
the possibility that competitors will develop products that will render
PolyHeme obsolete or non-competitive, our ability to protect our
intellectual property rights, the outcome of certain governmental
inquiries and purported class action lawsuit as described in our most
recently filed annual report on Form 10-K and quarterly report on
Form 10-Q, the possibility that we may be subject to product liability
claims and other legal actions, our dependency on a limited number of
key personnel, the uncertainty of third party reimbursement for our
product and other risks and uncertainties described from time to
time in our periodic reports filed with the Securities and Exchange
Commission, including our most recently filed annual report on Form 10-K
and quarterly report on Form 10-Q. These forward-looking
statements speak only as of the date of this press release. We do
not undertake any obligation to update or publicly release any revisions
to forward-looking statements to reflect events, circumstances or
changes in expectations after the time such statement is made. All
subsequent written and oral forward-looking statements attributable to
Northfield or any person acting on our behalf are qualified by this
cautionary statement.
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