Pulmonary Tuberculosis

South Africa's Competition Commission has decided not to move ahead with prosecuting allegations of anticompetitive conduct against Johnson & Johnson and its Janssen unit after the company agreed to cut the price of its tuberculosis (TB) drug Sirturo (bedaquiline) by about 40% in the country.The probe, which began last September, examined accusations that Johnson & Johnson had filed a secondary patent for Sirturo, potentially restricting generic competition until 2027 and enabling the company to charge "excessive" prices to South Africa's National Department of Health."The decision to non-refer the complaint of alleged anti-competitive conduct... to the Competition Tribunal for prosecution, follows extensive engagements with the two companies," according to a statement by the Competition Commission. "The companies, in turn, have agreed not to enforce the bedaquiline patent in 134 low- and middle-income countries, including South Africa."After backlash from advocacy groups against the decision to enforce patents on Sirtuto in several markets, the drugmaker confirmed its intention last year to forgo patents in those countries.South Africa's Competition Commission noted that the discounted price aligns with what Johnson & Johnson offers to the Global Drug Facility, the world's largest procurer of TB medicines and diagnostics.The decision coincides with a pair of regulatory milestones for Sirturo. Earlier this month, the drug received full approval in the US and EU for the treatment of multidrug-resistant pulmonary tuberculosis in adults and children aged 5 and older.

Johnson & Johnson (J&J) has received approvals from both the European Commission (EC) and US Food and Drug Administration (FDA) for its tuberculosis (TB) treatment, Sirturo (bedaquiline). The EC has granted the drug full approval to treat pulmonary multidrug-resistant tuberculosis (MDR-TB) as part of an appropriate combination regimen in adult and paediatric patients aged five years and older and weighing at least 15kg. The EU regulator’s decision, which specifically indicates Sirturo when other combinations cannot be used because the disease is resistant to them or because of their side effects, follows a recent recommendation from the European Medicines Agency’s human medicines committee and converts its previous 2014 conditional approval of the drug to a standard marketing authorisation. The FDA has also granted Sirturo traditional approval for use as part of a combination therapy for adult and paediatric patients, also aged five years and older and weighing at least 15kg, with pulmonary MDR-TB. The approval removes the label restrictions that were included when the medicine was granted accelerated approval in the US in 2012, J&J outlined. The new authorisations were based on results from the phase 3 STREAM stage 2 study, in which a Sirturo-containing regimen offered a significant improvement in treatment outcomes for patients with MDR-TB compared to injectable-containing regimens. An estimated 410,000 people globally developed multidrug- or rifampicin-resistant TB in 2022, according to the World Health Organization, which also noted that the treatment success rate for patients diagnosed with this form of the infection remains “alarmingly low” despite improvements. The decisions on Sirturo come just days after J&J’s Rybrevant (amivantamab) was approved by the EC as a first-line treatment for non-small cell lung cancer (NSCLC). The bispecific antibody was specifically authorised for use alongside carboplatin and pemetrexed chemotherapy to treat advanced NSCLC in adults with epidermal growth factor receptor exon 20 insertion mutations. The company also recently received a recommendation from the Committee for Medicinal Products for Human Use for the use of its tyrosine kinase inhibitor Balversa (erdafitinib) in certain adults with unresectable or metastatic urothelial carcinoma.

Approvals supported by Phase 3 STREAM Stage 2 study results confirming favorable treatment outcomes compared to injectable-containing regimens Approvals of SIRTURO ® follow accelerated approval by U.S. FDA in December 2012 and conditional approval by the EMA in March 2014 BEERSE, Belgium I July 2, 2024 I Johnson & Johnson announced today that the U.S. Food and Drug Administration (FDA) has issued traditional approval for SIRTURO ® (bedaquiline) as part of combination therapy in adult and pediatric patients (5 years and older and weighing at least 15 kg) with pulmonary tuberculosis (TB) due to Mycobacterium tuberculosis resistant to at least rifampicin and isoniazid. With the FDA’s approval, label restrictions that were included when the medicine was granted accelerated approval in the U.S. in December 2012 are removed. The European Commission (EC) has also granted full approval of SIRTURO ® , converting its Conditional Marketing Authorisation to a Standard Marketing Authorisation, following a positive opinion in April 2024 from the European Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA). The approvals were supported by results from the Phase 3 STREAM Stage 2 study ( NCT02409290 ), the first large-scale, randomized, multi-country open-label clinical study to evaluate the efficacy and safety of an all-oral bedaquiline-containing regimen for treatment of MDR-TB. Results confirmed that a bedaquiline-containing regimen offered a significant improvement in treatment outcomes compared to injectable-containing regimens. Findings from the study were published in The Lancet in November 2022. i SIRTURO ® was granted accelerated approval by the FDA in December 2012 and conditional approval by the EMA in March 2014 following positive Phase 2 study data. A supplemental New Drug Application was submitted to the FDA in August 2023 to support the transition to full approval in the U.S. in addition to a Type II variation filed with the European Medicines Agency (EMA) in November 2023 to support the transition to Standard Marketing Authorisation. Johnson & Johnson’s Commitment to TB Patients Johnson & Johnson has long been committed to helping end tuberculosis. When Johnson & Johnson introduced SIRTURO ® , it was the first medicine for TB with a novel mechanism of action to be introduced in over 40 years. Today, it is a core component of World Health Organization-recommended treatment guidelines for drug-resistant TB, and three of every four MDR-TB patients on treatment are receiving an all-oral regimen containing bedaquiline. More than 845,000 courses of the medicine have been shipped to 160 countries. Johnson & Johnson has spent the decade since the introduction of SIRTURO ® partnering with healthcare providers, communities, governments and non-governmental organizations to help ensure the medicine is accessible and remains effective for patients today and tomorrow. These efforts include investing in critical TB systems capacity, such as healthcare professional training, resistance testing and surveillance, and supply chain security. The Company also supports community-centered initiatives to help identify adults and children living with TB and bring them into treatment, expanding access to TB medicines. In 2023, Johnson & Johnson granted the Stop TB Partnership’s Global Drug Facility (GDF) a license that enabled GDF to tender, procure and supply generic versions of SIRTURO ® for the majority of low-and middle-income countries (LMICs). The Company also confirmed its intent not to enforce bedaquiline patents in 134 low- and middle-income countries. To learn more about Johnson & Johnson’s efforts in TB, visit https://www.jnj.com/tb . About SIRTURO ® EU For a full list of adverse events and information on dosage and administration, contraindications and other precautions when using bedaquiline, please refer to the Summary of Product Characteristics. U.S. SIRTURO ® is a diarylquinoline antimycobacterial drug indicated as part of combination therapy in adult and pediatric patients (5 years and older and weighing at least 15 kg) with pulmonary tuberculosis (TB) due to Mycobacterium tuberculosi s resistant to at least rifampin and isoniazid. Please read the full Prescribing Information for more details. About Johnson & Johnson At Johnson & Johnson, we believe health is everything. Our strength in healthcare innovation empowers us to build a world where complex diseases are prevented, treated, and cured, where treatments are smarter and less invasive, and solutions are personal. Through our expertise in Innovative Medicine and MedTech, we are uniquely positioned to innovate across the full spectrum of healthcare solutions today to deliver the breakthroughs of tomorrow, and profoundly impact health for humanity. Learn more at https://www.jnj.com/ . Footnotes i Goodall, Ruth L, et al. “Evaluation of two short standardised regimens for the treatment of rifampicin-resistant tuberculosis (STREAM stage 2): an open-label, multicentre, randomised, non-inferiority trial.” The Lancet, Volume 400, Issue 10366, 1858 – 1868. Available at: https://www-thelancet-com.libproxy1.nus.edu.sg/journals/lancet/article/PIIS0140-6736(22)02078-5/fulltext SOURCE: Johnson & Johnson