On 24 August 2022, the US Food and Drug Administration (FDA) approved ibrutinib (Imbruvica, Pharmacyclics LLC) for paediatric patients ≥ 1 year of age with chronic graft versus host disease (cGVHD) after failure of 1 or more lines of systemic treatment. Formulations include capsules, tablets, and oral suspension.
Efficacy was evaluated in iMAGINE (NCT03790332), an open-label, multicentre, single-arm study of ibrutinib for paediatric and young adult patients 1 year to less than 22 years old with moderate or severe cGVHD. The study included 47 patients who required additional treatment after failure of 1 or more lines of systemic treatments. Patients were excluded if single organ genitourinary involvement was the only manifestation of cGVHD.
The median age of patients was 13 years (range, 1 to 19). Selected demographics of the 47 patients were as follows: 70% male, 36% White, 9% Black or African American, 55% other or unreported.
The main efficacy outcome measure was overall response rate (ORR) through week 25. The ORR included complete response or partial responses according to the 2014 NIH Consensus Development Project Response Criteria. The ORR by week 25 was 60% (95% confidence interval [CI] 44, 74). The median duration of response was 5.3 months (95% CI 2.8, 8.8). The median time from first response to death or new systemic treatments for cGVHD was 14.8 months (95% CI 4.6, not evaluable).
The most common (≥20%) adverse reactions, including laboratory abnormalities, were anaemia, musculoskeletal pain, pyrexia, diarrhoea, pneumonia, abdominal pain, stomatitis, thrombocytopenia, and headache.
The recommended dosage of Imbruvica for patients 12 years of age and older with cGVHD is 420 mg orally once daily, and for patients 1 to less than 12 years of age with cGVHD is 240 mg/m2 orally once daily (up to a dose of 420 mg), until cGVHD progression, recurrence of an underlying malignancy, or unacceptable toxicity.
Full prescribing information for Imbruvica is available here.
This review used the Assessment Aid, a voluntary submission from the applicant to facilitate the FDA’s assessment.
The applications for this action were granted priority review. Ibrutinib also was granted orphan drug designation. The applications were submitted in response to a paediatric Written Request issued by the FDA.
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