Takeda to Produce Innovative Drug for Multiple Myeloma Patients in Yaroslavl, Russia

August 1, 2018

Osaka, Japan and Yaroslavl, Russia, August 1, 2018 – Takeda Pharmaceutical Company Limited (TSE: 4502) today announced the opening of a production site for NINLARO^® (ixazomib), an innovative drug for patients with multiple myeloma, at its Yaroslavl plant. The move takes the Company’s total investment in local Russian manufacturing and production of the product to RUR477mln.

NINLARO^®, which is part of Takeda’s global portfolio of innovative medicines, is indicated in combination with lenalidomide and dexamethasone for multiple myeloma patients who have previously received at least one line of therapy. NINLARO^®, which has orphan drug status, was first registered in Russia in 2017, and was made available to patients locally in 2018.

“Takeda Russia celebrates 25 years of operations this year. Throughout these years we have always sought to increase the availability of innovative drugs and new treatments for local people. I am proud that in this, our silver jubilee year, we have brought an innovative medicine to Russian patients with multiple myeloma, and also began its production at our Yaroslavl plant,” commented Andrey Potapov, General Director of Takeda Russia & Area Head Takeda Russia-CIS. “Yaroslavl will become only the second production site for ixazomib in the world. Critically, local production will better help meet the unmet medical needs of patients in Russia and, as we will also be able to export ixazomib produced at this facility, patients in CIS countries.”

Andrei Obruchnikov, Commercial and Logistics Director, Takeda Russia said: “We started work on transferring the production of ixazomib in 2015 and as early as the fourth quarter of the year, plan to start full cycle production. That means that even more patients will be able to access this innovative, high quality treatment.”

Dmitry Koloda, Medical Director, Takeda Russia-CIS said: “The main goal for the treatment of patients with multiple myeloma are to achieve the maximum possible clinical response with long-term disease control, while maintaining patient quality of life. Ixazomib in combination with lenalidomide and dexamethasone, is the first fully oral triplet therapy that allows patients to receive out-patient treatment, which also reduces the burden on doctors in hospitals and allows patients to continue to lead an active life.”

Multiple myeloma is an incurable disease and accounts for 1% of all malignant tumors, and 13% of instances of hemoblastosis (cancers of hematopoietic and lymphatic tissues)^1,2. The disease incidence of multiple myeloma in Russia is 2.0 cases per 100,000 people, and has a mortality rate is 4.1 cases per 100,000 people, per year³. The average age of patients in Russia with multiple myeloma is 64 years³.

Media Contact:
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Media outside Russia and Japan
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Japanese Media
Kazumi Kobayashi
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About NINLARO^® (ixazomib) capsules
NINLARO^® (ixazomib) is an oral proteasome inhibitor which is also being studied across the continuum of multiple myeloma treatment settings as well as systemic light-chain (AL) amyloidosis. It was the first oral proteasome inhibitor to enter Phase 3 clinical trials and to receive approval. NINLARO was approved by the U.S. Food and Drug Administration (FDA) in November 2015 following a priority review and by the European Commission in November 2016. In the U.S. and Europe, NINLARO is indicated in combination with lenalidomide and dexamethasone for the treatment of patients with multiple myeloma who have received at least one prior therapy. NINLARO has received marketing authorization by regulatory authorities in more than 55 countries.

Ixazomib was granted orphan drug designation in multiple myeloma in both the U.S. and Europe in 2011 and for AL amyloidosis in both the U.S. and Europe in 2012. Ixazomib received Breakthrough Therapy status by the U.S. FDA for relapsed or refractory systemic light-chain (AL) amyloidosis, a related ultra orphan disease, in 2014. The Japanese Ministry of Health, Labour and Welfare granted Orphan Drug designation to ixazomib in 2016.

The comprehensive ixazomib clinical development program, TOURMALINE, includes a total of six ongoing pivotal trials – five, which together are investigating every major multiple myeloma patient population, and one in light-chain amyloidosis:

TOURMALINE-MM1, investigating ixazomib vs. placebo in combination with lenalidomide and dexamethasone in relapsed and/or refractory multiple myeloma
TOURMALINE-MM2, investigating ixazomib vs. placebo in combination with lenalidomide and dexamethasone in patients with newly diagnosed multiple myeloma
TOURMALINE-MM3, investigating ixazomib vs. placebo as maintenance therapy in patients with newly diagnosed multiple myeloma following induction therapy and autologous stem cell transplant (ASCT)
TOURMALINE-MM4, investigating ixazomib vs. placebo as maintenance therapy in patients with newly diagnosed multiple myeloma who have not undergone ASCT; this study is currently enrolling
TOURMALINE-MM5, investigating ixazomib plus dexamethasone vs. pomalidomide plus dexamethasone in patients with relapsed and/or refractory multiple myeloma who have become resistant to lenalidomide
TOURMALINE-AL1, investigating ixazomib plus dexamethasone vs. physician choice of selected regimens in patients with relapsed or refractory AL amyloidosis; this study is currently enrolling

For more information about actively enrolling Phase 3 studies please visit: https://www.tourmalinetrials.com/

In addition to the TOURMALINE program, ixazomib is being evaluated in multiple therapeutic combinations for various patient populations in investigator initiated studies globally.

NINLARO^® (ixazomib) capsules: Global Important Safety Information

SPECIAL WARNINGS AND PRECAUTIONS
Thrombocytopenia has been reported with NINLARO (28% vs. 14% in the NINLARO and placebo regimens, respectively) with platelet nadirs typically occurring between Days 14-21 of each 28-day cycle and recovery to baseline by the start of the next cycle. It did not result in an increase in hemorrhagic events or platelet transfusions. Monitor platelet counts at least monthly during treatment with NINLARO and consider more frequent monitoring during the first three cycles. Manage with dose modifications and platelet transfusions as per standard medical guidelines.

Gastrointestinal toxicities have been reported in the NINLARO and placebo regimens respectively, such as diarrhea (42% vs. 36%), constipation (34% vs. 25%), nausea (26% vs. 21%), and vomiting (22% vs. 11%), occasionally requiring use of antiemetic and anti-diarrheal medications, and supportive care.

Peripheral neuropathy was reported with NINLARO (28% vs. 21% in the NINLARO and placebo regimens, respectively). The most commonly reported reaction was peripheral sensory neuropathy (19% and 14% in the NINLARO and placebo regimens, respectively). Peripheral motor neuropathy was not commonly reported in either regimen (< 1%). Monitor patients for symptoms of peripheral neuropathy and adjust dosing as needed.

Peripheral edema was reported with NINLARO (25% vs. 18% in the NINLARO and placebo regimens, respectively). Evaluate patients for underlying causes and provide supportive care, as necessary. Adjust the dose of dexamethasone per its prescribing information or the dose of NINLARO for severe symptoms.

Cutaneous reactions occurred in 19% of patients in the NINLARO regimen compared to 11% of patients in the placebo regimen. The most common type of rash reported in both regimens was maculo-papular and macular rash. Manage rash with supportive care, dose modification or discontinuation.

Hepatotoxicity, drug-induced liver injury, hepatocellular injury, hepatic steatosis, and hepatitis cholestatic have been uncommonly reported with NINLARO. Monitor hepatic enzymes regularly and adjust dose for Grade 3 or 4 symptoms.

Pregnancy- NINLARO can cause fetal harm. Advise male and females patients of reproductive potential to use contraceptive measures during treatment and for an additional 90 days after the final dose of NINLARO. Women of childbearing potential should avoid becoming pregnant while taking NINLARO due to potential hazard to the fetus. Women using hormonal contraceptives should use an additional barrier method of contraception.

Lactation- It is not known whether NINLARO or its metabolites are excreted in human milk. There could be potential adverse events in nursing infants and therefore breastfeeding should be discontinued.

SPECIAL PATIENT POPULATIONS
Hepatic Impairment: Reduce the NINLARO starting dose to 3 mg in patients with moderate or severe hepatic impairment.

Renal Impairment: Reduce the NINLARO starting dose to 3 mg in patients with severe renal impairment or end-stage renal disease (ESRD) requiring dialysis. NINLARO is not dialyzable and, therefore, can be administered without regard to the timing of dialysis.

DRUG INTERACTIONS
Co-administration of strong CYP3A inducers with NINLARO is not recommended.

ADVERSE REACTIONS
The most frequently reported adverse reactions (≥ 20%) in the NINLARO regimen, and greater than in the placebo regimen, were diarrhea (42% vs. 36%), constipation (34% vs. 25%), thrombocytopenia (28% vs. 14%), peripheral neuropathy (28% vs. 21%), nausea (26% vs. 21%), peripheral edema (25% vs. 18%), vomiting (22% vs. 11%), and back pain (21% vs. 16%). Serious adverse reactions reported in ≥ 2% of patients included thrombocytopenia (2%) and diarrhea (2%). For each adverse reaction, one or more of the three drugs was discontinued in ≤ 1% of patients in the NINLARO regimen.

For European Union Summary of Product Characteristics: http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/003844/WC500217620.pdf
For US Prescribing Information: https://www.ninlarohcp.com/pdf/prescribing-information.pdf
For Canada Product Monograph: http://www.takedacanada.com/ninlaropm

About Takeda Pharmaceutical Company Limited
Takeda Pharmaceutical Company Limited (TSE: 4502) is a global, research and development-driven pharmaceutical company committed to bringing better health and a brighter future to patients by translating science into life-changing medicines. Takeda focuses its R&D efforts on oncology, gastroenterology and neuroscience therapeutic areas plus vaccines. Takeda conducts R&D both internally and with partners to stay at the leading edge of innovation. Innovative products, especially in oncology and gastroenterology, as well as Takeda’s presence in emerging markets, are currently fueling the growth of Takeda. Approximately 30,000 Takeda employees are committed to improving quality of life for patients, working with Takeda’s partners in health care in more than 70 countries.
For more information, visit https://www.takeda.com/newsroom/

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Anderson KC, Alsina M, Atanackovic D, et al. NCCN Guidelines Insights: Multiple Myeloma, Version 3.2016. J Natl Compr Canc Netw. 2016;14(4):389-400.
Ferlay J, et al. GLOBOCAN 2008 (version 1.2), Cancer Incidence and Mortality Worldwide. Lyon, France: International Agency for Research on Cancer, 2010.
ЗЛОКАЧЕСТВЕННЫЕ НОВООБРАЗОВАНИЯ В РОССИИ В 2015 ГОДУ (ЗАБОЛЕВАЕМОСТЬ И СМЕРТНОСТЬ), под. ред. А.Д. Каприна, 2016.