• A single intradiscal injection of SI-6603 demonstrated significantly greater improvement in leg pain vs. sham at Week 13 in trials conducted in the U.S. and Japan
• Pivotal U.S. Phase 3 study results published in The Spine Journal
• About nine million adults in the U.S. suffer from lumbar disc herniation each year

Ferring Pharmaceuticals and its clinical development partner, Seikagaku Corporation (Seikagaku), today announced the presentation of data from two Phase 3 trials evaluating the efficacy and safety of SI-6603 (generic name: condoliase), an investigational product being studied for the treatment of radicular leg pain associated with lumbar disc herniation (LDH). The podium presentation at the North American Spine Society’s (NASS) Annual Meeting included results from one study conducted in the U.S. and one in Japan. In addition, The Spine Journal has published the results of the pivotal U.S. Phase 3 study.

NASS Presentation

In the double-blind, sham or placebo controlled Phase 3 studies, patients with LDH were randomized to receive either a single intradiscal injection of SI-6603 1.25 Units or control (sham injection for U.S. study; placebo injection for Japanese study) followed by 52 weeks of observation. The modified intention-to-treat population in the U.S. study included 341 participants (SI-6603 n=169; sham n=172), and the study population in Japan included 163 participants (SI-6603 n=82; placebo n=81). The studies met their primary endpoint, showing significantly greater change from baseline (CFB) in worst leg pain at Week 13 compared to sham (U.S.) / placebo (Japan) (least squares mean [LSM] difference: -7.5 [p=0.0263] for the U.S. study and -15.2 [p=0.001] for the Japan study).

“Treatment for radicular leg pain associated with lumbar disc herniation is currently limited to conservative pain management and physical therapy or surgery. The data from these two Phase 3 studies further support the potential of SI-6603 as a therapeutic option for the millions of Americans suffering from the debilitating impact of this condition,” said Kee Kim, MD, University of California, Davis.

The most common treatment-emergent adverse events (TEAEs) in the U.S. trial were spinal magnetic resonance imaging abnormalities (SI-6603 28.1%; sham 9.2%) and back pain (SI-6603 19.2%; sham 12.6%). In the Japan trial, the most common TEAEs were back pain (SI-6603 36.6%; placebo 33.3%) and leg pain (SI-6603 25.6%; placebo 35.8%). There were no treatment-related serious adverse events (SAEs) with SI-6603 in the U.S. study, and in the Japan study, one SAE (back pain) was considered potentially related to SI-6603.

About the Phase 3 Trial in the U.S.

In this randomized double-blind, sham-controlled, parallel Phase 3 study — known as the Discovery 6603 clinical trial (NCT03607838) — participants were randomized 1:1 to receive either SI-6603 (1.25 U) or sham injection followed by 52 weeks of observation. The primary endpoint was defined as the CFB to Week 13 in worst leg pain during the past 24 hours averaged over the previous seven days, as assessed by Visual Analogue Scale, a pain rating score from 0 – 100 with a higher score indicating greater pain intensity. Key secondary endpoints included the CFB in average worst leg pain at 52 weeks, percentage of participants with negative straight leg raise test, and 50% responder rates for worst leg pain and Oswestry Disability Index (ODI). Since the key secondary endpoint of change in average worst leg pain at Week 52 was not significant, the serial gatekeeping testing algorithm dictated that there were no significant group differences for Week 13 herniation volume or ODI score regardless of their p-values. Endpoints were assessed using a mixed model for repeated measures (MMRM) analysis of the modified intention-to-treat population (mITT).

The trial included U.S. participants ages 30 to 70 years old who had contained posterolateral LDH with the chief complaint being unilateral radiculopathy/radicular leg pain and inadequate improvement in pain despite more than six weeks of conservative treatment. Among 352 randomized participants, 341 constituted the mITT population (SI-6603 n=169; sham injections n=172).

About the Phase 3 Trial in Japan

In this randomized, double-blind, placebo-controlled study, participants were randomized 1:1 to receive either a single injection of SI-6603 (1.25U) or placebo injection, followed by 52 weeks of observation. The primary endpoint was the CFB to Week 13 in average worst leg pain during the past 24 hours over the previous seven days, as assessed by Visual Analogue Scale, a pain rating score from 0 – 100 with a higher score indicating greater pain intensity. Secondary endpoints included CFB up to Week 52 in average worst leg pain, herniation volume and ODI score. Endpoints were assessed using an analysis of covariance model.

About Lumbar Disc Herniation

About 9 million adults in the U.S. suffer from lumbar disc herniation each year. A disc herniation is a displacement of the gel-like inner core of the intervertebral disc, called the nucleus pulposus, through its external membrane (annulus fibrosus) due to wear and tear, aging or sudden injury. As a result of this displacement, the disc presses on the spinal nerve, often producing pain.^1,2

About SI-6603

SI-6603, which contains condoliase as its active pharmaceutical ingredient, is an investigational product being studied for the treatment of radicular leg pain associated with lumbar disc herniation via a single, direct intradiscal injection. SI-6603 (condoliase) is designed to reduce nerve root compression and thereby the radicular leg pain.

SI-6603 was developed by Seikagaku. Marketing approval for SI-6603 in Japan was obtained from the Japanese Ministry of Health, Labour and Welfare in March 2018 and SI-6603 has been marketed in Japan only as HERNICORE^® 1.25 units for intradiscal injection through Seikagaku's Japanese sales partner Kaken Pharmaceutical Co., Ltd. (Tokyo, Japan) since August 1, 2018.³

Alliance with Seikagaku

Seikagaku and Ferring entered into a license agreement for SI-6603 in August 2016. Ferring plans to commercialize the product in the United States upon FDA approval and has received further rights to develop, register and commercialize SI-6603 worldwide, excluding Japan.

About Ferring Pharmaceuticals

Ferring Pharmaceuticals is a privately-owned, research-driven, specialty biopharmaceutical group committed to building families and helping people live better lives. In the United States, Ferring is a leader in reproductive medicine and maternal health, and in areas of gastroenterology and orthopaedics. We are at the forefront of innovation in microbiome-based therapeutics and uro-oncology intravesical gene therapy. Our company was founded in 1950 and is headquartered in Saint-Prex, Switzerland. Ferring employs more than 7,000 people worldwide and markets its medicines in over 100 countries. Ferring USA is based in Parsippany, New Jersey, and employs more than 900 employees.

For more information, please visit www.ferringusa.com, call 1-888-FERRING (1-888-337-7464), or connect with us on LinkedIn and X (Twitter).

References:

1. Vialle LR, Vialle EN, Suárez Henao JE, Giraldo G. Lumbar Disc Herniation. Rev Bras Ortop. 2015 Nov 16;45(1):17-22. doi: 10.1016/S2255-4971(15)30211-1. PMID: 27019834; PMCID: PMC4799068.
2. Herniated Disk in the Lower Back. OrthoInfo. American Academy of Orthopaedic Surgeons. Available at: https://orthoinfo.aaos.org/en/diseases–conditions/herniated-disk-in-the-lower-back/. Accessed May 23, 2023.
3. Press Release. Seikagaku and Kaken Announce the Launch of HERNICORE^® 1.25 Units for Intradiscal Injection in Japan. July 31,2018. Available at: https://www.seikagaku.co.jp/en/news/news-6617037418084939174/main/0/link/20180731-e.pdf. Accessed May 24, 2023.

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