Dimethyl fumarate

CAMBRIDGE, England & BOSTON--( BUSINESS WIRE )--Cycle Pharmaceuticals, Inc. (Cycle) announces today completion of the acquisition of Banner Life Sciences, LLC (Banner) which includes its BAFIERTAM ® (monomethyl fumarate) product for the treatment of relapsing forms of multiple sclerosis (MS), in adults, approved by the US Food and Drug Administration (FDA). MS affects an estimated 1 million people in the US with around 200 new cases being diagnosed each week. 1 Approximately 85% of diagnoses are the relapsing-remitting form of the condition and, without treatment, about 50% of those progress to the more serious secondary-progressive form within 10 years. 1 BAFIERTAM will become Cycle’s second branded product for the treatment of MS alongside TASCENSO ODT ® (fingolimod). As with TASCENSO, BAFIERTAM patients will benefit from Cycle’s industry leading hub program, Cycle Vita™*. BAFIERTAM patients will continue to be supported by Banner’s established network during a transition period. The purchase of Banner was funded from cash on hand and demonstrates the capability of Cycle to reinvest in products where it can provide the highest quality medicines and support to patients who need it most. This acquisition comes at a time of increasing attention to the long-standing concern about the substandard quality of generic medicines in the neurology community 2 , as most recently documented in MS by Professor Darin Okuda (UT Southwestern Medical Center, Dallas, TX). 3 “ We are delighted to strengthen Cycle’s offer to the MS community by adding BAFIERTAM to our MS product portfolio. We will be able to support more patients via our best-in-class patient support hub Cycle Vita*, as well as giving patients full confidence in the medicines they are using to manage their MS, ” says James Harrison – CEO of Cycle. Ondra LLP served as exclusive financial advisor to Cycle, Goodwin Procter LLP acted as legal advisor. Leerink Partners served as exclusive financial advisor to Banner and Skadden, Arps, Slate, Meagher & Flom LLP acted as legal advisor. To find out more about BAFIERTAM, please visit www.bafiertam.com . To find out more about TASCENSO ODT, please visit www.tascenso.com . To find out more about Cycle Vita, please visit www.cyclevita.life or call 888-360-8482. About BAFIERTAM ® (monomethyl fumarate) BAFIERTAM is a prescription medicine used to treat relapsing forms of multiple sclerosis (MS), to include clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease, in adults. It is not known if BAFIERTAM is safe and effective in children. SELECTED SAFETY INFORMATION CONTRAINDICATIONS BAFIERTAM is contraindicated in patients with known hypersensitivity to monomethyl fumarate, dimethyl fumarate, diroximel fumarate, or to any of the excipients of BAFIERTAM. BAFIERTAM should not be taken with dimethyl fumarate or diroximel fumarate. WARNINGS AND PRECAUTIONS Anaphylaxis and Angioedema - BAFIERTAM can cause anaphylaxis and angioedema after the first dose or at any time during treatment. Signs and symptoms in patients taking dimethyl fumarate (the prodrug of BAFIERTAM) have included difficulty breathing, urticaria, and swelling of the throat and tongue. Patients should be instructed to discontinue BAFIERTAM and seek immediate medical care should they experience signs and symptoms of anaphylaxis or angioedema. Progressive Multifocal Leukoencephalopathy - Progressive multifocal leukoencephalopathy (PML) has occurred in patients with MS treated with dimethyl fumarate (the prodrug of BAFIERTAM). PML is an opportunistic viral infection of the brain caused by the JC virus (JCV) that typically only occurs in patients who are immunocompromised, and that usually leads to death or severe disability. A fatal case of PML occurred in a patient who received dimethyl fumarate for 4 years while enrolled in a clinical trial. During the clinical trial, the patient experienced prolonged lymphopenia (lymphocyte counts predominantly <0.5x10 9 /L for 3.5 years) while taking dimethyl fumarate. The patient had no other identified systemic medical conditions resulting in compromised immune system function and had not previously been treated with natalizumab, which has a known association with PML. The patient was also not taking any immunosuppressive or immunomodulatory medications concomitantly. PML has also occurred in patients taking dimethyl fumarate in the postmarketing setting in the presence of lymphopenia (<0.9x10 9 /L). While the role of lymphopenia in these cases is uncertain, the PML cases have occurred predominantly in patients with lymphocyte counts <0.8x10 9 /L persisting for more than 6 months. At the first sign or symptom suggestive of PML, withhold BAFIERTAM and perform an appropriate diagnostic evaluation. Typical symptoms associated with PML are diverse, progress over days to weeks, and include progressive weakness on one side of the body or clumsiness of limbs, disturbance of vision, and changes in thinking, memory, and orientation leading to confusion and personality changes. Magnetic resonance imaging (MRI) findings may be apparent before clinical signs or symptoms. Cases of PML, diagnosed based on MRI findings and the detection of JCV DNA in the cerebrospinal fluid in the absence of clinical signs or symptoms specific to PML, have been reported in patients treated with other MS medications associated with PML. Many of these patients subsequently became symptomatic with PML. Therefore, monitoring with MRI for signs that may be consistent with PML may be useful, and any suspicious findings should lead to further investigation to allow for an early diagnosis of PML, if present. Lower PML-related mortality and morbidity have been reported following discontinuation of another MS medication associated with PML in patients with PML who were initially asymptomatic compared to patients with PML who had characteristic clinical signs and symptoms at diagnosis. It is not known whether these differences are due to early detection and discontinuation of MS treatment or due to differences in disease in these patients. Herpes Zoster and Other Serious Opportunistic Infections - Serious cases of herpes zoster have occurred with dimethyl fumarate (the prodrug of BAFIERTAM), including disseminated herpes zoster, herpes zoster ophthalmicus, herpes zoster meningoencephalitis, and herpes zoster meningomyelitis. These events may occur at any time during treatment. Monitor patients on BAFIERTAM for signs and symptoms of herpes zoster. If herpes zoster occurs, appropriate treatment for herpes zoster should be administered. Other serious opportunistic infections have occurred with dimethyl fumarate, including cases of serious viral (herpes simplex virus, West Nile virus, cytomegalovirus), fungal (Candida and Aspergillus), and bacterial (Nocardia, Listeria monocytogenes, Mycobacterium tuberculosis) infections. These infections have been reported in patients with reduced absolute lymphocyte counts (ALC) as well as in patients with normal ALC. These infections have affected the brain, meninges, spinal cord, gastrointestinal tract, lungs, skin, eye, and ear. Patients with symptoms and signs consistent with any of these infections should undergo prompt diagnostic evaluation and receive appropriate treatment. Consider withholding BAFIERTAM treatment in patients with herpes zoster or other serious infections until the infection has resolved. Lymphopenia - BAFIERTAM may decrease lymphocyte counts. In the MS placebo-controlled trials with dimethyl fumarate (the prodrug of BAFIERTAM), mean lymphocyte counts decreased by approximately 30% during the first year of treatment with dimethyl fumarate and then remained stable. Four weeks after stopping dimethyl fumarate, mean lymphocyte counts increased, but did not return to baseline. Six percent (6%) of dimethyl fumarate patients and <1% of placebo patients experienced lymphocyte counts <0.5x10 9 /L (lower limit of normal 0.91x10 9 /L). The incidence of infections (60% vs 58%) and serious infections (2% vs 2%) was similar in patients treated with dimethyl fumarate or placebo, respectively. There was no increased incidence of serious infections observed in patients with lymphocyte counts <0.8x10 9 /L or <0.5x10 9 /L in controlled trials, although one patient in an extension study developed PML in the setting of prolonged lymphopenia (lymphocyte counts predominantly <0.5x10 9 /L for 3.5 years). In controlled and uncontrolled clinical trials with dimethyl fumarate, 2% of patients experienced lymphocyte counts <0.5 x 10 9 /L for at least six months, and in this group, the majority of lymphocyte counts remained <0.5x10 9 /L with continued therapy. In these patients with prolonged, severe lymphopenia, the median time for lymphocyte counts to return to normal after discontinuing dimethyl fumarate was 96.0 weeks. In these controlled and uncontrolled clinical studies, among patients who did not experience prolonged, severe lymphopenia during treatment, the median times for lymphocyte counts to return to normal after discontinuing dimethyl fumarate were as follows: 4.3 weeks in patients with mild lymphopenia (lymphocyte count ≥0.8x10 9 /L) at discontinuation, 10.0 weeks in patients with moderate lymphopenia (lymphocyte count 0.5 to <0.8x10 9 /L) at discontinuation, and 16.7 weeks in patients with severe lymphopenia (lymphocyte count <0.5x10 9 /L) at discontinuation. Neither BAFIERTAM nor dimethyl fumarate have been studied in patients with preexisting low lymphocyte counts. Obtain a CBC, including lymphocyte count, before initiating treatment with BAFIERTAM, 6 months after starting treatment, and then every 6 to 12 months thereafter, and as clinically indicated. Consider interruption of BAFIERTAM in patients with lymphocyte counts less than 0.5 x 10 9 /L persisting for more than six months. Given the potential for delayed recovery of lymphocyte counts, continue to obtain lymphocyte counts until their recovery if BAFIERTAM is discontinued or interrupted because of lymphopenia. Consider withholding treatment from patients with serious infections until resolution. Decisions about whether or not to restart BAFIERTAM should be individualized based on clinical circumstances. Liver Injury - Clinically significant cases of liver injury have been reported in patients treated with dimethyl fumarate (the prodrug of BAFIERTAM) in the postmarketing setting. The onset has ranged from a few days to several months after initiation of treatment with dimethyl fumarate. Signs and symptoms of liver injury, including elevation of serum aminotransferases to greater than 5-fold the upper limit of normal and elevation of total bilirubin to greater than 2-fold the upper limit of normal have been observed. These abnormalities resolved upon treatment discontinuation. Some cases required hospitalization. None of the reported cases resulted in liver failure, liver transplant, or death. However, the combination of new serum aminotransferase elevations with increased levels of bilirubin caused by drug-induced hepatocellular injury is an important predictor of serious liver injury that may lead to acute liver failure, liver transplant, or death in some patients. Elevations of hepatic transaminases (most no greater than 3 times the upper limit of normal) were observed during controlled trials with dimethyl fumarate. Obtain serum aminotransferase, alkaline phosphatase (ALP), and total bilirubin levels prior to treatment with BAFIERTAM and during treatment, as clinically indicated. Discontinue BAFIERTAM if clinically significant liver injury induced by BAFIERTAM is suspected. Flushing - BAFIERTAM may cause flushing (e.g., warmth, redness, itching, and/or burning sensation). In clinical trials of dimethyl fumarate (the prodrug of BAFIERTAM), 40% of dimethyl fumarate-treated patients experienced flushing. Flushing symptoms generally began soon after initiating dimethyl fumarate and usually improved or resolved over time. In the majority of patients who experienced flushing, it was mild or moderate in severity. Three percent (3%) of patients discontinued dimethyl fumarate for flushing, and <1% had serious flushing symptoms that were not life-threatening but led to hospitalization. Studies with dimethyl fumarate show that administration of non-enteric coated aspirin (up to a dose of 325 mg) 30 minutes prior to dosing may reduce the incidence or severity of flushing. In the BAFIERTAM studies, the presence of food did not impact the incidence of flushing. Serious Gastrointestinal Reactions - Serious gastrointestinal reactions, including perforation, ulceration, hemorrhage, and obstruction, some with fatal outcomes, have been reported in the postmarketing setting with the use of fumaric acid esters, including dimethyl fumarate, with or without concomitant aspirin use. The majority of these events have occurred within 6 months of fumaric acid ester treatment initiation. In controlled clinical trials, the incidence of serious gastrointestinal adverse events was 1% in patients treated with dimethyl fumarate; these events, none of which were fatal, included vomiting (0.3%) and abdominal pain (0.3%). Monitor patients, promptly evaluate, and discontinue BAFIERTAM for new or worsening severe gastrointestinal signs and symptoms. DRUG INTERACTIONS Concomitant Dimethyl Fumarate or Diroximel Fumarate - Both dimethyl fumarate and diroximel fumarate are metabolized to monomethyl fumarate. Therefore, BAFIERTAM is contraindicated in patients currently taking dimethyl fumarate or diroximel fumarate. BAFIERTAM may be initiated the day following discontinuation of either of these drugs. USE IN SPECIFIC POPULATIONS Pregnancy - There are no adequate data on the developmental risk associated with the use of BAFIERTAM in pregnant women. Available data from a pregnancy registry for dimethyl fumarate (the prodrug of BAFIERTAM), observational studies, and pharmacovigilance with dimethyl fumarate use in pregnant women have not indicated an increased risk of major birth defects, miscarriage, or other adverse maternal or fetal outcomes. Most of the reported exposures to dimethyl fumarate occurred during the first trimester of pregnancy (see Data). In animals, adverse effects on offspring survival, growth, sexual maturation, and neurobehavioral function were observed when dimethyl fumarate (DMF) was administered during pregnancy and lactation at clinically relevant doses (see Data). The background risk of major birth defects and miscarriage for the indicated population is unknown. All pregnancies have a background risk of birth defect, loss, or other adverse outcomes. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2-4% and 15-20%, respectively. Lactation - There are no data on the presence of DMF or MMF in human milk. The effects on the breastfed infant and on milk production are unknown. Patients should call their healthcare provider if they are breastfeeding or plan to breastfeed because it is not known if BAFIERTAM passes into breast milk. Pediatric Use - Safety and effectiveness in pediatric patients have not been established. Geriatric Use - Clinical studies of dimethyl fumarate (the prodrug of BAFIERTAM) and of BAFIERTAM did not include sufficient numbers of patients aged 65 and over to determine whether they respond differently from younger patients. Please click here for Important Safety Information and full Prescribing Information , including Patient Information for BAFIERTAM. About TASCENSO ODT ® INDICATIONS TASCENSO ODT is a prescription medicine used to treat relapsing forms of multiple sclerosis (MS), to include clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease, in adults and children 10 years of age and older. CONTRAINDICATIONS Do not take TASCENSO ODT if: In the last 6 months you experienced heart attack, unstable angina, stroke or mini-stroke (transient ischemic attack or TIA), or certain types of heart failure. You have an irregular or abnormal heartbeat (arrhythmia), including a heart finding called prolonged QT as seen on an ECG, or if you take medicines that change your heart rhythm. You are allergic to fingolimod or any of the other ingredients. IMPORTANT SAFETY INFORMATION Warnings and Precautions TASCENSO ODT may cause serious side effects. TASCENSO ODT can slow your heart rate, therefore you will be monitored after the first dose. There is an increased risk of serious infections, some of which can be life threatening; contact your doctor if you develop any symptoms of infections. You may experience shortness of breath and increased blood pressure. Progressive Multifocal Leukoencephalopathy (PML), a rare brain infection, has occurred in patients taking fingolimod; call your doctor immediately if you experience symptoms including weakness on one side of the body or clumsiness of limbs, disturbance of vision, and changes in thinking, memory, and orientation leading to confusion and personality changes. If PML is confirmed, treatment should be stopped. Your doctor will monitor you for the development of Immune Reconstitution Inflammatory Syndrome (PML-IRIS), which has been reported in patients who stopped treatment after developing PML. Macular edema, a vision problem that can cause some of the same vision symptoms as an MS attack may occur; call your doctor immediately if you have any vision changes. TASCENSO ODT may cause liver damage; call your doctor immediately if you experience unexplained nausea, abdominal pain, fatigue, anorexia, jaundice and/or dark urine. Rare cases of Posterior Reversible Encephalopathy Syndrome in adults have been reported with fingolimod; call your doctor immediately if you experience sudden onset of severe headaches, altered mental status, visual disturbances or seizures. TASCENSO ODT may cause harm to your unborn baby; speak to your doctor before becoming pregnant. Stopping TASCENSO ODT may cause worsening of your MS symptoms, consult a doctor before stopping treatment. Malignancies have been associated with fingolimod treatment; limit exposure to sunlight and call your doctor if you have any changes in skin appearance. You may experience a hypersensitivity reaction; call your doctor if you experience rash, urticaria and angioedema. TASCENSO ODT remains in the blood and can continue to have effects up to two months after treatment. Adverse Reactions The most common side effects with fingolimod are headache, abnormal liver tests, diarrhea, cough, flu, inflammation of the sinuses, back pain, stomach pain, and pain in arms and legs. If you have any new or worsening negative side effects whilst taking TASCENSO ODT you should immediately call you doctor. Tell your doctor about all your medical conditions and all medicines you take, before starting treatment. If you take too much TASCENSO ODT immediately call your doctor or go to the nearest hospital emergency room. For more detailed information, please refer to the full Prescribing Information at www.tascenso.com/PI . For more detailed information, please refer to the Medication Guide - www.tascenso.com/MG . To report SUSPECTED ADVERSE REACTIONS, contact Cycle Pharmaceuticals Ltd at 1-888-533-1625 or the FDA at: 1-800-FDA-1088 or www.fda.gov/medwatch . References Healthline. (2022). Multiple Sclerosis: Facts, Statistics, and You. [online] Available via: https://www.healthline.com/health/multiple-sclerosis/facts-statistics-infographic#risk-factors [Accessed Jan 13 2025]. American Academy of Neurology. (2001). Substitution of Generic Drugs May Cause Problems for Epilepsy Patients. [online] Available via: https://www.aan.com/PressRoom/home/PressRelease/115 [Accessed Jan 13 2025]. Okuda DT, et al. (2024). Clinical and radiological implications of subpotent generic fingolimod in multiple sclerosis: a case series. Therapeutic Advances in Neurological Disorders. 2024;17, 17562864241300047. Available at: https://doi/10.1177/17562864241300047 [Accessed: Jan 13 2025]. *Some areas of support may not be accessible to all patients. Eligibility criteria may apply to ensure compliance with all applicable federal and state requirements, and benefits may be limited to commercially insured patients only. For more detailed information about eligibility, terms and conditions, please contact the Cycle Vita team at 888-360-8482 or visit www.cyclevita.life . BAFIERTAM ® is a registered trademark of Banner Life Sciences, LLC. TASCENSO ODT ® is a registered trademark of Handa Neuroscience, LLC. Cycle Vita™ is a trademark of Cycle Pharmaceuticals Limited. ©2025 Cycle Pharmaceuticals Limited. All rights reserved. About Cycle Pharmaceuticals Cycle Pharmaceuticals was founded in 2012 with the sole aim of delivering drug treatments and product support to the underserved rare disease patient community. Cycle focuses on rare metabolic, immunological, and neurological genetic conditions. Within neurological conditions, we focus on multiple sclerosis. Cycle is headquartered in Cambridge, UK and has offices in Boston, Massachusetts. For more information, please visit www.cyclepharma.com and follow us on X , LinkedIn and Facebook .