C. R. Bard, Inc. (NYSE:BCR) today announced that the U.S. Food and Drug
Administration's (FDA) Circulatory System Devices Advisory Panel
provided a unanimous favorable recommendation to FDA for use of the
Lutonix® Drug Coated Balloon PTA Catheter (DCB) in the U.S.
The Lutonix® DCB is currently under review by FDA for
improving luminal diameter and reducing the incidence of restenosis for
the treatment of obstructive de novo or non-stented restenotic lesions
(= 15 cm in length) in native femoropopliteal arteries with reference
vessel diameters of 4 mm to 6 mm. If approved, it is expected that the
Lutonix® DCB will be the first and only FDA-approved DCB
available in the U.S.
Data presented at today's advisory committee meeting included one-year
primary endpoint data from the LEVANT 2 pivotal study, which is a
global, prospective, single-blind, randomized, 54-site study (42 sites
in the U.S. and 12 in Europe) that enrolled all patients under one
protocol. LEVANT 2 investigators have submitted a manuscript for
publication with a top-tier medical journal.
At one year, LEVANT 2 demonstrated superior primary patency of the
target lesion with the Lutonix® DCB for the efficacy endpoint
(73.5% vs. 56.8%, p<0.001 by Kaplan-Meier time-to-event analysis) and
non-inferiority for the safety endpoint; both endpoints were compared to
standard percutaneous transluminal balloon angioplasty (PTA).
The secondary efficacy endpoint results at one year for patients
randomized to treatment with the Lutonix® DCB demonstrated
superiority in binary restenosis (26.5% vs. 43.2%, p<0.001 by
Kaplan-Meier time-to-event analysis at 365 days) when compared to
uncoated balloons, and measurable but not statistically significant
improvement in freedom from target lesion revascularization (TLR) (89.7%
vs. 84.8%, p=0.1673 by Kaplan-Meier time-to-event analysis).
Comparing results to other trials can be challenging and misleading, as
each study may have varying patient profiles, protocol structures and
other criteria that may affect the reported outcomes. LEVANT 2 raises
the bar for scientific rigor in superficial femoral artery (SFA) trials
and was designed to reduce bias in the results in order to accurately
and scientifically assess and compare the long-term performance of key
clinical measures. Two key aspects of the study design differentiate
this trial from recent SFA studies. First, unlike some other SFA trials,
the LEVANT 2 clinical trial did not count bail-out stenting as a primary
patency or TLR failure. Second, to reduce the potential introduction of
bias into the subjective clinical decision for revascularization, the
protocol required the clinical assessment to be performed by a physician
who was blinded to the treatment group and the doppler patency
This methodology of blinding the evaluating physicians in SFA trials is
unique to LEVANT 2. Published data suggest that trials with less
rigorous blinding methodologies have shown physicians to intervene more
often in the control arm than in the treatment arm, even when presented
with similar objective results such as binary restenosis. This can have
a significant impact on subjective results, such as TLR. For example,
the blinding methodology in LEVANT 2 showed very similar rates of
intervention when binary restenosis occurred in either arm of thetrial.
If instead the evaluating physicians in LEVANT 2 had intervened at the
rates in unblinded DCB trials when binary restenosis occurred (as
estimated from public data), the company estimates the comparable
freedom from TLR for LEVANT 2 could have been approximately 94% in the
treatment arm compared to approximately 78% in the control arm at one
PTA balloons are a well-established and accepted treatment for
peripheral arterial disease (PAD) according to the American College of
Cardiology and American Heart Association guidelines. The Lutonix®
DCB is a standard angioplasty balloon that is coated with a low dose of
the anti-restenotic agent, paclitaxel, and is designed as adjunct
therapy to standard mechanical dilatation of the vessel to restore blood
flow. Successful treatment of PAD in the femoropopliteal arteries
requires improved blood flow (patency) for longer periods of time. PTA
is typically the first and preferred method to treat patients with PAD.
"The PAD patient population is growing and the variety of treatment
needs for these challenging patients is increasing," said Kenneth
Rosenfield, M.D., Section Head for Vascular Medicine and Intervention,
Massachusetts General Hospital and LEVANT 2 Co-Primary Investigator.
"There is a need to improve upon the current well-established treatment
modality and the Lutonix® DCB can be another tool to treat
PAD in the difficult anatomy of the femoropopliteal artery without
leaving an implant behind."
The FDA will consider the positive recommendation of the advisory panel
in its review of the PreMarket Approval (PMA) Application that was
submitted by C. R. Bard in November 2013. Currently, the Lutonix®
DCB is available commercially in Europe.
Timothy M. Ring, chairman and chief executive officer of C. R. Bard,
commented, "We are hopeful that the unanimous positive recommendation
for Lutonix® DCB is the next step in establishing a new
standard of care for those patients in the U.S. confronted with
femoropopliteal occlusive disease. Clinicians have been calling for a
first-line alternative treatment to expand the therapy options for this
painful, progressive and debilitating disease and we look forward to
working closely with the FDA as it completes its review."
About Peripheral Arterial Disease (PAD) and Treatment Options
PAD is a life-threatening condition that narrows arteries and reduces
blood flow to limbs1 putting millions of people in danger of
heart attack, stroke and potential lower-extremity amputation.2
The American Heart Association (AHA) estimates that PAD affects at least
8 million Americans with approximately 3 percent of people younger than
60 years and 20 percent of people older than 70 years affected by
lower-extremity peripheral arterial disease.
There are both noninvasive and invasive SFA treatment options available,
each of which has associated limitations. The most conservative approach
is treatment with pharmacotherapy and/or exercise with risk factor
modification; however, the effectiveness of these treatment options is
often limited by patient intolerance to medication or lack of medication
efficacy. Surgical bypass is at the other end of the spectrum. For most
patients who fail conservative therapy alone, interventionalists and
surgeons will typically offer percutaneous endovascular procedure as the
initial treatment option, as a lower risk alternative to surgical
bypass. PTA is the first-line, standard-of-care treatment for PAD,
according to the American College of Cardiology and American Heart
Association 2011 guideline; however, it is limited by its relative lack
of long-term patency.
1 Why PAD Matters - American Heart Association Web site.
Available at: http://www.heart.org/HEARTORG/Conditions/More/PeripheralArteryDisease/Why-PAD-Matters_UCM_301303_Article.jsp.
2 Peripheral Arterial Disease - NIH National Heart, Lung, and
Blood Institute. Available at: https://www.nhlbi.nih.gov/health/health-topics/topics/pad/.
C. R. Bard, Inc. (www.crbard.com),
headquartered in Murray Hill, NJ, is a leading multinational developer,
manufacturer and marketer of innovative, life-enhancing medical
technologies in the fields of vascular, urology, oncology and surgical
The FDA advisory panel vote should not be construed as an indication of
the likelihood of the product gaining regulatory approval or being
successful commercially. This press release may contain forward-looking
statements within the meaning of the Private Securities Litigation
Reform Act of 1995, which are based on management's current
expectations, the accuracy of which is necessarily subject to risks and
uncertainties. These statements are not historical in nature and use
words such as "anticipate", "estimate", "expect", "project", "intend",
"forecast", "plan", "believe", and other words of similar meaning in
connection with any discussion of future operating or financial
performance. Many factors may cause actual results to differ materially
from anticipated results including product developments, sales efforts,
income tax matters, the outcomes of contingencies such as legal
proceedings, and other economic, business, competitive and regulatory
factors. The company undertakes no obligation to update its
forward-looking statements. Please refer to the Cautionary Statement
Regarding Forward-Looking Information in our March 31, 2014 Form 10-Q
for more detailed information about these and other factors that may
cause actual results to differ materially from those expressed or
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