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  * Steroids, widely used to treat inflammatory conditions, can cause 
    bone loss and increase risk of fractures in up to 50% of patients 
    on long-term therapy[1] 
 
  * European approval based on data showing Aclasta better at 
    increasing bone mass than oral risedronate, a current established 
    therapy[2],[3] 
 
  * Clinical trial results also reaffirm efficacy and safety of 
    Aclasta, used in more than 500,000 patients worldwide since 
    launch in 2007[4],[5] 
 
  * Approval is fifth indication for once-yearly Aclasta, already 
    approved worldwide to treat postmenopausal osteoporosis[6] 
 
Basel, June 26, 2009 -  Once-yearly Aclasta® (zoledronic acid 5  mg)* 
has  been  approved  in   the  European  Union   to  treat  men   and 
postmenopausal women  with osteoporosis  caused by  long-term use  of 
glucocorticoids, commonly known  as steroids[6]. Glucocorticoids  are 
widely used  to  treat inflammatory  conditions  such as  asthma  and 
rheumatoid arthritis, but also cause  bone loss and can increase  the 
risk of fracture in up to 50% of patients on long-term glucocorticoid 
therapy[1]. 
 
The new  indication for  men  and women  with  glucocorticoid-induced 
osteoporosis (GIO) is based on study data showing that Aclasta, given 
once a year as  a 15-minute infusion, is  more effective at  treating 
bone  loss  than  daily  oral  risedronate,  a  current   established 
therapy[2],[3]. 
 
The study  results,  recently  published in  The  Lancet,  show  that 
Aclasta produced  a significantly  greater increase  in bone  mineral 
density (BMD) than  risedronate at  six months,  indicating a  faster 
onset of efficacy[2]. 
 
"Oral bisphosphonates have been used for many years for the treatment 
of GIO,  but they  are associated  with poor  compliance as  patients 
frequently fail to take them as prescribed," said Professor David  M. 
Reid, Head of the Division of  Applied Medicine at the University  of 
Aberdeen, UK. "Available data show that patients who remember to take 
their  medicines  only  half  of  the  time  receive  little  or   no 
protection[7]." 
 
He added: "The approval of Aclasta is a significant step forward,  as 
it is more  effective and  faster-acting than  a current  established 
therapy for the treatment of GIO  and has the advantage of  year-long 
compliance and sustained osteoprotection." 
 
This is the fifth indication for Aclasta, which is approved to  treat 
osteoporosis in  men and  postmenopausal women,  including those  who 
have experienced  a  low-trauma hip  fracture.  Aclasta is  the  only 
bisphosphonate approved  in the  EU  and US  to  reduce the  risk  of 
fractures at  all  key osteoporotic  fracture  sites, like  the  hip, 
spine,  and   other  bones   in  the   treatment  of   postmenopausal 
osteoporosis[8].  It is also approved to treat Paget's disease of the 
bone. 
 
In the US, the same medicine  under the trade mark Reclast® has  also 
been approved by the Food and Drug Administration (FDA) to treat  and 
prevent GIO in men and women. In May it was approved in the US as the 
only  therapy  to  prevent  postmenopausal  osteoporosis  with   less 
frequent dosing (i.e. a single dose every two years)[9]. 
 
The GIO indication is important because it is estimated that  between 
700,000 and 1.3 million adults in Western Europe, and between 1.5 and 
2.7 million adults in the US, are receiving prolonged courses of oral 
glucocorticoids[10],[11]. Up to 50%  of patients receiving  long-term 
glucocorticoid therapy are  at increased risk  of fracture, as  their 
use  is  associated  with  side   effects  such  as  bone  loss   and 
consequently osteoporosis[1]. 
 
"This European  approval  marks  another  important  achievement  for 
Aclasta by adding to  the broad spectrum of  patients who can now  be 
treated with this therapy,"  said Trevor Mundel,  MD, Global Head  of 
Development at Novartis Pharma AG. "Aclasta has a strong efficacy and 
safety profile  established during  eight years  of clinical  trials. 
Since its launch in 2007, Aclasta has been used in more than  500,000 
patients, demonstrating that an annual infusion has become a valuable 
treatment option." 
 
The latest approval was based on a  study of 833 men and women  which 
investigated both the prevention  and treatment of  GIO (288 and  545 
patients respectively)[2].  The  study had  several  advantages  over 
previous trials studying the effects of bisphosphonate drugs on  GIO, 
including the large sample size, the inclusion of both prevention and 
treatment subgroups, and an excellent retention rate. 
 
The study showed that over one year, a single intravenous infusion of 
Aclasta produced increases  in BMD  of the lumbar  spine and  femoral 
neck, trochanter and total hip  that were significantly greater  than 
those seen with once-daily oral risedronate (Actonel®)[2]. 
 
The greater efficacy of Aclasta was evident at six months in both the 
treatment group  (Aclasta  4.03%, risedronate  2.70%;  P=0.0002)  and 
prevention group  (Aclasta  2.34%, risedronate  0.36%;  P<0.0001)[2]. 
Aclasta was better than risedronate at increasing lumbar spine BMD at 
12 months  in both  the treatment  group (Aclasta  4.1%,  risedronate 
2.7%; P=0.0001) and prevention group (Aclasta 2.6%, risedronate 0.6%; 
P<0.0001)[2]. 
 
Results from the study showed that Aclasta is generally safe and well 
tolerated[2], supporting previous clinical  trial evidence from  more 
than 14,000 patients[4].  The most common  adverse events  associated 
with Aclasta  were transient  post-dose symptoms  such as  fever  and 
muscle pain. Most of these symptoms occurred in the first three  days 
after Aclasta administration and resolved  within the same period  of 
time. Post-dose  symptoms can  be reduced  by taking  paracetamol  or 
ibuprofen shortly after the Aclasta infusion[2],[6],[8]. 
 
In this trial  there were  no cases of  osteonecrosis of  the jaw  or 
delayed fracture healing,  and no  evidence of an  increased risk  of 
atrial fibrillation[2]. 
 
Zoledronic acid, the  active ingredient in  Aclasta/Reclast, is  also 
available  under  the  trade  name   Zometa®  for  use  in   oncology 
indications. 
 
Disclaimer 
The foregoing release contains forward-looking statements that can be 
identified by  terminology such  as  "can," "risk,"  "estimated,"  or 
similar expressions, or by  express or implied discussions  regarding 
potential new  indications  or  labeling  for  Aclasta  or  regarding 
potential future revenues  from Aclasta. You  should not place  undue 
reliance on these statements. Such forward-looking statements reflect 
the current views of management regarding future events, and  involve 
known and unknown  risks, uncertainties  and other  factors that  may 
cause actual results with Aclasta to be materially different from any 
future results, performance or  achievements expressed or implied  by 
such statements.  There can  be  no guarantee  that Aclasta  will  be 
approved for any  additional indications or  labeling in any  market. 
Nor can  there  be  any  guarantee  that  Aclasta  will  achieve  any 
particular  levels  of   revenue  in  the   future.  In   particular, 
management's expectations  regarding Aclasta  could be  affected  by, 
among other  things,  unexpected  regulatory  actions  or  delays  or 
government regulation generally;  unexpected clinical trial  results, 
including unexpected  new  clinical data  and  unexpected  additional 
analysis of existing clinical data;  the company's ability to  obtain 
or  maintain  patent  or  other  proprietary  intellectual   property 
protection; competition in general; government, industry and  general 
public pricing pressures; the impact that the foregoing factors could 
have on  the values  attributed to  the Novartis  Group's assets  and 
liabilities as recorded  in the Group's  consolidated balance  sheet, 
and other risks and factors referred to in Novartis AG's current Form 
20-F on file with the  US Securities and Exchange Commission.  Should 
one or more of  these risks or  uncertainties materialize, or  should 
underlying assumptions  prove  incorrect,  actual  results  may  vary 
materially from those anticipated,  believed, estimated or  expected. 
Novartis is providing  the information  in this press  release as  of 
this date  and  does  not  undertake any  obligation  to  update  any 
forward-looking statements  contained  in  this press  release  as  a 
result of new information, future events or otherwise. 
 
About Novartis 
Novartis AG provides healthcare  solutions that address the  evolving 
needs of  patients  and  societies.  Focused  solely  on  healthcare, 
Novartis offers a  diversified portfolio  to best  meet these  needs: 
innovative medicines, cost-saving generic pharmaceuticals, preventive 
vaccines, diagnostic tools and consumer health products. Novartis  is 
the only company with leading positions in these areas. In 2008,  the 
Group's continuing operations achieved net sales of USD 41.5  billion 
and net income of USD 8.2 billion. Approximately USD 7.2 billion  was 
invested in  R&D activities  throughout the  Group. Headquartered  in 
Basel, Switzerland,  Novartis  Group companies  employ  approximately 
98,000 full-time-equivalent associates and  operate in more than  140 
countries around  the  world.  For  more  information,  please  visit 
http://www.novartis.com. 
 
References 
[1.] Sambrook PN. Corticosteroid Osteoporosis: Practical Implications 
of Recent Trials. JBMR 2000; 15:1645-1649. 
[2.] Reid DM, Devogelaer J-P, Saag K, Roux C, et al. Zoledronic acid 
 
 
and risedronate in the prevention and treatment of 
glucocorticoid-induced osteoporosis (HORIZON): a multicenter, 
double-blind, double-dummy, randomized controlled trial. Lancet 2009; 
373: 1253-63. 
[3.] Actonel 5mg Film Coated Tablets SPV. Available at: 
http://emc.medicines.org.uk/document.aspx?documentId=3340. Last 
accessed June 8, 2009. 
[4.] Novartis data on file. Novartis Pharma AG; June, 2009. 
[5.] Novartis - NPMR, May 2009, based on vials sold (retreatments 
taken into account). 
[6.] Aclasta Summary of Product Characteristics. West Sussex, United 
Kingdom: Novartis Europharm Limited, 2009. 
[7.] Siris SE, Harris ST, Rosen CT et al. Adherence to Bisphosphonate 
Therapy and Fracture Rates in Osteoporotic Women: Relationship to 
Vertebral and Nonvertebral Fractures From 2 US Claims Databases. Mayo 
Clin Proc., August 2006;81(8):1013-1022. 
[8.] Black D, Delmas S, Eastell R et al for the HORIZON Pivotal 
Fracture Trial Group. Once-Yearly Zoledronic Acid for Treatment of 
Postmenopausal Osteoporosis. NEJM 2007; 356(18): 1809-22. 
[9.] Reclast® (zoledronic acid) Injection [Prescribing Information]. 
East Hanover, NJ: Novartis Pharmaceuticals Corporation; May 2009. 
[10.] Gluck O, Colic G. Recognizing and Treating 
Glucocorticoid-Induced Osteoporosis in Patients with Pulmonary 
Diseases. CHEST 2004; 125: 1859-1876. 
[11.] United Nations. Department of Economic and Social Affairs. 
Population Division. The 2008 Revision. Western Europe and United 
States of America Population Statistics. Available at: 
http://esa.un.org/unpp. Last accessed 30 March, 2009. The estimated 
figures for glucocorticoid use in Western Europe and the US were 
calculated by extrapolating the percentage of UK adults receiving 
oral glucocorticoids at any given time (between 0.5% and 0.9% of the 
adult population) to the populations of Western Europe (145 million 
adults) and the US (300 million adults). 
 
 
[*] The tradename is Reclast® in the  US and Aclasta® in the rest  of 
the world. 
 
 
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Novartis Media Relations 
 
 
Eric Althoff                    Irina Ferluga 
Novartis Global Media Relations Novartis Pharma Communications 
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