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Avatar universal

CTON, DO YOU HAVE A LINK TO V-950 W/OUT RIBA

Do you have a link to the (2) vertex-950 studies that you referred to earlier today, the two that didn't use riba and peg.  I can only find info about one study that seems to have concluded in May of 2005 where 28 chronically infected HCV patients were dosed with (3) different amounts of vertex, 450 mgs, 750 and 1250 mcgs respectively.  

If this study concluded in spring of 2005, I don't understand why we're not hearing any svr news regarding this study.

Vertex's press release dated May 17, 2005 regarding this study does say that "at the end of dosing, a total of 5 patients in the Phase Ib study across the dose groups tested HCV-RNA negative in the quantitative Roche COBAS TaqMan
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Avatar universal
I should add, that 950 and SCH are both being tested with Ritonavir. Rit. has a boosting effect with HIV drugs, to lower dosing, and early tests indicate it would do the same with the above drugs. This is a case of drugs being tested together, but one of them is already known and approved. Ritonavir acts to slow the elimination of the drug from the liver, to allow less frequent dosing. In the example of 950, it might allow 1 or 2 times daily dosing. I am not sure if ritonavir would work with polymerase inhibitors, but it does work well with Protease inhibitors.
Tests are ongoing with that combo.
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Avatar universal
IMO so called "monotherapies", especially in regard to VX950, will not be a commonly implemented strategy for many years, if ever really. The likely initial approved usage of VX950 will almost certainly be with peg IFN with or without riba. By that time other PI's will likely be coming online too. At that point combining the best PI's will probably become a very appealing and possibly extremely effective strategy too. Plus there are so many other new drugs being researched and coming along, that the options for a myriad of other combinations will also become possible. This gives rise to a bit of a quandary though, so many new drugs coming online within a 3-7 year timeframe will start to greatly increase the total possible number of combinations of these various drugs. But none of them can be dosed in combination unless they have been completely and successfully tested in whatever combination has been deemed worthy of evaluation. When you think of all the possible ways to combine all the various drugs, you can quickly end up with a colossal test matrix with all kinds of dosage/duration permutations, which would cost a huge fortune and a very long time to fully carry out and evaluate. This process could take years and years. As just one example, what if albuferon, VX950 and SCH503034 were to be combined? It's probably unlikely Vertex is going to be willing to participate in a combo trial with a competing PI manufacturer before their drug is approved and on the market. So assuming VX will be out in 3 years, give another year for them to establish market share (dominance more like) and formulate new test protocols, then it would probably take at least another 2-3 years to get these tested and approved. All told probably close to 7-9 years (from now) before just one of these combinations might come to market.

But, all in all it is good to be in the position where all of these drugs seem to be successfully moving to the forefront, and with more good news all the time suggesting even better advancements for the future. This is a very exciting time for HCV research, I feel there will likely be what will largely constitute an outright cure for nearly all of us within 10 years, and for most of us within 5 years. I think we
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Avatar universal
Good post, and I can tell you why drugs like SGP's and VRTX's will not be tested pre-market. No drug company will spend the money or waste their time on drugs that aren't approved. I asked if VRTX had considered testing with Albuferon, and they flat out said no, too much room for failure. If they test with an experimental drug, they are screwed if the OTHER drug flops.

As far as after, that would be possible, and does happen. Look at the new HIV pill that actually combines 2 or 3 drugs into 1 pill. For VRTX, it would be no skin off of their back, as there's looks to be the cornerstone. SGP is a different story, as they are testing for 48 weeks, and doing a combo in shorter time hurts their projected revenue stream.

And, I have said many times, the next gen of drugs are being developed, but not talked about. VRTX finally had to admit they had one, in response to analyst's questions after the J&J deal.

And, many may not realize this, but 950 is actually already a second gen. drug. MMPD was their first, and they were combining it with SOC. They stopped the program, because 950 is light years ahead of it, and was actually about to pass MMPD's timeline. They completed phase 2, and decided not to waste time, money, and resources on phase 3. It was a good businees decision.
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Avatar universal
Probably not necessary, but to clarify anyway, my post had nothing to do with previous discussions in this thread and in no way was a negative reflection on Vertex or the company.

It was just that for me -- and I'm sure others -- interferon is a more troublesome drug than ribavirin, and since they're testing it in Europe without riba, I wondered why they weren't testing it somewhere without peg. My guess is that this will happen at some point depending of course on how well the trials go. On a theoretical level, I would never again treat with any more than 12 weeks of interferon (and wouldn't be all that happy even with that) but riba, while no day at the beach, I don't think did me any long-lasting harm.

-- Jim
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Avatar universal
I know you weren't commenting in that light.
I guess I did want to vent against Wyeth though, as I haven't forgotten some of their skeletons.

If they just did the monotherapy, it would be a longer, less-sure route to market, and VRTX has told me that their goal is to keep the IFN as short as possible, due to cumulative effects. No doubt, as everyone in here who has had it (and I can't speak from experience), IFN affects most from day 1.
I have a cousin who took IFN (don't know the dose) for 2 years due to cancer, but doesn't anymore. He won't talk about it though, so unfortunately, I can't really get info from him.

This is why I really hope that Albuferon does well and gets to market with or before 950 (assuming both make it on their timelines). It would be a huge step IF (if, if, if) you could take 950 for 12 weeks, with only 6 shots of Albuferon. At least it wouldn't be 48. This is the absolute best case scenario IMHO right now. Then, the next gen of HCV drugs could go after monotherapy. And it could take a comob approach, maybe ITMN's candidate, or a polymerase inhibitor with a PI. I think VRTX had mono. as their original goal, but data, and the regulatory authorities I am sure have steered them the other way.

It is only MHO, but I think they are getting very strong guidance and I know they are getting good dialogue from the FDA. These drugs and this disease do seem to be a priority (or at the very least more of one) than in the past with these new compounds. Even if it seems (and we do) have a lack of good advocates.

I don't want IFN either. Not with my history of allergies and tendency towards fibro.

I just wish that there were a lot more focus on life after AFTER SVR, and longer term effects. Unfortunately, that side of the equation isn't pushed enough.

And I hope and pray that all those with SVR do recover from the nasty sides. A cure should also mean feeling better.
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Avatar universal
I have stated before, I think the FDA is telling VRTX what they want, and VRTX is doing that. The fastest way to market, is with SOC.  There is a strong push to get these new drugs out, and the makers of IFN have nothing to do with this. In fact, they would need 4x as many people to tx for 3 months than now to essentially break even. That doesn't even include those today who re-treat.
And then there is Albuferon. So, the makers of IFN know their days of dominance are likely numbered.
IFN is being used because it has the antiviral effects, and riba is not well understood. But, it is not an antiviral.
IFN is known to be sensitive against mutant strains, particularly the A156T strain that had PREVIOUSLY shown up in VRTX trials, although it was less fit, and also is a good boost.

Neither drug is pleasant (IFN or riba), but for me, I won't take riba, with thalassemia minor. My hgb last month was 12.2. Imagine after riba gets a hold of it.

From VRTX's standpoint, right now, their goal is to get a good cure to market ASAP, to beat their competitors (note to some, this is a good thing).
Their next gen compound, or competitors compounds might be better suited for a monotherapy.
And, a monotherapy (today) might require longer treatments, lesser SVR, etc, so trials would take longer, burn more money.

I am not a conspiracy theorist. But I am very cognizant of what goes on in this area. If those want to spew venom (not you jim) at drug companies, Wyeth is a great one to do it. None of you know how much garbage they did, and I am sure for as much as I know, there is a lot more.

What bugged me earlier in this thread was that it was ok to trust one set of published data, and not another. It is ok to be skeptical, but there is that innocent until proven guilty thing.
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Avatar universal
I understand Vertex will be tested with both combo drugs now, with peg only shortly and perhaps by itself at some point. But I haven't read anything about it being tested without peg and with riba. And I wonder why?

As much as I don't like ribavirin, for me, Peg was the big problem in terms of autoimmune skin issues and also seems to be the culprit for many of the problems people are experiencing post treatment. If I had the choice (and hopefully I never will) to re-treat. SVR odds being equal, I'd much rather treat without Peg as opposed to without riba. I sometimes wonder if the reason they're testing without riba (and with peg) has more to do with what I perceive as the lack of acknowledgement by the medical community of the long-term dangers of inteferon therapy. Or more sinister -- and I'm not a cospiracy theory type of guy :) -- that the big drug companies may have some input into this and therfore championed testing with Peg (their bread winner) as opposed to riba.

My understanding was always that Peg knocked the virus down and riba mutated it so it stayed down. So even on a pharmacological level, seems like riba would be a better companion drug to Vertex as opposed to Peg -- or at least should be tested as such.

-- Jim
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Avatar universal
It's so encouraging to know all this is going on behind the scenes.  It actually makes me feel so much more positive and upbeat about our collective prognosis.  I know it's largely about the $$$ for these companies, what isn't, but major changes in treatment seem to be imminent. In what form exactly we don't know but, to be sure, they're coming.  Really exciting stuff!

So, would it be unethical for me to ask you to share your thoughts on investing in some of these endeavors? Oh and btw, don't give a 2nd thought to getting frustrated...I would have been frustrated as well and probably wouldn't have handled it quite as well as you did.

Char

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Avatar universal
I very much appreciate your help in clarifying those studies.  Your explanation makes complete sense and I do appreciate your patience in helping resolve my questions. They are actually a little difficult for me to wade through.  Did I mention that I feel like my i.q. level has dropped a point or 10 since the begining of treatment.

If you don't mind me asking, what do you do?
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Avatar universal
One more thing, I feel like your explanations are logical and based in fact. What I'm trying to say is you've made your point and made it well.  If people don't get it, just let it go.  Just an observation.  (I just don't want you to get frustrated and leave...kinda like being able to bounce things off of you here.)

Thanks again, Charlotte
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Avatar universal
Thank you, by your posts (and that you are in the trial) it is obvious to me you want to know all you can.
I am a financial advisor, and started following drug stocks and this area since the mid 90's. Started with the generics, last many years following biotechs. It does help that I know a medical chemist also, and he has experience with HCV drugs.
What helps is that I have followed this particular compound (and many others in truth) before most here have heard of them. So, as time goes by, it seems like old news in a way, even though it might not be for many.
Sorry to let my frustrations out, but there have been some in here that seem to have a bias against either VRTX or 950 for whatever reason. They will tell you I have one for it. If there is, it is a result of looking at this compound for so many years, and determining that it had the best chance for all us. I would call it optomism. And no, I wouldn't let phase 2 data necessarily determine whether one should treat.
A lot to prove, so far, it has cleared all hurdles, and I hope it clears the rest. Nothing is guaranteed in any way. Drugs in phase 2 have about a 30-35% chance of getting to market. It goes much higher in phase 3. That data is courtesy of the FDA I believe, I don't know if I still have the link.

BTW, chemically, Intermune's compound is superior to VRTX's. but it isn't in the clinic yet, and the only thing that matters is data in real people. Schering's looked like it could be better than 950, and that isn't the case.
And, many biotechs are working on drugs to "better" 950, including VRTX themselves. They don't talk much about it, but their second gen. compound is a couple of years behind 950.
The goal is lower dosing, beating resistant strains, and maybe the time factor.
There is a lot going on out there we don't know.
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Avatar universal
The IFN/950 trial, they were rolled over to SOC for 1 year also, if they so choose. They did, they are still being treated. They may not release SVR data for those either, as it can't be used for 950, and in my mind, from a data standpoint, means nothing.

Here is the breakdown you were looking for I think:

Study Design and Results
The 14-day, randomized, blinded, placebo-controlled Phase Ib study enrolled 20 treatment-na
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Avatar universal
It wouldn't be unethical for you to ask me, it might not be a great idea for me to answer though. Not for any "inside" knowledge, or anything like that, but it is a regulatory thing.
Thing is, that the "know your customer" rule is critical. That is why I am against radio and tv shows where someone calls in and expects their problems solved by a stranger they talk to for 1 minute, which usually ends with "buy my book". They can be more free than I am.
So many factors matter, and it isn't as simple as which one would make the most money either.
Especially in this area where risk and reward run so high.
I have never talked about the investment opportunities in here, or other forums, because of the above, and if something didn't work out, I wouldn't like that.
And, it isn't only about a particular company. 75% of a stock's movement is because of the overall market, and its sector.

I guess what I am saying is, thanks, I appreciate the sentiment, but it isn't something I am comfortable with. I am not sure it would be fair to you either.
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Avatar universal
I didn't "accuse" you of anything. You stated SOC cant achieve UND status by week 2 and there is no factual basis for that statement. That isn't a accusation it's a clarification. We do know SOC CAN and does create UND status by week 4 (very close to 28 days) in many patients, that is fact. We know at least half of patients can achieve SVR on SOC, that is fact.
It isnt that I "dont get it" at all, the facts are not there to get. Everything we know about VRTX is info put out by the company itself that will be selling the product! ALL of the data you put forth comes from them. Im sorry, but I need facts and independant confirmation before I believe what a company claims about a product they want to sell me so they and their investors can profit to the tune of  billions of dollars especially when my health is at stake. It benefits THEM and their stock price to spin it as the "answer" to HCV but they have no verifiable basis at this point that SVR is even possible or durable and nothing at all from any independant source. The facts do not exist yet that VRTX can create durable SVR in even ONE patient. 12 people clearing the virus in 2 weeks means little if the virus bounces back, we dont know if it will or if it wont. All of this is yet to be known and therefore should be taken with a grain of salt and not as fact. Considering the source of info is the company making the product, the info is clearly going to be biased in favor of the product.
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Avatar universal
Ok, you don't trust data by research scientists in trials that are up to FDA standards, so basically, you don't trust ANY trial data because companies can't be trusted.
If you have proof those numbers are not valid, provide it. Otherwise, it is a red herring. When I asked my contact there about getting in a trial, he told me he couldn't help me. They cannot have a part in that. Data is compiled by researchers, and is blinded until the study is over and reported by the researchers at various clinics. Standard Operating Procedure.

I have not seen any SOC data that says people get und. in 2 weeks. and be careful. I don't know how many GENO 1'S get und. on SOC by week 4 either. GENO 2's do not count, as that is easier to treat.
So, basically, you are saying that in all filings with the SEC, and the FDA (which they are held legally accountable for) they are not presenting the facts.

You also don't seem concerned that current data is largely provided by the makers of SOC.

And please stop with this "they don't have SVR in one patient" stuff. No one said they did, no one claims they do. No SVR claims have EVER been made.
It seems that I mention that myself and it gets ignored.
SVR data isn't fact because there is none. VL reduction is, because it has been shown.
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Avatar universal
You're absolutely right.  I do agree with everything you said.   I'm sitting here laughing, you couldn't be more right.  Of course, you can't randomly willy nilly give a complete stranger such advice.  I shouldn't have asked but I just had to.....Good answer, you handled that well.

Char
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Avatar universal


Pds, that trial was not for SVR. Viral Kinetics was a secondary end point, the primary endpoint being safety.
None of them treated long enough, and I don't think any went over to SOC that I know of, so there will be no SVR data. Don't expect SVR data that counts for 950 from the other 2 trials either. Those trials only used 950 for 14 and 28 days.
What VRTX has done, is allowed those who got undet. to go over to SOC on their dime for a cure. I don't know what the original 28 were offerred after, if anything.
I would also note that no one, including the company, expected them to ever get SVR. They have said repeatedly that tx was too short.

Kalio:
A+B+C=D.
If VRTX in EVERY trial has gotten 4.4 logs or higher, to undet. status in 2-4 weeks, and done it in almost all of their patients, and SOC gets half undet. by week 12, where is the issue? Your point is that maybe all did there, but the numbers got worse on SOC by week 12? I don't understand.
There is no data from SOC on 2 weeks, there probably is at 4 weeks. If you look at geno 1's ONLY (toughest group) why would one expect SOC to match 950 when it can't even do it by week 12?

SVR data IS the only data that counts. They don't have it yet. Asking for it from before does not matter, and IS NOT LOGICAL.
No one EVER said 950 could do SVR after 2 weeks of dosing. And you know, I am concerned it may take longer than 3 months. Maybe 4, or 5? We don't know.

Here is what we do know.
IFN+riba gets about half undtect. in 12 weeks.
950 plus IFN/Riba get >90% undtect. in 2-4 weeks. Seems pretty clear that 950 was the reason, especially considering what it has done alone. This isn't including the mono. trial.

What you are saying is that you think SOC may have the same response as week 2, but there is no data. Illogical, since it doesn't get the same response at week 12, THERE IS NO WAY it could be better at week 2.
Data takes time, trials need to progress. Eventually they'll have SVR data.
I think you are missing key points here.
I am not making up stats here, there are conclusions that can be safely made.
Frankly, I don't like the accusations.
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Avatar universal
Thanks for the other study and the results with 8 people being dosed with peg & vertex do seem impressive.  There doesn't seem to be any data in that study, unlike the stand alone study, that sugests that a slow increase in HCR-RNA levels took place during post dosing period.

Do you understand my concern that, at this point, why don't we have any svr data on the 28 people that did stand alone vertex 950 in May 05.  That would be 15 months at this point.  I understand they were trying to find proper dosages and they came to the conclusion that the 750 mcg every 8 hours was the most effective.  But no data has been published about svr even in that group, am I right?

It sounds spectacular on the surface but no one seems to be paying attention to the following statement:

Following completion of the 14-day dosing period, a slow increase in HCV-RNA levels was observed during a 28-day post-dosing period in these patients. Twenty-eight days after receiving their last dose of VX-950, there were two patients that had viral levels of more than 1 log10 below their pre-treatment levels."

Is this possibly why we're not seeing svr data on this group?  In the study talked about in the Jan. 9 press release, a portion of the 20 people were dosed with just vertex, but I can't find where it says exactly how many people were involved in that portion of the study.  If'd be nice to have that information, just for the hell of it.

I guess it doesn't really matter at this point.  Bottom line, vertex seems to be much more effective with peg as opposed to without.

Thanks, Char

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Avatar universal
Thats the point, there is no data showing how many on SOC clear the virus by week two, so comparisons cant be made. You stated it was superior to SOC in that regard but there is no data on which to base such an analysis.

a dozen people with incomplete data who took VRTX doesnt prove much with NO SVR data. Clearing the virus is only part of the battle, remaining clear is the issue and there is no data at all showing VRTX can do that. If people are waiting on this as a magic answer to Hep C they need more data, provable data to base important health decisions like waiting on drugs that arent even thru drug trials yet to do that. VRTX looks promising, but there isnt any concrete data to show people can SVR using it and you cant legitimately compare two week UND stats if you have no stats on SOC UND rates at two weeks and there is NO data for VRTX SVR rates at two weeks at all. You said that SOC can't do that, I say how do you know? I want VRTX to be the answer but that doesnt mean we can just make up stats to make it appear that is so or that it is "better than" SOC. It seems obvious to me it is far too early to say what VRTX will or wont do regarding SVR, SVR is all that matters.
In addition those taking VRTX in trials now are ALSO on SOC drugs so we still wont know even after the current trials are completed how much VRTX had to do with SVR.
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Avatar universal
Sorry to disappoint you, I am not making up data to make VRTX look better. Tell me, if they got a 4.4 log reduction in 2 weeks, and SOC avgs 2 logs in 12 weeks (the key marker), how am I making up data?
Models used to predict undet. and SVR use decline slopes. There is no contest between the 2.
If 2 weeks is a bad example, then use 28 days. 12 out of 12 vs. what percent for SOC?
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Avatar universal
It cant be said what UND levels for SOC are at week two because there are no studies looking at it. Only now are people starting to get a 4 week PCR. They would have to do 2 week PCRs o SOC patients first before you can make such a statement. Many patients clear on SOC tx by week 4. You cant just make up things to try to make VRTX appear better. No data exists but that does NOT mean SOC doesnt clear the virus in 2 weeks for many, maybe it does but they dont test at 2 weeks so we dont know the stats.
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Avatar universal
I have to respectfully disagree that the monotherapy trial wasn't spectacular.
Keep in mind, they were trying to find a good dose. Even so, 4 out of 8 at the 750 mg level got to undetectable status in only 2 weeks. An average 4.4 log reduction in 2 weeks.
SOC can't come close to that. In fact, SOC hopes to get half undetectable in 12 weeks, let alone 2. VL reduction is twice as great in 1/6 the time. That is an amazing leap forward, results never seen before, not matched since.

And, it was only 950. No riba, no IFN.

A leading hepatologist at a liver meeting called it the single most important presentation at that meeting.

Remember, the faster you knock it down, the better the chance for cure.
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Avatar universal
The other study without riba was a month before the 12 patient triple combo study. That phase 1b study was 2 weeks of IFN and 950, where they got a 5.5 log reduction in those 2 weeks.
Found at www.vrtx.com.

Cambridge, MA, January 9, 2006
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