Telaprevir-Based Treatment in Ph III Trial data

[Fl_Gator]

http://tiny.cc/pxn1f




CAMBRIDGE, Mass., May 25, 2010 (BUSINESS WIRE) -- Vertex Pharmaceuticals Incorporated (Nasdaq: VRTX) today announced that 75% of people chronically infected with genotype 1 hepatitis C virus (HCV) who had not previously been treated achieved a sustained viral response (SVR or viral cure) after receiving a 12-week telaprevir-based combination regimen, followed by treatment with pegylated-interferon and ribavirin alone, in the Phase 3 ADVANCE trial. 69% of people achieved SVR after receiving an 8-week telaprevir-based combination regimen, followed by treatment with pegylated-interferon and ribavirin alone. 44% of people in the control arm achieved SVR after 48 weeks of treatment with the currently approved regimen of pegylated-interferon and ribavirin.

The safety and tolerability profile of telaprevir in the ADVANCE trial was consistent with the profile reported in Phase 2 studies, with an improvement in treatment discontinuation rates due to adverse events. Adverse events leading to discontinuation of all study drugs occurred in 6.9%, 7.7% and 3.6% of patients in the 12-week telaprevir-based arm, the 8-week telaprevir-based arm and the control arm, respectively.

"These first Phase 3 results are important for people with hepatitis C, as they represent a potential new era of therapy where doctors may be able to use direct acting antiviral medicines to improve treatment and help patients potentially avoid life-threatening liver-related consequences associated with chronic hepatitis C," said Ira Jacobson, M.D., Chief of the Division of Gastroenterology and Hepatology, Weill Cornell Medical College, and an Investigator for the ADVANCE trial. "The ADVANCE results confirm findings seen in earlier trials of telaprevir and highlight that telaprevir-based combination regimens may increase viral eradication rates and shorten treatment time for many patients."

"These groundbreaking data are the result of our more than decade-long commitment to improving care for people with hepatitis C and should provide new hope for patients with this disease," said Robert Kauffman, M.D., Ph.D., Senior Vice President and Chief Medical Officer for Vertex. "As fewer than half of people with genotype 1 hepatitis C achieve a viral cure with currently approved therapies, new and more effective medicines are urgently needed.

"These results for telaprevir show that 75 percent of patients in the 12-week telaprevir arm achieved a viral cure, with the majority receiving only 24 weeks of therapy, marking what we believe may be a potentially dramatic improvement in the future treatment of hepatitis C," concluded Dr. Kauffman.

Telaprevir is an investigational, oral inhibitor of HCV protease, an enzyme essential for viral replication, and is being developed by Vertex Pharmaceuticals in collaboration with Tibotec Pharmaceuticals and Mitsubishi Tanabe Pharma. Vertex plans to submit a New Drug Application to the U.S. Food and Drug Administration (FDA) for telaprevir in the second half of 2010 for both treatment-naïve and treatment-failure patients.

About the ADVANCE Trial

ADVANCE was a Phase 3, randomized, double-blind, placebo-controlled trial that enrolled approximately 1,095 people infected with genotype 1 chronic HCV, the most common form of the virus in the U.S. and Europe, who had not previously been treated for their HCV infection. The trial enrolled patients at 114 international clinical trial sites worldwide. Approximately 60% of the patients in ADVANCE were enrolled at trial sites in North America. Additionally, approximately 20% of the patients in ADVANCE were African American, Black, Hispanic or Latino, and approximately 20% had advanced fibrosis or cirrhosis.

The primary endpoint of the ADVANCE trial was SVR defined as the proportion of patients who had undetectable HCV RNA both at the end of treatment and 24 weeks after the end of treatment. The secondary endpoint was to evaluate the safety of telaprevir when dosed in combination with pegylated-interferon and ribavirin.

As part of a response-guided design, patients in the telaprevir-based treatment arms who had undetectable HCV RNA (<25IU/mL and undetectable by Roche COBAS Taqman HCV test) at Week 4 and Week 12 of treatment were eligible to receive 24 total weeks of therapy. Patients who did not meet the response-guided criterion but were undetectable at Week 24 received 48 total weeks of therapy. Patients received 750 mg of telaprevir (or placebo) orally (tablets) every eight hours (q8h), a 180 ug injection of peginterferon alfa-2a (Pegasys) once-weekly, and a 1,000 mg or 1,200 mg weight-based daily oral dose of ribavirin (Copegus).

SVR Results (Intent to Treat Analysis)

Telaprevir-Based
Treatment Arm
    SVR Rate     Treatment Regimen  
12-week telaprevir-based arm:     75%
(p<0.0001)
    12 weeks of telaprevir, pegylated-interferon and ribavirin followed by 12 or 36 weeks of only pegylated interferon and ribavirin, based on response to treatment at Week 4 and Week 12  
8-week telaprevir-based arm:     69%
(p<0.0001)
    8 weeks of telaprevir, pegylated-interferon and ribavirin followed by 16 or 40 weeks of only pegylated interferon and ribavirin, based on response to treatment at Week 4 and Week 12  
Control arm:     44%     48 weeks of pegylated-interferon and ribavirin  
        

[Cory255]

This shows where things are going with the newer and better tx drugs.

http://pubs.acs.org/cen/coverstory/88/8818cover.html

Researchers expect three waves of small-molecule drug approvals, each of which will improve HCV treatment. First, telaprevir and boceprevir are likely to be approved next year as add-ons to the current treatment regimen. The second wave, in three to five years, will bring second-generation protease blockers, a crop of polymerase inhibitors, and new classes of compounds such as Bristol-Myers Squibb’s NS5A inhibitor and Debiopharm’s cyclophilin inhibitor. Finally, researchers hope that in the next five to 10 years they will reach the ultimate goal—enough data to convince doctors and the Food & Drug Administration that the virus can be quieted with combinations of small molecules alone.

[can-do-man]

The more interesting news which should be coming out soon for both telaprevir and boceprevir will be the latest trials that was for prior relapsers and non-responders only. Keep a close eye on those hard to tx and the number of cirrhotics in those trials.

cando

[Trinity4]

I'm sure I won't Magnum because like you, I haven't got the time to say never.
It ain't over till it's over.

Trin

[Magnum]

"So of the 25% who don't achieve SVR, they're petty much screwed in that they will not be able to treat again with a protease inhibitor."

Even if it were true, now that other pharmaceutical companies are going to copy-cat Merck & Schering for a piece of the pie, you can rest assured there will be more and more PI's and possibly even an inoculation or “magic pill” to clear the non-responders. The process for further eradication will be to “starve” the virus by denying it the protein it needs to replicate. This is already in the works with overseas pharmaceutical companies. Never say “never” to re-treating with PI’s or other means if you first fail the current PI’s...


Magnum

[newleaf09]

Not resistance to a whole class of protease inhibitor drugs, but to teleprevir or boceprevir, the first 2 that will become available.  They both interfere with viral replication (reproduction) by attacking the virus at the same site.  Other protease inhibitors may target the interference of replication at a different site and may still work for those who don't respond to teleprevir or boceprevir.  And don't forget there will also be polymerase inhibitors coming further down the road.  There is lots of cause for hope with the new drugs that will be out within the next 10 years.  I think it takes about 12 years from the first tiny investigational study of a drug until its release and there are many, many that are nearly half way through the process of approval.

[Trinity4]

Yes it is relevant. I'm talking about Telaprevir specifically as it will be the first released from what I have read and for which I am anxiously waiting for.

Actually, if Boceprevir  were to hit the market at the same time that would be my choice.

Trinity

[robo229]

Is that true?

Did I miss some published data that indicated resistance to one PI meant resistance to a whole class of drugs?  Almost all trials would exclude a prior PI failure so at present, this is not relevant until they are widely available.  75% is way better than <50 %.  This study is cause for optimism.

Thanks, Gator for posting it.

Robo

[Trinity4]

So of the 25% who don't achieve SVR, they're petty much screwed in that they will not be able to treat again with a protease inhibitor.  

That's a scary thought for those who have advanced liver disease.

Trinity

[Fl_Gator]

The SVR rates observed in the two telaprevir-based treatment arms were statistically significant when compared to the control arm (p<0.0001).

For patients in the 12-week telaprevir-based arm, the 8-week telaprevir-based arm and the control arm, 68%, 66% and 9%, respectively, had undetectable HCV RNA 4 weeks after the initiation of treatment, defined as a rapid viral response (RVR) by the American Association for the Study of Liver Diseases Practice Guidelines.1

Viral Relapse Rates

For patients in the 12-week telaprevir-based treatment arm, the 8-week telaprevir-based treatment arm and the control arm, 8.6%, 9.5% and 28%, respectively, experienced viral relapse (defined as the proportion of patients who achieved undetectable HCV RNA at the completion of all treatment but relapsed during post-treatment follow up).

Safety & Tolerability Results from ADVANCE

The safety and tolerability profile of telaprevir in the ADVANCE trial was consistent with the profile reported in Phase 2 trials of telaprevir, with an improvement in treatment discontinuation rates due to adverse events, including rash and anemia. The most common adverse events reported in the telaprevir arms were fatigue, rash, pruritus, nausea, headache and anemia, of which anemia, rash, pruritus and nausea occurred more frequently in the telaprevir-based treatment arms than in the control arm. The majority of these adverse events were mild to moderate.

Adverse events leading to discontinuation of all study drugs occurred in 6.9%, 7.7% and 3.6% of patients in the 12-week telaprevir-based arm, the 8-week telaprevir-based arm and the control arm, respectively. Discontinuation of all treatment due to rash was 1.4%, 0.5% and 0.0% in the 12-week telaprevir-based arm, the 8-week telaprevir-based arm and the control arm, respectively, while discontinuation due to anemia was 0.8%, 3.3% and 0.6% in the 12-week telaprevir-based arm, the 8-week telaprevir-based arm and the control arm, respectively.

Additional data from the ADVANCE trial will be submitted for presentation at a medical meeting in the second half of 2010.

About the Telaprevir Development Program

To date, more than 2,000 patients with hepatitis C have received telaprevir-based regimens as part of Phase 2 clinical trials and the Phase 3 ADVANCE trial. Together, these trials enrolled both treatment-naïve and treatment-failure HCV patients, including difficult to treat patients such as null responders. The telaprevir clinical development program is the largest conducted to date for any investigational direct-acting antiviral therapy for hepatitis C.

ADVANCE is the first of three clinical trials conducted as part of a global Phase 3 registration program for telaprevir in treatment-naïve and treatment-failure patients with chronic HCV infection. Data from the remaining two clinical trials in the registration program, known as the ILLUMINATE and REALIZE trials, are expected in the third quarter of 2010. ILLUMINATE is evaluating telaprevir-based regimens in approximately 500 treatment-naïve HCV patients. REALIZE is evaluating telaprevir-based regimens in approximately 650 treatment-failure HCV patients.

Telaprevir is being developed by Vertex Pharmaceuticals in collaboration with Tibotec Pharmaceuticals and Mitsubishi Tanabe Pharma. Vertex retains commercial rights to telaprevir in North America. Tibotec has rights to commercialize telaprevir in Europe, South America, Australia, the Middle East and certain other countries. Mitsubishi Tanabe Pharma has rights to commercialize telaprevir in Japan and certain Far East countries.

About Hepatitis C

Hepatitis C is a liver disease caused by the hepatitis C virus (HCV), which is found in the blood of people with the disease.2 While chronic HCV infection affects up to 3.9 million individuals in the United States, 75% of those infected are unaware of their infection.3 Approximately 60 percent of genotype 1 patients who undergo an initial 48-week regimen with pegylated-interferon and ribavirin, the currently approved treatment regimen, do not achieve sustained viral response (SVR),4,5,6 or a virologic cure. 1

HCV is spread through direct contact with the blood of infected people.2 Though many people with HCV infection may not experience symptoms, others may have symptoms such as fatigue, fever, jaundice and abdominal pain.2 Chronic HCV can lead to serious liver problems, including liver damage, cirrhosis, liver failure, or liver cancer.2 If treatment is not successful and patients do not achieve an SVR, they remain at risk for progressive liver disease.7,8,9,10,11 In the United States, HCV infection is the leading cause of liver transplantations and is reported to contribute to 4,600 to 12,000 deaths annually.8 The majority of patients infected with HCV were born between 1946 and 1964, accounting for two of every three chronic HCV cases.11 Over the next 20 years, total annual medical costs for patients with HCV infection are expected to more than double, from $30 billion today to approximately $85 billion.11