- This all-oral treatment regimen is being studied as an interferon-free and ribavirin-free option
- Investigational regimen involves three different classes of direct-acting antivirals (DAAs) - an NS5A replication complex inhibitor, an NS3 protease inhibitor and an NS5B non-nucleoside polymerase inhibitor
- Phase III development as a fixed-dose combination is anticipated to begin by late 2013
Bristol-Myers
Squibb Company (NYSE: BMY) today announced additional, interim Phase
II data demonstrating that 12- and 24-week Triple DAA treatment regimens
of daclatasvir (DCV), asunaprevir (ASV) and BMS-791325 (’325) achieved
high rates of sustained virologic response (SVR) of up to 94%, in
treatment-naïve, genotype 1 chronic hepatitis C patients, at time points
ranging from 4 to 36 weeks post-treatment depending on the treatment
group. These data support the continued development of this interferon
alfa-, ribavirin (RBV)- and ritonavir (RTV)-free regimen, with Phase III
initiation anticipated to begin by late 2013.
The study results will be presented this week at the International Liver
Congress, the 48th annual meeting of the European Association
for the Study of the Liver (EASL), in Amsterdam.
Two serious adverse events (2/66), renal calculus and cerebral
vasoconstriction, were reported in this study. The renal calculus was
determined by the investigator to be unrelated to study drug. The
cerebral vasoconstriction was associated with treatment intensification
with peginterferon alfa and ribavirin following viral breakthrough in
one patient. Headache was the most common adverse event in the study
(27.3%, 18/66).
“The diversity of the hepatitis C patient population requires multiple
treatment options that can enable a personalized approach to therapy.
Effective and well-tolerated oral treatment regimens that are
ribavirin-free remain an important unmet medical need in hepatitis C,”
said Brian
Daniels, MD, senior vice president, Global Development and Medical
Affairs, Research
and Development, Bristol-Myers Squibb. “These data, which
demonstrate comparable efficacy among the 12- and 24-week Triple DAA
treatment groups, support the rapid Phase III development of this
investigational Triple DAA regimen and provide further data on
daclatasvir as an important component of DAA-based therapy.”
Daclatasvir is the first NS5A replication complex inhibitor to be
investigated in HCV clinical trials and is currently in Phase III
development. Asunaprevir is an oral, NS3 protease inhibitor in Phase III
development with daclatasvir. BMS-791325 is a non-nucleoside inhibitor
of the NS5B polymerase, currently in Phase II development for hepatitis
C as a component of daclatasvir-based treatment regimens.
Study Design and Results
This open-label, two-part Phase II study is designed to evaluate the
safety and antiviral activity of the investigational hepatitis C
treatment regimen of DCV, ASV and ‘325 in treatment-naïve patients with
genotype 1a and 1b chronic hepatitis C infection. The primary endpoint
of the study is viral load below the lower limit of quantitation (LLOQ;
HCV RNA <25 IU/mL) at 12 weeks post-treatment (SVR12).
Part 1 of the study evaluated a treatment regimen of DCV 60 mg QD, ASV
200 mg BID and ‘325 75 mg BID for 24 or 12 weeks (Groups 1 and 2,
respectively). Part 2 of the study evaluated the same DAA regimen for 24
or 12 weeks, with ‘325 dosed at 150 mg BID (Groups 3 and 4,
respectively).
Interim results for Part 1 of the study were previously reported at the
American Association for the Study of the Liver (AASLD) annual meeting
in November 2012.
The study was expanded in November 2012, adding eight new treatment
groups including the evaluation of this Triple DAA regimen in
treatment-naïve patients with HCV genotype 4 and null responders with
HCV genotype 1. Results from these treatment groups are not yet
available.
Virologic Response
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100% (28/28) of patients in Groups 1 and 2 (24- and 12-week treatment,
‘325 75 mg) with post-treatment follow-up data achieved SVR24
and/or SVR36. There was no viral breakthrough during
treatment and no post-treatment relapse in either group.
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91% (31/34) of patients overall in Groups 3 and 4 (24- and 12-week
treatment, ’325 150 mg) achieved SVR4. Three out of the 34
patients experienced virologic failure on or after treatment.
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Group 1
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Group 2
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Group 3
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Group 4
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(n=16)
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(n=16)
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(n=16)
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(n=18)
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BMS-791325 Dose
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75 mg
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75 mg
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150 mg
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150 mg
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Treatment Duration
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24 weeks
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12 weeks
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24 weeks
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12 weeks
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SVR4
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94%a
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94%b
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94%
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89%c,d
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(15/16)
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(15/16)
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(15/16)
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(16/18)
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SVR12
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94%a
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94%b
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N/A*
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89%c,d
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(15/16)
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(15/16)
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(16/18)
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SVR24
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88%a,b
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94%b
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N/A
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N/A
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(14/16)
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(15/16)
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SVR36
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N/A
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88%e
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N/A
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N/A
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(14/16)
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Viral Breakthrough
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0%
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0%
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6%
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6%
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(1/16)
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(1/18)
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Relapse
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0%
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0%
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0%
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6%
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(1/18)
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a Patient withdrew consent;
bOne patient missed this visit but had achieved
undetectable viral load at end of treatment or SVR at earlier endpoints;
cOne patient experienced viral breakthrough; dOne
patient relapsed; eTwo patients missed this
visit, but had achieved SVR at earlier endpoints
* N/A =
data not available at time of analysis
On-Treatment Safety
There were no deaths and no patient discontinuations due to treatment
intolerance or adverse events (AEs) related to BMS therapy. Two serious
adverse events (SAEs) were reported in the study. One SAE, cerebral
vasoconstriction, occurred in Group 3 during treatment intensification
with peginterferon alfa and RBV following viral breakthrough and lead to
treatment discontinuation; cerebral vasoconstriction is a known side
effect of interferon alfa. The remaining SAE reported on-treatment,
renal calculus, was observed in Group 2 and was determined by the
investigator to be unrelated to study drug.
Most AEs were mild to moderate in severity. The most common AEs (≥10%
total) across all study groups were headache (27.3%, 18/66), asthenia
(16.7%, 11/66), diarrhea (16.7%, 11/66), and nausea (13.6%, 9/66).
No Grade 3-4 elevations in liver enzymes (ALT/AST) or bilirubin were
observed in this study. One grade 3 AE (headache) resolved after seven
days with continued study treatment. One grade 3–4 laboratory
abnormality was reported in this study. One case of lymphopenia was
recorded in Group 2 at a single study visit concomitant with influenza.
All other AEs were grade 1 or 2.
About Bristol-Myers Squibb’s Commitment to Liver Disease
Bristol-Myers Squibb is studying a portfolio of compounds that aims to
address unmet medical needs across the liver disease continuum,
including hepatitis C, hepatitis B and liver cancer. The Company’s
hepatitis C pipeline includes compounds with different mechanisms of
action, pursuing both biologics as well as small molecule direct-acting
antivirals. These compounds are being studied as part of multiple
treatment regimens with the goal of increasing SVR rates across diverse
patient types and geographies.
Daclatasvir is an NS5A replication complex inhibitor that is being
extensively studied as a key component of potential DAA-based hepatitis
C treatment regimens. Studied in more than 4,100 patients to date,
daclatasvir is in Phase III development. Asunaprevir is an NS3 protease
inhibitor in Phase III development for hepatitis C as a component of
daclatasvir-based treatment regimens, and has been studied in more than
2,000 patients to date. BMS-791325 is a non-nucleoside inhibitor of the
NS5B polymerase, currently in Phase II development for hepatitis C as a
component of daclatasvir-based treatment regimens that has been studied
in more than 300 patients to date.
About Hepatitis C
Hepatitis C is a virus that infects the liver and is transmitted through
direct contact with infected blood and blood products. An estimated 170
million people worldwide are infected with hepatitis C, with genotype 1
being the most prevalent genotype. Up to 90 percent of those infected
with hepatitis C will not clear the virus and will become chronically
infected. Twenty percent of people with chronic hepatitis C will develop
cirrhosis and, of those, up to 25 percent may progress to liver cancer.
About Bristol-Myers Squibb
Bristol-Myers Squibb is a global biopharmaceutical company whose mission
is to discover, develop and deliver innovative medicines that help
patients prevail over serious diseases. For more information, please
visit http://www.bms.com
or follow us on Twitter at http://twitter.com/bmsnews.
Bristol-Myers Squibb Forward Looking Statement
This press release contains “forward-looking statements” as that term
is defined in the Private Securities Litigation Reform Act of 1995,
regarding the research, development and commercialization of
pharmaceutical products. Such forward-looking statements are
based on current expectations and involve inherent risks and
uncertainties, including factors that could delay, divert or change any
of them, and could cause actual outcomes and results to differ
materially from current expectations. No forward-looking
statement can be guaranteed. Among other risks, there can be no
guarantee that the clinical trials of these compounds will support
regulatory filings, or that the compounds will receive regulatory
approvals or, if approved, that they will become commercially successful
products. Forward-looking statements in this press release should be
evaluated together with the many uncertainties that affect Bristol-Myers
Squibb’s business, particularly those identified in the cautionary
factors discussion in Bristol-Myers Squibb’s Annual Report on Form 10-K
for the year ended December 31, 2012, in our Quarterly Reports on Form
10-Q, and our Current Reports on Form 8-K. Bristol-Myers Squibb
undertakes no obligation to publicly update any forward-looking
statement, whether as a result of new information, future events, or
otherwise.
Bristol-Myers SquibbMedia:Sonia Choi, 609-213-6015sonia.choi@bms.comorCarrie Fernandez, 215-859-2605carrie.fernandez@bms.comorInvestors:John Elicker, 609-252-4611john.elicker@bms.comorRanya Dajani, 609-252-5330ranya.dajani@bms.comorRyan Asay, 609-252-5020ryan.asay@bms.com