Healthcare Industry News: gout
News Release - March 31, 2011
VICTRELIS(TM) (boceprevir), Merck's Investigational Medicine, Added to Peginterferon Alfa-2a and Ribavirin Achieved Significantly Higher SVR Rates In Treatment-Failure Patients with Chronic HCV Genotype 1 Compared to ControlResults Similar to Regimen using Peginterferon Alfa-2b in HCV RESPOND-2 Study
BERLIN--(Healthcare Sales & Marketing Network)-- Merck (NYSE:MRK ), known as MSD outside of the United States and Canada, reported that final results from a Phase III study of VICTRELIS™ (boceprevir), its investigational oral hepatitis C protease inhibitor, added to peginterferon alfa-2a (Pegasys®) and ribavirin therapy demonstrated significantly higher sustained virologic response (SVR)1 rates in adult patients who failed previous treatment for chronic hepatitis C virus (HCV) genotype 1 compared to a control group receiving peginterferon alfa-2a and ribavirin alone, the primary endpoint of the 48-week study. Significantly more patients in the treatment group receiving VICTRELIS achieved SVR, 64 percent (86/134) vs. 21 percent (14/67) for control, p<0.0001; and fewer patients receiving VICTRELIS relapsed after the end of treatment, 12 percent (11/95) vs. 33 percent (7/21) for control. These results were presented for the first time today as part of a late-breaker poster session [Poster #1366] at The International Liver Congress™ / 46th European Association for the Study of the Liver (EASL) annual meeting.
"In this study, the addition of VICTRELIS to peginterferon alfa-2a and ribavirin resulted in approximately a three-fold increase in sustained virologic response in patients who were previous nonresponders or relapsers to standard hepatitis C therapy," said Steven L. Flamm, M.D., professor in medicine-hepatology and surgery, Northwestern University Feinberg School of Medicine, Chicago. "These results are similar to those seen with the 48-week treatment regimen of VICTRELIS added to peginterferon alfa-2b and ribavirin in HCV RESPOND-2, a pivotal Phase III study. Taken together, these studies showed that VICTRELIS combined with either peginterferon alfa-2a or alfa-2b and ribavirin achieved significantly higher SVR rates in chronic HCV genotype 1 patients who failed prior therapy compared to peginterferon and ribavirin alone."
As published in today's edition of The New England Journal of Medicine, in the HCV RESPOND-2 study in patients who failed prior therapy, the addition of VICTRELIS to peginterferon alfa-2b (PEGINTRON®) and ribavirin in a 48-week regimen achieved an SVR rate of 66 percent (107/161) compared to 21 percent for control (17/80), p<0.0001. The relapse rate was 12 percent (14/121) for the group receiving VICTRELIS compared to 32 percent (8/25) for control.
VICTRELIS added to peginterferon alfa-2a and ribavirin
The study of VICTRELIS added to peginterferon alfa-2a and ribavirin (PEG2a/R) presented at EASL was a Phase III, placebo-controlled trial in which 201 adult patients with chronic HCV genotype 1 infection who were either relapsers or nonresponders to prior peginterferon and ribavirin therapy were randomized to one of two 48-week treatment groups in a 1:2 ratio. The control group received a 4-week lead-in of PEG2a/R followed by placebo + PEG2a/R for 44 weeks. The group treated with VICTRELIS received a 4-week lead-in of PEG2a/R followed by the addition of VICTRELIS for 44 weeks. Peginterferon alfa-2a was administered subcutaneously at a dose of 180 mcg once weekly in combination with ribavirin 1,000-1,200 mg/day orally based on patient weight in a divided daily dose. VICTRELIS was administered orally at a dose of 800 mg three times daily. Patients in the study with detectable virus (HCV-RNA) at treatment week 12 were considered treatment failures and discontinued all therapy.
HCV-RNA decline after 4-week lead-in was a stronger predictor of SVR than historical treatment response
In the study, SVR was strongly associated with a patient's response to peginterferon and ribavirin, whether defined by historical classification of response to previous treatment (SVR for prior relapsers was greater than SVR for prior nonresponders), or by a decrease in HCV-RNA at the end of the 4-week lead-in period. The lead-in allowed for an assessment of a patient’s current response as compared to their historical response. Patients with good response after the lead-in, defined by a greater than or equal to 1.0-log10 decline in HCV-RNA, achieved an SVR rate of 71 percent (79/112) with VICTRELIS added to PEG2a/R compared to 25 percent (14/57) for PEG2a/R alone. Patients with poor response after the lead-in, defined by a less than 1.0-log10 decline in HCV-RNA, had an SVR rate of 39 percent (7/18) with VICTRELIS added to PEG2a/R compared to 0 percent (0/9) for PEG2a/R alone.
Consistent with results from the HCV RESPOND-2 study, response after the 4-week lead-in phase in this study was a stronger predictor of SVR than historical treatment response.
The five most common treatment-emergent adverse events in the study reported for patients receiving VICTRELIS added to PEG2a/R and control, respectively, were: fatigue (50 and 54 percent), anemia (50 and 33 percent), nausea (39 and 27 percent), dysgeusia (39 and 15 percent) and headache (28 and 31 percent). Neutropenia was reported more frequently in patients receiving VICTRELIS compared to control (31 and 18 percent, respectively). Serious adverse events were reported in 13 and 10 percent of patients in the study groups, respectively. Treatment discontinuations due to adverse events over the total course of treatment were 17 percent and 4 percent, respectively. Erythropoietin (EPO) for management of anemia was allowed at the discretion of the investigator per the study protocol, and was used by 47 and 30 percent of patients in the study groups, respectively.
Merck's global commitment to advancing hepatitis therapy
Merck is committed to building on its strong legacy in the field of viral hepatitis by continuing to discover, develop and deliver vaccines and medicines to help prevent and treat viral hepatitis. In hepatitis C, company researchers developed the first approved therapy for chronic HCV in 1991 and the first combination therapy in 1998. 2011 marks the 10-year anniversary of the introduction of PEGINTRON and ribavirin in combination therapy, a current standard therapy for chronic HCV worldwide. In addition to ongoing studies with VICTRELIS, extensive research efforts are underway to develop additional innovative oral therapies for viral hepatitis care.
PEGINTRON is indicated for use in combination with ribavirin for the treatment of chronic hepatitis C in patients 3 years of age and older with compensated liver disease.
The following points should be considered when initiating therapy with PEGINTRON in combination with ribavirin: (1) These indications are based on achieving undetectable HCV-RNA after treatment for 24 or 48 weeks and maintaining a Sustained Virologic Response (SVR) 24 weeks after the last dose. (2) Patients with the following characteristics are less likely to benefit from re-treatment after failing a course of therapy: previous nonresponse, previous pegylated interferon treatment, significant bridging fibrosis or cirrhosis, and genotype 1 infection. (3) No safety and efficacy data are available for treatment of longer than one year.
PEGINTRON is also indicated for use alone for the treatment of chronic hepatitis C in patients with compensated liver disease previously untreated with interferon alpha and who are at least 18 years of age.
The following points should be considered when initiating therapy with PEGINTRON alone: Combination therapy with ribavirin is preferred over PEGINTRON monotherapy unless there are contraindications to, or significant intolerance of, ribavirin. Combination therapy provides substantially better response rates than monotherapy.
Selected Safety Information on PEGINTRON
WARNING: RISK OF SERIOUS DISORDERS AND RIBAVIRIN-ASSOCIATED EFFECTS
Alpha interferons, including PEGINTRON, may cause or aggravate fatal or life-threatening neuropsychiatric, autoimmune, ischemic, and infectious disorders. Patients should be monitored closely with periodic clinical and laboratory evaluations. Patients with persistently severe or worsening signs or symptoms of these conditions should be withdrawn from therapy. In many, but not all cases, these disorders resolve after stopping PEGINTRON therapy.
Use with Ribavirin: Ribavirin may cause birth defects and death of the unborn child. Extreme care must be taken to avoid pregnancy in female patients and in female partners of male patients. Ribavirin causes hemolytic anemia. The anemia associated with ribavirin therapy may result in a worsening of cardiac disease. Ribavirin is genotoxic and mutagenic and should be considered a potential carcinogen.
PEGINTRON is contraindicated in patients with known hypersensitivity reactions such as urticaria, angioedema, bronchoconstriction, anaphylaxis, Stevens-Johnson syndrome and toxic epidermal necrolysis to interferon alpha or any other component of the product, autoimmune hepatitis, and hepatic decompensation (Child-Pugh score greater than 6 [class B and C]) in cirrhotic CHC patients before or during treatment. PEGINTRON/ribavirin combination therapy is additionally contraindicated in women who are pregnant or may become pregnant, men whose female partners are pregnant, patients with hemoglobinopathies (e.g., thalassemia major, sickle-cell anemia), and patients with creatinine clearance less than 50 mL per min.
Ribavirin therapy should not be started until a report of a negative pregnancy test has been obtained immediately prior to planned initiation of therapy. Patients should use at least two effective forms of contraception and have monthly pregnancy tests during therapy and for six months after completion of therapy. If this drug is used during pregnancy, or if a patient becomes pregnant, the patient should be apprised of the potential hazard to a fetus. A Ribavirin Pregnancy Registry has been established to monitor maternal-fetal outcomes of pregnancies in female patients and female partners of male patients exposed to ribavirin during treatment, and for six months following cessation of treatment. Physicians and patients are encouraged to report such cases by calling 1-800-593-2214.
Patients with the following conditions should be closely monitored and may require dose reduction or discontinuation of therapy:
- Hemolytic anemia with ribavirin
- Neuropsychiatric events
- History of significant or unstable cardiac disease
- Hypothyroidism, hyperthyroidism, hyperglycemia, diabetes mellitus that cannot be effectively treated by medication
- New or worsening ophthalmologic disorders
- Ischemic and hemorrhagic cerebrovascular events
- Severe decreases in neutrophil or platelet counts
- History of autoimmune disorders
- Pancreatitis and ulcerative or hemorrhagic/ischemic colitis and pancreatitis
- Pulmonary infiltrates or pulmonary function impairment
- Child-Pugh score greater than 6 (Class B and C)
- Increased creatinine levels in patients with renal insufficiency
- Serious, acute hypersensitivity reactions and cutaneous eruptions
- Dental/periodontal disorders reported with combination therapy
- Hypertriglyceridemia may result in pancreatitis (e.g., triglycerides greater than 1000 mg/dL)
- Weight loss and growth inhibition reported with combination therapy in pediatric patients.
Serious adverse reactions have occurred in approximately 12 percent of subjects in clinical trials. The most common serious events occurring in subjects treated with PEGINTRON and ribavirin were depression and suicidal ideation, each occurring at a frequency of less than 1 percent. The most common fatal events occurring in subjects treated with PEGINTRON and ribavirin were cardiac arrest, suicidal ideation, and suicide attempt, all occurring in less than 1 percent of subjects.
The incidence of serious adverse reactions was comparable between PEGINTRON monotherapy (about 12 percent) and PEGINTRON/ribavirin combination therapy weight-based (12 percent) or flat-dose (17 percent). In many but not all cases, adverse reactions resolved after dose reduction or discontinuation of therapy. Some patients experienced ongoing or new serious adverse reactions during the 6-month follow-up period. In a study with PEGINTRON/ribavirin (weight-based) combination therapy in adult patients, anemia with weight-based dosing occurred at an increased rate (29 percent vs. 19 percent); however, the majority of these cases were mild and responded to dose reductions. The incidence of serious adverse reactions reported for the weight-based ribavirin group was 12 percent. There were 31 deaths in clinical trials which occurred during treatment or during follow-up. Of the deaths, 19 were patients on either PEGINTRON or PEGINTRON/ribavirin combination therapy and three occurred during the follow-up period but had been on PEGINTRON/ribavirin combination therapy.
Additional serious adverse reactions seen in clinical trials at a frequency of equal to or less than 1 percent included psychosis, aggressive reaction, relapse of drug addiction/overdose; nerve palsy (facial, oculomotor); cardiomyopathy, angina, pericardial effusion, retinal ischemia, retinal artery or vein thrombosis, blindness, decreased visual acuity, optic neuritis, transient ischemic attack, supraventricular arrhythmias, loss of consciousness; neutropenia, infection (sepsis, pneumonia, abscess, cellulitis); emphysema, bronchiolitis obliterans, pleural effusion, gastroenteritis, pancreatitis, gout, hyperglycemia, hyperthyroidism and hypothyroidism, autoimmune thrombocytopenia with or without purpura, rheumatoid arthritis, interstitial nephritis, lupus-like syndrome, sarcoidosis, aggravated psoriasis, urticaria, injection site necrosis, vasculitis, and phototoxicity.
Greater than 96 percent of all subjects in clinical trials experienced one or more adverse events. Most common adverse reactions (greater than 40 percent) in adult patients receiving either PEGINTRON or PEGINTRON/ribavirin are injection site inflammation/reaction, fatigue/asthenia, headache, rigors, fevers, nausea, myalgia, and anxiety/emotional lability/irritability.
The adverse reaction profile was similar between weight-based and flat-dose PEGINTRON/ribavirin therapies. Weight-based PEGINTRON/ribavirin dosing resulted in increased rates of anemia. Most common adverse reactions with PEGINTRON/ribavirin (weight-based) therapy were psychiatric, which occurred among 68-69 percent of patients and included depression, irritability, and insomnia, each reported by approximately 30-40 percent of subjects in all treatment groups. Suicidal behavior (ideation, attempts, and suicides) occurred in 2 percent of all patients during treatment or during follow-up after treatment cessation. Other common reactions included injection site reactions, fatigue/ asthenia, headache, rigors, fever, nausea, myalgia, anxiety/emotional lability/irritability. The severity of some of these systemic symptoms tends to decrease as treatment continues.
Subjects receiving PEGINTRON/ribavirin as re-treatment after failing a previous interferon combination regimen reported adverse reactions similar to previous treatment-naďve patients receiving this regimen.
In general, the adverse reaction profile in the pediatric population was similar to that observed in adults. Most common adverse reactions (greater than 25 percent) in pediatric patients receiving PEGINTRON/ribavirin are pyrexia, headache, neutropenia, fatigue, anorexia, injection site erythema, abdominal pain, and vomiting.
Please see full prescribing information at http://www.spfiles.com/pipeg-intron.pdf.
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Prescribing Information, Medication Guide, and Instructions for Use are available at http://www.spfiles.com/pipeg-intron.pdf, http://www.spfiles.com/mgpeg-intron.pdf and http://www.spfiles.com/ifupeg-intron.pdf.
1 SVR, the protocol specified primary efficacy endpoint of the studies, is defined as achievement of undetectable HCV-RNA at 24 weeks after the end of treatment in all randomized patients treated with any study medication. Per protocol, if a patient did not have a 24-week post-treatment assessment, the patient’s 12-week post-treatment assessment was utilized.
PEGINTRON® is a trademark of Schering Corp., a subsidiary of Merck & Co., Inc., Whitehouse Station, N.J., USA.
VICTRELIS™ is a trademark of Schering Corp., a subsidiary of Merck & Co., Inc., Whitehouse Station, N.J., USA
Pegasys® is a trademark of its respective owner and is not a trademark of Merck & Co., Inc., Whitehouse Station, N.J., USA.
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