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Hepatitis C Drug Viramidine Fails Pivotal Phase III Trial, Again

By Ronald Baker, PhD

Valeant Pharmaceuticals announced study results this week showing that its anti-hepatitis C drug Viramidine (taribavirin, a prodrug of ribavirin) did not prove non-inferior in terms of effectiveness compared with standard ribavirin therapy (Rebetol; Copegus; Ribaspheret).

The Phase III trial, called VISER 2, was the second of two pivotal Phase III trials of Viramidine conducted by the company. VISER 1, the first Phase III trial of Viramidine, also failed to show non-inferiority to standard ribavirin in terms of efficacy. Results of VISER 1 were announced by Valeant in March of 2006.

When used in combination with pegylated interferon (Pegasys or Peg-Intron), ribavirin is a critical component of the current standard of care for chronic hepatitis C, but the drug may produce debilitating side effects, in particular hemolytic anemia (abnormally low numbers of red blood cells). As a consequence of developing anemia, some patients may be forced to lower the dose of ribavirin or to cease taking it altogether.
Physicians may choose to prescribe epoetin alfa (Procrit) to reduce or eliminate anemia in patients using ribavirin, but Procrit is not FDA-approved for this purpose and is an expensive medication. Viramidine is less likely to cause anemia (hemoglobin less than 10g/dL) than ribavirin, thus its appeal as a potential substitute for ribavirin in the treatment of chronic hepatitis C.

In the VISER 2 Phase III trial, study volunteers taking Viramidine experienced a 40% sustained virological response (SVR) rate compared with 55% of the participants taking ribavirin. But researchers noted (as they did in the VISER 1 trial) that volunteers taking a higher dose of Viramidine registered higher response rates without an increase in anemia.

The researchers emphasized that Viramidine appeared safer than ribavirin in the study. Valeant CEO Timothy Tyson noted that the more favorable safety profile of Viramidine compared to ribavirin convinced the company to plan a weight-based dose study of Viramidine. In addition, Tyson said that the company would look for a partner to develop the drug if they launch a third Phase III trial in 2007.

Valeant announced the somewhat disappointing data from VISER 2 just a few hours after the company announced that the SEC had begun a probe into stock trades made this spring around the time it released data from a Phase III trial of Viramidine that sent its stock significantly lower. Investigators are also probing stock option grants and the company's efforts to recover bonuses paid to former CEO Milan Panic, who was fired in 2002 (report from The Los Angeles Times on the probe).

Following is the text of the recent announcement by Valeant of the results of the VISER 2 Phase III trial of Viramidine:

Valeant Pharmaceuticals Reports VISER2 Results for Viramidine

September 12, 2006

Valeant Pharmaceuticals International (NYSE:VRX) today reported summary results of VISER 2, the second of two Phase 3 pivotal trials, for Viramidine(R). The company is developing Viramidine (taribavirin hydrochloride), a nucleoside (guanosine) analog prodrug of ribavirin, in oral form, for administration in combination with a pegylated interferon for the treatment of chronic hepatitis C in treatment-naive patients.

The VISER 2 trial included two co-primary endpoints: one for safety (superiority to ribavirin in the incidence of anemia) and one for efficacy (non-inferiority to ribavirin in sustained viral response, SVR).

The VISER 2 study did not meet the non-inferiority efficacy endpoint on an intent-to-treat (ITT) basis, with overall SVR rates of 40 percent versus 55 percent for the Viramidine and ribavirin arms, respectively. However, consistent with the results seen in VISER 1, SVR rates in VISER 2 trended higher among patients receiving increased exposure on a mg/kg basis in the Viramidine arm without a substantial increase in the anemia rate.

Consistent with results from the VISER 1 trial released earlier in the year, VISER 2 confirmed the safety advantages of Viramidine. Anemia rates (Hgb less than 10g/dL) during the treatment period were significantly lower in patients treated with Viramidine than those treated with ribavirin (6 percent versus 22 percent; p less than 0.001).

As a result of the combined VISER 1 and VISER2 data, the company also announced that it is initiating a Phase 2b program to evaluate the efficacy of Viramidine at higher doses. The Phase 2b program is a multi-center, randomized, parallel, open-label study in 240 treatment naive, genotype-one patients and will evaluate Viramidine at 20 mg/kg, 25 mg/kg, and 30 mg/kg per day in combination with pegylated interferon alpha-2b.

There also will be a control group comprised of ribavirin and pegylated interferon alpha-2b. Treatment duration will be 48 weeks with a post-treatment follow-up period of 24 weeks. Based on a 12-week interim analysis of this study, the company will decide whether to begin a third Phase 3 study at the appropriate higher dose indicated by the Phase 2b study.

The company will seek to co-develop the product should it decide to pursue another phase 3 registration trial next year.

Timothy C. Tyson, president and chief executive officer, said, "As expected, VISER2 results were consistent with those seen in VISER 1. Although VISER 1 and 2 did not meet non-inferiority efficacy endpoints, Viramidine demonstrates meaningful clinical efficacy. Our retrospective analyses of 750 patient plasma samples indicate that Viramidine could be as effective as ribavirin at higher doses. These analyses, coupled with feedback from the medical community that there will continue to be a strong need for ribavirin or ribavirin analogues in the treatment of hepatitis C, indicate that further clinical testing is prudent. Our Phase 2b program should provide us with sufficient information at little relative cost and time to confirm the dose response, select an appropriate dose, test safety at higher doses, establish the path for registration of the drug and make a go/no-go decision."

The company also announced the issuance of a U.S. patent for Viramidine for use in the treatment of hepatitis C, which will not expire until 2020.

The following table summarizes the anemia and SVR rates for both VISER 1 and VISER 2:

Additional planned analyses of VISER 1 and VISER 2 data based on weight (mg/kg) indicated that SVR was improved with increased mg/kg concentrations while preserving the safety benefit as summarized below:

*Anemia = hemoglobin <10g/dL

The majority of adverse events other than anemia and gastrointestinal side effects were similar between treatment groups. The anemia rate was lower in the Viramidine arm, while the gastrointestinal rate was lower in the ribavirin arm. The most common other adverse events associated with combination therapy included fatigue, headache, insomnia, depression and myalgia.

VISER 2 Trial Design

The VISER 2 trial (VISER stands for Viramidine's Safety and Efficacy vs. Ribavirin) evaluated a fixed 600 mg BID dose of Viramidine to a weight-based 1,000/1,200 mg daily dose of ribavirin, both in combination with peginterferon alfa 2a. The study, conducted in the United States, Canada, Europe, Israel, Argentina and Australia, enrolled 962 treatment-naive subjects with chronic HCV.

Treatment duration was based on genotype, with genotypes 2 and 3 receiving 24 weeks of treatment and genotype non 2, 3 receiving 48 weeks of treatment, each with a post-treatment follow-up period of 24 weeks. The study was stratified for genotype, weight and viral load.

Additional information regarding the Phase 3 trial will be furnished by the company today with the Securities and Exchange Commission on Form 8-K and is also available on the company's Web site at www.valeant.com.

Viramidine is an investigational compound that has not been found by the Food and Drug Administration (FDA) or any other regulatory agency to be safe or effective in the diagnosis, mitigation, treatment or cure of any disease or illness. It may not be sold or promoted in the United States unless and until FDA has approved a New Drug Application. Similar restrictions apply in other countries.

09/15/06

Sources

Valeant Pharmaceuticals

Valeant Pharmaceuticals. Valeant Pharmaceuticals Reports VISER2 Results for Viramidine. Press Release. September 12, 2006.

www.LATimes.com. SEC Begins Inquiry at Valeant. September 12, 2006.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FDA-approved
Monotherapies for HCV
Intron A
Roferon

Infergen

Pegasys

PEG-Intron

FDA-approved
Combination
Therapies
for HCV
Pegasys + Copegus
PEG-Intron + Rebetol
Intron A + Rebetol
Roferon A + Ribavirin