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Vertex Will Study All-Oral Regimen of HCV Protease Inhibitor Telaprevir plus Polymerase Inhibitor VX-222

SUMMARY: Vertex Pharmaceuticals announced this week that the company will test its lead hepatitis C virus (HCV) protease inhibitor, telaprevir, in combination with its investigational HCV polymerase inhibitor VX-222. The dual oral regimen will be evaluated both on its own and with the current standard therapy, pegylated interferon plus ribavirin.

With the most advanced directly targeted oral hepatitis C drugs now in Phase 3 trials, investigators have begun to look at all-oral combination regimens, which are expected to slow emergence of resistance and could potentially allow people with hepatitis C to avoid the side effects of pegylated interferon and ribavirin.

Roche/Genentech was the first to test such a combination, the HCV protease inhibitor RG7227 (also known as ITMN-191) plus the polymerase inhibitor RG7128; the first results from the INFORM-1 trial were presented this past fall. The Abbott/Enantta collaboration also announced this week that it will begin a Phase 2 trial testing 3 new agents, the investigational protease inhibitor ABT-450 and the polymerase inhibitors ABT-333 and ABT-072. Each agent will be studied in combination with standard therapy now, but they offer the potential for all-oral regimens in the future.

Below is an excerpt from the recent Vertex press release announcing their pending trial.

Vertex Broadens its Commitment to Improving HCV Care with Clinical Trial to Evaluate Combination Regimens Based on Oral Antiviral Therapies

Trial will evaluate safety and SVR rates with multiple 12-week response-guided regimens of telaprevir/VX-222-based combination therapy, including two-drug regimens of telaprevir and VX-222
Interim clinical data expected in the second half of 2010
Multiple clinical trial sites in the U.S. to enroll patients

Cambridge, Mass. -- March 1, 2010 -- Vertex Pharmaceuticals Incorporated (Nasdaq: VRTX) today announced that it is initiating the first clinical trial evaluating Vertex's lead investigational hepatitis C virus (HCV) protease inhibitor, telaprevir, dosed in combination with the company's lead investigational HCV polymerase inhibitor, VX-222. This Phase 2 trial will evaluate sustained viral response rates (SVR; defined as undetectable HCV RNA 24 weeks after the end of treatment) using multiple 12-week response-guided regimens of telaprevir/VX-222-based combination therapy, including two-drug regimens that contain only telaprevir and VX-222. The trial is expected to enroll approximately 100 treatment-naive genotype 1 HCV patients at multiple clinical trial sites, the majority of which will be located in the U.S. Enrollment is expected to be completed in the second quarter of 2010. Vertex expects to obtain interim clinical data, including safety and viral kinetic data, from this trial in the second half of 2010.

"Vertex is committed to improving patient care in HCV, and the announcement of this clinical trial combining two oral agents, telaprevir and VX-222, signifies our first exploration into this combination regimen's potential role to further improve the treatment of HCV," said Peter Mueller, PhD, Vertex's Chief Scientific Officer and Executive Vice President, Global Research and Development.

"The completion of the Phase 3 development program for telaprevir remains our primary focus, and we are on track to submit a New Drug Application for telaprevir in the second half of 2010. We believe telaprevir could represent a significant opportunity to improve the treatment of HCV, and simultaneously, we are focused on evaluating additional opportunities to potentially enhance HCV therapy even more in the years ahead using novel combination regimens based on oral antiviral agents. We believe the trial announced today will inform the development path for telaprevir/VX-222-based combination therapy, and we look forward to obtaining the first clinical data from the trial later this year," continued Dr. Mueller.

About the Phase 2 Trial of Telaprevir and VX-222

The randomized, parallel-group, dose-ranging trial announced today is designed to evaluate the safety and antiviral activity, including SVR, of multiple 12-week response-guided telaprevir/VX-222-based combination regimens. The primary endpoint of this trial is to assess safety and tolerability of telaprevir/VX-222-based combination therapy. A secondary endpoint of this study is to assess the proportion of patients in each study arm who achieve SVR. The trial is expected to enroll approximately 100 treatment-naïve genotype 1 HCV patients at approximately 20 clinical trial sites, predominantly in the U.S. Vertex expects to complete enrollment for the trial in the second quarter of 2010. The trial will consist of four arms, as noted below:

12-Week Treatment Regimens
Telaprevir (1125 mg BID) + VX-222 (100 mg BID)
Telaprevir (1125 mg BID) + VX-222 (400 mg BID)
Telaprevir (1125 mg BID) + VX-222 (100 mg BID) + peg-IFN + RBV
Telaprevir (1125 mg BID) + VX-222 (400 mg BID) + peg-IFN + RBV
BID = twice daily, peg-IFN = pegylated interferon, RBV = ribavirin

Response-Guided Trial Design

The trial will utilize response-guided criteria aimed at evaluating shorter-duration treatment regimens. All patients, regardless of treatment group, whose HCV RNA levels are undetectable (<10 IU/mL) at week 2 and week 8 of treatment, will stop their assigned treatment at week 12. Patients who do not meet these criteria will complete their assigned treatment and at week 12, those in the dual-drug regimen will receive follow-on therapy of 24 weeks of pegylated-interferon (peg-IFN) and ribavirin (RBV), for a total of 36 weeks of treatment. Patients in the quad-therapy regimens who do not meet these criteria at week 12 will receive an additional 12 weeks of follow-on therapy with peg-IFN and RBV for a total of 24 weeks of peg-IFN and RBV therapy.

Potential Additional Arms of Telaprevir/VX-222-based Combination Treatment

Based on an evaluation of on-treatment safety, pharmacokinetic and antiviral data from patients in each arm of the trial, Vertex may elect to enroll up to two additional treatment arms that will evaluate telaprevir/VX-222-based combination therapy. The components of the treatment regimens of these arms will be selected based on clinical data that emerges from the four initially studied regimens. If enacted, up to 25 patients are expected to enroll in each additional treatment arm.

Recent Clinical Trials Support Evaluation of Telaprevir/VX-222-based Combination Regimens

Phase 1b/2a Clinical Trial of VX-222 in HCV Patients

Interim clinical results from a two-part Phase 1b/2a clinical trial of VX-222 showed that in the multiple-dose Phase 1b viral kinetic portion of the trial (Part A), VX-222 was well-tolerated across four VX-222 dose groups with no serious adverse events reported. Part A enrolled 32 genotype 1 HCV patients to receive three days of dosing, and a mean HCV RNA decline of greater than 3 log10 was observed across all four VX-222 dose groups. An increasing dose response was observed across the four dose groups, with the results with 500 mg and 750 mg BID, and 1500 mg QD (once-daily) being very similar. The mean HCV RNA decline achieved after three days of dosing with 250 mg, 500 mg, and 750 mg of VX-222 every 12 hours (q12h) was 3.1 log10, 3.4 log10, and 3.2 log10, respectively. Additionally, the mean HCV RNA decline achieved after three days of dosing with 1500 mg of VX-222 every 24 hours (QD) was 3.4 log10. For patients who received placebo, the mean HCV RNA decline after three days of dosing was 0.1 log10. The majority of the patients enrolled in Part A had genotype 1a chronic HCV infection. Full results including the final safety analysis from Part A of this trial are expected to be presented at a medical meeting in 2010.

The interim results of Part A of this trial are consistent with the findings from a previously conducted three-day, five-patient viral kinetic study of VX-222. Part B of the study, which will be initiated shortly will evaluate 12 weeks of VX-222 dosed in combination with peg-IFN and RBV in treatment-naïve HCV patients.

Drug-Drug Interaction Study of Telaprevir and VX-222 in Healthy Volunteers

Vertex also recently completed a Phase 1 study of telaprevir and VX-222 designed to evaluate the safety, tolerability and drug-drug interaction of telaprevir and VX-222 in approximately 20 healthy volunteers. In the study, the 10-day telaprevir/VX-222-based combination regimens were well-tolerated with no serious adverse events reported.

In this study, an increase in the plasma exposure of VX-222 was observed when dosed in combination with telaprevir, while the plasma exposure of telaprevir was not affected when dosed in combination with VX-222. Based on this observation, Vertex selected VX-222 doses of 100 mg twice-daily BID and 400 mg BID for evaluation in the Phase 2 trial of telaprevir/VX-222-based combination therapy announced today. The VX-222 doses of 100 mg BID and 400 mg BID are expected to provide plasma exposures similar to those observed with doses of 250 mg BID and 750 mg BID, respectively, in the previously conducted viral kinetic studies of VX-222 monotherapy in HCV patients.

The results of both the three-day viral kinetic study of VX-222 and the drug-drug interaction study of telaprevir/VX-222-based regimens support the Phase 2 combination trial of telaprevir and VX-222 in HCV patients, as announced today.

About Telaprevir and VX-222

Telaprevir is an investigational oral inhibitor of HCV protease, an enzyme essential for viral replication, and is being evaluated as part of a global Phase 3 registration program in more than 2,200 treatment-naïve and treatment-failure patients. Vertex is collaborating with Tibotec and Mitsubishi Tanabe Pharma to develop telaprevir. Vertex retains commercial rights to telaprevir in North America. Tibotec has rights to commercialize telaprevir in Europe, South America, Australia, the Middle East and other countries. Mitsubishi has rights to commercialize telaprevir in Japan and certain Far East countries.

VX-222 is an investigational oral non-nucleoside inhibitor of HCV NS5B polymerase. Vertex added VX-222 to its development pipeline as part of the acquisition of ViroChem Pharma Inc. in March 2009. Vertex retains worldwide commercial rights to VX-222.

About Vertex

Vertex Pharmaceuticals Incorporated is a global biotechnology company committed to the discovery and development of breakthrough small molecule drugs for serious diseases. The Company's strategy is to commercialize its products both independently and in collaboration with major pharmaceutical companies. Vertex's product pipeline is focused on viral diseases, cystic fibrosis, inflammation, autoimmune diseases, epilepsy, cancer, and pain. Vertex co-discovered the HIV protease inhibitor, Lexiva, with GlaxoSmithKline.

For more information, see


Vertex Pharmaceuticals. Vertex Broadens its Commitment to Improving HCV Care with Clinical Trial to Evaluate Combination Regimens Based on Oral Antiviral Therapies. Press release. March 1, 2010.






















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