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BMS claims advance with hepatitis C regimen

Published on 10/11/14 at 08:10am
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Bristol-Myers Squibb has reported data for its hepatitis C virus cocktail that it says outperforms even newer all-oral therapies in very ill patients. 

A regimen of BMS' regimen of NS5A inhibitor daclatasvir, NS3/4A protease inhibitor asunaprevir and non-nucleoside NS5B polymerase inhibitor beclabuvir (formerly BMS-791325) - collectively known as DCV-TRIO - was able to achieve a clinical cure in patients with genotype 1 HCV that had progressed to cirrhosis despite prior treatment in just 12 weeks. 

The trial - which was called UNITY-2 and presented at the American Association for the Study of Liver Diseases (AASLD) - involved both treatment-naïve and treatment-experienced patients with compensated cirrhosis, and found that DCV-TRIO achieved a sustained virologic response (SVR) at 12 weeks of 98% and 93%, respectively. 

"Even with the most recent HCV treatment advances, genotype 1 patients with cirrhosis remain difficult to treat," says Andrew Muir of Duke University Medical Centre's gastroenterology division, one of the investigators in the trial.

Genotype 1 HCV accounts for around 70% of all cases in the US and is also the most common strain of the virus in Europe and South America. 

"Currently, treatment-experienced cirrhotic patients still require a 24-week regimen to achieve high SVR rates," says Muir. "The data from this clinical trial using the DCV-TRIO regimen showed high cure rates for this population in a 12-week regimen."

Other new all-oral regimens have also shown efficacy at 12 weeks in patients with cirrhosis. For instance, Gilead Sciences' combination of multibillion dollar drug Sovaldi (sofosbuvir) given with NS5A inhibitor ledipasvir and ribavirin showed SVR rates of 82%-86% at 12 weeks, rising to 100% at week 24, in the ION-2 trial. 

Similarly, in the TURQUOISE-II study AbbVie's ABT-450/ritonavir, ABT-267 and ABT-333 achieved SVR's of 80% to 100% at week 12 and 94%-100% at week 24. 

According to the Centers for Disease Control and Prevention (CDC), about 3.2 million Americans are infected with HCV and - without proper treatment - 15%-30% of them will go on to develop cirrhosis. Patients with cirrhosis have the greatest risk for the development of liver failure, liver cancer and the need for transplantation. 

Effective in genotype 3 

BMS also reported data at the AASLD meeting showing that a combination of daclatasvir with Gilead's Sovaldi (sofosbuvir) achieved a 90% SVR rate at 12 weeks in treatment-naïve patients with genotype 3 HCV and an 86% rate in treatment-experienced patients.

Genotype 3 HCV is commonly encountered in Asian countries and is the second most common form of the virus behind genotype 1. Advances in the treatment for this mean that genotype 3 is now considered the most difficult-to-treat of the set, particularly as it has a tendency to progress quickly to advanced liver disease and cancer. 

The new data is a lift to BMS' ambitions in HCV, which suffered something of a setback last month when the company announced it would not seek approval of a daclatasvir/asunaprevir dual combination, and has withdrawn its US marketing application for the latter drug.

The company took the decision in the face of growing competition in the HCV sector, particularly from Gilead which recently secured US approval for a fixed-dose combination of sofosbuvir and ledipasvir called Harvoni. Earlier data had shown BMS' dual treatment was not as effective as the Gilead combination.

Phil Taylor

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