Vertex’s “Prove 3″ Study “Goes Yard!” — Teleprevir Likely to Be God-Send for “Non-Responder” Hep C Patients

November 2, 2008 · 16 Comments


The top-line, here: Vertex keeps rollin’ toward an FDA approvable letter. . . .

Now, while it is true that Schering released some interesting interim data, in the SPRINT series of studies on its candidate, Boceprivir — all of that data centered on “new” Hep C patients — so-called “treatment naive” patients. That is not the bulk of the market — nor is it the bulk of the current problem. That will likely belong to Vertex’s Teleprevir (as we much earlier noted — see that link).

You see, the current problem is that a significant portion of Hep C patients are “non-responders” to all forms of current treatment (including a current FDA-approved Schering drug-products-cocktail — think canibalization, here). That is, there seemed (until Vertex’s Teleprevir) to be no drug to help them.

And so, while this is a moment of “dueling pharma-spun press releases” — with the American Association for the Study of Liver Diseases Conference in session, in San Francisco — it still seems clear that Vertex retains the lead on both efficacy, and length of remission, in the largest segment of the market — patients already living with Hep C, with prior failed treatment attempts. Per Reuters, now:

. . . .telaprevir, when combined with standard treatments, showed the potential to cut in half the 48 weeks of treatment needed with the current standard of care and with greater efficacy.

In a study known as Prove 3 with 453 patients who had failed previous treatment with pegylated-interferon and ribavirin, 52 percent of those who received telaprevir saw the virus fall to undetectable levels and remain there 12 weeks after stopping treatment, according to interim analysis of data to be presented at the American Association for the Study of Liver Diseases meeting in San Francisco next week.

The percentage with undetectable virus 24 weeks after stopping treatment will yield the critical measure known as sustained viral response (SVR).

Within the 52 percent result, the virus was undetectable in 41 percent of patients who had not responded to previous treatment and 73 percent of those who had relapsed after previous treatment.

“Efficacy in non-responders is huge. No one should have any doubt about whether this drug works,” said Jason Kolbert, an analyst with Susquehanna Financial Group. . . .

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16 responses so far ↓

  • OLGA JOCIC // December 20, 2008 at 11:59 am | Reply

    I have been treated with Peg.Int + Riba. for 48 weeks. At 6 months I was negative, and at the end of therapy positive. Genotype 1 with 2.500.000, copies at the RNA test PCR at the end of treatnent, What are my chances to get negative after treatment with this medication, and when will appear this madication for commercial use. This is very important to me, since , my liver is in a stage of high fibrosis,

    Concerned mother!

    • condor // December 20, 2008 at 12:33 pm | Reply

      I cannot give you any medical advice, but I can make a rather well-educated guess that — in the US at least, by 2010, you ought to see an FDA approval for Teleprevir. Worldwide might come a little later, though EU approval might come before the US — late 2009.

      My very best wishes. . . .

  • OLGA JOCIC // December 20, 2008 at 12:44 pm | Reply

    Thank you very much for such prompt answer. I live in Belgrade, Serbia, and it is very encouriging, that it might be approved in EU by late 2009. Does that mean, that it will be for commercial use then?

  • condor // December 21, 2008 at 12:01 am | Reply

    Again, these are only my guesses.

    But yes, if Teleprevir wins EU approval, it will be commercially available in all EU countries.

    Keep an eye on my blog, as I will keep the readership up-to-date on the progress of this
    drug candidate, as I run across development news.

    Cheers!

  • Grasshopper // January 12, 2009 at 10:36 am | Reply

    I’m a non-responder to peg interferon-ribavarin with stage 3 liver disease. Last treated in 2002-2003 and ready to go through it again. Have signed up for clinical trials ongoing that are recruiting for double blind studies treating non-responders with standard drugs and teleprevir. I have not yet been accepted to any program and am just now returning to the doctors to get back on the band wagon.
    My bloodwork sounds scary with viral load of nearly 5 million, elevated bilirubin and MCH, low Eosinophils.
    Had little interest repeating treatment with the poor success rate of standard drugs but will try teleprevir and hope to be amoung the lucky 50% that respond this time.
    Tomorrow have a CT scan of liver to see what new developments are visible. Hopefully not too bad.

  • condor // January 12, 2009 at 10:41 am | Reply

    I wish you the best — I hope Teleprevir works for you!

    Keep your chin up!

    Namaste

  • aliceintune // May 6, 2009 at 5:19 pm | Reply

    I have cirhosis. I feel great. My doctor wants to give me the pegalated, ribo. I wish I could have the Telprvir now, I had a blood transfusion over 40 years ago. I don’t want my liver to get worse. How can I get the teleprvir? Can I go to Europe and get it this year?

  • condor // May 6, 2009 at 10:46 pm | Reply

    Hello Aliceintune –

    Again, I cannotgive you medical advice — but I do not think Teleprevir is approved yet — even in the EU.

    Your best bet would be to contact Vertex (http://www.vpharm.com) — and see if you can join one of the enrolling studies, here in the US.

    I wish you the best!

    – Condor

  • Grasshopper // May 7, 2009 at 2:29 pm | Reply

    Latest news from me: Tried to get into clinical trial for Telaprevir being conducted at University of Miami. I was just in time to make the roster and met all criteria that I know of save for one. I did not achieve a two log drop in viral load when first treated. The Pharmaceutical monitor refused my participation despite my willingness to be included. They did not want non-responders unless they had at least a two log drop in viral load during prior treatment. I think they are trying to stack the deck to come up with best results in the study so they can market the drug. What about people like me who had some response but not the two log drop they think is most likely to give good test results in the Telaprivir study? Come on man, if they have a drug that works but for some it’s still not going to cure this crap, some truth in advertising is in order. All I hear is how great it is for “non-responders”. How many of these “non-responders are like me with a poor response to the first treatment? Or are they making sure they only test with best case scenario “non-responders”?

  • max // May 10, 2009 at 8:12 pm | Reply

    Grasshopper, I thought they wanted all the harder to treat relapses and non responders to show the rest of the competing drug companies how good this drug is and get early approval.
    I really hope this drug works even though the side effects look bad.

  • Patricia Russo // June 17, 2009 at 2:04 pm | Reply

    whom do you call to request information on studys now or comming in the next year for teleprevier

    • condor // June 17, 2009 at 8:05 pm | Reply

      Go to clinicaltrials.gov — they will all be registered, right there.

      Better yet, just click here. That’s the full clinicaltrials.gov “teleprevir” listing.

      Namaste

      – Condor

  • CHRIS HANDEGARD // June 18, 2009 at 10:13 am | Reply

    I have been informed that the term “NONRESPONDER” applies only to those who achieve at least a 2 log drop in viral load.

    I belong to the group that did not have a 2 log drop. I had maybe a 1 log drop. That puts me in the category of “NULLRESPONDER” if I understand the terminolgy correctly now.

    Does the fact that Teleprevir and Boceprevir are avoiding NULLRESPONERS like the plague in their clinical trials mean they are simply trying to help the most likely curable cases and of course tally the most favorably study results when taking the drug to market for big money?

    Okay, understandable from a clinical and monetary standpoint, so here’s my question to the almighty drug pushers in thier corner offices somewhere high up the building;

    HOW ABOUT A TRIAL THAT INCLUDES THE HARD TO CURE “NULLRESPONDERS” OR ARE YOU THINKING THAT WILL MAKE YOU LOOK BAD? WE’RE ONLY TALKING A FEW DOSES OF YOUR MAGIC POTION IN THE GRAND SCHEME OF THINGS, WHAT ARE YOU AFRAID OF? ADMITING THE TRUTH THAT THERE ARE STILL GOING TO BE VAST NUMBERS OF UNFORTUNATE PEOPLE FOR WHOM YOUR NEW WONDER DRUG OFFERS LITTLE OR NO HOPE?

    How about it Vertex? Scherring-Plough? No comment? What a surprise.

    • condor // June 18, 2009 at 1:04 pm | Reply

      Of course, I cannot give you any medical advice, Chris, but a “non-responder” would presumably be someone who showed little or no viral load decline, in therapy — and the standard as to what a “non-responder” is, will vary, study-by-study.

      In any event, I wish you the very best — Namaste

  • CHRIS HANDEGARD // June 18, 2009 at 1:45 pm | Reply

    I’m so sick of this prattle. I googled “NullResponder” and got this definition of terms from thebody.com website. Please read.

    Terms For Response to HCV Treatment
    Part of Hepatitis C: New Treatments in the Pipeline

    By Tracy Swan

    April 2008

    Treatment Response: Response to hepatitis C treatment is measured by change in HCV viral load at different time points. Since it is a common practice to release interim data from HCV treatment trials, it is important to understand what these terms mean, so that interim results can be properly interpreted. It is important to consider the threshold of detection of the test used to measure HCV viral load, since these thresholds vary widely. The most sensitive tests can detect >5 copies IU/mL.

    RVR (Rapid Virological Response): RVR means that there is no detectable hepatitis C virus in the blood after 4 weeks of treatment. An RVR is a good indication of SVR, but it is not as accurate for predicting who is unlikely to have SVR. Therefore, HCV treatment should not be discontinued if there is no RVR. RVR is mainly used in research.

    EVR (Early Virological Response): EVR means that hepatitis C viral load has dropped by 99% (2 logs), or is undetectable after 12 weeks of HCV treatment. An EVR is a good predictor of the ultimate response to HCV treatment. If a person does not have an EVR, their chance of SVR is very low (1-4%). Usually, HCV treatment is discontinued in people who do not have an EVR.

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    ETR (End-of-Treatment Response): ETR means that there is no detectable hepatitis C virus in the blood at completion of HCV treatment. The ETR is usually higher than the SVR rate, because the hepatitis C virus may reappear in a person’s blood after completion of HCV treatment.

    SVR (Sustained Virological Response): SVR means that there is no hepatitis C virus detectable in the blood six months after a person completes HCV treatment. Many experts regard SVR as a cure, and it is an indication of long-term remission. SVR rates are always lower than response rates from earlier time points.

    SVR-12: SVR-12 means that there is no hepatitis C virus detectable in the blood 12 weeks after completion of HCV treatment. Although it has not been prospectively validated, many experts agree that relapse (meaning the emergence of detectable hepatitis C virus in blood after completion of treatment) is most likely to occur within 12 weeks. However, FDA and other regulatory agencies require 24 weeks of post-treatment follow-up before a person is considered to have achieved an SVR.

    HCV Treatment History: There is a growing population of people who did not have a sustained virological response from HCV treatment. They are sometimes referred to as “treatment failures,” but the term “treatment-experienced” is preferable, although both are not sufficiently specific.

    It is important to know how treatment-experienced people responded to their first course of treatment, and the regimen that they were treated with, because these factors help to predict the likelihood of SVR from re-treatment. People initially treated with standard interferon, or standard interferon plus ribavirin, may achieve SVR when re-treated with pegylated interferon and ribavirin. Sometimes, HCV re-treatment trials study a mixed population of relapsers, partial responders, non-responders, and null responders, which makes it difficult to interpret the results.

    Null Responder: A null responder is someone who achieves little or no decrease in hepatitis C viral load during HCV treatment. Null responders are highly unlikely to respond to re-treatment with an interferon-based regimen.

    Non-responder: Often referred to as a “treatment failure,” a non-responder is someone who does not have an EVR or, if they stay on treatment for 24 weeks, does not ever have a 2-log (99%) drop in hepatitis C viral load or undetectable HCV RNA during hepatitis C treatment.

    Partial Responder: A partial responder is someone who experiences at least a 2-log decrease in hepatitis C viral load during HCV treatment. Partial responders are more likely to respond to re-treatment than non-responders or null responders.

    Relapser: The term relapser refers to someone who has had an EVR or ETR, but whose virus rebounded after they completed HCV treatment. People who had a relapse after completing HCV treatment are more likely to achieve SVR after re-treatment than partial responders, non-responders, or null responders.

    ACCORDING TO THIS I’M A “NON-RESPONDER”. I WENT THE FULL YEAR AND NEVER MADE IT TO A 2 LOG DROP.

    THE DRUG TRIALS WERE SPECIFIC AS TO WHY THEY REFUSED ME FOR ENROLLMENT. THEY WERE ONLY ALLOWING PEOPLE WHO HAD ACHIEVED A 2 LOG DROP. THOSE PEOPLE ARE CLASSED AS “PARTIAL RESPONDERS” AND MUCH MORE LIKELY TO RESPOND TO FURTHER TREATMENT.

    THAT’S WHY I’M POSTING. PEOPLE NEED TO KNOW HOW BOGUS THE CLAIMS OF WHAT THIS DRUG DOES FOR “NON-RESPONDERS” REALLY ARE. THEY AREN’T USING “NON-RESPONDERS” , OR VERY FEW.

    • condor // June 18, 2009 at 3:38 pm | Reply

      Chris — with all due respect, I think you might want to have your doctor contact the PI on the various Vertex teleprevir studies. Vertex is currently enrolling patients in studies — patients who did not respond to traditional therapy. See the clinicaltrials.gov page link I left for one Patricia Russo, above (Q.: Is she the famous business leader, and Schering-Plough Board Compensation Committee chairwoman? I dunno. But I digress.)

      Do follow that link — and print out the list of 24 trials — and take it to your doctor. Ask your doctor call and talk to the PI — let them decide, together.

      That would be a good start, in my humble opinion.

      Namaste

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