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8-K - FORM 8-K - Pharmasset Inc | d8k.htm |
EX-99.1 - ABSTRACT 1372 - Pharmasset Inc | dex991.htm |
EX-99.3 - PRESS RELEASE - Pharmasset Inc | dex993.htm |
Exhibit 99.2
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ONCE DAILY DUAL-NUCLEOTIDE COMBINATION OF PSI-938 AND PSI-7977 PROVIDES 94% HCV RNA < LOD AT DAY 14: FIRST PURINE/PYRIMIDINE CLINICAL COMBINATION DATA (THE NUCLEAR STUDY)
E. Lawitz1, M. Rodriguez-Torres2, J. Denning3, M.T. Cornpropst3, D. Clemons3, L. McNair3, M.M. Berrey3, W.T. Symonds3
1Alamo Medical Research, San Antonio, TX, 2Fundacion de Investigacion de Diego, San Juan, PR, 3Pharmasset, Inc., Princeton, NJ
Abstract
#1370
Background
The purine PSI-352938 (PSI-938) was created to be an optimal partner DAA for the pyrimidine PSI-7977. The nucleotides employ different prodrug cleavage pathways, largely independent phosphorylation pathways, competition with separate endogenous nucleotide pools (purine/pyrimidine) and complementary resistance profiles (Sofia J Med Chem 2010, Lam AAC 2010, Reddy Bio Med Chem Ltr 2010). This study is the first proof of concept for the combination of 2 nucleotides for the treatment of HCV infection.
Figure 1. PSI-7977 and PSI-938 are Complementary Nucleotides for Combination Therapy
Pyrimidine
PSI-7977
prodrug
MP
MP
UMP-CMP kinase 1
DP
TP
S282T Resistance
Equipotent vs. 938 triple mutant
Different
Prodrug cleavage
Pathway
Different
Phosphorylation
Pathway
NDPK
(Not rate limiting)
Different
In vitro
Resistance
Profile
Purine
PSI-938
prodrug
MP
MP
Guanosine monophosphate
kinase
DP
TP
Requires triple mutant for resistance*
Equipotent vs. S282T Variants
* Lam, et al., EASL 2011 Abstract 1071
Objectives
To determine the safety, pharmacokinetic interaction and impact on antiviral activity of PSI-938 and PSI-7977 administered as monotherapy or in combination for 7-14 days.
Design
Day 0
Cohort 1
Cohort 2
Cohort 3
Cohort 4
PSI-938 300 mg QD
PSI-7977 400 mg QD
PSI-7977 + PSI-938
PSI-938 + PSI-7977
PSI-7977 + PSI-938
Forty HCV GT1, treatment-naïve subjects
8 active and 2 placebo per cohort
Sequential enrollment into Cohort 1, Cohorts 2/3 and Cohort 4
HCV RNA >50,000 IU/mL, no evidence of cirrhosis
PSI-938 300 mg QD and PSI-7977 400 mg QD
Safety, PK, viral kinetics, and resistance monitored throughout
All subjects offered full course of peg-interferon (Peg-IFN) and ribavirin (RBV) on study day 15
Results
Table 1. Subject Demographics and Baseline Characteristics
Cohort 1
(n = 8) Cohort 2
(n = 8) Cohort 3
(n = 8) Cohort 4
(n = 8) Placebo
(n = 8)
Male (n) 5 7 7 6 7
Caucasian (n) 7 5 5 5 6
Median age (y) 46 43 41 48 39
Mean BMI (kg/m2) 28 26 28 28 29
Median (Q1,Q3)
HCV RNA (log10 IU/mL) 6.9
(6.2,7.5) 6.3
(5.8,6.7) 6.3
(5.9,6.6) 6.2
(5.7,6.8) 5.9
(5.2,6.6)
HCV 1a/1b (n) 6/2 8/0 8/0 7/1 7/1
SAFETY
No discontinuations or serious adverse events
28 AEs reported in 16/32 subjects receiving active treatment
Five AEs considered possibly related to active study drug
Headache [2], fatigue, non cardiac chest pain, dizziness
AEs were mild in intensity
Two AEs considered possibly related to placebo
Increased pruritus and headache
No dose- or duration-related toxicities were identified
No clinically significant treatment-emergent changes in laboratory parameters, vital signs or ECGs
No treatment-emergent grade 4 laboratory abnormalities
47% had abnormal ALT at baseline, all normalized during study
Table 2. Summary of Individual HCV RNA Data and Follow-on Therapy Across All Cohorts
Study Day
Subject Baseline 1 3 5 7 10 14 16 201 7.43 4.75 3.23 3.14 2.84 2.16 1.41 1.62
202 5.16 2.77 <LOD <LOD <LOD <LOD <LOD
203 6.60 3.90 2.55 2.34 2.19 1.30
1 <LOD <LOD
205 5.81 3.54 2.45 2.03 <LOD <LOD <LOD <LOD
Cohort 206 6.93 4.78 3.06 2.73 2.25 1.57 <LOD
224 5.45 2.77 <LOD <LOD <LOD <LOD <LOD <LOD
229 6.29 4.16 2.40 1.70 1.30 <LOD <LOD
2
230 6.13 3.77 1.75 <LOD <LOD <LOD <LOD
Cohort 231 5.44 n.d. 2.75 2.39 2.23 1.48
207 6.97 4.99 3.45 3.05 2.85 2.27 1.97
209 7.48 4.87 4.00 3.54 3.12 2.97 2.71
210 7.49 4.84 3.47 3.07 2.80 2.20 1.72
221 6.96 4.39 2.87 2.56 2.13 1.51 <LOD
231 5.44 n.d. 2.75 2.39 2.23 1.48 <LOD
233 6.88 4.78 3.45 2.86 2.63 2.24 <LOD
239 6.36 4.38 3.15 2.69 2.35 1.51 <LOD
225 5.89 3.71 2.32 1.81 <LOD <LOD <LOD
232 7.51 5.78 4.26 3.44 2.67 1.46 <LOD
235 6.55 4.41 2.05 1.63 1.26 <LOD <LOD
240 5.54 n.d. 2.06 1.46 <LOD <LOD <LOD
262 6.26 3.31 2.37 2.11 1.56 <LOD <LOD <LOD
266 6.09 3.34 1.65 1.30 <LOD <LOD <LOD
269 7.48 4.28 2.91 2.67 2.33 2.26 1.48
238 6.54 4.05 2.66 2.41 1.36 1.57 <LOD
222 4.98 3.03 <LOD <LOD <LOD <LOD <LOD
223 6.98 4.59 3.14 2.74 2.31 1.93 1.62 225 5.89 3.71 2.32 1.81
228 5.80 3.78 1.53 1.67 <LOD <LOD <LOD
234 6.51 4.59 3.87 3.44 2.53 <LOD <LOD
261 6.37 3.71 2.71 2.43 2.16 2.09 1.59 <LOD
264 5.54 3.05 1.92 1.75 1.51 <LOD <LOD <LOD
265 5.71 3.18 2.53 1.78 1.30 1.18 <LOD <LOD
268 6.83 3.89 3.18 2.90 2.37 1.89 <LOD
270 6.27 3.78 2.77 2.59 2.35 2.12 1.20 <LOD
PSI-938 PSI-7977 PSI-938/PSI-7977 Washout P-IFN/RBV
HCV RNA declined rapidly in a biphasic manner in all subjects
Individual subjects reached the assay limit of detection (LOD, <15 IU/mL) in as few as 3 days. This correlated with baseline HCV RNA and did not differ by treatment
Results
Table 3. Summary of Antiviral Response by Cohort
Median (Q1,Q3) HCV RNA Change from Baseline and Number of Subjects
with HCV RNA <15 IU/mL (LOD) by Cohort
Day 7 Day 14 Total1
# < LOD Median
[Q1,Q3] # < LOQ # < LOD Median
[Q1,Q3] # < LOD
Cohort 1 2 -4.5
(-4.3,-4.7) 5 4 -5.2
(-4.8,-5.8) 4/8 (50%)
Cohort 2 2 -4.6
(-4.2,-5.0) 8 8 -5.2
(-4.8,-5.5) 8/8 (100%)
Cohort 3 4 -4.7
(-4.3,-4.8) 8 7 -5.0
(-4.6,-5.4) 7/8 (88%)
Cohort 4 1 -4.4
(-4.2,-4.8) 8 5 -5.0
(-4.7,-5.3) 7/8 (88%)2
1. Cumulative total of individuals whose HCV RNA reached < LOD as a result of the study treatment
2. Includes 2 additional subjects whose HCV RNA reached < LOD on Day 16
Figure 2. Median [Q1,Q3] HCV RNA Change from Baseline
PSI-938 Monotherapy
PSI-938 - PSI-938/PSI-7977
PSI-7977 - PSI-7977/PSI-938
PSI-938/PSI-7977 Combination
0 -1 -2 -3 -4 -6 -5 -7
0 2 4 6 8 10 12 14 days
* Rodriguez-Torres, et al. Abst. LB17, AASLD, Nov. 2009
Figure 3. Comparison of Monotherapy Antiviral Responses with PSI-7851, PSI-7977 and PSI-938 (Median, [Q1,Q3])
PSI-938 Monotherapy
PSI-938 - PSI-938/PSI-7977
PSI-7977 - PSI-7977/PSI-938
PSI-7851 Monotherapy*
0 0.5 -1 -1.5 -2 -2.5 -3 -3.5 -4 -4.5
0 1 2 3 Days
PSI-7977 is a single isomer found in PSI-7851, a mixture of 2 isomers
PSI-7977 monotherapy resulted in greater viral suppression at Day 3 than PSI-7851 at Day 3
Monotherapy with either PSI-938 at 300 mg QD or PSI-7977 at 400 mg QD resulted in 3.7 to 3.9 log10 IU/mL declines in HCV RNA after 3 days
HCV RNA Change from Baseline (log10 IU/mL)
HCV RNA Change from Baseline (log10 IU/mL)
Results
Figure 4. HCV RNA Change from Baseline by Cohort
Cohort 1 Cohort 2
8 8
7 7
L) 6 L)6
/m /m IU 5 IU
10 5 10
og og
(L 4 (L 4 A
RN A V3 RN3 HC V
2 HC2
1 PSI-938 monotherapy 1 PSI-938 monotherapy PSI-938 + PSI-7977
0 0
0 2 4 6 8 10 12 14 0 2 4 6 8 10 12 14 92% Days Days Cohort 3 Cohort 4
8 8
7 7
L) 6 6 /m IU 5 IU/mL)
10 5 og 4 4
(L (Log10 A RN3 RNA 3 V HC2 HCV 2
1 PSI-7977 monotherapy PSI-938 + PSI-7977 1 PSI-938 + PSI-7977
0 0
0 2 4 6 8 10 12 14 0 2 4 6 8 10 12 14
Days Days
Figure 5Cohort 3
Cohort 4. Pharmacokinetic Interaction Data
PSI-6206 Concentration (ng/mL) Time (h)Time (h)
PSI-938 Concentration (ng/mL)
Day 7 PSI-7977 alone
Day 14 PSI-7977 + PSI-938
10000
1000
100
10
0 6 12 18 24
10000
1000
100
10
0 6 12 18 24
Day 7 PSI-938 alone
Day 14 PSI-938 + PSI-7977
Conclusions
PSI-938 and PSI-7977 as monotherapy and in combination were generally safe and well tolerated over 7-14 days
Significant antiviral activity was observed with rapid a-phase reductions followed by continued ß-phase reductions until the end of treatment or assay LOD was reached
Of note, PSI-7977 monotherapy produced HCV RNA reductions over 7 days which were similar to PSI-938
No viral breakthrough was observed during therapy
No significant PK interaction between PSI-938 and PSI-7977 was observed
Data support progression to a Phase 2 combination study including PSI-938 and PSI-7977
Disclosures
E.L., M.R.T. - Grant/Research Support: Pharmasset; J.D.; M.C.; D.C.; W.S.; M.B. - Employee: Pharmasset; L.Mc. - Consultant
Presented at the 46th Annual Meeting of the European Association for the Study of the Liver, EASL, March 30, 2011 – April 3, 2011, Berlin, Germany