勃林格殷格翰（Boehringer Ingelheim）3月6日公布了III期STARTVerso-4研究中实验性丙肝药物faldaprevir用于治疗丙型肝炎病毒和艾滋病毒（HCV/HIV）合并感染患者的积极数据。
STARTVerso-4研究共招募了308例HCV初治或经历了HCV/HIV合并感染的患者，旨在调查faldaprevir与聚乙二醇化干扰素和利巴韦林（PegIFN/RBV）联合用药的疗效和安全性。研究中调查了faldaprevir的2种剂量（120mg和240mg），数据表明，全部患者在治疗结束后12周的丙型肝炎病毒治愈率（SVR12）达到了72%。此外，全部患者中有80%符合条件随机分配进入缩短的持续治疗期（24周 vs 48周），因为这些患者实现了方案定义（protocol-defined）的早期治疗成功（ETS），这些患者中有86%实现SVR12。
研究中，faldaprevir 120mg剂量组和240mg剂量组分别有71%和72%的患者实现了SVR12。SVR12数据在全部治疗组一致，且与HCV基因型1亚型（GT1a或GT1b）、存在代偿性肝硬化、faldaprevir剂量及持续时间、PegIFN/RBV持续时间均无关。一项事后分析（post hoc analysis）表明，携带Q80K变异的群体中有75%的患者实现SVR12，未携带该变异的群体有71%实现SVR12。
严重不良事件（AEs）共报告32例（10%）。到目前为止，有24名患者因不良事件停止faldaprevir治疗。研究中，最常见的不良事件为恶心、疲劳、腹泻、头痛和乏力。结束治疗后所有患者将随访24周（SVR24）。
此外，勃林格还公布了faldaprevir与常规HIV药物相互作用的分析数据，包括依非韦伦（efavirenz），阿扎那韦/利托那韦（atazanavir/ritonavir），达芦那韦/利托那韦（darunavir/ritonavir），拉替拉韦（raltegravir）和替诺福韦（tenofovir）。分析结果表明，faldaprevir对这些常规HIV药物的药代动力学无临床相关的影响。目前，STARTVero-4研究中的患者，已经正在接受ritonavir增效的HIV蛋白酶抑制剂（达芦那韦/利托那韦，120mg faldaprevir治疗组）或依非韦伦（240mg faldaprevir治疗组）治疗。
关于
faldaprevir是一种强效的新一代口服HCV NS3/A4蛋白酶抑制剂，目前正开发与聚乙二醇干扰素和利巴韦林（PegIFN/RBV）联合用于广泛的基因型1（GT-1）丙型肝炎群体的治疗，包括难治性群体，如HCV-HIV共感染群体及晚期肝病群体。
—Additional drug-drug interaction data for faldaprevir combined with commonly prescribed HIV medications also presented at CROI 2014
—Faldaprevir NDA has been accepted for review by U.S. FDA as part of a combination regimen for patients with chronic hepatitis C
Ingelheim, Germany and Ridgefield, CT, March 6, 2014 – Today Boehringer Ingelheim announced results from STARTVerso?4 in patients with HCV/HIV co-infection. Hepatitis C viral cure 12 weeks after the conclusion of treatment (SVR12) was achieved by 72% of all patients in the trial. Patients were enrolled in either 120mg or 240mg faldaprevir dose groups. Further, 80% of all patients were eligible for randomization to a shortened duration of treatment (24 versus 48 weeks) because they achieved protocol-defined early treatment success (ETS)* and 86% of these patients achieved SVR12. STARTVerso?4 is a Phase 3 trial that enrolled 308 hepatitis C (HCV) treatment-na?ve or experienced patients with HCV/HIV co-infection and evaluated the efficacy and safety of the investigational compound faldaprevir in combination with pegylated interferon and ribavirin (PegIFN/RBV).
"The SVR12 data from STARTVerso?4 are encouraging, especially given the inclusion of patients with cirrhosis," said Peter Piliero, MD, vice president, Clinical Development and Medical Affairs, Boehringer Ingelheim Pharmaceuticals, Inc. "Comprehensive data from our STARTVerso? clinical trial program, including data from patients with HCV/HIV co-infection, have been filed with the FDA as part of our New Drug Application for faldaprevir."
In each faldaprevir dose group, 71% (120mg) and 72% (240mg) of patients achieved SVR12. SVR12 results were consistent across patients regardless of HCV genotype-1 subtype (GT1a or GT1b), presence of compensated cirrhosis, dose and duration of faldaprevir, and duration of PegIFN/RBV. In a post hoc analysis, 75% of patients with the Q80K variant achieved SVR12 compared with 71% of patients who did not have the variant.
Serious adverse events (AEs) were reported in 32 patients (10%). To date, 24 patients have prematurely discontinued faldaprevir due to AEs. The most frequent AEs in STARTVerso?4 were nausea (37%), fatigue (34%), diarrhea (27%), headache (25%) and weakness (23%). Patients will be followed to 24 weeks after the conclusion of treatment (SVR24).
In separate poster presentations at CROI, investigators described the results from analyses that evaluated drug-drug interactions of faldaprevir with common HIV medications, including: efavirenz, atazanavir/ritonavir, darunavir/ritonavir, raltegravir and tenofovir. In each of these analyses, there was no clinically relevant effect of faldaprevir on the pharmacokinetics of any of the HIV medications studied. Patients in STARTVerso?4 already taking ritonavir-boosted HIV protease inhibitors (darunavir or atazanavir) or efavirenz were enrolled into the 120mg and 240mg faldaprevir groups, respectively.
Boehringer Ingelheim HCV Development Update
The New Drug Application (NDA) for faldaprevir has been accepted for filing by the U.S. Food and Drug Administration (FDA). Faldaprevir is currently under review as a component of a combination antiviral treatment regimen for the treatment of chronic HCV infection in adult patients who are treatment-na?ve or have been previously treated with interferon-based treatment, as well as those with compensated liver disease, cirrhosis, or HCV/HIV co-infection. The FDA target action date for faldaprevir is in the fourth quarter of 2014.
The NDA submission for faldaprevir is supported by Boehringer Ingelheim’s STARTVerso? (NCT01343888, NCT01297270, NCT01358864, NCT01399619) clinical trial program, a multi-study Phase 3 trial program that evaluated faldaprevir for 12 or 24 weeks in combination with pegylated interferon and ribavirin (PegIFN/RBV). The four trials that make up this program studied treatment-na?ve, treatment-experienced, and HCV/HIV co-infected patients with chronic genotype-1 (GT1) HCV. The primary efficacy endpoint of each STARTVerso? trial is viral cure 12 weeks after the conclusion of treatment (SVR12).
In November 2013, Boehringer Ingelheim announced that the faldaprevir application for marketing authorization is under review by the European Medicines Agency (EMA). If authorized by the European Commission, faldaprevir could be available for marketing in the EU in the second half of 2014.
Following an assessment of the blinded Phase 3 trial data from HCVerso? 1 and 2 for the combination of deleobuvir, faldaprevir and ribavirin, Boehringer Ingelheim has decided to halt further development of deleobuvir-containing HCV regimens. Ongoing regulatory reviews of faldaprevir are not affected by the decision on the deleobuvir-containing regimens.
About Faldaprevir
Faldaprevir is an investigational, oral protease inhibitor that is specifically designed to target viral replication in the liver. Faldaprevir is an investigational compound that has not been approved by the FDA; its safety and efficacy have not been established.
About Boehringer Ingelheim in Hepatitis C Virus (HCV)
In partnership with the scientific community, our clinical trial program is rigorously designed to find answers to the challenges that HCV patients face, including those who are the most difficult to cure. Our pivotal HCV clinical trials for faldaprevir, STARTVerso?, included four trials that studied treatment-na?ve, treatment-experienced, and HCV/HIV co-infected patients with chronic GT1 HCV.
Hepatitis C is a blood-borne infectious disease and a leading cause of chronic liver disease, transplant and failure that affects as many as 150 million people globally. In the United States, approximately 3.2-5.2 million people have chronic HCV infection. Since 1999 there has been a significant increase in deaths due to chronic HCV, which accounts for 15,000 deaths in the United States per year.
STARTVerso? is a registered service mark of Boehringer Ingelheim International GmbH.
Boehringer Ingelheim
The Boehringer Ingelheim group is one of the world’s 20 leading pharmaceutical companies. Headquartered in Ingelheim, Germany, it operates globally with 140 affiliates and more than 46,000 employees. Since it was founded in 1885, the family-owned company has been committed to researching, developing, manufacturing and marketing novel medications of high therapeutic value for human and veterinary medicine.
Social responsibility is a central element of Boehringer Ingelheim's culture. Involvement in social projects, caring for employees and their families, and providing equal opportunities for all employees form the foundation of the global operations. Mutual cooperation and respect, as well as environmental protection and sustainability are intrinsic factors in all of Boehringer Ingelheim’s endeavors.
In 2012, Boehringer Ingelheim achieved net sales of about 14.7 billion euro. R&D expenditure in the business area Prescription Medicines corresponds to 22.5% of its net sales.
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