NEW in the treatment of chronic hepatitis B (CHB)
Power with a purpose
Early Response. Powerful Performance.
FAVORABLE SAFETY & CONVENIENCE
INTRODUCING SEBIVO— UNITING THE CRITICAL ELEMENTS OF TREATMENT FOR IMPROVED DISEASE CONTROL
SUBJECT TO NP4 REVIEW AND COMPLIANCE WITH LOCAL LAWS AND REGULATIONS
Early Response. Predictable Performance.
CHB Overview
Powerful Efficacy
Rapid Response
Favorable Safety & Convenience
Predictable Outcomes
In the REVEAL study, the HBV DNA level corresponded directly to the risk of disease progression1*
CHB Overview
It’s time for higher expectations in managing CHB
High viral load leads to serious consequences of CHB
GOALS FOR SUCCESSFUL ANTIVIRAL THERAPY
Powerful Efficacy 3
• High viral load (≥105) is associated with increased mortality from HCC and chronic liver disease, which strike 15% to 40% of all patients with CHB1,2 The primary goal of antiviral therapy is HBV suppression to the lowest possible level3 IN THE CALM STUDY, HBV DNA SUPPRESSION REDUCED DISEASE PROGRESSION4‡
Disease Progression (patients, %)
25
P<0.001
20 15
2X
Placebo O
Less Progression
10
Lamivudine O
0
6
12
18
24
30
Rapid Response5 • R apid antiviral efficacy provides: —Early indication of treatment success —Correlation with improved long-term outcomes Predictable Outcomes5 • PCR negativity at 24 weeks predicts: —Higher HBeAg seroconversion rates —Higher ALT normalization —Lower resistance Favorable Safety & Convenience • C lean preclinical profile • Well tolerated in clinical trials • One tablet, once a day, with or without food for improved compliance
5 0
• P otent viral suppression/ PCR negativity • HBeAg seroconversion • ALT normalization • H istologic improvement/ regression of fibrosis
36
Time (months)
Go beyond potency with rapid response that predicts outcomes5 Driving down HBV DNA with a potent therapy increases the likelihood of successful treatment outcomes3 * Ten-year prospective cohort study of 2354 CHB patients. † Hepatocellular carcinoma. ‡ Study of 651 HBeAg-positive or HBeAg-negative patients randomly assigned to receive lamivudine (n=436) or placebo (n=215).
Rapid Suppression
Predictable Outcomes
PCR negativity at 24 weeks predicts increased therapeutic success at 1 year 5
SUBJECT TO NP4 REVIEW AND COMPLIANCE WITH LOCAL LAWS AND REGULATIONS
Efficacy
Favorable Safety & Convenience
SEBIVO—powerful viral suppression ensures greater control over CHB Superior viral load reduction in GLOBE, the largest trial to date (N=1367) for CHB6*
Serum HBV DNA (Mean log10 change from baseline)
MEAN CHANGE IN HBV DNA FROM BASELINE HBeAg-POSITIVE PATIENTS (n=921) 0
P<0.0001
-1 -2 -3 -4
Lamivudine O
-5 -6
-5.5 log10
10X
-6.5 log10
-7 0
4
8
Greater Viral Suppression
SEBIVO Weeks 12 16 20 24 28 32 36 40 44 48 52 56 60 64 68 7
undectableHBV_Global_623 More of your patients can achieve PCR negativity with SEBIVO Potent viral suppression means the majority of your patients can become PCR negative6*‡ PCR NEGATIVITY (HBV DNA <300 COPIES/mL) AT 1 YEAR IN HBeAg-POSITIVE PATIENTS (n=921)
Patients With Undetectable HBV Levels (%)
Predictable Outcomes
HBeAg-Positive Patients
Rapid Response
60
60 %
20%
more patients achieved PCR negativity with SEBIVO than with lamivudine
40 %
40 20 0
SEBIVO (n=458)
Lamivudine (n=463)
O
0 4 8 12 16 20 24 28 32 36 40 44 48 52 56 60 64 68 72 76 Weeks
Weeks
• 75% of HBeAg-positive patients treated with SEBIVO achieved therapeutic response at 1 year vs 67% of patients treated with lamivudine (P=0.0047) 6 § *First-year results of the international GLOBE trial—the largest drug registration trial to date for CHB. GLOBE was a phase 3 comparative trial of SEBIVO vs lamivudine for CHB. Enrolled ITT population included 1367 patients. Patients were randomized to either SEBIVO (n=680 [458 HBeAg-positive, 222 HBeAg-negative patients]) or lamivudine (n=687 [463 HBeAg-positive, 224 HBeAg-negative patients]).
SEBIVO delivers rapid, profound viral suppression6* † WEEK 4
WEEK 24
WEEK 52
-4.3
-6.4
-6.5
log10
P<0.0001
80
Efficacy
HBeAg-Positive Patients
Powerful Efficacy
log10
log10
These data represent mean viral load reduction at weeks 4, 24, and 52 PCR negativity was defined as HBV DNA <300 copies/mL. § Therapeutic response was a composite serologic end point at 1 year requiring suppression of HBV DNA to <5 log10 in conjunction with either loss of HBeAg or normal ALT. † ‡
SUBJECT TO NP4 REVIEW AND COMPLIANCE WITH LOCAL LAWS AND REGULATIONS
Early Response. Predictable Performance.
Efficacy
Proven Safety Profile Favorable Safety & Convenient & Convenience
Overall e antigen response with SEBIVO is impressive6,7
26% 23%
of all patients treated with SEBIVO experienced HBeAg loss at 1 year 6,7 of all patients treated with SEBIVO experienced HBeAg seroconversion at 1 year 6,7
Rapid Suppression
Higher HBeAg Seroconversion
Patients treated with SEBIVO who achieved PCR negativity at 24 weeks (n=183) experienced higher rates of HBeAg seroconversion at 1 year 8 HBeAg SEROCONVERSION AT 1 YEAR BASED ON VIRAL SUPPRESSION AT 24 WEEKS IN HBeAg-POSITIVE PATIENTS (n=425)
40
Almost 90% of patients treated with SEBIVO were PCR negative at 1 year 6* TIME TO PCR NEGATIVITY (HBV DNA <300 COPIES/mL) IN HBeAg-NEGATIVE PATIENTS (n=446)
PCR negative at 24 weeks P<0.0129
80 SEBIVO O
60 Lamivudine O
40 20 0
0
8
12
16
20
24
28
32
36
40
44
48
52
SEBIVO provides early, profound viral suppression6† WEEK 8
20
10 %
10
-4.4
2% PCR negative
4
Weeks
30 %
(<300 copies/mL) (n=183)
88% PCR negative at 1 year P<0.0001
80%
100
39 %
30
0
Rapid, powerful viral suppression leads to higher maintained PCR negativity
Maintained PCR Negativity (patients, %)
Predictable Outcomes Predictable Outcomes
HBeAg-Negative Patients
Rapid Response Rapid Response
SEBIVO—early viral suppression predicts higher HBeAg seroconversion
HBeAg Seroconversion at 1 Year
HBeAg-Positive Patients
Powerful Efficacy Powerful Efficacy
300 copies/mL to 3 log (n=54)
3 to 4 log (n=81)
log10
WEEK 24
-5.2
log10
WEEK 52
-5.2
log10
>4 log (n=107)
• Therapeutic response was comparable among HBeAg-negative patients treated with SEBIVO and lamivudine (75% vs 77%, respectively) 6 †‡ * PCR negativity was defined as HBV DNA <300 copies/mL. † These data represent mean viral load reduction at weeks 8, 24, and 52. ‡ Therapeutic response was a composite serologic end point at 1 year requiring suppression of HBV DNA to <5 log10 in conjunction with either loss of HBeAg or normal ALT.
SerocInclineChart_623.ai
SUBJECT TO NP4 REVIEW AND COMPLIANCE WITH LOCAL LAWS AND REGULATIONS
Early Response. Predictable Performance.
ALT/Histology
Powerful Efficacy Powerful Efficacy
Rapid Response Rapid Response
Predictable Outcomes Predictable Outcomes
Proven Safety Profile Favorable Safety & Convenient & Convenience
ALT Normal Chart6_23
SEBIVO improves liver histology in the majority of patients
Powerful viral suppression leads to ALT normalization6
ALT Normal Chart6_23
improves liver histology* at 1 year regardless of 69% SEBIVO HBeAg status
ALT NORMALIZATION AT 1 YEAR WITH SEBIVO
IMPROVEMENT
100
Patients (%)
80
77%
7
SEBIVO halts or reverses fibrosis at 1 year7†
74%
CHANGE IN ISHAK FIBROSIS SCORE AT 1 YEAR WITH SEBIVO
60 40
80
80 %
82%
20 0
HBeAg-Positive Patients (n=458)
Patients (%)
60 HBeAg-Negative Patients (n=222)
3 OUT OF 4 90 % 79 %
Higher ALT Normalization
34%
NO PROGRESSION
HBeAg-Positive Patients (n=399)
HBeAg-Negative Patients (n=205)
of HBeAg-positive patients treated with SEBIVO who achieved PCR negativity at 24 weeks experienced ALT normalization at 1 year 8
Change in Ishak fibrosis score at 1 year for patients treated with lamivudine: • 46% and 32% of HBeAg-positive patients experienced improvement or no change, respectively 7
of HBeAg-negative patients treated with SEBIVO who achieved PCR negativity at 24 weeks experienced ALT normalization at 1 year 8
• 44% and 43% of HBeAg-negative patients experienced improvement or no change, respectively 7
PATIENTS TREATED WITH SEBIVO ACHIEVED ALT NORMALIZATION AT 1 YEAR
39 %
NO PROGRESSION
0
48 %
IMPROVEMENT
20
• 79% of HBeAg-negative patients (n=224)
Rapid Suppression
40
ALT/Histology
Patients treated with lamivudine who experienced ALT normalization at 1 year 6,7: • 75% of HBeAg-positive patients (n=463)
41%
IMPROVEMENT
*Histologic response: ≥2-point decrease in Knodell necroinflammatory score from baseline with no worsening of Knodell fibrosis score. † Ishak fibrosis score: improvement defined as ≥1-point reduction in Ishak fibrosis score from baseline to week 52.
SUBJECT TO NP4 REVIEW AND COMPLIANCE WITH LOCAL LAWS AND REGULATIONS
Early Response. Predictable Performance.
Resistance/Preclinical Safety Profile
Powerful Efficacy Powerful Efficacy
Rapid Response Rapid Response
Predictable Outcomes Predictable Outcomes
Proven Safety Profile Favorable Safety & Convenient & Convenience
Powerful viral suppression minimizes resistance with SEBIVO
SEBIVO—a favorable preclinical safety profile
The superior potency of SEBIVO leads to significantly lower resistance6
SEBIVO has shown no genotoxicity, carcinogenicity, or teratogenicity11,12 RESULTS OF PRECLINICAL SAFETY TESTS FOR NUCLEOSIDE/NUCLEOTIDE ANALOGS13-16
OVERALL HBV RESISTANCE AT 1 YEAR (n=630)
SEBIVO
3 % (P=0.0007)
HBeAg Positive (n = 438)
SEBIVO
2% (P=0.0052)
HBeAg Negative (n =192)
§
Minimal Resistance
of HBeAg-positive patients treated with SEBIVO who achieved PCR negativity at 24 weeks developed resistance at 1 year 8
Positive finding of in vitro human lymphocyte chromosome aberration assay
Positive finding of increased rate of non-HCC tumors in oral carcinogenicity studies in mice and rats §
Positive finding of in vitro human lymphocyte chromosome aberration and in vitro mouse lymphoma cell assays
No risk of carcinogenicity was shown in rat and mouse studies
No evidence of genotoxicity was shown in in vitro or in vivo studies
No risk of carcinogenicity was shown in bioassay studies
Adefovir *
• No activity was noted against multiple other RNA and DNA viruses (including HIV) in vitro Not incorporated into human DNA11 • Selectively terminates HBV with low affinity for human DNA in vitro
Lamivudine
Resistance/Preclinical Safety Profile
L80I/V L180M A181V A184G S202I M204I + M204V + N236T M250V M204I M204V
†
T he theoretical concern for an increased risk of non-hepatocellular carcinoma cancers to humans based on the carcinogenicity findings in rodents will be addressed in a large, randomized, prospective, observational study with long-term follow-up.16
Potent antiviral activity specific to HBV11
HEPATITIS B POLYMERASE MUTATIONS ASSOCIATED WITH VIROLOGIC REBOUND BY TREATMENT
SEBIVO
No risk of carcinogenicity was shown in rat and mouse studies
SEBIVO has a preference for inhibiting + strand synthesis17
The key polymerase mutation associated with breakthrough to SEBIVO is M204I
†
Carcinogenicity Studies
SEBIVO—a potent and selective nucleoside analogue
of HBeAg-negative patients treated with SEBIVO who achieved PCR negativity at 24 weeks developed resistance at 1 year 8
Entecavir
Positive finding of in vitro human lymphocyte chromosome aberration and in vitro mouse lymphoma cell assays
SEBIVO
Rapid Suppression
*
Adefovir
Lamivudine
• 9% of HBeAg-negative patients (n=187)
*
Genotoxicity Studies
Entecavir
Patients treated with lamivudine experienced significantly higher rates of resistance at 1 year 6 : SEBIVO activity is only patients reduced against • 8% of HBeAg-positive (n=442)M204I pathway7
0% 1%
Treatment
SEBIVO
inhibits + strand HBV DNA synthesis
‡
*Mutations at A184G or S202I or M250V in addition to L180M+M204V may be required to confer resistance to entecavir. † M204I by itself has not been associated with clinical breakthrough to entecavir, but is resistant in vitro. ‡ L180M+M204V has not been associated with clinical breakthrough to SEBIVO, but is resistant in vitro.
10
SUBJECT TO NP4 REVIEW AND COMPLIANCE WITH LOCAL LAWS AND REGULATIONS
Early Response. Predictable Performance.
11
Tolerability/Convenience
Powerful Efficacy Powerful Efficacy
Rapid Response Rapid Response
Predictable Outcomes Predictable Outcomes
Proven Safety Profile Favorable Safety & Convenient & Convenience
SEBIVO—a favorable safety and tolerability profile
A convenient therapy that’s easy for your patients to take
In the GLOBE study (N=1367), the incidence of adverse events associated with SEBIVO was similar to lamivudine for up to 104 weeks7
Greater convenience leads to improved patient compliance DOSING & ADMINISTRATION13-16,18
SELECTED TREATMENT-EMERGENT CLINICAL ADVERSE EVENTS (GRADE 2-4)
Adverse Event
SEBIVO (n=680)
Lamivudine (n=687)
All Subjects Muscle-Related Symptoms Fatigue/Malaise Headache Pyrexia Abdominal Pain Arthralgia Cough Diarrhea Gastritis
22% 2% 1% 1% 1% <1% <1% <1% <1% <1%
22% 2% 1% 2% <1% <1% 1% <1% <1% 0%
In the GLOBE study, SEBIVO showed no nephrotoxicity, similar to lamivudine. Lower rate of discontinuation vs lamivudine7 •O nly 0.6% of patients taking SEBIVO discontinued therapy due to adverse events, clinical disease progression, or lack of efficacy vs 2.0% of patients taking lamivudine 5.5 times fewer ALT flares vs lamivudine •O nly 0.4% of patients treated with SEBIVO experienced ALT flares from week 24 to week 52 vs 2.2% of patients treated with lamivudine (P=0.0002) 7
Oral Administration
No Food Effect
Adefovir Administer on an empty stomach (at least 2 hours after a meal and 2 hours before the next meal)
Entecavir Lamivudine Peg-Interferon
Once weekly
Subcutaneous injection in the abdomen or thigh
SEBIVO REFERENCES: 1. Chen G, Lin WY, Shen FM, Iloeje UH, London WT, Evans AA. Viral load as a predictor of mortality from hepatocellular carcinoma and chronic liver disease in chronic hepatitis B infection. Presented at: 40th Annual Meeting of the European Association for the Study of the Liver. April 13-17, 2005; Paris, France. 2. Chen C-J, Yang H-I, Su J, et al, for the REVEAL-HBV Study Group. Risk of hepatocellular carcinoma across a biological gradient of serum hepatitis B virus DNA level. JAMA. 2006;295:65-73. 3. Keeffe EB, Dieterich DT, Han S-HB, et al. A treatment algorithm for the management of chronic hepatitis B virus infection in the United States. Clin Gastroenterol Hepatol. 2004;2:87-106. 4. Liaw Y-F, Sung JJY, Chow WC, et al, for the Cirrhosis Asian Lamivudine Multicentre Study Group. Lamivudine for patients with chronic hepatitis B and advanced liver disease. N Engl J Med. 2004;351:1521-1531. 5. Lai C-L, Gane E, Liaw Y-F, et al, and the GLOBE Study Group. Maximal early HBV suppression is predictive of optimal virologic and clinical efficacy in nucleoside-treated hepatitis B patients: scientific observations from a large multinational trial (the GLOBE Study). Presented at: American Association for the Study of Liver Diseases; November 11-15, 2005; San Francisco, Calif. 6. Lai C-L, Gane E, Thongsawat S, et al, and the GLOBE Study Group. Telbivudine (LdT) vs lamivudine in the treatment of chronic hepatitis B: results from GLOBE, an international phase III trial. Poster presented at: Shanghai-Hong Kong International Liver Congress; March 25-28, 2006; Shanghai, China. Poster 182. 7. US Tyzeka Prescribing Information. 8. Di Bisceglie A, Lai C-L, Gane E, et al, and the GLOBE Study Group. Maximal HBV suppression in the first six months is associated with optimal virologic and clinical efficacy at one year in nucleoside-treated hepatitis B patients. Presented at: Hep DART 2005; December 11-15, 2005; Kohala Coast, Big Island, Hawaii. 9. Locarnini S, Hatzakis A, Heathcote J, et al. Management of antiviral resistance in patients with chronic hepatitis B. Antivir Ther. 2004;9: 679-693. 10. Standring DN, Seifer M, Patty A, et al. HBV resistance determination from the telbivudine GLOBE registration trial. Poster presented at: 41st Annual Meeting of the European Association for the Study of the Liver; April 26-30, 2006; Vienna, Austria. Poster 514. 11. Standring DN, Bridges EG, Placidi L, et al. Antiviral b-l-nucleosides specific for hepatitis B virus infection. Antivir Chem Chemother. 2001;12(suppl 1):119-129. 12. Bridges EG. Telbivudine preclinical safety studies suggest minimal risk of chronic toxicity, reproductive toxicity, or carcinogenicity. Poster presented at: Shanghai-Hong Kong International Liver Congress; March 25-28, 2006; Shanghai, China. Poster 179. 13. Baraclude Prescribing Information. 14. Hepsera Prescribing Information. 15. Epivir Prescribing Information. 16. Zhou X-J, Lloyd DM, Chao GC, Brown NA. Absence of food effect on the pharmacokinetics of telbivudine following oral administration in healthy subjects. J Clin Pharmacol. 2006;46:275-281. 17. Seifer M, Patty A, Dukhan D, et al. Telbivudine (LdT) preferentially inhibits second (+) strand HBV DNA synthesis. Presented at: 40th Annual Meeting of the European Association for the Study of the Liver; April 13-17, 2005; Paris, France. 18. Pegasys Prescribing Information.
Treatment SEBIVO
NONE
NONE
NONE
Entecavir Adefovir
Lamivudine
•A s with other therapies in this class, cases of myopathy have been reported with SEBIVO several weeks to months after starting therapy 12
SUBJECT TO NP4 REVIEW AND COMPLIANCE WITH LOCAL LAWS AND REGULATIONS
Early Response. Predictable Performance.
13
Tolerability/Convenience
Additional findings •T he most common grade 3-4 lab abnormality seen with SEBIVO was elevations in creatinine kinase (9.0% vs 3.0% with lamivudine). Most CK elevations were asymptomatic but the mean recovery time was slightly longer for subjects taking SEBIVO than subjects taking lamivudine 7
One Tablet/ Once Daily
Your patients deserve a therapy that delivers power with a purpose Give your patients an uncompromising treatment choice with SEBIVO Powerful Efficacy 6 • Potent viral suppression/ PCR negativity
Rapid Response7 • Rapid antiviral efficacy provides:
• HBeAg seroconversion
— Early indication of treatment success
• ALT normalization
— Correlation with improved longterm outcomes
• Histologic improvement/ regression of fibrosis
Predictable Outcomes7
Favorable Safety & Convenience 6
• PCR negativity at 24 weeks predicts:
• Clean preclinical profile
— Higher HBeAg seroconversion rates
• Well tolerated in clinical trials
— Higher ALT normalization
• One tablet, once a day, with or without food for improved compliance
—Lower resistance
SUBJECT TO NP4 REVIEW AND COMPLIANCE WITH LOCAL LAWS AND REGULATIONS ©2006 All rights reserved. Printed in XXX. [Code] Nov 2006
Early Response. Predictable Performance.