John E Shulze, CTO Biosensors International Inc

Slides:



Advertisements
Similar presentations
ENDEAVOR IV Acronym: ENDEAVOR IV. Lead investigator: Dr Martin Leon from Columbia University, New York Source: Transcatheter cardiovascular Therapeutics,
Advertisements

Copyleft Clinical Trial Results. You Must Redistribute Slides PEPCAD II ISR Study Paclitaxel-eluting devices: randomized comparison of the SeQuent™ please.
“Real World”: SVG, De Novo or Restenotic Coronary Artery Lesions Chronic Stable Angina, Silent Ischemia, Acute Coronary Syndromes Vessel Diameters:
Www. Clinical trial results.org  Major Endpoints: Death, MI, stent thrombosis, TLR, TVR, MACE, and CKMB >3x nl  Major Endpoints: Death, MI, stent thrombosis,
EXCELLA BD Randomized Trial 12-month Results
Www. Clinical trial results.org The RAVEL Study A RAndomised (double blind) study with the Sirolimus coated BX™ VElocity balloon expandable stent (CYPHER™)
Four Drug Eluting Stent Trials Keith D Dawkins MD FRCP FACC Southampton University Hospital Keith D Dawkins MD FRCP FACC Southampton University Hospital.
A Randomized Comparison of a Sirolimus-eluting Stent with Biodegradable Polymer versus an Everolimus-eluting Stent with a Durable Polymer for Percutaneous.
3rd CEEGI Advisory Board1 Resolute in the DES era: Indications & Limitations Georgios I. Papaioannou, MD, MPH, FACC, FSCAI Athens Medical Center Cardiac.
Resolute all comers trial Objective:To compare the efficacy and safety of the new generation ZES stent versus the everolimus eluting stent. Study:Multicenter,
2 Year Clinical Outcomes from the Pivotal RESOLUTE US Study Laura Mauri MD, MSc on behalf of the RESOLUTE US Investigators Brigham and Women’s Hospital.
29th ANNUAL SCIENTIFIC SESSIONS – SCA&I
Non-Polymeric and Bioabsorbable Polymers Will Reign Supreme in Near Future Instituto Dante Pazzanese de Cardiologia Sao Paulo - Brazil Sao Paulo - Brazil.
Basel Stent Cost-effectiveness Trial-Late Thrombotic Events (BASKET LATE) Trial Basel Stent Cost-effectiveness Trial-Late Thrombotic Events (BASKET LATE)
DIABETES trial P Jiménez-Quevedo, M Sabaté, DJ Angiolillo, JA Gómez-Hospital, R Hernández-Antolín, J Goicolea, F Alfonso, C Bañuelos, J Escaned, R Moreno,
Clinical Result Overview
BIOLIMUS-ELUTING STENT WITH BIODEGRADABLE POLYMER VERSUS SIROLIMUS-ELUTING STENT WITH DURABLE POLYMER: A RANDOMISED, NON-INFERIORITY TRIAL Stephan Windecker,
As presented by Patrick W. Serruys, MD, PhD, FACC Principal Investigator Thoraxcentre - Erasmus University Rotterdam, The Netherlands PISCES Paclitaxel.
Biolimus-Eluting Stent With Biodegradable Polymer Versus Sirolimus-Eluting Stent With Durable Polymer: A Randomised, Non-Inferiority Trial Stephan Windecker,
BIOSENSORS-CLINICAL UPDATE “LEADERS AND BEYOND” John E Shulze, CTO BIOSENSORS INTERNATIONAL GROUP Jan 29, 2010.
DR ALEX CHASE REGIONAL HEART CENTRE MORRISTON SWANSEA SLIDE MATERIAL:PERSONAL COMMUNICATION WITH AUTHORS ABBOTT, BOSTON SCIENTIFIC, CORDIS, MEDTRONIC TCT.
Meredith ● EVOLVE Primary Endpoint ● TCT 2011 ● San Francisco, CA Slide 1 Meredith ● EVOLVE overview ● TCT 2010 ● Washington, DC Slide 1 Clinical and Angiographic.
Keith Dawkins MD FRCP FACC FSCAI Chief Medical Officer Senior Vice President Boston Scientific Corporation Why Boston Scientific Persists with the Two-Drug.
The Stent of Choice in ACS patients The Stent of Choice in ACS 1) The Rationale…
Two-Year Clinical Outcomes Yan Li MD., PhD. On behalf of FIREMAN Investigators Associated Professor of Department of Cardiology of Xijing Hospital Fourth.
The REALITY Study Results. REALITY Study Design The REALITY Study : Prospective randomized clinical trial to evaluate the safety and efficacy of CYPHER®
Rapamycin- and Paclitaxel-Eluting Stents With Identical Biodegradable Polymeric Coating and Design Trial Presented at The American College of Cardiology.
NOBORI New Generation Drug Eluting Stent Clinical Data Danny Detiege Clinical Manager - Cardiology Terumo Europe N.V. Leuven, Belgium.
TAXUS ATLAS Trial Presented at The EuroPCR meeting Paris, France May 2006 Presented by Dr. Mark Turco TAXUS ATLAS 9-Month Results: Evaluation of TAXUS.
Two-Year Outcomes After Everolimus- or Sirolimus- Eluting Stents in Patients With Coronary Artery Disease in the ISAR-TEST 4 Trial Robert A. Byrne, Adnan.
A Prospective, Randomized Trial Evaluating a Paclitaxel-Eluting Balloon in Patients TReated with Endothelial Progenitor Cell CapTuring Stents for De Novo.
Treatment of bifurcation lesions is a complex problem Different techniques are commonly used (Y-/T-stenting, „culotte“ technique, „kissing stent“ technique…)
The Endeavor Zotarolimus-Eluting Stent: Device Description and Comprehensive Update of the Clinical Trial Program.
Robert A. Byrne, MB MRCPI Deutsches Herzzentrum and 1. Med. Klinik rechts der Isar, Technische Universität Munich, Germany A Polymer-Free Dual Drug-Eluting.
Biolimus-Eluting Stent With Biodegradable Polymer Versus Sirolimus-Eluting Stent With Durable Polymer: A Randomised, Non-Inferiority Trial Stephan Windecker,
Endeavor 4: A Randomized Comparison of a Zotarolimus- Eluting Stent and a Paclitaxel- Eluting Stent in Patients with Coronary Artery Disease Martin B.
Www. Clinical trial results.org Cypher sirolimus-eluting stent Primary Endpoint:  In-stent and late lumen loss at 9 months (determined by QCA) Secondary.
Philip Urban, Alexandre Abizaid, Ian T. Meredith, Stuart J. Pocock, Didier Carrié, Christoph Naber, John Gregson, Samantha Greene, Hans Peter Stoll and.
NEXT A Prospective, Randomized Trial Comparing Cre8, a Polymer-Free Stent Eluting Sirolimus, to a Paclitaxel-Eluting Stent Didier Carrié, MD,PhD On behalf.
Trial to Assess the Use of the Cypher Stent in Acute Myocardial Infarction Treated with Balloon Angioplasty (TYPHOON) Trial Presented at The American College.
Final 5 year results from the all-comer COMPARE trial: a prospective randomized comparison between Xience-V and Taxus Liberté TCT 2013 San Francisco Pieter.
XIENCE V vs TAXUS: Game Over! The Studies are Definitive
Two-year clinical outcomes in the EVOLVE FHU trial: A randomized evaluation of a novel bioabsorbable polymer-coated, everolimus-eluting stent Ian Meredith.
The Tryton Bifurcation Trial:
LONG-DES II Trial Randomized Comparison of the Efficacy of Sirolimus-Eluting Stent Versus Paclitaxel-Eluting Stent in the Treatment of Long Native Coronary.
Update on the BioMatrix Program
TAXUS IV Trial Slow-rate release polymer-based paclitaxel-eluting stent compared with bare stent in patients with single de novo coronary lesions Presented.
Did the LEADERS trial prove the superiority of biodegradable polymer?
Novolimus Elution from a Biodegradable Polymer Coated Coronary Stent
DES Should be Used as the Default Stent in ACS!
The Biofreedom Surface Etching Polymer-Free DES System
Progenitor Endothelial Cell Capturing with a Drug Eluting Stent
FINAL FIVE-YEAR CLINICAL OUTCOMES OF THE NOBORI2 TRIAL
Stenting of Coronary Arteries in Non Stress/Benestent Disease
BioFreedom – the world’s first coronary stent system coated with BA9
The OrbusNeich EPC Capture Biodegradable Polymer Sirolimus-eluting Stent Program Michael JB Kutryk, MD, PhD St Michael’s Hospital, Toronto.
TAXUS II and IV: two-year follow-up
Kyoto University Hospital, Japan
3-Year Clinical Outcomes From the RESOLUTE US Study
ENDEAVOR IV: 5 Year Final Outcomes
Presented at ACC 2003 Late Breaking Clinical Trials
SIRIUS: A U.S. Multicenter, Randomized, Double-Blind Study of the SIRolImUS-Eluting Stent in De Novo Native Coronary Lesions Presented at TCT 2002.
On behalf of all principal COMPARE II investigators:
ENDEAVOR II Five-Year Clinical Follow-up
ENDEAVOR III Multicenter Randomized Trial Clinical/MACE Angio/IVUS
Updated 3-Year Meta-Analysis of the TAXUS Clinical Trials Safety and Efficacy Demonstrated in 3,445 Randomized Patients Time allocation for this talk.
Martin B. Leon, David R. Holmes, Dean J. Kereiakes, Jeffrey J
Primary safety endpoint
TYPHOON Trial Trial to Assess the Use of the Cypher Stent in Acute Myocardial Infarction Treated with Balloon Angioplasty (TYPHOON) Trial Presented at.
Presentation transcript:

John E Shulze, CTO Biosensors International Inc Drug Application in Stent Technology: How to Diversify? John E Shulze, CTO Biosensors International Inc 1

My Conflicts of interest are: Chief Technology Officer and a shareholder of Biosensors International Inc.1 (1Biosensors’ development pipeline products to be discussed in this Presentation)

BIOLIMUS A9™ DRUG RAPAMYCIN DERIVATIVE Developed specifically for stent application by Biosensors Potent immunosuppressive and anti-inflammatory properties LIPOPHILICITY COMPARISON Highest lipophilic and hydrophobic properties of commercially available limus drugs Mainly localized effects, minimal drug release into bloodstream

ABLUMINAL BIODEGRADABLE COATING The Abluminal Biodegradable Polymer DES ABLUMINAL BIODEGRADABLE COATING Early BMS-like endothelial coverage1 More targeted tissue release Less systemic exposure BIOLIMUS A9™ DRUG Biosensors’ proprietary rapamycin derivative Highest lypophilicity of the common limus drugs1 BIODEGRADABLE PLA Simultaneous PLA biodegradation and BA9™ elution No PLA /BA9™ coating on the stent after 6 to 9months2 10810-000-EN – Rev.01 1 Data on file at Biosensors Intl 2 In vivo testing in porcine model demonstrates abluminal coating is absorbed after 6 to 9 months - Data on file at Biosensors Intl

Trial Design (LEADERS) Stable and ACS Patients Undergoing PCI Assessor-blind 1:1 Randomisation N=1700 Patients 3-year follow-up (N=1,621; 95.0%) BES BioMatrix Flex N=850 SES Cypher Select N=850 1:3 Randomisation Clinical F/U N=640 Angio F/U N=210 Clinical F/U N=640 Angio F/U N=210 1o endpoint: CV death, MI, clinically-indicated TVR (9 months) 2o endpoints: Death, CV death, MI, TLR, TVR Stent thrombosis according to ARC Angiographic study: In-stent % diameter stenosis Late loss, binary restenosis DAPT recommended for 12 month

Primary Endpoint MACE (Cardiac Death, MI and TVR) @ 9 Months 15 pnon-inferiority = 0.003 Cypher® Select™ 10.5% 10 MACE % BioMatrix Flex™ 9.2% 5 1 2 3 4 5 6 7 8 9 Months of Follow-up BioMatrix Flex™ reached its primary endpoint Windecker S. et al., The Lancet 2008; 372 No. 9644: 1163-1173

MACE 3-year HR 0.82 [0.65 to 1.03] P = 0.09* 1-year HR 0.88 [0.66 to 1.17] P = 0.37* 13.0% 15.4% 2-year HR 0.84 [0.65 to 1.08] P = 0.18* BES 20 19.0% SES 15 15.7% 12.1% % 10 10.7% 5 6 12 18 24 30 36 Number at risk BES 857 851 761 743 729 712 668 SES 850 846 749 732 713 686 639 Months *P values for superiority MACE = Cardiac Death, MI, or Clinically-Indicated TVR Serruys, P. W., oral presentation ,TCT 2010

Definite ST through 3 years BES 2.0% 1-year HR 0.99 [0.51 to 1.94] P = 0.98* 2.2% 2.5% 2-year HR 0.90 [0.48 to 1.67 P = 0.73* 3-year HR 0.78 [0.43 to 1.43] P = 0.43* 4.0 SES 1.0 2.0 3.0 2.9% Δ 0.7% % Δ 0.3% 2.2% Δ 0.0% 6 12 18 24 30 36 Months Number at risk BES 857 846 808 797 787 774 732 SES 850 841 801 792 779 758 715 *P values for superiority Serruys P.W., oral presentation, TCT 2010 Footer

PROVISIONAL STENTING USE

Micro-CT Biomatrix results MV STENTING AFTER KISSING

MACE in Complex Patients % Months 8.4% 19.7% 15.9% 6.8% 5 10 15 20 6 12 18 24 36 30 10.0% 21.3% 3-year HR 0.43 [0.23 to 0.84] P = 0.01* 25 STEMI 15.3% 21.8% 18.6% 12.7% 17.0% 23.8% 0.69 [0.46 to 1.04] P = 0.08* High Syntax Score (>16) BES SES Bifurcations % 15.6% 18.9% 16.4% 12.9% 5 10 15 20 6 12 18 24 36 30 18.5% 23.3% 3-year HR 0.79 [0.53 to 1.16] P = 0.22* 25 16.0% 24.1% 0.65 [0.41 to 1.03] P = 0.06* 15.0% 23.5% 17.1% 13.0% Multi-vessel *P values for superiority Windecker, S., oral presentation ,TCT 2010

Grube E., oral presentation, TCT 2010 BioFreedom™ Selectively micro-structured surface holds drug in abluminal surface structures Hypothesis: Polymer-free drug release via porous-eluting stents may reduce late events caused by polymer stent coatings. Potential advantage Avoid long term late adverse effects that might be attributable to the polymer Improved surface integrity since there is no polymer to be sheared or peeled away from the stent struts Possible shorter need of dual antiplatelet therapy Proprietary Highly Lipophilic Limus drug Grube E., oral presentation, TCT 2010

BioFreedom FIM Design BioFreedom FIM 4 Month Angio FU 182 patients First Cohort Second Cohort 12 Month Clinical FU 99% 4 Month Angio FU 75 patients 12 Month Angio FU 107 patients BioFreedom standard dose (BFD SD) N=25 low dose (BFD LD) N=26 TAXUS® Liberté ® N=24 Angio FU 92% BioFreedom standard dose (BFD SD) N=35 low dose (BFD LD) N=36 TAXUS® Liberté ® Angio FU 92% Enrollment Period Sept 2008 – Jan 2009 Enrollment Period Jan 2009 – Jun 2009

12 Month Angiographic FU In-Stent Late Lumen Loss: 2nd Cohort Primary Endpoint Non – inferiority P values P = 0.001 P = 0.21 (mm) N = 31 N = 35 N = 31 Grube E., oral presentation, TCT 2010 All values are presented as median [IQR]

12 Month MACE All Patients (1st + 2nd Cohorts) BFD SD N = 60 BFD LD N = 62 Taxus MACE* (All Death, MI, Emergent Bypass or TLR) 3 (6.1%) 7 (11.6%) 3 (5.5%) All Death 1 (1.8%) 0 (0.0%) MI 1 (1.6%) Q Wave MI Non-Q Wave MI 1 (1.6%)** Emergent Bypass TLR 6 (10.0%) No ST event out to 12 months: ARC defined Definite, Probable or Possible! *Time to first event **In-hospital MI All p values are non significant. Tests were performed for BFD SD vs. Taxus and BFD LD vs. Taxus.

The AXXESS stent The AXXESS stent is a dedicated bifurcation stent Nitinol self explandable stent Using PLA/BA9™ abluminal coating technology 4 references: 3.0 and 3.5 mm in diameter; 11 and 14 mm in lengths 2 models: bifurcation and LM (difference in sizes of the conical shape) The AXXESS stent is associated to a clinical program AXXESS Plus and DIVERGE for de novo bifurcation AXXENT for LM lesion THE AXXESS stent received CE mark in August 2010 Indication: bifurcation AXXESS

Restenosis in DIVERGE Any in-Bifurcation restenosis: 6.4% (9/140 at 9 months) Lowest restenosis rates ever reported in a bifurcation study of any kind Parent Vessel RS 3 pts Side Branch RS 4pts 2 pts Both

What is next?

Sparrow™ Microstent: designed for small vessels The smallest profile drug-eluting stent system in the world 60% smaller than the nearest available coronary stent system. limus drug with a biodegradable polymer matrix Self-expanding ultra-thin Nitinol stent 0.014-inch guidewire delivery system unique “stent-on-the-wire” construction BMS System CE Marking 3/2010 Non-Sterile, reusable, hand-held Power Supply Sterile, Disposable Adapter Delivery System Stent Lead Connection/ Wire Extension TCT 2010

CARE II DESIGN Primary Endpoint: In Stent Late lumen loss @ 8 mo 2 Arm Sub-Set 1:1 randomization Sparrow DES: Sparrow BM 4 Centers CARE II RCT 4:4:3 (80:80:60) Total N=220 + roll in 3 Arm Sub-Set 1:1:1 randomization Sparrow DES: Sparrow BM: Micro-Driver/Driver BM 14 Centers IVUS sub-study (n = 120 @ 7 centers) Sparrow - BM (N=60) Micro-Driver/ Driver Sparrow – DES (~6ug/mm Sirolimus) Sparrow - BM (N=20) Sparrow – DES (~6 ug/mm Sirolimus) Primary Endpoint: In Stent Late lumen loss @ 8 mo Sparrow DES= 80 Sparrow BM = 80 Micro-Driver/Driver = 60 20 20

CARE II 8 month QCA Binary Restenosis (in Lesion) SES Sparrow Stent demonstrated superior in-stent LLL - CARE II Primary Endpoint met (%) P=0.0012 % CMI-SES CMI-BMS Driver Mean (mm) 0.29±0.45 0.86±0.54 0.94±0.39 Range (mm) -0.59-1.28 -0.20-1.89 0.44-2.11 p 0.0001 < 0.0001 n 30 31 25 P=.00006 6.7 45.2 44 CMI-SES (n=30) CMI-BMS (n=31) Driver (n=25) Abiziaid A.C. et al., TCT 2010

*BA9 application under development Take-home message BA9 shows sustained Safety and Efficacy – Independent from stent platform or method of drug delivery! BioMatrixTM BioMatrixTM Flex BioFreedomTM AXXESSTM Plus Sparrow-DES Nobori (Terumo) Custom NXTM (XTENT) Stainless Steel Balloonexpandable Abluminal biodegradable polymer Polymer Free Nitinol Self-expandable Designed for Bifurcations Sirolimus*/PLA Designed for small vessels SS BA9/PLA Cobalt-Chrome *BA9 application under development

BioMatrix Flex™ Drug Eluting Coronary Stent System is CE approved Not available for sale in the United States and certain other countries of Biosensors International group, Ltd. in the United States and other countries BioMatrix Flex, Biolimus A9 and BA9 are trademarks or registered trademarks All cited trademarks are the property of their respective owners © 2011 Biosensors International Group, Ltd. All rights reserved