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Interferon-free 3 DAA Plus Ribavirin Regimen in HCV Genotype 1-Infected Patients on Methadone or Buprenorphine 20 th International AIDS Conference Melbourne,

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Presentation on theme: "Interferon-free 3 DAA Plus Ribavirin Regimen in HCV Genotype 1-Infected Patients on Methadone or Buprenorphine 20 th International AIDS Conference Melbourne,"— Presentation transcript:

1 Interferon-free 3 DAA Plus Ribavirin Regimen in HCV Genotype 1-Infected Patients on Methadone or Buprenorphine 20 th International AIDS Conference Melbourne, Australia 21 July 2014 Jacob Lalezari, J Greg Sullivan, Peter Varunok, Edward Galen, Kris V Kowdley, Vinod Rustgi, Humberto Aguilar, Franco Felizarta, Martin King, Daniel Cohen

2 Interferon-free 3 DAA Plus Ribavirin Regimen in HCV Genotype 1-Infected Patients on Methadone or Buprenorphine| International AIDS Conference 2014 | 21 July 2014 2 Disclosures J Lalezari: Grant/Research support: AbbVie JG Sullivan: Grant/Research support: AbbVie P Varunok: Speaker for Vertex, Merck and Forest Pharmaceuticals E Galen: Research support: AbbVie. KV Kowdley: Grants and Research Support (paid to institution): AbbVie, Beckman, BMS, Boeringer Ingelheim, Gilead, Ikaria, Intercept, Janssen, Merck, Mochida, Vertex; Consultant: Novartis (honorarium paid to institution); Service on Advisory Boards: AbbVie, Gilead, Ikaria, Janssen, Merck, Trio Health, Vertex (honorarium paid to institution) V Rustgi: Research support: AbbVie. H Aguilar: Grants: AbbVie. Speaker: Santarus, Ironwood. F Felizarta: Speaker for Merck, Vertex, Boehringer-Ingelheim and ViiV; research (as principal investigator) with AbbVie, Merck, Vertex, BI, Janssen, Gilead, Roche, BMS, and ViiV. M King, D Cohen: employees of AbbVie and may own AbbVie stock or options The design, study conduct, analysis, and financial support of the clinical trials were provided by AbbVie. AbbVie participated in the interpretation of data, review, and approval of the content. All authors had access to all relevant data. This presentation contains information on the investigational products ABT-450/r, ombitasvir (ABT-267) and dasabuvir (ABT-333).

3 Interferon-free 3 DAA Plus Ribavirin Regimen in HCV Genotype 1-Infected Patients on Methadone or Buprenorphine| International AIDS Conference 2014 | 21 July 2014 3 Background People who inject drugs are at high risk for chronic hepatitis C virus (HCV) infection Only a minority initiate treatment Even fewer complete a course of interferon-based therapy New interferon-free treatment regimens of DAAs are associated with significantly less toxicity, which may improve treatment initiation and completion rates among people receiving opioid replacement therapy with methadone or buprenorphine

4 Interferon-free 3 DAA Plus Ribavirin Regimen in HCV Genotype 1-Infected Patients on Methadone or Buprenorphine| International AIDS Conference 2014 | 21 July 2014 4 The 3 DAA (“3D”) Regimen The 3D regimen includes: Co-formulated ABT-450/r/Ombitasvir plus Dasabuvir ABT-450, a NS3/4A protease inhibitor (identified by AbbVie and Enanta as a lead compound for clinical development) Ritonavir, a pharmacokinetic enhancer Ombitasvir, a NS5A inhibitor (formerly ABT-267) A non-nucleoside NS5B polymerase inhibitor (formerly ABT-333)

5 Interferon-free 3 DAA Plus Ribavirin Regimen in HCV Genotype 1-Infected Patients on Methadone or Buprenorphine| International AIDS Conference 2014 | 21 July 2014 5 Ombitasvir/ABT-450/r + Dasabuvir Phase 3 Results The 3D regimen been studied in >2700 patients to date

6 Interferon-free 3 DAA Plus Ribavirin Regimen in HCV Genotype 1-Infected Patients on Methadone or Buprenorphine| International AIDS Conference 2014 | 21 July 2014 6 Ombitasvir/ABT-450/r + Dasabuvir Phase 3 Results 1 Feld J, et al. N Engl J Med. 2014; 370:1594. 2 Zeuzem S, et al. N Engl J Med. 2014; 370:1604. 3 Strasser S, et al. IAC 2014; Poster TUPE051. The 3D regimen been studied in >2700 patients to date 12 weeks of 3D + RBV resulted in SVR 12 in 96% of treatment-naïve and experienced GT1-infected patients without cirrhosis 1,2,3

7 Interferon-free 3 DAA Plus Ribavirin Regimen in HCV Genotype 1-Infected Patients on Methadone or Buprenorphine| International AIDS Conference 2014 | 21 July 2014 7 Ombitasvir/ABT-450/r + Dasabuvir Phase 3 Results 1 Feld J, et al. N Engl J Med. 2014; 370:1594. 2 Zeuzem S, et al. N Engl J Med. 2014; 370:1604. 3 Strasser S, et al. IAC 2014; Poster TUPE051. 4 Ferenci P, et al. N Engl J Med. 2014; 370:1983. 5 Andreone, et al. Gastroenterology. 2014; published on-line. The 3D regimen been studied in >2700 patients to date 12 weeks of 3D + RBV resulted in SVR 12 in 96% of treatment-naïve and experienced GT1-infected patients without cirrhosis 1,2,3 12 weeks of 3D without RBV resulted in SVR 12 in 99%-100% of treatment-naïve and treatment-experienced GT1b-infected patients without cirrhosis 4,5

8 Interferon-free 3 DAA Plus Ribavirin Regimen in HCV Genotype 1-Infected Patients on Methadone or Buprenorphine| International AIDS Conference 2014 | 21 July 2014 8 Ombitasvir/ABT-450/r + Dasabuvir Phase 3 Results 1 Feld J, et al. N Engl J Med. 2014; 370:1594. 2 Zeuzem S, et al. N Engl J Med. 2014; 370:1604. 3 Strasser S, et al. IAC 2014; Poster TUPE051. 4 Ferenci P, et al. N Engl J Med. 2014; 370:1983. 5 Andreone, et al. Gastroenterology. 2014; published on-line. 6 Poordad F, et al. N Engl J Med. 2014; 370:1973. The 3D regimen been studied in >2700 patients to date 12 weeks of 3D + RBV resulted in SVR 12 in 96% of treatment-naïve and experienced GT1-infected patients without cirrhosis 1,2,3 12 weeks of 3D without RBV resulted in SVR 12 in 99%-100% of treatment-naïve and treatment-experienced GT1b-infected patients without cirrhosis 4,5 12-24 weeks of 3D + RBV resulted in SVR 12 in 92%-96% of GT1-infected patients with compensated cirrhosis 6

9 Interferon-free 3 DAA Plus Ribavirin Regimen in HCV Genotype 1-Infected Patients on Methadone or Buprenorphine| International AIDS Conference 2014 | 21 July 2014 9 The 3D regimen been studied in >2700 patients to date 12 weeks of 3D + RBV resulted in SVR 12 in 96% of treatment-naïve and experienced GT1-infected patients without cirrhosis 1,2,3 12 weeks of 3D without RBV resulted in SVR 12 in 99%-100% of treatment-naïve and treatment-experienced GT1b-infected patients without cirrhosis 4,5 12-24 weeks of 3D + RBV resulted in SVR 12 in 92%-96% of GT1-infected patients with compensated cirrhosis 6 Overall discontinuation rate of 2% Ombitasvir/ABT-450/r + Dasabuvir Phase 3 Results 1 Feld J, et al. N Engl J Med. 2014; 370:1594. 2 Zeuzem S, et al. N Engl J Med. 2014; 370:1604. 3 Strasser S, et al. IAC 2014; Poster TUPE051. 4 Ferenci P, et al. N Engl J Med. 2014; 370:1983. 5 Andreone, et al. Gastroenterology. 2014; published on-line. 6 Poordad F, et al. N Engl J Med. 2014; 370:1973.

10 Interferon-free 3 DAA Plus Ribavirin Regimen in HCV Genotype 1-Infected Patients on Methadone or Buprenorphine| International AIDS Conference 2014 | 21 July 2014 10 M14-103: A Phase 2, open-label, single-arm study Eight sites in North America Evaluating safety and efficacy of interferon-free 3D + RBV regimen for 12 weeks in GT1-infected patients without cirrhosis on stable opioid replacement therapy Treatment response (HCV RNA < 25 IU/mL) assessed at End of treatment (EOTR) Week 4 post-treatment (SVR4) Week 12 post-treatment (SVR12) Week 24 post-treatment (SVR24)

11 Interferon-free 3 DAA Plus Ribavirin Regimen in HCV Genotype 1-Infected Patients on Methadone or Buprenorphine| International AIDS Conference 2014 | 21 July 2014 11 Eligibility Criteria 18 to 70 years of age BMI ≥18 and <38 kg/m2 Chronic HCV GT1 infection Plasma HCV RNA >10,000 IU/mL Absence of cirrhosis Treatment-naïve or previous pegIFN/RBV-experienced Stable opioid replacement therapy with methadone or buprenorphine ± naloxone No evidence of HIV or hepatitis B co-infection No liver disease due to causes other than hepatitis C

12 Interferon-free 3 DAA Plus Ribavirin Regimen in HCV Genotype 1-Infected Patients on Methadone or Buprenorphine| International AIDS Conference 2014 | 21 July 2014 12 M14-103 Study Design 3D: co-formulated ombitasvir/ABT-450/r, 25 mg /150 mg/100 mg QD; dasabuvir, 250 mg BID RBV: 1000-1200 mg daily according to body weight (<75 kg and ≥75kg, respectively) Day 0Week 24Week 12 SVR12SVR24 3D + RBV N=38 (N=38) 3D + RBV N=38 (N=38) Week 36

13 Interferon-free 3 DAA Plus Ribavirin Regimen in HCV Genotype 1-Infected Patients on Methadone or Buprenorphine| International AIDS Conference 2014 | 21 July 2014 13 Demographics and Patient Characteristics n (%) unless otherwise noted:3D+RBV(N=38) Male 25 (65.8) White race 36 (94.7) Hispanic or Latino ethnicity 1 (2.6) Mean age in years (SD) 48.2 (11.0) Mean BMI in kg/m 2 (SD) 27.0 (3.9) HCV RNA level, log 10 IU/mL (SD) 6.58 (0.70) IL28B non-CC26 (68.4) Fibrosis stage F0-F130 (78.9) F2 6 (15.8) F3 2 (5.3) HCV genotype 1a 26 (68.4) Treatment-naïve 36 (94.7) Opioid replacement therapy Methadone 19 (50.0) Buprenorphine 19 (50.0)

14 Interferon-free 3 DAA Plus Ribavirin Regimen in HCV Genotype 1-Infected Patients on Methadone or Buprenorphine| International AIDS Conference 2014 | 21 July 2014 14 37/38 patients (97.4%) achieved each efficacy endpoint 1 patient (2.6%) prematurely discontinued the study at week 2 of treatment due to a serious adverse event unrelated to study drug 97.4% Efficacy Results 37/38 37/38 37/38 37/38

15 Interferon-free 3 DAA Plus Ribavirin Regimen in HCV Genotype 1-Infected Patients on Methadone or Buprenorphine| International AIDS Conference 2014 | 21 July 2014 15 Treatment-Emergent Adverse Event Summary Treatment-Emergent Adverse Event, n (%)3D+RBV(N=38) Any AE35 (92.1) Severe AE2 (5.3) Serious AE2 a (5.3) AE leading to early study discontinuation1 (2.6) No patient required a change in the dosage of methadone or buprenorphine during study treatment a Unrelated to study drug, per investigator.

16 Interferon-free 3 DAA Plus Ribavirin Regimen in HCV Genotype 1-Infected Patients on Methadone or Buprenorphine| International AIDS Conference 2014 | 21 July 2014 16 Adverse Events Experienced by >10% of Patients Event, %3D+RBV(N=38) Nausea19 (50.0) Fatigue18 (47.4) Headache12 (31.6) Insomnia7 (18.4) Rash6 (15.8) Arthralgia5 (13.2) Anxiety5 (13.2) Anemia4 (10.5) Vomiting4 (10.5) Irritability4 (10.5)

17 Interferon-free 3 DAA Plus Ribavirin Regimen in HCV Genotype 1-Infected Patients on Methadone or Buprenorphine| International AIDS Conference 2014 | 21 July 2014 17 Post-Baseline Grade 3 or 4 Laboratory Abnormalities Parameter, n (%)3D+RBV(N=38) Total bilirubin Grade 3 (>3X–10 X ULN)1 (2.6) Grade 4 (>10 X ULN)0 Hemoglobin Grade 3 (<8.0–6.5 g/dL)2 (5.3) Grade 4 (<6.5 g/dL)0 Eight patients experienced hemoglobin <10 g/dL while on treatment Seven patients reduced RBV dose for anemia/decreased hemoglobin; all achieved SVR24

18 Interferon-free 3 DAA Plus Ribavirin Regimen in HCV Genotype 1-Infected Patients on Methadone or Buprenorphine| International AIDS Conference 2014 | 21 July 2014 18 Discussion Poorly tolerated interferon-based therapies have been a significant barrier to treatment among people who inject drugs, including those on opioid replacement therapy 7,8 Patients on stable opioid replacement therapy may be well suited to all-oral treatment for HCV This study was conducted prior to completions of the phase 3 PEARL studies in GT1b patients, in which 99% of treatment-naïve 4 and 100% of treatment-experienced 5 GT1b patients achieved SVR12 without RBV 7 Bruggmann P. Journal of Viral Hepatitis. 2012;19: 829–35. 8 Treloar C, et al. Journal of Viral Hepatitis. 2013; published on-line. 4 Ferenci P, et al. N Engl J Med. 2014; 370:1983. 5 Andreone, et al. Gastroenterology. 2014; published on-line.

19 Interferon-free 3 DAA Plus Ribavirin Regimen in HCV Genotype 1-Infected Patients on Methadone or Buprenorphine| International AIDS Conference 2014 | 21 July 2014 19 Conclusions The 3D + RBV regimen achieved an SVR24 rate of 97.4% among these 38 GT1-infected patients receiving opioid replacement therapy Comparable to results previously reported in both treatment-naïve and treatment-experienced GT1-infected patients No viral breakthroughs or relapses were observed The 3D + RBV regimen was well tolerated in this study Low rate of discontinuation Adverse events were generally mild Drug-drug interactions did not impact HCV treatment or opioid maintenance A 12-week, highly efficacious, well-tolerated all-oral regimen may be an attractive treatment option for GT1-infected patients receiving opioid replacement therapy

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