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Replicor announces publication of the REP 401 study achieving high rates of virologic control and functional cure in patients with chronic hepatitis B infection
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Pub pdf attached
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Abstract
Background & Aims
Nucleic acid polymers (NAPs) inhibit assembly and secretion of hepatitis B virus (HBV) subviral particles. We performed an open-label, phase 2 study of the safety and efficacy of the NAPs REP 2139 or REP 2165 combined with tenofovir disoproxil fumarate (TDF) and pegylated interferon alfa-2a (pegIFN) in patients with negative chronic HBV infection who were negative for HB e antigen (HBeAg).
Methods
Following 24 weeks TDF therapy, 40 patients were randomly assigned to groups that received 48 weeks of experimental therapy (TDF + pegIFN + REP 2139-Mg or REP 2165-Mg) or 24 weeks of control therapy (TDF + pegIFN) followed by 48 weeks experimental therapy. Patients were then followed for a treatment-free period of 48 weeks. Primary outcomes were the safety and tolerability of REP 2139-Mg or REP 2165-Mg in combination with TDF + pegIFN compared to TDF + pegIFN alone through the first 48 weeks of therapy and subsequently throughout 48 weeks of NAP-based combination therapy (treatment weeks 24-72 in the experimental group and weeks 48-96 in the control group). Secondary outcomes reductions in HBsAg in control and experimental groups over the first 48 weeks of the study and throughout 48 weeks of combination therapy and virologic control (HBsAg positive, HBV DNA below 2000 IU/mL, normal level of alanine aminotransferase) or functional cure (HBsAg below 0.05 IU/mL, HBV DNA target not detected, normal level of alanine aminotransferase) after removal of all therapy.
Results
Levels of HBsAg, anti-HBs, and HBV DNA did not differ significantly between the groups given REP 2139 vs REP 2165. PegIFN-induced thrombocytopenia (P=.299 vs controls) and neutropenia (P=.112 vs controls) were unaffected by NAPs (REP 2139 vs REP 2165). Increases in levels of transaminases were significantly more frequent (P<.001 vs controls) and greater (P=.002 vs controls) in the NAP groups (but did not produce symptoms), correlated with initial decrease in HBsAg, and normalized during therapy and follow up. During the first 24 weeks of TDF and pegIFN administration, significantly higher proportions of patients in NAP groups had decreases in HBsAg to below 1 IU/mL (P<.001 vs control) and HBsAg seroconversion (P=.046 vs control). At the time patients completed the TDF + pegIFN + NAP regimen, HBsAg levels were 0.05 IU/mL or lower in 24/40 participants (all with seroconversion up to 233,055 mIU/mL). During 48 weeks of treatment-free follow up, virologic control persisted in 13/40 participants (2 lost to follow up after 24 weeks), whereas functional cure persisted in with 14/40 participants (all completing 48 weeks of follow-up) with persistent HBsAg seroconversion. One participant had a viral rebound during follow up with hepatic decompensation and was placed on TDF therapy.
Conclusions
In a phase 2 randomized trial, we found that addition of NAPs to TDF + pegIFN did not alter tolerability and significantly increased rates of HBsAg loss and HBsAg seroconversion during therapy and functional cure after therapy. Clinicaltrials.gov no: NCT02565719.
MONTREAL, March 9, 2020 - Replicor Inc., a privately held biopharmaceutical company targeting functional cure for patients with chronic hepatitis B and D infection, announced the publication of the final results of its latest REP 401 study in the prestigious journal Gastroenterology.
The article, entitled "Safety and Efficacy of 48 Weeks REP 2139 or REP 2165, Tenofovir Disoproxil, and Pegylated Interferon Alfa-2a in Patients With Chronic HBV Infection Naïve to Nucleos(t)ide Therapy", presents the analysis of the safety and efficacy of NAP therapy when added to a backbone of TDF and pegIFN in patients with treatment naïve chronic HBV infection.
The culmination of more than a decade of clinical investigation of NAPs, transitioning from REP 2055 to REP 2139-Mg, the REP 401 study achieved dramatic increases in the incidence of HBsAg loss and seroconversion during therapy (60%) and therapeutic transaminase flares (95%) compared to that observed with TDF + pegIFN alone. Importantly 78% of participants achieved virologic control of HBV of whom 39% further achieved functional cure. These outcomes dramatically improve those achieved by TDF + pegIFN alone and far exceed those observed with any other therapy currently in development in mono or combination therapy.
Dr. Andrew Vaillant, CSO of Replicor commented, "Our substantial body of published data clearly demonstrates that all NAPs using Replicor's proprietary poly AC technology have very similar activity with similar doses required in humans. However, only NAPs formulated as magnesium chelate complexes such as REP 2139-Mg and REP 2165-Mg have the excellent tolerability and safety required for use with immunotherapy. This combination approach is essential to awaken an effective immune response capable of driving high rates of therapeutic transaminase flares essential for restoring virologic control and functional cure. The successful completion of the REP 401 study paves the way for the long-planned transition of REP 2139-Mg to subcutaneous administration and assessment in combination with other immunotherapies capable of driving HBsAg specific T-cell activation, an activity we believe is a critical component of achieving functional cure."
The article can be accessed directly at the following link:
https://www.gastrojournal.org/article/S0016-5085(20)30320-6/fulltext
About Replicor
Replicor is a privately held biopharmaceutical company with the most advanced animal and human clinical data in the development of the cure for HBV and HDV. The company is dedicated to accelerating the development of an effective treatment for patients with HBV and HBV/HDV co-infection. For further information about Replicor please visit our website at www.replicor.com.
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