Vertex Initiates Phase 3 Studies of VX-445, Tezacaftor and Ivacaftor as a Triple Combination Regimen for People with Cystic Fibrosis
-VX-445 triple combination regimen is the second of two different triple combination regimens to enter Phase 3 development in 2018-
-Phase 3 study in approximately 360 patients with one F508del mutation and one minimal function mutation designed to support New Drug Application based on 4-week primary efficacy endpoint and 12-week safety data-
-Phase 3 study in approximately 100 patients with two F508del mutations supported by new Phase 2 data announced today that showed an incremental mean absolute improvement in ppFEV1 of 11.0 percentage points when VX-445 was added in patients already receiving tezacaftor and ivacaftor; triple combination regimen was generally well tolerated-
-Additional dose-ranging of once-daily potentiator VX-561 to be conducted to support potential late-stage development of future once-daily triple combination regimens-
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“The initiation of pivotal development for VX-445 marks important progress toward our goal of advancing two different next-generation triple combination regimens into pivotal development to allow us to bring the best regimen to people with CF,” said Jeffrey Leiden, M.D., Ph.D., Chairman, President and Chief Executive Officer of Vertex. “We recognize that many people with CF are awaiting the first treatment for the underlying cause of their disease, and I am pleased that we have been able to advance both VX-659 and VX-445 into pivotal studies. We look forward to the rapid progression of these and other studies over the coming year, including studies in people currently eligible for our approved medicines where a triple combination regimen may provide significant benefit.”
Vertex also today announced safety and efficacy results for the
once-daily potentiator, VX-561, when dosed as part of a triple
combination regimen with a next-generation corrector (VX-659 or VX-445)
and tezacaftor in Phase 2 studies of people with one F508del
mutation and one minimal function mutation. In these studies, mean
absolute improvements in ppFEV1 of 12.2 and 11.7 and
percentage points from baseline through week four of treatment were
observed for the VX-659 and VX-445 triple combination regimens,
respectively. The once-daily triple combination regimens were generally
well tolerated, and the majority of adverse events were mild to moderate
in severity. Following discussions with the
About the VX-445 Phase 3 Study in People with One F508del
Mutation and One Minimal Function Mutation
The randomized,
double-blind, placebo-controlled Phase 3 study will evaluate VX-445 in
combination with tezacaftor and ivacaftor, or triple placebo, in
approximately 360 patients ages 12 and older who have one F508del mutation
and one minimal function mutation. A list of the minimal function
mutations currently included in this study can be found here.
The primary endpoint of the study is the mean absolute change in lung
function (ppFEV1) from baseline at week four of triple
combination treatment compared to triple placebo.
The study is designed to support the submission of an NDA to the U.S.
The study will evaluate a fixed-dose combination of VX-445 (200 mg), tezacaftor (100 mg) and ivacaftor (150 mg) in the morning followed by ivacaftor (150 mg) in the evening. An open-label extension study will be conducted where all eligible patients, including those who received triple placebo, will receive the VX-445 triple combination regimen for up to an additional 96 weeks.
About the VX-445 Phase 3 Study in People with Two F508del
Mutations
The randomized, double-blind, controlled Phase 3
study will evaluate four weeks of treatment with VX-445 or placebo in
combination with tezacaftor and ivacaftor in approximately 100 patients
ages 12 years or older who have two F508del mutations. All
patients will receive tezacaftor in combination with ivacaftor during a
4-week run-in prior to the start of the triple combination treatment
period. The primary endpoint of the study is the mean absolute change in
lung function (ppFEV1) from baseline (end of the 4-week
tezacaftor/ivacaftor run-in) at week four of treatment with VX-445 in
combination with tezacaftor and ivacaftor compared to those who received
placebo, tezacaftor and ivacaftor. Key secondary endpoints will also be
measured at week four and include change in sweat chloride and change in
patient-reported outcomes as measured by the CFQ-R respiratory domain
score.
The study is designed to support an application for U.S.
The study will evaluate a fixed-dose combination of VX-445 (200 mg) with tezacaftor (100 mg) and ivacaftor (150 mg) in the morning followed by ivacaftor (150 mg) in the evening, which is the same dosing regimen being evaluated in the Phase 3 study of patients with one F508del mutation and one minimal function mutation. An open-label extension study will be conducted where all eligible patients, including those who received placebo, tezacaftor and ivacaftor, will receive the VX-445 triple combination regimen for up to an additional 96 weeks.
Phase 2 Data for VX-445 Triple Combination in People with Two F508del
Mutations
The initiation of the Phase 3 study in people with
two F508del mutations is supported by data announced today from a
randomized, double-blind, controlled Phase 2 study where the primary
objectives were safety, tolerability and efficacy as assessed by mean
absolute change in ppFEV1 from baseline (end of the 4-week
tezacaftor/ivacaftor run-in period) through week four of treatment.
Secondary endpoints included absolute change in sweat chloride and
change in the CFQ-R respiratory domain score.
All patients received a 4-week run-in of tezacaftor in combination with ivacaftor. Patients were then randomized to add either once-daily VX-445 (200 mg) or placebo to tezacaftor and ivacaftor for four weeks. After the 4-week triple combination dosing period, all patients received four weeks of tezacaftor and ivacaftor, followed by a 4-week safety follow-up period.
Safety Data: The triple combination regimen was generally well tolerated, and the safety profile was similar to that observed in previously reported parts of this study. The majority of adverse events were mild or moderate. No serious adverse events were reported in the triple combination group and one serious adverse event (pulmonary exacerbation) was reported in the group that received placebo added to tezacaftor and ivacaftor. The most common adverse events occurring in at least two patients in any treatment group were sputum increased, cough, infective pulmonary exacerbation, fatigue, pyrexia, AST increased, CPK increased, chills, hemoptysis, ALT increased, respiration abnormal and sputum discolored. There was one discontinuation in the triple combination group due to chest pain, and one patient interrupted then discontinued treatment in the group that received placebo added to tezacaftor and ivacaftor due to increased bilirubin without associated elevations in transaminases. Following treatment discontinuation, the chest pain resolved and the increased bilirubin returned to baseline. One patient in the triple combination group interrupted treatment in the tezacaftor/ivacaftor treatment period that followed triple combination dosing due to myopathy and increased CPK, ALT and AST. The events resolved following interruption of treatment, and the patient subsequently restarted and completed treatment in the tezacaftor/ivacaftor period without any further incidence.
Efficacy Data: A summary of the within-group lung function and sweat chloride data is provided below:
|
VX-445 Added to Ongoing Treatment with Tezacaftor and Ivacaftor in Patients with Two F508del Mutations |
||||||
|
Mean Absolute Within-Group Change |
Mean Absolute Within- |
Mean Absolute Within- |
||||
|
Placebo + tezacaftor (100 mg QD) + |
+0.4
|
+0.8
|
||||
|
VX-445 (200 mg QD) + tezacaftor (100 |
+11.0
|
-39.6
|
||||
| * all p-values are within group p-values based on mixed effect models; values expressed as ‘Through Day 29' are the average of Day 15 and Day 29 measures; baseline reflects the end of the 4-week tezacaftor/ivacaftor run-in period | ||||||
A secondary endpoint in the study measured mean absolute within-group change in the respiratory domain score of the CFQ-R1, a validated patient-reported outcome measure, at Day 29. The mean absolute improvement for patients who received VX-445 in addition to tezacaftor and ivacaftor was 20.7 points. The improvement for those who received placebo in addition to tezacaftor and ivacaftor was 5.2 points.
Once-daily Triple Combination Regimens
Vertex today
announced the first safety and efficacy results for once-daily triple
combination regimens that included a next-generation corrector (VX-659
or VX-445), tezacaftor and VX-561, a once-daily potentiator, in patients
with one F508del mutation and one minimal function mutation.
These once-daily regimens were evaluated as separate parts within the
Phase 2 studies for VX-659 and VX-445, and safety and efficacy data from
previously completed parts of these studies in patients with one F508del
mutation and one minimal function mutation were reported earlier in
2018. The primary objectives of the studies were safety, tolerability
and efficacy as assessed by mean absolute change in ppFEV1
from baseline through week four of treatment. Secondary endpoints
included change in sweat chloride and change in the CFQ-R respiratory
domain score.
VX-659 Once-daily Regimen
Safety Data: In this study,
the once-daily triple combination regimen of VX-659, tezacaftor and
VX-561 was generally well tolerated, and the safety profile was similar
to that observed in previously reported parts of this study that
evaluated VX-659, tezacaftor and ivacaftor. The majority of adverse
events were mild or moderate. Serious adverse events were reported in
three patients in the placebo group (infective pulmonary exacerbations)
and two in the triple combination group (1 with pyrexia, dyspnea and
pleuritic pain, and 1 with infective pulmonary exacerbation and
pneumonia). None of these serious adverse events were considered related
to treatment and none resulted in treatment discontinuation. The most
common adverse events occurring in at least two patients in any
treatment group were cough, infective pulmonary exacerbation, nausea,
oropharyngeal (throat) pain, pyrexia, rales and rash. One patient in the
triple combination group interrupted treatment for rash and subsequently
restarted then discontinued treatment for drug hypersensitivity, which
resolved after treatment discontinuation. A second patient in the triple
combination treatment group interrupted treatment for rash. The rash
resolved, and the patient restarted and completed triple combination
treatment without any further incidence.
Efficacy Data: A summary of the within-group lung function and sweat chloride data is provided below:
|
Once-daily VX-659, tezacaftor and VX-561 in Patients with one F508del Mutation and One Minimal Function Mutation |
||||||
|
Mean Absolute Within-Group |
Mean Absolute Within- |
Mean Absolute Within- |
||||
| Triple placebo (n=6) |
-5.0
|
-1.3
|
||||
|
VX-659 (400 mg QD) + tezacaftor |
+12.2
|
-38.1
|
||||
| * all p-values are within group p-values based on mixed effect models; values expressed as ‘Through Day 29' are the average of Day 15 and Day 29 measures | ||||||
A secondary endpoint in the study measured mean absolute within-group change in the respiratory domain score of the CFQ-R1 at Day 29. The mean absolute improvement for patients who received the triple combination was 14.7 points. The change for those who received placebo was -4.1 points.
VX-445 Once-daily Regimen
Safety Data: In this study,
the once-daily triple combination regimen of VX-445, tezacaftor and
VX-561 was generally well tolerated, and the safety profile was similar
to that observed in previously reported parts of this study that
evaluated VX-445, tezacaftor and ivacaftor. The majority of adverse
events were mild or moderate. A serious adverse event was reported in
one patient in the placebo group (infective pulmonary exacerbation), and
there were no serious adverse events in the triple combination group.
The most common adverse events occurring in at least two patients in any
treatment group were cough, nausea, oropharyngeal (throat) pain,
infective pulmonary exacerbation, nasal congestion, productive cough,
sputum increased, chest pain, paranasal sinus discomfort, upper
respiratory tract infection and vomiting. There was one discontinuation
in the triple combination group due to rash. Following treatment
discontinuation, the rash resolved.
Efficacy Data: A summary of the within-group lung function and sweat chloride data is provided below:
|
Once-daily VX-445, tezacaftor and VX-561 in Patients with One F508del Mutation and One Minimal Function Mutation |
||||||
|
Mean Absolute Within-Group |
Mean Absolute Within- |
Mean Absolute Within- |
||||
| Triple placebo (n=8) |
+1.2
|
+1.0
|
||||
|
VX-445 (200 mg QD) + tezacaftor |
+11.7
|
-33.6
|
||||
| * all p-values are within group p-values based on mixed effect models; values expressed as ‘Through Day 29' are the average of Day 15 and Day 29 measures | ||||||
A secondary endpoint in the study measured mean absolute within-group change in the respiratory domain score of the CFQ-R1 at Day 29. The mean absolute improvement for patients who received the triple combination was 20.2 points. The improvement for those who received placebo was 20.2 points.
Following discussions with the U.S.
About CF
CF is a rare, life-shortening genetic disease
affecting approximately 75,000 people in
CF is caused by a defective or missing CFTR protein resulting from mutations in the CFTR gene. Children must inherit two defective CFTR genes — one from each parent — to have CF. There are approximately 2,000 known mutations in the CFTR gene. Some of these mutations, which can be determined by a genetic test, or genotyping test, lead to CF by creating non-working or too few CFTR proteins at the cell surface. The defective function or absence of CFTR protein results in poor flow of salt and water into and out of the cell in a number of organs. In the lungs, this leads to the buildup of abnormally thick, sticky mucus that can cause chronic lung infections and progressive lung damage in many patients that eventually leads to death. The median age of death is in the mid-to-late 20s.
About Vertex
Vertex is a global biotechnology company that
invests in scientific innovation to create transformative medicines for
people with serious and life-threatening diseases. In addition to
clinical development programs in CF, Vertex has more than a dozen
ongoing research programs focused on the underlying mechanisms of other
serious diseases.
Founded in 1989 in
Collaborative History with
Vertex initiated its CF research program in 2000 as
part of a collaboration with CFFT, the nonprofit drug discovery and
development affiliate of the
Special Note Regarding Forward-looking Statements
This press
release contains forward-looking statements as defined in the Private
Securities Litigation Reform Act of 1995, including, without limitation,
Dr. Leiden’s statements in the second paragraph and the information
provided regarding (i) the timing and design of the Phase 3 studies of
VX-445 in combination with tezacaftor and ivacaftor, (ii) the potential
to submit approval applications to the
(VRTX-GEN)
1 CFQ-R results reported are based on a mixed effect model not adjusted for baseline CFQ-R
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