Bristol-Myers setback another blow to hep C field

The once-crowded field of candidates jostling to be part of the first all-oral hepatitis C antiviral cocktail got decidedly emptier today with the news that Bristol-Myers Squibb had cancelled development of its $2bn asset BMS-986094. The safety worries that had triggered a clinical hold on the drug turned out too deep to accept – a death in the original heart failure patient, plus nine other hospitalised subjects resulting from heart and kidney toxicity.

Excitement around the space has already dissipated with Gilead Sciences’ seemingly uninterrupted march towards the all-oral holy grail and signs that the untreated population might be smaller than was originally believed. Failure of a closely watched candidate – and indeed one validated by a big pharma deal – will do nothing to reinvigorate the interest of investors whose interest may be turning elsewhere.

Hefty price tag

The news is not necessarily a setback for the nucleoside NS5B polymerase inhibitor class or for Bristol-Myers, which still has a decent pipeline in spite of some failures (see tables). However, it is another knock to sentiment for developers in the hep C space – at least, the ones that are not called Gilead (Signs are growing that the hep C ship is sailing, August 1, 2012).

Hepatitis C nucleoside NS5B polymerase inhibitor pipeline
Status Product Company Selected trial IDs
Phase III GS-7977 Gilead Sciences NCT01497366
NCT01542788
NCT01604850
NCT01641640 
       
Phase II RG7128 Gilead Sciences/Roche NCT00869661
NCT01057667
NCT01278134
  IDX184 Idenix Pharmaceuticals Partial clinical hold
       
Phase I RO5303253 Roche NCT01181024
  RO5428029 Roche NCT01371162
NCT01345942 
  ALS-2200 Vertex Pharmaceuticals NCT01590407 
  ALS-2158 Vertex Pharmaceuticals NCT01554085

As if further confirmation were needed, California-based Gilead is now decisively in the lead to get a much-heralded all-oral hepatitis C combination to the market and address those patients thought to be awaiting a therapy free of interferon and its side effects.

The failure of ‘094 makes Gilead’s decision to go it alone rather than pairing its own $11bn NS5B, GS-7977, with Bristol-Myers’ daclatasvir all the more painful for Bristol-Myers (EASL - Gilead-BMS score all-oral hep C win but will pairing last?, April 19, 2011).

It also calls into question the company’s judgement when it decided to snap up Inhibitex earlier this year for $2.5bn in order to gain access to ‘094 (Bristol-Myers Squibb lays claim to new hep C stake with Inhibitex buyout, January 9, 2012). The New York group announced today that it was taking a $1.8bn charge in the third quarter related to R&D costs.

Selected abandoned Hepatitis C nucleoside NS5B polymerase inhibitor projects
Abandoned phase Product Company Termination Date
Phase II Valopicitabine (NM283) Novartis/Idenix Pharmaceuticals 13/07/2007
  BMS-986094 Bristol-Myers Squibb 23/08/2012
       
Phase I HCV-POL Johnson & Johnson/Medivir 06/04/2012

Collateral damage

It has not been stated exactly why, but only one other drug in the class has been subject to regulators’ caution flag: Idenix Pharmaceuticals’ IDX 184, a project that was under a partial clinical hold once before (Idenix hep C drug hit by cardiovascular worries, August 16, 2012). Analysts contend that the reason IDX 184 and ‘094 are structurally similar and have an identical active metabolite suggests that the metabolite is the toxic agent.

Massachusetts-based Idenix did not make any statements today in the wake of Bristol-Myers’ announcement. Its shares were down 1% to $6.01 in early trade today.

Benefiting from the Bristol-Myers news was Achillion Pharmaceuticals, which other than Idenix remains one of the last independent hep C plays. Its shares were up 3% to $6.80 this morning. It does not hurt the Connecticut firm that it is not testing an NS5B at all, and its lead candidate, sovaprevir, is a protease inhibitor, a drug class that has already seen hep C success in the form of Vertex Pharmaceuticals' Incivek and Merck & Co’s Victrelis.

For a while, hep C had seemed to be the exception to the rule in drug development, producing almost nothing but success and generating some jaw-dropping M&A deals. Although it seems inevitable that an all-oral regimen will soon be launched, it was equally inevitable that expectations would fall back to earth.

To contact the author of this story email Jonathan Gardner in London at jonathang@epvantage.com

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