Biotech Values

[DewDiligence]

HCV: Most Likely to Succeed (IMHO)

[Updated entries for Telaprevir (PROVE-3),
Presidio’s PPI-461, and VRUS’ PSI-938.]


The following paragraphs are in descending order of likelihood of success. There is no claim of completeness in this compilation, i.e. paragraphs 2-6 do not necessarily mention all of the applicable drug candidates within a given grouping.

Please see #msg-42396728 for the distinction between a nucleoside and a nucleotide, and see #msg-43114117 for some historical perspective from the HIV arena.


1. The two leading protease inhibitors: Telaprevir (VRTX/JNJ; phase-3) and Boceprevir (MRK; phase-3). The Telaprevir program is further advanced, so let’s call Telaprevir and Boceprevir 1a and 1b, respectively. Both drugs have shown very impressive efficacy in phase-2 trials, although neither has a completely clean safety profile (see references below).

Telaprevir in the treatment-naïve setting: phase-3 program: #msg-27623529 (ADVANCE study), #msg-26228377 (both studies); phase-2b program: #msg-29019931 (PROVE-1/2 trials made simple), #msg-28746843 (PROVE-1/2 detailed results); C208 study of BID vs TID dosing: #msg-43114192.

Telaprevir in the second-line setting: phase-3 program (REALIZE study): #msg-32901932; phase-2 program: #msg-48759554 (PROVE-3 study), #msg-42965441 (‘107’ open-label extension for PROVE-1/2 failures).

Boceprevir in the treatment-naïve setting: phase-3 program (SPRINT-2 and RESPOND-2): #msg-29474929; phase-2b program: #msg-42086185 (AASLD 2009 abstract re SPRINT-1), #msg-37298987, (interim SPRINT-1 results at EASL 2009), #msg-37298085 (EPO usage), #msg-31190433 (Dew’s musings on SPRINT-1 data).

Boceprevir in the second-line setting: phase-3 (RESPOND-2) study: #msg-29474929.


2. Programs in phase-2b or later: BI 201335 (B-I; phase-2b), a protease inhibitor: #msg-33564560 (phase-2b design), #msg-47877812 (2010 EASL), #msg-42086185 (2009 AASLD); Debio 025 (NVS/Debiopharm; phase-2b), a cyclophilin inhibitor: #msg-46432280; ITMN-191 (Roche/ITMN; phase-2b; a/k/a RG7227), a protease inhibitor: #msg-46797334, #msg-43666728 (Dew’s bearish take), #msg-43632598 (first report of liver tox), #msg-45340745 (phase-2b design change and delay), #msg-47860488, #msg-42016434, #msg-44330890 (phase-1b boosting with ritonavir), #msg-43185247 (INFORM-1 data from AASLD 2009); Locteron (Biolex; phase-2b), a long-acting interferon made in transgenic plants that may qualify for the 505b2 approval pathway: #msg-37298340 (phase-2a data from EASL 2009), #msg-37178496 (phase-2b design), #msg-40953698 (manufacturing agreement); RG7128 (Roche/VRUS; phase-2b), a nucleoside polymerase inhibitor: #msg-46762882 (phase-2b overview), #msg-43836489 (safety evaluation passes in first phase-2b in genotype-1/4), #msg-43185247 (INFORM-1 data from AASLD 2009); Zalbin (HGSI/NVS; BLA/MAA submitted; a/k/a Albuferon/Joulferon): #msg-36140577 (phase-3 data), #msg-36254180 (lack of SPA), #msg-48180658, #msg-48213975 (phase-2b with monthly dosing).


3. Programs in phase-1b/2a with an established MoA: ABT-072 (ABT; phase-2), a non-nucleoside polymerase inhibitor: #msg-47086871; #msg-47060142; ABT-333 (ABT; phase-2a), a nucleoside polymerase inhibitor: #msg-47060142, #msg-42098204; ABT-450 (ABT/Enanta; phase-2a), a protease inhibitor: #msg-47060142, #msg-35708745; ACH-1625 (ACHN; phase-1b), a protease inhibitor: #msg-45339022, #msg-44560695, #msg-44566075; ANA598 (ANDS; phase-2a), a non-nucleoside “palm” polymerase inhibitor: #msg-47053147, #msg-47098741, #msg-47087879, #msg-44645147 (interim phase-2a data), #msg-40064675 (musings on phase-1b data); BMS-650032 (BMY; phase-2a), a protease/NS3 inhibitor that’s being tested in an all-oral trial with BMS-790052: #msg-44700187, #msg-40361108; BMS-790052 (BMY; phase-2a), an NS5A inhibitor that’s being tested in an all-oral trial with BMS-650032: #msg-44700187 (phase-2 combination trial), #msg-47876219 (phase-2a monotherapy data); GS9190 (GILD; phase-2), a non-nucleoside polymerase inhibitor with QT-prolongation issues that GILD is testing in an all-oral combination with GILD’s newly disclosed protease inhibitor GS9256: #msg-46036072; IDX184 (IDIX; phase-2a), a nucleotide polymerase-inhibitor: #msg-47150426 (phase-2a data from 50mg qD cohort), #msg-39719159, (phase-1b monotherapy data), #msg-39720566, #msg-26915921 (MoA and how IDX184 is better than NM283), #msg-47954632 (replicon data in combination with IDX375+IDX320); IFN-alpha-XL (FLML; phase-2a): #msg-44688995; IFN-Lambda (BMY/ZGEN; phase-2): #msg-34768182 (BMY partnership), #msg-43123220 (final phase-1b data), #msg-43360640 (start of phase-2); MK-7009 (MRK; phase-2a), a protease inhibitor: #msg-34337398, #msg-34335327; PSI-7977 (VRUS; phase-2a), a nucleotide polymerase inhibitor that’s a single-isomer version of PSI-7851: #msg-45735193 (start of phase-2a), #msg-40115833 (phase-1b data for PSI-7851); TMC435 f/k/a/ TMC435350 (Medivir/JNJ; phase-2b), a protease inhibitor: #msg-43361309 (overview of phase-2a/2b program at 2009 AASLD), #msg-37298740 (phase-2a data at EASL 2009), #msg-45415884 (2010 PK trial re hepatic impairment); VX-222 (VRTX; phase-2; a/k/a VCH-222), a non-nucleoside “thumb” polymerase inhibitor (acquired from ViroChem) being tested with Telaprevir+SoC as well as with Telaprevir alone: #msg-47189924 (combo trial with Telaprevir), #msg-47242513 (musings on combo trial), #msg-47879091 (monotherapy data from 2009 EASL).


4. Very-early-stage programs with an established MoA: ACH-2684 (ACHN; preclinical), a protease inhibitor: #msg-46160360; EDP-239 (Enanta; preclinical): an NS5A inhibitor: #msg-47301187; ‘hyperglycosylated’ interferon (Alios BioPharma; preclinical): #msg-35612425; IDX320 (IDIX; phase-1), a macrocyclic protease inhibitor: #msg-45598790) (rationale for program), #msg-47954632 (replicon data in combination with IDX184+IDX375); IDX375 (IDIX; phase-1), a non-nucleoside “palm” polymerase inhibitor: #msg-45350536 (phase-1 PK data), #msg-47954632 (replicon data in combination with IDX184+IDX320); INX-189 (INHX, preclinical), a nucleotide polymerase inhibitor: #msg-48567678; MK-3281 (MRK; phase-1), a non-nucleoside “thumb” polymerase inhibitor: #msg-42093301 (safety signal in AASLD 2009 abstract); PPI-461 (Presidio Pharma; preclinical), an NS5A inhibitor: #msg-48720121; PSI-938 (VRUS; phase-1), a purine-analog nucleotide prodrug: #msg-48719338; PSI-879 (VRUS; preclinical), a purine-analog nucleotide prodrug billed as the successor to PSI-938: #msg-42245955; an unnamed NS5A inhibitor (IDIX; preclinical): #msg-47110147; an unnamed NS5A inhibitor (GSK via Genelabs; status unknown): #msg-33209281, #msg-33211420; an unnamed NS5A inhibitor (VRTX via ViroChem; preclinical): #msg-36022752.


5. Programs in phase-2 or earlier with a novel MoA: ACH-1095 (ACHN; preclinical), an NS4A inhibitor that GILD dropped while retaining the right to opt back in: #msg-41217537; AVL-181 (Avila Therapeutics; preclinical), a small-molecule drug that purportedly binds to an infected hepatocyte: #msg-47113598; CF-102 (Can-Fite; phase-1/2), a polymerase inhibitor that purportedly induces apoptosis: #msg-39588570; clemizole (Stanford University; preclinical), an NS4B inhibitor: #msg-39883747; CTI-1027 (Conatus; phase-2): #msg-46034554; GI-5005 (GlobeImmune; phase-2), an injectable immunomodulator: #msg-47955988; IL-7 (Cytheris; phase-1/2) an injectable immunomodulator: #msg-33152073; IMO-2125 (IDRA; phase-1), a TLR9 agonist: #msg-44746537; ITX5061 (iTherX; phase-2a), MoA unknown: #msg-35319690; MB11362 (Roche/MBRX; preclinical), MoA undisclosed: #msg-38456136; nitazoxanide (Romark/Chugai; phase-2): #msg-35738696; NOV-205 (NVLT, phase-2), supposedly an immunomodulator: #msg-48269914; SCY-635 (Scynexis; phase-1b), a cyclophilin inhibitor: #msg-46669845; SD-101 (DVAX; phase-1b), a TLR9 agonist: #msg-45932364; SPC3649 (Santaris; preclinical), MoA based on microRNA: #msg-44177354; an unnamed entry inhibitor (PGNX; preclinical): #msg-38519885; an unnamed miR-122 inhibitor (GSK/Regulus; preclinical): #msg-47081015.


6. Programs on the back burner: A-831 (AZN; status unknown), an NS5A inhibitor: #msg-16682361 (acquisition), #msg-47300638 (possible termination); ANA773 (ANDS; phase-1), an oral TLR7 modulator that ANDS discontinued in Jun 2009 and is nominally available for partnering: #msg-38418158; SCH 900518/narlaprevir (MRK; phase-2a), a protease inhibitor originally owned by Schering-Plough that MRK discontinued following a pipeline pruning: #msg-47224801 (3/1/10 announcement of discontinuation), #msg-43169835 (interim phase-2a data), #msg-34338549 (final phase-1b data); taribavirin (VRX; phase-2b), a “legacy” prodrug of ribavirin that has been floating around for a long time: #msg-38280961 (musings on final phase-2b data), #msg-37299101 (detailed 60-week data); VX-813/VX-985 (VRTX; phase-1/preclinical), protease inhibitors that were previously touted as the backups to Telaprevir: #msg-45333927.


JMHO, FWIW