NEW YORK, April 23, 2015 (GLOBE NEWSWIRE) -- Intercept Pharmaceuticals, Inc. (Nasdaq:ICPT) (Intercept) announced today the availability of additional post-hoc analyses from the Phase 2b FLINT trial of obeticholic acid (OCA) in patients with nonalcoholic steatohepatitis (NASH) at the International Liver Congress 2015, the 50th Annual Meeting of the European Association for the Study of the Liver (EASL), being held in Vienna, Austria, from April 22-26, 2015. The poster entitled "Obeticholic Acid for NASH: Benefits in a High-Risk Subgroup and the Effects of Concomitant Stain Use" (late-breaker ePoster LP18) is currently available for viewing and will be presented in Room A-09 at 3:30 p.m. CET on Saturday April 25, 2015. The senior authors include Dr. Brent Neuschwander-Tetri, of St Louis University and Dr. Arun Sanyal, former President of the American Association of the Study of Liver Disease, from the NASH Clinical Research Network that conducted the trial.
Advanced liver fibrosis is currently the best predictor of liver-related mortality in patients with NASH, while patients with early disease and concomitant risk factors such as diabetes, obesity or elevated ALT are also at risk of rapid progression to cirrhosis. The efficacy of OCA was evaluated in a high-risk subgroup of NASH patients in the FLINT trial considered more likely to experience liver-related clinical outcomes, defined as patients with a NAFLD activity score (NAS) of at least 4 and either (i) advanced fibrosis (stage 2 or 3), or (ii) early fibrosis (stage 1) together with concomitant diabetes, obesity or elevated ALT. Approximately 80% of the FLINT patients met these high-risk criteria.
In this post-hoc analysis of the high-risk subgroup after 72 weeks of treatment (n=160; OCA=84; placebo=76), a significant percentage of OCA-treated patients experienced complete resolution of their fibrosis (15% OCA vs. 4% placebo, p=0.006). Improvements in fibrosis resolution were observed in OCA-treated patients across all baseline fibrosis stages (stage 1: 31% OCA vs. 11% placebo, stage 2: 16% OCA vs. 3% placebo, stage 3: 3% OCA vs. 0% placebo). Additionally, OCA treatment prevented progression to cirrhosis (2% OCA vs. 7% placebo), but this finding did not achieve statistical significance in this small number of patients. Improvements in cirrhosis prevention were also observed in patients with stage 3 bridging fibrosis (6% OCA vs. 14% placebo) and stage 2 fibrosis (0% OCA vs. 3% placebo).
The results reported today build on previously reported data from post-hoc analyses showing that OCA-treated patients experienced significant improvements in key histologic features of steatohepatitis, including NAS reduction by at least two points (60% OCA vs. 30% placebo, p=0.0004), NASH resolution (18% OCA vs. 5% placebo, p=0.014), and liver fibrosis improvement by at least one stage (39% OCA vs. 21% placebo, p=0.007). These histologic benefits were observed in OCA-treated patients in all subgroups and regardless of baseline fibrosis stage.
The impact of statin use on LDL cholesterol was also evaluated in the FLINT trial population (n=283). In this post-hoc analysis, OCA-treated patients who initiated statins during the FLINT trial (n=26) experienced a rapid reversal of their observed mean LDL increase to below baseline levels, with a mean decrease after 72 weeks of treatment of -18.9 mg/dL. In contrast, other OCA-treated patients with no reported initiation or change in statin therapy experienced an increase in LDL that peaked at week 12 and was sustained over the 72 week treatment period. Patients treated with statins at baseline who maintained statin treatment over the duration of the study (n=50) experienced a mean LDL increase of 8.7 mg/dL at 72 weeks. Patients not treated with statins during the study (n=65) experienced a mean LDL increase of 16.0 mg/dL. Treatment related LDL increases in all groups reversed with treatment discontinuation. This post-hoc analysis suggests that the OCA associated LDL increase appears to reach a maximum peak and plateaus soon after initiation of therapy and that concomitant statin use in NASH patients receiving OCA may ameliorate any treatment-related LDL increases.
"These data add to our understanding of the potential for OCA treatment to reverse fibrosis and prevent progression to cirrhosis, a pharmacologic benefit not previously confirmed in NASH patients," said Dr. Brent Neuschwander-Tetri, the principal investigator of the trial. "Furthermore, the data support the potential for statins to effectively manage LDL in NASH patients, as currently recommended in the AASLD and EASL practice guidelines."
As previously reported in the primary analysis of FLINT, OCA was generally well tolerated. Adverse events were mild to moderate in severity and the incidence in the OCA and placebo treatment groups was similar for all symptoms except pruritus. Compared with placebo, pruritus in OCA-treated patients occurred more frequently (23% vs 6%, p<0.0001). Typically, the pruritus was of moderate intensity and resulted in one patient discontinuation. The incidence of severe or life threatening events was not different between the two treatment groups and most of the events in both groups were deemed to be unrelated to treatment, including all severe or life threatening cardiovascular events. Two deaths occurred in the OCA treatment group; neither was considered related to OCA treatment.
About FLINT
The Farnesoid X Receptor Ligand Obeticholic Acid in Nonalcoholic Steatohepatitis Treatment (FLINT) trial was sponsored by the National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK). FLINT enrolled 283 adult NASH patients at eight U.S. centers comprising the NIDDK's NASH clinical research network (CRN). Patients were randomized to receive either a 25-mg dose of OCA or placebo for 72 weeks. Patients enrolled in the trial were qualified based on a diagnosis determined by liver biopsy at the start of the trial with a NAFLD Activity Score (NAS) of four or greater and with a score of at least one in each component of the NAS eight point scale (steatosis 0-3, lobular inflammation 0-3, ballooning 0-2). End of trial biopsies were conducted in patients after the 72-week treatment period, with all biopsies centrally scored in a blinded fashion. Further details can be found at https://clinicaltrials.gov/ct2/show/NCT01265498. The results from the FLINT trial were published online in The Lancet in November 2014.
About Nonalcoholic Steatohepatitis
NASH is a serious chronic liver disease caused by excessive fat accumulation in the liver that induces chronic inflammation which leads to progressive fibrosis (scarring) that can lead to cirrhosis, eventual liver failure and death. There are currently no drugs approved for the treatment of NASH. Studies have shown that 21-26% of NASH patients will develop cirrhosis over 8.2 years of follow-up and that liver-related mortality due to this disease is ten-fold that of the general population. According to recent epidemiological studies, it is estimated that more than 10% of the U.S. adult population has NASH with more than 60% of patients (potentially more than 14 million in total) believed to have liver fibrosis or cirrhosis due to progression of the disease. The proportion of liver transplants attributable to NASH has increased rapidly in past years and by 2020 the disease is projected to become the leading indication for liver transplant ahead of chronic hepatitis C and alcoholic liver disease. NASH patients with fibrosis are at greater risk of progressing to cirrhosis, liver failure and cancer.
About Intercept and Obeticholic Acid
Intercept is a biopharmaceutical company focused on the development and commercialization of novel therapeutics to treat neglected chronic liver diseases. The company's lead product candidate, obeticholic acid (OCA), is a first-in-class agonist of the farnesoid X receptor (FXR). OCA is being developed for a variety of chronic liver diseases, including primary biliary cirrhosis (PBC), nonalcoholic steatohepatitis (NASH), primary sclerosing cholangitis (PSC) and biliary atresia. The FDA has granted OCA breakthrough therapy designation for the treatment of NASH with fibrosis, a population representing potentially more than 14 million patients in the United States, and granted OCA fast track designation for the treatment of patients with PBC who have an inadequate response to or are intolerant of ursodiol. OCA has also received orphan drug designation in both the United States and Europe for the treatment of PBC and PSC. Intercept owns worldwide rights to OCA outside of Japan, China and Korea, where it has out-licensed the product candidate to Sumitomo Dainippon Pharma. For more information about Intercept, please visit the Company's website at: www.interceptpharma.com.
Safe Harbor Statements
This press release contains "forward-looking statements" within the meaning of the Private Securities Litigation Reform Act of 1995, including, but not limited to, statements regarding the potential utility of the histological primary and secondary endpoints used in FLINT; the potential acceptance by regulatory authorities of the endpoints and data from FLINT; the potential of OCA to treat patients with NASH; the potential for OCA to improve histological features of NASH, including resolving liver fibrosis and limiting progression to cirrhosis; the potential that statin use may ameliorate LDL increases resulting from OCA treatment; the anticipated clinical, regulatory and commercial milestones for OCA, including the anticipated completion of the NDA for OCA in PBC in 2Q 2015 and the anticipated commercial launch of OCA in PBC in 2016; and our strategic directives under the caption "About Intercept." These "forward-looking statements" are based on management's current expectations of future events and are subject to a number of important risks and uncertainties that could cause actual results to differ materially and adversely from those set forth in or implied by such forward-looking statements. These risks and uncertainties include, but are not limited to: the initiation, cost, timing, progress and results of our development activities, preclinical studies and clinical trials; the timing of and our ability to obtain and maintain regulatory approval of OCA, INT-767 and any other product candidates we may develop, particularly the possibility that regulatory authorities may require clinical outcomes data (and not just results based on achievement of a surrogate endpoint) as a condition to any marketing approval for OCA, and any related restrictions, limitations, and/or warnings in the label of any approved product candidates; our plans to research, develop and commercialize our product candidates; the election by our collaborators to pursue research, development and commercialization activities; our ability to attract collaborators with development, regulatory and commercialization expertise; our ability to obtain and maintain intellectual property protection for its product candidates; our ability to successfully commercialize our product candidates; the size and growth of the markets for our product candidates and our ability to serve those markets; the rate and degree of market acceptance of any future products; the success of competing drugs that are or become available; regulatory developments in the United States and other countries; the performance of third-party suppliers and manufacturers; our need for and ability to obtain additional financing; our estimates regarding expenses, future revenues and capital requirements and the accuracy thereof; our ability to retain key scientific or management personnel; and other factors discussed under the heading "Risk Factors" contained in our annual report on Form 10-K for the year ended December 31, 2014 filed on March 2, 2015 as well as any updates to these risk factors filed from time to time in our other filings with the Securities and Exchange Commission. All information in this press release is as of the date of the release, and Intercept undertakes no duty to update this information unless required by law.
This press release contains the results of retrospective analyses presented at a scientific congress. Retrospective analyses after the unblinding of results can potentially introduce bias and regulatory authorities typically give greatest weight to results from pre-specified analyses as compared to retrospective analyses.