Researchers seeking to enhance transplant
patient care with less toxic drug regimens presented early findings of a
steroid-free treatment regimen in liver transplant recipients with
hepatitis C. One-year data from an open label study reported Sunday at the
American Transplant Congress (ATC) suggests that a steroid-free treatment
regimen including CellCept® (mycophenolate mofetil) provided comparable
efficacy and safety to a standard steroid-containing protocol. CellCept is
approved for the prevention of organ rejection in combination with
cyclosporine and corticosteroids in patients receiving kidney, heart and
liver transplants.
Steroids have been a cornerstone of transplant therapy for the past 50
years. However, long-term steroid use has shown significant side effects,
which can include bone and muscle problems, eye disease, delayed wound
healing and decreased ability to fight infection. For patients with
hepatitis C, steroids are widely recognized to have an adverse effect on
virus replication, putting them at an increased risk for hepatitis C
recurrence following liver transplantation.
"The question has always been: how do we achieve the right balance of
immunosuppression to prevent acute rejection without over-suppressing the
immune system, which would allow hepatitis C virus to rapidly replicate?"
said Goran Klintmalm, M.D., principal investigator, who is Chief and
Chairman of the Baylor Regional Transplant Institute, Baylor University
Medical Center, Dallas. "In our study, the steroid-free CellCept regimen
demonstrated comparable efficacy, without increasing the risk of hepatitis
C recurrence. We are encouraged by these trends at one year."
Study Background and Results(1)
A total of 312 adult hepatitis C liver transplant patients participated in
the open-label, prospective multicenter study. Patients were randomized to
one of three treatment regimens: tacrolimus and prednisone (arm one);
CellCept, tacrolimus and prednisone (arm two); or CellCept, tacrolimus, and
three-dose Zenapax® (daclizumab) without steroids (arm three). Primary
endpoints in the study were clinically significant differences in acute
cellular rejection (ACR) and/or clinically significant differences in
hepatitis C recurrence. Acute rejection rates were 16%, 9% and 5% in the
three arms, respectively.
A total of 151 patients had one-year follow-up data available for the
preliminary analysis presented at ATC. Study results found that hepatitis
C recurrence was comparable across all arms. Additionally, the
CellCept-based steroid-free regimen was comparable to the standard
steroid-containing regimens in organ survival, patient survival and
incidence of adverse events (infections, malignancies, hyperlipidemia and
diabetes).
Additional Study Underway
"With transplant physicians around the world using CellCept for more than a
decade to prevent organ rejection in their transplant patients, Roche is
looking to the future," said Robert Gordon, M.D., senior medical director
at Roche and a former transplant surgeon. "We're evaluating new,
low-toxicity regimens with CellCept that we hope will further improve
patient outcomes."
Roche recently initiated the Liver Spare the Nephron (STN) study, a
prospective, open-label randomized trial to evaluate low toxicity regimens
including CellCept. The study will take place in more than 35 transplant
centers in the U.S. and Canada. The study, which will recruit 340 liver
transplant recipients, is designed to evaluate the efficacy and safety of a
regimen of CellCept with either sirolimus or standard calcineurin
inhibitors (CNI). Investigators will evaluate the effect of these regimens
on preservation of renal function and prevention of acute rejection, organ
loss and patient survival.
CellCept - A Cornerstone of Treatment for 10 Years
CellCept is an immunosuppressant or anti-rejection drug approved for use in
combination with other immunosuppressive drugs (cyclosporine and
corticosteroids) for the prevention of rejection in patients receiving
kidney, heart and liver transplants. Ten years after its approval by the
FDA, CellCept is the most frequently used branded immunosuppressant in the
United States with more than four million prescriptions filled. CellCept
received FDA approval for the prevention of organ rejection in transplanted
kidneys in 1995, in hearts in 1998 and in livers in 2000.
The FDA approved dosages for CellCept are: for adult kidney transplants, 2
g daily; for pediatric kidney transplants, oral suspension 600 mg/m2; for
adult heart and liver, 3 g/day.
Additional CellCept Information
There are no adequate and well-controlled studies in pregnant women. As
CellCept (mycophenolate mofetil) has been shown to have teratogenic effects
in animals at subclinical doses on a body surface area basis, it may cause
fetal harm when administered to a pregnant woman. CellCept should not be
used in pregnant women unless the potential benefit justifies the potential
risk to the fetus. Women of childbearing potential should have a negative
serum or urine pregnancy test with a sensitivity of at least 50 mIU/mL
within one week prior to beginning therapy even where there has been a
history of infertility, unless due to hysterectomy.
Women of childbearing potential must use effective contraception before
beginning CellCept therapy, during therapy and for six weeks following
discontinuation of therapy. Two reliable forms of contraception must be
used simultaneously unless abstinence is the chosen method. If pregnancy
occurs during treatment, the physician and patient should discuss the
desirability of continuing the pregnancy (see complete product
information).
Adverse events reported in > 30% of renal, cardiac or liver transplant
patients receiving CellCept (in combination with cyclosporine and
corticosteroids) were pain, fever, headache, asthenia, anemia,
leukopenia(2), thrombocytopenia, leukocytosis, urinary tract infection,
hypertension, hypotension, peripheral edema, hypercholesteremia,
hypokalemia, hyperglycemia, creatinine, BUN and cough increased,
hypomagnesemia, diarrhea, constipation, nausea, vomiting, respiratory
infection, dyspnea, lung disorder, pleural effusion, tremor and insomnia.
Patients receiving immunosuppressant regimens are at increased risk of
developing lymphomas and other malignancies, particularly of the skin.
Warning: Increased susceptibility to infection and the possible development
of lymphoma may result from immunosuppression. Only physicians experienced
in immunosuppressive therapy and management of renal, cardiac or hepatic
transplant patients should use CellCept. Patients receiving the drug
should be managed in facilities equipped and staffed with adequate
laboratory and supportive medical resources. The physician responsible for
maintenance therapy should have complete information requisite for the
follow-up of the patient. For full prescribing information, visit
www.rocheusa.com/products/cellcept/pi.html.
About Roche - More Than a Century in the U.S. and the World
Founded in 1896 and headquartered in Basel, Switzerland, Roche is one of
the world's leading innovation-driven healthcare groups. Its core
businesses are pharmaceuticals and diagnostics. Roche is one of the
world's leaders in diagnostics, the leading supplier of pharmaceuticals for
cancer, as well as a leader in virology and transplantation. As a supplier
of products and services for the prevention, diagnosis and treatment of
disease, the Group contributes on many fronts to improve people's health
and quality of life. Roche employs roughly 65,000 people in 150 countries,
including approximately 15,000 in the United States.
Roche's U.S. operations celebrate their American Centennial in 2005. In
another milestone this year, Roche was named in January to Fortune
magazine's list of Best Companies to Work for in America. One of an
increasingly rare breed of major healthcare companies that still bear their
original name, Roche today has more than a dozen U.S. sites located in
California, Colorado, Indiana, New Jersey and South Carolina, as well as in
Puerto Rico. Roche has alliances and research and development agreements
with numerous partners, including majority ownership interests in Genentech
and Chugai. Roche's Pharmaceuticals Division offers a portfolio of leading
medicines in therapeutic areas including cancer, HIV/AIDS, hepatitis C,
transplantation, dermatology and influenza. Roche's Diagnostics Division
supplies a wide array of innovative testing products and services to
researchers, physicians, patients, hospitals and laboratories worldwide.
For further information, please visit our worldwide and U.S. websites
(Global: www.roche.com and U.S.: www.roche.us).
(1) Fasola CG, Klintmalm GB, et al. Abstract #475: Multicenter Randomized
Hepatitis C (HCV) Three Trial Post-Liver Transplantation (OLT): A One-Year
Follow-Up Report.
(2) Patients should be monitored for neutropenia. Dosing should be
interrupted or the dose reduced if neutropenia develops.
Contacts:
Maureen Byrne
Roche
Office: (973) 562-2203
Cell: (973) 800-5097
Freya Leff
Ketchum
Office: (646) 935-4050
Cell: (646) 338-9567