Showing posts with label Hepatitis. Show all posts
Showing posts with label Hepatitis. Show all posts

Friday, 26 July 2013

Mechanism discovered behind development of autoimmune hepatitis

Main Category: Liver Disease / Hepatitis
Also Included In: Immune System / Vaccines;  Genetics
Article Date: 25 Jul 2013 - 1:00 PDT Current ratings for:
Mechanism discovered behind development of autoimmune hepatitis
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A gene mutation disrupts the activity of certain immune cells and causes the immune system to erroneously attack the liver, according to a new animal study from the Icahn School of Medicine at Mount Sinai. The findings, published in the Journal of Clinical Investigation, will provide a new model for studying drug targets and therapies for Autoimmune Hepatitis (AIH), a condition for which the only treatment options are short-acting steroids or liver transplant.

T-cells, immune cells created in an organ called the thymus, grow into healthy T-cells with the help of medullary thymic epithelial cells (mTECs). mTECs act as coaches to T-cells to teach them when to attack tissue that might be harmful and when to leave it alone. T-cells that attack healthy body tissue are programmed to die. Led by Konstantina Alexandropoulos, PhD, Associate Professor of Medicine in the Division of Clinical Immunology at Mount Sinai, the research team sought to create a model for understanding why certain immune cells called T-cells inappropriately attack healthy tissues in the body, leading to inflammation and autoimmune diseases like lupus, rheumatoid arthritis, and AIH.

Dr. Alexandropoulos and her team, consisting of Anthony Bonito, first author and PhD candidate at Mount Sinai and contributing author Costica Aloman, PhD, former Assistant Professor of Medicine in the Division of Liver Diseases at Mount Sinai, created mutations in a gene called Traf6 in a mouse model, which caused depletion of mTECs. The research team hypothesized that without mTECs to coach them, T-cells would aberrantly attack healthy cells. Surprisingly, while the depletion of mTECs did cause an autoimmune reaction, the T-cells homed directly to the liver and attacked it rather than other healthy tissue.

"We thought that deleting Traf6 would trigger an autoimmune reaction due to a depletion of mTECs, but did not expect the autoimmune response to be specific to the liver," said Dr. Alexandropoulos. "These findings provide an exciting new animal model to study AIH. We hope that this research will pave the way for new therapies to address a significant unmet need for people with this disease."

Dr. Alexandropoulos and her team hope to identify and study compounds or proteins that prevent the depletion of mTECs using cells from humans with AIH. Mount Sinai has one of the largest cohort of patients in the country to support research on liver diseases such as AIH.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our liver disease / hepatitis section for the latest news on this subject.

This research was supported by grants R01 AI49387-01, R56 AI049387-05, and R01 AI068963-01 from the National Institute of Allergy and Infectious Disease, a division of the National Institutes of Health.

The Mount Sinai Hospital / Mount Sinai School of Medicine

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Treating people who use drugs is the first step towards eliminating hepatitis C - international guidelines for treatment released today

Main Category: Liver Disease / Hepatitis
Also Included In: Alcohol / Addiction / Illegal Drugs
Article Date: 25 Jul 2013 - 1:00 PDT Current ratings for:
Treating people who use drugs is the first step towards eliminating hepatitis C - international guidelines for treatment released today
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The burden of liver disease could be dramatically reduced by increasing treatment for hepatitis C infection among people who inject drugs, suggest new recommendations developed by researchers from the Kirby Institute at UNSW, in collaboration with colleagues from the International Network on Hepatitis Care in Substance Users (INHSU).

In Australia, 226,000 people are living with chronic hepatitis C and over 10,000 new cases are reported every year. Hepatitis C can lead to serious liver complications such as liver failure or cancer, which are associated with considerable costs to the health care system. Although almost 80 per cent of all infections occur among people who inject drugs, only one per cent of these people currently receive treatment.

"Treatment for hepatitis C infection among people who inject drugs remains unacceptably low," said Dr Jason Grebely, Senior Lecturer at the Kirby Institute, UNSW, and co-lead author of the recommendations. "Clinicians have been hesitant to recommend treatment in this population because of a lack of understanding about how lifestyle factors may impede successful treatment."

But research supporting the first set of international recommendations ever released for treating hepatitis C in people who inject drugs has shown that treatment can be very successful when barriers are addressed within a supportive environment.

"Reducing the significant burden of liver disease related to hepatitis C in Australia and internationally will require improved assessment and treatment of the population most affected: people who currently inject drugs and those who have injected drugs in the past," says Philip Bruggmann, President of INHSU. "By providing appropriate care to this group, we can reduce the burden of hepatitis C-related liver disease in this vulnerable population and slow the spread of this world-wide epidemic. These new recommendations serve as a first step towards elimination of hepatitis C."

The global recommendations are published online today in the journal Clinical Infectious Diseases ahead of World Hepatitis Day on July 28. They are part of a supplement entitled "Prevention and Management of Hepatitis C Virus Infection Among People Who Inject Drugs: Moving the Agenda Forward", developed in collaboration with INHSU.

Additional Stakeholder Comments:

"These are exceptionally positive and welcome findings. Following the listing of new hep C treatments for subsidy by the Australian Government in April, almost all people in Australia living with hepatitis C in Australia can enjoy cure rates of around 75 to 80 per cent. This new evidence shows us that people who have been least able to access treatment in the past, can and should be able to benefit from these new treatment advances."

Stuart Loveday
CEO of Hepatitis NSW

"This report is most welcomed. It finally provides the much needed endorsement that peer support requires to validate it as an efficacious treatment modality. That combined with the recognition that people who continue to inject or use drugs can access treatment will mean that more people will be able to access treatment. For too long those most affected by hepatitis C have been on the periphery, this report puts them where they belong - front and centre."

Nicky Bath
CEO of the NSW Users and AIDS Association

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our liver disease / hepatitis section for the latest news on this subject. Please use one of the following formats to cite this article in your essay, paper or report:

MLA

Institute, Kirby. "Treating people who use drugs is the first step towards eliminating hepatitis C - international guidelines for treatment released today." Medical News Today. MediLexicon, Intl., 25 Jul. 2013. Web.
26 Jul. 2013. APA
Institute, K. (2013, July 25). "Treating people who use drugs is the first step towards eliminating hepatitis C - international guidelines for treatment released today." Medical News Today. Retrieved from
http://www.medicalnewstoday.com/releases/263862.php.

Please note: If no author information is provided, the source is cited instead.


'Treating people who use drugs is the first step towards eliminating hepatitis C - international guidelines for treatment released today'

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View the original article here

Treating people who use drugs is the first step towards eliminating hepatitis C - international guidelines for treatment released today

Main Category: Liver Disease / Hepatitis
Also Included In: Alcohol / Addiction / Illegal Drugs
Article Date: 25 Jul 2013 - 1:00 PDT Current ratings for:
Treating people who use drugs is the first step towards eliminating hepatitis C - international guidelines for treatment released today
not yet ratednot yet rated

The burden of liver disease could be dramatically reduced by increasing treatment for hepatitis C infection among people who inject drugs, suggest new recommendations developed by researchers from the Kirby Institute at UNSW, in collaboration with colleagues from the International Network on Hepatitis Care in Substance Users (INHSU).

In Australia, 226,000 people are living with chronic hepatitis C and over 10,000 new cases are reported every year. Hepatitis C can lead to serious liver complications such as liver failure or cancer, which are associated with considerable costs to the health care system. Although almost 80 per cent of all infections occur among people who inject drugs, only one per cent of these people currently receive treatment.

"Treatment for hepatitis C infection among people who inject drugs remains unacceptably low," said Dr Jason Grebely, Senior Lecturer at the Kirby Institute, UNSW, and co-lead author of the recommendations. "Clinicians have been hesitant to recommend treatment in this population because of a lack of understanding about how lifestyle factors may impede successful treatment."

But research supporting the first set of international recommendations ever released for treating hepatitis C in people who inject drugs has shown that treatment can be very successful when barriers are addressed within a supportive environment.

"Reducing the significant burden of liver disease related to hepatitis C in Australia and internationally will require improved assessment and treatment of the population most affected: people who currently inject drugs and those who have injected drugs in the past," says Philip Bruggmann, President of INHSU. "By providing appropriate care to this group, we can reduce the burden of hepatitis C-related liver disease in this vulnerable population and slow the spread of this world-wide epidemic. These new recommendations serve as a first step towards elimination of hepatitis C."

The global recommendations are published online today in the journal Clinical Infectious Diseases ahead of World Hepatitis Day on July 28. They are part of a supplement entitled "Prevention and Management of Hepatitis C Virus Infection Among People Who Inject Drugs: Moving the Agenda Forward", developed in collaboration with INHSU.

Additional Stakeholder Comments:

"These are exceptionally positive and welcome findings. Following the listing of new hep C treatments for subsidy by the Australian Government in April, almost all people in Australia living with hepatitis C in Australia can enjoy cure rates of around 75 to 80 per cent. This new evidence shows us that people who have been least able to access treatment in the past, can and should be able to benefit from these new treatment advances."

Stuart Loveday
CEO of Hepatitis NSW

"This report is most welcomed. It finally provides the much needed endorsement that peer support requires to validate it as an efficacious treatment modality. That combined with the recognition that people who continue to inject or use drugs can access treatment will mean that more people will be able to access treatment. For too long those most affected by hepatitis C have been on the periphery, this report puts them where they belong - front and centre."

Nicky Bath
CEO of the NSW Users and AIDS Association

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our liver disease / hepatitis section for the latest news on this subject. Please use one of the following formats to cite this article in your essay, paper or report:

MLA

Institute, Kirby. "Treating people who use drugs is the first step towards eliminating hepatitis C - international guidelines for treatment released today." Medical News Today. MediLexicon, Intl., 25 Jul. 2013. Web.
26 Jul. 2013. APA
Institute, K. (2013, July 25). "Treating people who use drugs is the first step towards eliminating hepatitis C - international guidelines for treatment released today." Medical News Today. Retrieved from
http://www.medicalnewstoday.com/releases/263862.php.

Please note: If no author information is provided, the source is cited instead.


'Treating people who use drugs is the first step towards eliminating hepatitis C - international guidelines for treatment released today'

Please note that we publish your name, but we do not publish your email address. It is only used to let you know when your message is published. We do not use it for any other purpose. Please see our privacy policy for more information.

If you write about specific medications or operations, please do not name health care professionals by name.

All opinions are moderated before being included (to stop spam). We reserve the right to amend opinions where we deem necessary.

Contact Our News Editors

For any corrections of factual information, or to contact the editors please use our feedback form.

Please send any medical news or health news press releases to:

Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional. For more information, please read our terms and conditions.



View the original article here

Thursday, 25 July 2013

4 Months Post-IPO, Enanta Pharmaceuticals Carries Compelling Valuation Next To Hepatitis Peers

By Ivan Deryugin

Since making its market debut in March, shares of Enanta Pharmaceuticals (ENTA) have remained virtually flat, excluding a post-IPO pop (shares closed at $17.18 on March 21, its first day of trading, and at $17.20 on July 23). We don't believe this will be the case for long. Backed by a strong balance sheet, a compelling valuation next to its industry peers, and a solid pipeline, Enanta is well positioned to offer investors meaningful returns.

A Backdoor HCV Play

Enanta, for those unfamiliar with the company, is developing a slate of HCV compounds via two collaboration agreements with AbbVie (ABBV) and Novartis (NVS), the most advanced of which is currently in Phase III trials. The compelling proposition Enanta offers can be highlighted in large part by simply examining its valuation. With 17,818,796 outstanding shares, Enanta carries a market capitalization of just over $300 million. The smallest of the mid- to late-stage HCV developers, Achillion Pharmaceuticals (ACHN), carries a market capitalization of nearly $600 million, and we believe that, despite our being bullish on ACHN, Enanta should rival Achillion in size.

Some investors and industry observers believe that Gilead Sciences (GILD) is the only viable HCV play due to the clinical profile of sofosbuvir, as well as the fact that the drug is already under FDA review. While we freely admit that Gilead is almost certain to capture a majority of the global HCV market [its future prospects in HCV are part of the reason that Gilead has captured the title of "world's largest biotechnology company by market cap" from Amgen (AMGN)], the global HCV market is large enough to accommodate multiple players. And with a valuation of just over $300 million, less than $200M on an EV basis, it doesn't take much to meaningfully move the needle at Enanta.

Enanta and its partners are currently developing three HCV treatments, the most advanced of which is ABT-450, a protease inhibitor now in Phase III trials (more on the economics of this collaboration later) in genotype 1 patients, with a primary completion date of September 2013. We note that in May, Enanta and AbbVie secured Breakthrough Therapy Designation for ABT-450, potentially allowing ABT-450 to reach the market alongside or just behind Gilead's sofosbuvir (Enanta and AbbVie intend to file an NDA for ABT-450 by mid-2014). ABT-450 is currently being tested in 4 separate clinical programs in several "HCV cocktails." The 4 programs include:

ABT-450 with ABT-267 and ABT-333 (2 proprietary HCV treatments in development by AbbVie; ABT-267 is an NS5A, and ABT-333 is a non-nucleotide), as well as ribavirinABT-450 with ABT-267 and ABT-333ABT-450, ABT-267, and ribavirinABT-450, ABT-333, and ribavirin

Given that patients taking these drugs will need to take at least three medicines, it's easy to see that convenience is not ABT-450's selling point. But existing clinical data suggests compelling efficacy and safety. In May, Enanta and AbbVie released new Phase IIb data from AbbVie's Aviator trial. The results showed that ABT-450, when combined with AbbVie's two proprietary direct-acting antivirals, resulted in minimum SVR's (sustained viral response) of 83%, with the highest SVR's coming in at 99% after 12 weeks of treatment. Phase IIb efficacy data is summarized below (ribavirin will be referred to as RBV.

Phase IIb ABT-450 Regimen Efficacy

ABT-450/r

ABT-267

ABT-333

RBV

ABT-450/r

ABT-267

ABT-333

RBV

ABT-450/r

ABT-267

ABT-333

RBV

ABT-450/r

ABT-267

ABT-333

RBV

ABT-450/r

ABT-267

ABT-333

RBV

ABT-450 was most effective when combined with ABT-267, ABT-333, and ribavirin in treatment-naïve patients, with SVR12 of 99%, and SVR24 of 96%. Compelling efficacy was also seen in null responders, with SVR24 rates as high as 95% in the 450/267/333/RBV arm of the trial. We note that in its Phase III NEUTRINO trial, Gilead's sofosbuvir showed an SVR12 of 90% in genotype 1-treatment naïve patients, lower than the 99% seen in the four-pill regimen tested here, and equal to the 450/267/333 regimen. ABT-450 also showed acceptable safety; just 4 of the 247 patients enrolled in this Phase IIb trial discontinued treatment due to adverse events. Enanta and AbbVie recorded serious events in four patients, although only one (an incident of arthralgia) was believed to be drug-related. Common side effects included headache, fatigue, insomnia, diarrhea, and nausea. One incident of elevated ALT levels and six incidents of abnormal bilirubin were reported as well, but Enanta notes that all seven cases were resolved within the trial, with no dosing interruption. Investors should note that the safety profile of Enanta and AbbVie's regiment is comparable to that of Gilead's sofosbuvir; in its own Phase III trials, sofosbuvir also saw less than 2% patient discontinuation, as well as fatigue, nausea, and headaches.

As data from the Phase IIb trial of ABT-450 show, Enanta and AbbVie's HCV candidate offers acceptable efficacy and safety, both on a standalone basis and in comparison with Gilead's sofosbuvir. And ABT-450 is not the only HCV compound Enanta and AbbVie are developing. The two companies are also developing ABT-493, a protease inhibitor designed to serve as a successor to ABT-450. ABT-493 is in Phase I trials, and the two companies are specifically targeting it to have higher barriers to resistance than ABT-450 or other treatment regimens. Co-dosing of ABT-450 and ABT-493 will occur in Q3 2013, with Phase II trials set to begin in mid-2014. Enanta's third HCV asset is EDP-239, developed in collaboration with Novartis. EDP-239 is now in Phase I trials, with a primary completion date of June 2013. The trial will test EDP-239 in several doses versus placebo, with changes in HCV viral loads serving as the primary endpoint, and with safety, changes in HCV RNA log, and EDP-239 plasma concentrations serving as secondary endpoints. Early data for EDP-239 has suggested the compound warrants further development; Enanta notes that EDP-239 has shown solid ability to overcome resistance in vitro, and has been shown to be synergistic and additive to interferon and direct acting antivirals (also known as DAAs). In addition, EDP-230 has not show cytochrome P450 interactions, and Enanta has determined that the drug is "amenable" to fixed-dose combination regimens. We expect further updates on EDP-239, as well as ABT-450 and ABT-493 when Enanta reports Q3 2013 results in August (the company's fiscal year ends in September).

Partnerships And Financials: The True Upside

Although the clinical data for ABT-450, and early data for both ABT-493 and EDP-239, have been acceptable, the true upside lies in Enanta's collaboration agreements with both AbbVie and Novartis. As we have noted in our previous coverage, Achillion is one of a few development-stage biotechnology companies that has been able to maintain full global rights to its entire pipeline, meaning that the full upside potential of sovaprevir and its other HCV programs belong to Achillion. That makes the company's $600 million market capitalization quite palatable. Enanta, however, has traded away most of the upside potential of its HCV pipeline. But it has done so on highly favorable terms, and when those terms are combined with a market capitalization of just over $300 million, they become highly compelling.

Enanta inked its collaboration agreement with AbbVie (then Abbot Laboratories) in November 2006 in exchange for a $57.2 million upfront payment (inclusive of the purchase of Enanta preferred stock). Since then, Enanta has received an additional $55 million in milestone payments and is entitled to a additional $275M in potential milestone payments ($195 million in development and regulatory milestones, $80 million tied to the development of follow-on products). Enanta will be entitled to tiered royalties on global sales of ABT-450 (ranging from low double digits to twenty percent; Enanta states that the blended royalty rate is in the high teens).

With peak sales of ABT-450 forecast to reach $2 billion, this equates to royalties of $300 million assuming a 15% royalty rate (which in fact may be conservative). However, perhaps the most compelling provision of the AbbVie agreement is the fact that under the terms of the agreement, AbbVie is responsible for all global development, manufacturing, and commercialization costs for ABT-450. Enanta can simply collect potential royalties without contributing a dime to ABT-450's development. Furthermore, Enanta holds an option to co-develop and co-promote ABT-493. Should it exercise the option, Enanta will be required to fund 40% of domestic development and commercialization costs in exchange for 40% of domestic profits. The option may only be exercised after the completion of Phase IIa trials within a pre-determined (but undisclosed) time frame.

Enanta's agreement with Novartis, struck in February 2012, was also done on highly favorable terms. Under the terms of the Novartis agreement (covering EDP-239), Enanta received $34.4 million upfront and $11 million in January 2013 when Novartis initiated Phase I trials of EDP-239. Enanta is entitled to $395 million in potential milestones (the breakdown has not been disclosed), as well as double-digit royalties on sales of EDP-239, ranging from low double digits to high teens. As with ABT-450, Enanta need not contribute a dime to developing EDP-239; all development, manufacturing, and commercialization costs are to be paid by Novartis.

Investors may be curious to note that Enanta still spends millions on research & development (nearly $4 million in Q2 2013). If Enanta's partners are funding all of the costs of its HCV assets, then where is this spending going? R&D spending is tied to Enanta's third collaboration agreement and proprietary programs. In addition to its HCV collaborations with AbbVie and Novartis, Enanta has an agreement in place with the National Institute for Allergies and Infectious Diseases (also known as NIAID). Under the terms of the agreement, struck in November 2011, NIAID will fund pre-clinical and early-stage costs for developing EDP-788, a bicyclolide antibiotic being developed to treat MRSA. Biocyclolides are a new class of macrolide antibiotics developed by Enanta that have been designed to overcome resistance more effectively than existing macrolide products such as Biaxin or Zithromax. IND-enabling studies are now in progress, and Enanta expects to initiate Phase I trials in the first half of 2014. The NIAID contract expired in March 2014, and NIAID has the right to extend it six times through September 2016. Enanta received $14.3 million when the contract was first signed, and is entitled to up to $42.7 million in payments should NIAID exercise all six options. Enanta's remaining R&D expenses are tied to two pre-clinical programs: one for a cyclophilin inhibitor, and another for a nucleotide polymerase inhibitor. Candidate selection for both is expected to occur by the end of the year.

Enanta's recent IPO, as well as milestone payments from its collaboration agreements, have fortified its balance sheet. Enanta ended its most recent quarter with nearly $122 million in cash and investments, and only $1.8 million in debt (tied to a warrant liability related to Enanta's preferred stock). Based on currently outstanding shares, Enanta holds $6.73 in net cash and investment per share. Notably, Enanta's IPO was the company's first equity raise since 2006, and management has stated that the company's present balance of cash and investments will be enough to fund operations for at least 2 years. Enanta's historical financials (those filed in its S-1) offer some insight into its historical burn rate. Enanta generated positive operating cash flow in both 2011 and 2012 due to the receipt of milestone payments. Enanta's maximum operating expenses in fiscal 2010-2012 were $25.299 million, and even if the company's expense run rate were to double, the company would have well over 2 years of capital on its balance sheet. In our view, Enanta may be conservative in its capital and liquidity forecasts, especially in light of the fact that consensus forecasts call for the company to post a profit of 64 cents/share in fiscal 2014 (the year ending September 30, 2014).

Conclusions

The upside potential embedded in Enanta Pharmaceuticals can be simplified into several key financial figures. Enanta, with a market capitalization of less than $307 million (as of the close of trading on July 23) is entitled to up to $670 million in further milestone payments from its agreements with AbbVie and Novartis, and peak ABT-450 royalties of $300 million annually (assuming a 15% royalty rate). That's without ascribing any value to EDP-239, ABT-493, or any of Enanta's earlier stage pipeline assets. Enanta has a solid balance sheet, a set of compelling collaboration agreements, as well as several early stage pipeline assets, assets that have likely been ignored by the market to date. In our view, this sets the stage for meaningful upside heading into Phase III ABT-450 data. Enanta is a compelling long-term holding.

Disclosure: I am long ENTA. I wrote this article myself, and it expresses my own opinions. I am not receiving compensation for it. I have no business relationship with any company whose stock is mentioned in this article. (More...)

Additional disclosure: PropThink is a team of editors, analysts, and writers. This article was written by Ivan Deryugin. We did not receive compensation for this article, and we have no business relationship with any company whose stock is mentioned in this article. Use of PropThink’s research is at your own risk. You should do your own research and due diligence before making any investment decision with respect to securities covered herein. You should assume that as of the publication date of any report or letter, PropThink, LLC and persons or entities with whom it has relationships (collectively referred to as "PropThink") has a position in all stocks (and/or options of the stock) covered herein that is consistent with the position set forth in our research report. Following publication of any report or letter, PropThink intends to continue transacting in the securities covered herein, and we may be long, short, or neutral at any time hereafter regardless of our initial recommendation. To the best of our knowledge and belief, all information contained herein is accurate and reliable, and has been obtained from public sources we believe to be accurate and reliable, and not from company insiders or persons who have a relationship with company insiders. Our full disclaimer is available at www.propthink.com/disclaimer.


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