Keryx Biopharmaceuticals
(Nasdaq: KERX) reported today the randomization of the last patient in its
pivotal Phase 3 clinical trial of Sulonex(TM) (sulodexide oral gelcap), the
Company's lead drug candidate, for the treatment of diabetic nephropathy.
This Phase 3 clinical program, with a total of 1,057 randomized patients
worldwide, is being conducted under the Subpart-H guidelines for
accelerated approval pursuant to a Special Protocol Assessment (SPA) with
the Food and Drug Administration (FDA). Based on the completion of
randomization, the Company expects to have the last patient complete the
six months of active treatment before the end of the year.
The Phase 3 clinical program is a multi-center, randomized,
double-blind, placebo-controlled study, comparing 200 mg daily of
Sulonex(TM) versus placebo, with a 1:1 randomization between the two arms.
The objective of this study is to determine the safety and efficacy of
sulodexide in the treatment of patients with type 2 diabetes and persistent
microalbuminuria, or diabetic nephropathy, despite being treated with a
maximum approved or tolerated dose of an angiotensin II receptor blocker
(ARB) or angiotensin-converting enzyme inhibitor (ACEi). The study is
designed for patients to be on treatment for six months, followed by two
months of evaluation off-treatment. During the treatment and off-treatment
evaluation period, all patients in the study population are expected to
continue to receive maximum approved or tolerated doses of ACEis or ARBs.
Patients who were not already on maximum approved or tolerated doses of
ACEis or ARBs for 120 days were required to go into a run- in period prior
to randomization of up to 120 days. This run-in period was designed to
stabilize blood pressure and to confirm persistent microalbuminuria while
the patients are treated with maximum approved or tolerated doses of ACEis
or ARBs.
The primary endpoint for this Phase 3 clinical trial is "therapeutic
success" at 6 months, where therapeutic success is defined as (i)
conversion from microalbuminuria to normoalbuminuria, as measured by
albumin/creatinine ratio (ACR), with at least a 25% reduction in ACR
relative to baseline ACR, or (ii) a 50% reduction in ACR relative to
baseline ACR.
Concurrently with this Phase 3 clinical trial, the Company is
continuing enrollment into its Phase 4 clinical trial, which is a
randomized, double- blind, placebo-controlled study, also comparing 200 mg
daily of Sulonex(TM) versus placebo, with a 1:1 randomization between the
two arms. The objective of this Phase 4 study is to determine the efficacy
of Sulonex(TM) in reducing the rate of progression to End-stage renal
disease and adverse clinical sequelae in patients with type 2 diabetes and
macroalbuminuria or overt diabetic nephropathy, despite being treated with
a maximum approved or tolerated dose of an ARB. All patients in the Phase 4
study population are expected to continue to receive maximum approved or
tolerated doses of ARBs during the course of the study. The Phase 4 study
is designed to enroll approximately 2,200 patients.
The Company has committed to the FDA, as a condition to the approval of
Sulonex based on the Phase 3 clinical trial under the guidelines of
accelerated approval, that the Phase 4 study would be substantially
enrolled at the time of the filing of the NDA for Sulonex. The Company
believes they are on track to meet their commitment with approximately 40%
of the required patients already randomized.
"We are very excited to have reached this significant milestone in the
development of Sulonex(TM) and we are grateful for the tremendous
dedication, support and guidance of the Collaborative Study Group and all
the CSG investigators worldwide who dedicated themselves to completing this
study in a timely-fashion for the potential benefit of their patients,"
stated Michael S. Weiss, Chairman & CEO of Keryx. Weiss added, "We eagerly
await the outcome of this international Phase 3 clinical trial."
Edmund J. Lewis, MD, commented, "This is the largest trial ever
conducted in patients with microalbuminuria and we are pleased that the
Collaborative Study Group could once again lead the development of a novel
agent for this disease. Randomizing this many patients in this timeframe is
testament to the dedication and quality of our CSG investigators. All of us
at the CSG are optimistic about the prospects of Sulonex and are eager to
have this new drug available to treat our patients."
The Sulonex phase 3 and Phase 4 program is being conducted by The
Collaborative Study Group (CSG), the world's largest standing renal
clinical trial group, whose execution of the angiotensin-converting enzyme
(ACE) inhibition trial of captopril in Type 1 diabetic nephropathy and the
angiotensin II receptor blocker (ARB) trial of irbesartan in Type 2
diabetic nephropathy (I.D.N.T. study) both led to FDA approval and the
recommendation of these agents as standards of care by the American
Diabetes Association.
The lead investigator for these studies is Dr. Edmund J. Lewis,
Director of Nephrology at the Rush-Presbyterian-St. Luke's Medical Center
in Chicago and Co-Chairman of the CSG. In North America, the
principal-investigators are Dr. Larry Hunsicker, Professor of Medicine at
the University of Iowa College of Medicine and Co-Chairman of the CSG, and
Dr. Julia Lewis, Professor of Medicine at Vanderbilt University and a
leading member of the CSG.
In Europe, the principal investigators are Dr. Dick de Zeeuw, Professor
and Head of the Department of Clinical Pharmacology at the University
Medical Center in Groningen, the Netherlands, and Dr. Itamar Raz, Professor
of Medicine and Head of the Diabetes Center at the Hadassah Hebrew
University Hospital in Jerusalem, Israel. Dr. de Zeeuw served as one of the
lead investigators in the pivotal Phase 3 study for losartan, an ARB, in
Type 2 diabetic nephropathy (R.E.N.A.A.L. study), which led to FDA approval
of losartan. Dr. Raz played a major role as co-principal investigator in
the I.D.N.T. study. Captopril, irbesartan and losartan are the only three
drugs approved for the treatment of diabetic nephropathy.
The Asian-Pacific principal investigator is Dr. Robert Atkins,
Professor of Medicine, Director of Nephrology at Monash University, in
Melbourne, Australia. Dr. Atkins also played a major role, as co-principal
investigator, in the I.D.N.T. study.
ABOUT THE SPA PROCESS AND SUBPART-H GUIDELINES
The SPA process is a procedure by which the FDA provides official
evaluation and written guidance on the design and size of proposed
protocols that are intended to form the basis for a new drug application
(NDA). Subpart- H guidelines allow for the use of surrogate endpoints in
pivotal Phase 3 trials to support NDA approval, with confirmatory studies
completed post- approval.
In March of 2005, Keryx announced that it had finalized a SPA agreement
with the FDA for the Phase 3 and Phase 4 clinical trials of Sulonex(TM).
The clinical plan to support an NDA approval for Sulonex(TM) under Subpart
H (accelerated approval), as agreed upon with the FDA under an SPA,
consists of: (i) a single Phase 3 trial in patients with microalbuminuria
based on the surrogate marker of regression of microalbuminuria as the
primary endpoint; (ii) supportive data from previously conducted clinical
studies; and (iii) substantial recruitment into our Phase 4 confirmatory study that will
measure clinical outcomes in patients with overt nephropathy, or
macroalbuminuria.
ABOUT SULONEX(TM)
Sulonex (sulodexide oral gelcap) belongs to a proposed new class of
nephroprotective, or kidney protecting, drugs, known as the
glycosaminoglycans. A variety of members of this chemical family have been
shown to decrease pathological albumin excretion in diabetic nephropathy in
humans. Some of the members of this chemical family include the following
approved drugs: standard heparin, low molecular weight heparin and
danaparoid. These agents all require therapy by injection and are all
potent anticoagulants, which are blood thinners capable of inducing
bleeding. Sulonex, on the other hand, is given orally and, in this form,
has demonstrated little, if any, anticoagulant effects to date.
Keryx owns the exclusive rights to use Sulonex(TM) for the treatment of
diabetic nephropathy in North America, Japan and certain other markets
outside of Europe. Diabetic nephropathy is a long-term complication of
diabetes in which the kidneys are progressively damaged. Sulonex is a
glycosaminoglycan compound with structural similarities to the broad family
of marketed heparins and low molecular weight heparins. This drug has been
marketed in a number of European, Asian and South American countries for
many years by our licensor for certain cardiovascular conditions and has an
established safety profile at the doses used for such indications.
Additionally, it has been demonstrated in multiple clinical trials
conducted in Europe and the U.S., including two randomized, double-blind,
placebo-controlled Phase II studies, that Sulonex can reduce urinary
protein excretion in patients with diabetic nephropathy.
Sulonex is in a pivotal Phase 3 and Phase 4 clinical program under a
Special Protocol Assessment, or SPA, with the Food & Drug Administration,
or FDA. These trials are being conducted by the Collaborative Study Group,
or the CSG, the world's largest standing renal clinical trials group.
ABOUT DIABETIC NEPHROPATHY
According to the American Diabetes Association, or the ADA, there are
20.8 million people in the United States (approximately 7% of the
population) who have diabetes. Of this population, approximately 14.6
million have been diagnosed with diabetes, of whom approximately 90-95%
have been diagnosed with Type II diabetes. Type 2 diabetes results from the
combination of insulin deficiency and the body's relative insensitivity to
the insulin present, as opposed to Type 1 diabetes, in which severe insulin
deficiency results from destruction of the insulin-producing beta cells of
the pancreas. Moreover, the ADA estimates that approximately 40% of all
diabetics in the United States, or approximately eight million people, have
diabetic nephropathy. Diabetes is the most common cause of ESRD in the
United States and in many other developed nations, and represents
approximately 45% of all new cases of ESRD in the United States. Despite
advances in clinical care, including improvements in glycemic or blood
sugar control and blood pressure control, the number of Type 1 and Type 2
diabetes-related cases of ESRD continues to rise. In particular, the
incidence of Type II diabetes-related ESRD is rapidly increasing.
Approximately 20% of diabetics on dialysis in the United States survive for
five years, making the mortality of end-stage renal failure in this group
higher than most forms of cancer. Unfortunately, renal transplantation is
an option for less than 15% of diabetics with ESRD, as compared to 35-40%
of non- diabetics, principally due to age and concomitant vascular disease.
Despite recent advances, diabetic nephropathy remains a potentially
catastrophic illness for which partial but insufficient treatment is
currently available.
ABOUT THE COLLABORATIVE STUDY GROUP
The Collaborative Study Group (CSG), the largest standing renal
clinical trials group worldwide, is comprised of academic and tertiary care
physician- researchers interested in collaborative clinical trials
investigating new therapeutic approaches in the treatment of kidney
disease. Since 1979, the CSG has conducted multiple large-scale clinical
trials resulting in over 40 major publications in peer-reviewed journals.
The CSG conducted pivotal trials of ACE Inhibition in Type 1 Diabetic
Nephropathy and of Irbesartan in Type 2 Diabetic Nephropathy (I.D.N.T.),
both of which led to FDA product registration for new indications and the
recommendation of these agents as standard of care by the American Diabetes
Association. The results of each of the CSG's last three major clinical
trials were published in the New England Journal of Medicine. The IDNT
multi-national trial in collaboration with Bristol-Myers Squibb and
Sanofi-Synthelabo is the largest trial in renal disease to date, consisting
of 1,715 patients from 210 investigative sites worldwide. The CSG is
currently conducting the pivotal clinical program for Sulonex(TM),
including both the Phase 3 and Phase 4 studies.
ABOUT KERYX BIOPHARMACEUTICALS, INC.
Keryx Biopharmaceuticals is focused on the acquisition, development and
commercialization of medically important, novel pharmaceutical products for
the treatment of life-threatening diseases, including diabetes and cancer.
Our lead compound under development is Sulonex(TM) (sulodexide), which we
previously referred to as KRX-101, a first-in-class, oral heparinoid
compound for the treatment of diabetic nephropathy, a life-threatening
kidney disease caused by diabetes. Sulonex is in a pivotal Phase 3 and
Phase 4 clinical program under a Special Protocol Assessment, or SPA, with
the Food & Drug Administration, or FDA. Additionally, we are developing
Zerenex(TM), an oral, inorganic, iron-based compound that has the capacity
to bind to phosphorous and form non-absorbable complexes. Zerenex is
currently in Phase II clinical development for the treatment of
hyperphosphatemia (elevated phosphate levels) in patients with end-stage
renal disease, or ESRD. We are also developing clinical-stage oncology
compounds, including KRX-0401, a novel, first-in- class, oral anti-cancer
agent that modulates Akt, a protein in the body associated with tumor
survival and growth, and a number of other key signal transduction
pathways, including the JNK and MAPK pathways, which are pathways
associated with programmed cell death, cell growth, cell differentiation
and cell survival. KRX-0401 is currently in Phase 2 clinical development
for multiple tumor types. We also have an active in-licensing and
acquisition program designed to identify and acquire additional drug
candidates. Keryx is headquartered in New York City.
Cautionary Statement
Some of the statements included in this press release, particularly
those anticipating future performance, future results from the Phase 3 and
Phase 4 clinical trials, timelines for the completion of the Sulonex(TM)
pivotal clinical trial program, including the Phase 3 and the Phase 4
clinical trials, the number of patients and clinical sites included in the
Phase 3 and Phase 4 clinical trials, expectations regarding FDA approval
and commercial launch of Sulonex(TM), market size estimates for
Sulonex(TM), growth and operating strategies and similar matters, are
forward-looking statements that involve a number of risks and
uncertainties. For those statements, we claim the protection of the safe
harbor for forward-looking statements contained in the Private Securities
Litigation Reform Act of 1995. Important factors may cause our actual
results to differ materially, including: our ability to successfully
complete the Sulonex(TM) pivotal clinical program on a cost- effective
basis; failure to meet the endpoints of the Phase 3 or Phase 4 studies; and
other risk factors identified from time to time in our SEC reports,
including, but not limited to, the report on Form 10-K for the year ended
December 31, 2006, and our quarterly report on Form 10-Q for the quarter
ended March 31, 2007. Any forward-looking statements set forth in this news
release speak only as of the date of this news release. We do not intend to
update any of these forward-looking statements to reflect events or
circumstances that occur after the date hereof. This press release and
prior releases are available at keryx. The information in
Keryx's website is not incorporated by reference into this press release
and is included as an inactive textual reference only.
Keryx Biopharmaceuticals, Inc.
keryx
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