-- Evotaz is the first and only protease inhibitor pharmacoenhanced by
cobicistat that is supported by comparative Phase III clinical trial
data
-- Evotaz is the only protease inhibitor pharmacoenhanced by cobicistat
with virologic failure rates as low as 6% [HIV-1 RNA =50 copies/mL at 48
weeks: 6% Evotaz arm; 4% Reyataz®(atazanavir)/ritonavir arm]*
PRINCETON, N.J.--(BUSINESS WIRE)--
Bristol-Myers
Squibb Company (NYSE:BMY) announced today that the U.S. Food and
Drug Administration (FDA) has approved Evotaz (atazanavir 300 mg
and cobicistat 150 mg) tablets in combination with other antiretroviral
agents for the treatment of HIV-1 infection in adults. Evotaz is
coformulated to be one pill, once-daily, combining the protease
inhibitor atazanavir, which is marketed as Reyataz (atazanavir
200 mg/300 mg) capsules, and cobicistat, a pharmacokinetic enhancer
marketed by Gilead Sciences, Inc. Today's approval offers patients
living with HIV an innovative treatment option that delivers proven
suppression (HIV-1 RNA <50 copies/mL, 85% Evotaz arm; 87% Reyataz/ritonavir
arm) through 48 weeks.
The use of Evotaz in patients who have previously received HIV
medication should be guided by their baseline resistance to protease
inhibitors. Evotaz and Reyataz do not
cure HIV-1 infection or AIDS. Evotaz is contraindicated in
patients with previously demonstrated clinically significant
hypersensitivity (e.g., Stevens-Johnson syndrome, erythema multiforme,
or toxic skin eruptions) to any of the product components and in
combination with certain drugs. See Evotaz full contraindications
in the Important Safety Information section below.
As a dedicated partner to the HIV community for more than 20 years,
Bristol-Myers Squibb continues to discover and develop innovative
therapies to meet the needs of a broad range of patients living with
HIV. There are approximately 50,000 new cases of HIV each year, with an
estimated 1.1 million people living with the condition in the U.S. While
many are diagnosed and undergoing treatment, only one quarter are
virally suppressed, demonstrating the continued need for additional
treatments to help patients achieve viral suppression.
"We are pleased to provide physicians and patients with an important new
option to treat HIV; atazanavir with cobicistat delivers sustained
efficacy and safety through 48 weeks, as demonstrated through its
rigorous clinical development plan, including a head-to-head Phase III
trial," said Murdo Gordon, Head of Worldwide Markets, Bristol-Myers
Squibb. "Evotaz increases the possibility of providing HIV
suppression by combining reduced pill burden with a low rate of
virologic failure (6% Evotaz arm; 4% Reyataz/ritonavir
arm) and zero protease inhibitor mutations." In the Evotaz arm,
zero patients developed tenofovir-associated resistance K65R; two
patients developed emtricitabine resistance M184V. In the Reyataz
/ritonavir arm, zero resistance was observed.
Evotaz is the first and only protease inhibitor pharmacoenhanced
by cobicistat that is supported by comparative Phase III trial data
(Gilead Sciences, Inc.'s Study 114). The randomized, double-blind
clinical trial (N=692) evaluated the efficacy and safety of Reyataz
300 mg with cobicistat 150 mg (the components of Evotaz) (n=344)
versus Reyataz 300 mg with ritonavir 100 mg (Reyataz/ritonavir)
(n=348), another pharmacokinetic enhancing agent, in combination with
emtricitabine/tenofovir disoproxil fumarate in treatment-naive adults.
Patients had a baseline estimated CrCL >70mL/min, a mean baseline plasma
HIV-1 RNA of 4.8 log10 copies/mL, and a mean baseline CD4+
cell count of 352 cells/mm. At 48 weeks, 85% of patients in the Evotaz
arm achieved HIV-1 RNA levels of <50 copies/mL compared to 87% of
patients in the Reyataz/ritonavir arm. Low rates of virologic
failure (HIV-1 RNA >=50 copies/mL: 6% Evotaz arm; 4% Reyataz/ritonavir
arm) were observed at 48 weeks, making Evotaz the only protease
inhibitor pharmacoenhanced with cobicistat with virologic failure rates
as low as 6%.
In the study, zero protease inhibitor resistance was detected through 48
weeks. No patients developed tenofovir associated resistance,
and two patients in the Evotaz arm developed
emtricitabine associated resistance. Various degrees of resistance and
cross-resistance have been observed among protease inhibitors; however,
resistance to atazanavir may not preclude the use of other protease
inhibitors.
"Maintaining sufficient drug concentrations inhibits viral replication
and prevents the development of resistance, which are critical
considerations in treating patients with HIV," said study investigator
Joel Gallant, associate medical director of Specialty Services at
Southwest CARE Center in Santa Fe, New Mexico, and adjunct professor of
medicine in the Division of Infectious Diseases at the Johns Hopkins
University School of Medicine. "Pharmacokinetic studies and a large
clinical trial have demonstrated that we can expect the same atazanavir
drug levels and clinical efficacy from Evotaz as with
ritonavir-boosted Reyataz with one less pill."
Evotaz demonstrated a safety profile comparable to Reyataz/ritonavir.
The most common moderate to severe adverse events in the Evotaz arm
and Reyataz/ritonavir arm were: rash (5%, 4%); jaundice (5%, 3%);
ocular iterus (3%, 1%); nausea (2%, 2%). There were similar low rates of
discontinuation due to adverse events (AEs) with Evotaz as
compared to Reyataz/ritonavir (7% and 7%, respectively).
Additional research confirmed that Evotaz is bioequivalent to the
co-administration of its components, Reyataz and cobicistat, when
given with a light meal.
In October 2011, Bristol-Myers Squibb announced a licensing agreement
with Gilead for the development and commercialization of a once-daily,
fixed-dose combination product of atazanavir and cobicistat, now
named Evotaz. Under the terms of the agreement,
Bristol-Myers Squibb and its affiliates are responsible for the
formulation, manufacturing, registration, distribution and
commercialization of the Evotaz fixed-dose combination product
worldwide. Gilead retains sole rights for the manufacture, development
and commercialization of cobicistat as a stand-alone product and for use
in combination with other agents.
About Reyataz (atazanavir)
Since the approval of Reyataz, a component of Evotaz, in
July 2003, more than 7 million prescriptions have been filled in the US*
for once-daily administration, with or without ritonavir as part of an
HIV-1 regimen.
Reyataz is indicated in combination with other antiretroviral
agents for the treatment of HIV-1 infection for patients 3 months and
older weighing at least 10 kg. Reyataz is not recommended for use
in pediatric patients less than 3 months due to the risk of kernicterus.
Use of Reyataz with ritonavir in treatment-experienced patients
should be guided by the number of baseline primary protease inhibitor
resistance substitutions. Reyataz is contraindicated in patients
with previously demonstrated clinically significant hypersensitivity
(e.g., Stevens-Johnson syndrome, erythema multiforme or toxic skin
eruptions) to any of the product components. See Reyataz full
contraindications in the Important Safety Information section below.
For more information, please visit www.reyatazhcp.com.
About Bristol-Myers Squibb's HIV Research Portfolio
For more than 20 years, Bristol-Myers Squibb has focused on discovering,
developing and delivering innovative medicines to help meet the needs of
patients living with HIV-1 and continues to pursue advances in
treatment, for both children and adults with HIV-1. Studies are ongoing
for new treatments including an HIV-1 attachment inhibitor (BMS-663068),
an HIV-1 maturation inhibitor (BMS-955176) and an anti-PD-L1
(BMS-936559).
INDICATIONS for Evotaz (atazanavir and cobicistat) and Reyataz
(R) (atazanavir)
Evotaz is a fixed dose combination of atazanavir and cobicistat,
and is indicated for use with other antiretroviral agents for the
treatment of HIV-1 infection in adults.
Reyataz is indicated in combination with other antiretroviral
agents for the treatment of HIV-1 infection in adults, and for patients
3 months and older weighing at least 10 kg.
LIMITATIONS OF USE
-- Use of Evotaz or Reyataz/ritonavir in treatment-experienced patients
should be guided by the number of baseline primary protease inhibitor
resistance substitutions
-- Reyataz is not recommended for use in patients less than 3 months due to
the risk of kernicterus
IMPORTANT SAFETY INFORMATION for EVOTAZ and REYATAZ
CONTRAINDICATIONS
EVOTAZ and REYATAZ are contraindicated:
-- In patients with previously demonstrated clinically significant
hypersensitivity (e.g., Stevens-Johnson syndrome, erythema multiforme,
or toxic skin eruptions) to any of the product components
-- When coadministered with drugs highly dependent on CYP3A or UGT1A1 for
clearance and for which elevated plasma concentrations of the
interacting drugs are associated with serious and/or life-threatening
events. The following are contraindicated with EVOTAZ and
REYATAZ:alfuzosin, rifampin, irinotecan, triazolam, orally administered
midazolam, dihydroergotamine, ergotamine, methylergonovine, cisapride,
St. John’s wort (Hypericum perforatum),lovastatin, simvastatin,
pimozide, sildenafil when used for pulmonary arterial hypertension,
indinavir, nevirapine. Additionally, EVOTAZ is contraindicated with:
dronedarone, ranolazine, lurasidone, colchicine in patients with renal
and/or hepatic impairment. Additionally, REYATAZ is contraindicated with
ergonovine
-- When coadministered with drugs that strongly induce CYP3A and may lead
to lower exposure and loss of efficacy of EVOTAZ and REYATAZ
WARNINGS AND PRECAUTIONS
The following Warnings & Precautions are associated with EVOTAZ
(atazanavir and cobicistat) and REYATAZ (atazanavir):
-- Cardiac Conduction Abnormalities:PR interval prolongation may occur in
some patients. Atrioventricular (AV) conduction abnormalities were
asymptomatic and generally limited tofirst-degree AV block. There have
been reportsof second-degree AV block and other conduction
abnormalities. There is limited clinical experience in patients with
preexisting conduction system disease such as marked first degree AV
block or second or third degree AV block. Consider ECG monitoring in
these patients
-- Rash:Cases of Stevens-Johnson syndrome, erythema multiforme, and toxic
skin eruptions, including drug rash, eosinophilia, and systemic symptoms
(DRESS) syndrome, have been reported in patients receiving atazanavir.
Discontinue if severe rash develops. Mild-to-moderate maculopapular skin
eruptions have also been reported, and generally did not require
discontinuation of treatment
-- Nephrolithiasis and cholelithiasishave been reported during
postmarketing surveillance in HIV-infected patients receiving
atazanavir. Somepatients required hospitalization and some had
complications. If signs or symptoms of nephrolithiasis and/or
cholelithiasis occur, consider temporary interruption or discontinuation
of therapy
-- Hepatotoxicity:Patients with hepatitis B or C viral infections or marked
elevations in transaminases are at risk of further transaminase
elevations or hepatic decompensation. In these patients, hepatic
laboratory testing should be performed before and during therapy
o EVOTAZis not recommended in patients with hepatic impairment
o REYATAZ/ritonaviris not recommended in patients withhepatic impairment
o REYATAZ is not recommended for patients with severe hepatic impairment
-- Hyperbilirubinemia:Reversible, asymptomatic elevations in indirect
(unconjugated) bilirubin occurred in most patients treated with
atazanavir. There are no long-term safety data for patients with
persistent elevations in total bilirubin >5 times upper limit of normal.
Alternative antiretroviral therapy may be considered if jaundice or
scleral icterus present cosmetic concerns
-- Immune reconstitution syndrome has been reported in patients treated
with combination antiretroviral therapy, including atazanavir.
Autoimmune disorders (such as Graves’ disease, polymyositis, and
Guillain-Barre syndrome) have also been reported to occur in the setting
of immune reconstitution; however, the time to onset is more variable,
and can occur many months after initiation of treatment
-- Diabetes mellitus/hyperglycemia:New onset of diabetes, exacerbation of
preexisting diabetes, and hyperglycemia have been reported in
postmarketing surveillance in HIV-infected patients treated with
protease inhibitor therapy. A causal relationship has not been
established
-- Fat Redistributionor accumulation of body fatincluding central obesity,
dorsocervical fat enlargement (buffalo hump), peripheral wasting, breast
enlargement, and “cushingoid appearance” have been seen in patients
receiving antiretroviral therapy. A causal relationship has not been
established
-- Hemophilia:Increased bleeding has been reported in patients with
hemophilia type A and B treated with protease inhibitors. A causal
relationship has not been established
EVOTAZ (atazanavir and cobicistat): ADDITIONAL WARNINGS AND
PRECAUTIONS
-- Effects on Serum Creatinine:Cobicistat decreases estimated creatinine
clearance (CrCl) by inhibiting the tubular secretion of creatinine
without affecting actual renal glomerular function. This effect should
be considered when interpreting changes in estimated CrCl in patients
initiating EVOTAZ, particularly in patients with medical conditions or
receiving drugs needing monitoring with estimated CrCl. Prior to
initiating therapy with EVOTAZ, assess estimated CrCl. Dosage
recommendations are not available for drugs that require dosage
adjustment in cobicistat-treated patients with renal impairment.
Consider alternative medications that do not require dosage adjustments
in patients with renal impairment. Patients who experience a confirmed
increase in serum creatinine of greater than 0.4 mg/dL from baseline
should be closely monitored for renal safety
-- New onset or worsening renal impairment when used with tenofovir
disoproxil fumarate:Renal impairment, including cases of acute renal
failure and Fanconi syndrome, has been reported when cobicistat was used
with tenofovir disoproxil fumarate (tenofovir DF).
o Coadministration of EVOTAZ and tenofovir DF is not recommended in
patients who have an estimated creatinine clearance below 70 mL/min
o When EVOTAZ is used with tenofovir DF, evaluate baseline and perform
routine monitoring of estimated CrCl, urine glucose, and urine
protein. Measure serum phosphorus in patients at risk for renal
impairment
o Coadministration of EVOTAZ and tenofovir DF in combination with
concomitant or recent use of a nephrotoxic agent is not recommended
-- Risk of Serious Adverse Reactions or Loss of Virologic Response Due to
Drug Interactions:Coadministration of EVOTAZ with medications that are
metabolized by CYP3A may lead to increased exposures of these
medications, which may increase the risk of clinically significant
adverse reactions (including life-threatening or fatal reactions).
Coadministration of EVOTAZ with CYP3A inducers may lead to lower
exposure of atazanavir and cobicistat and loss of efficacy of atazanavir
and possible resistance. The potential for drug interactions prior to
and during EVOTAZ therapy should be considered, review concomitant
medications and monitor patients for adverse reactions
-- Antiretrovirals that are Not Recommended:EVOTAZ is not recommended in
combination with other antiretroviral drugs that require CYP3A
inhibition to achieve adequate exposures (e.g. other HIV protease
inhibitors or elvitegravir) because dosing for such combinations has not
been established; coadministration may lead to loss of therapeutic
effect and development of resistance
EVOTAZ is not recommended in combination with products containing the
individual components of EVOTAZ (atazanavir or cobicistat) or in
combination with ritonavir containing products
REYATAZ: ADDITIONAL WARNING AND PRECAUTION
-- Patients with Phenylketonuria:Phenylalanine can be harmful to patients
with phenylketonuria (PKU). REYATAZ oral powder contains phenylalanine
(a component of aspartame). REYATAZ capsules do not contain
phenylalanine
-- Resistance/cross resistancein various degrees have been observed among
protease inhibitors
MOST COMMON MODERATE OR SEVERE ADVERSE REACTIONS
EVOTAZ (atazanavir and cobicistat), regardless of causality:
-- In treatment-naive adults(=2%): nausea (2%), ocular icterus (3%),
jaundice (5%), rash (5%)
REYATAZ (atazanavir), regardless of causality:
-- In treatment-naive adults(=2%): nausea (4-14%), jaundice/scleral icterus
(5-7%), rash (3-7%), headache (1-6%), abdominal pain (4%), vomiting
(3-4%), peripheral neurologic symptoms (<1-4%), diarrhea (1-3%),
insomnia (<1-3%), and dizziness (<1-2%)
-- In treatment-experienced adults(=2%): jaundice/scleral icterus (9%),
myalgia (4%), diarrhea (3%), depression (2%), and fever (2%)
-- In pediatric patients taking the capsule formulation(=5%): cough (21%),
fever (18%), jaundice/sclera icterus (15%), rash (14%), vomiting (12%),
diarrhea (9%), headache (8%), peripheral edema (7%), extremity pain
(6%), nasal congestion (6%), oropharyngeal pain (6%), wheezing (6%), and
rhinorrhea (6%)
-- In pediatric patients taking the oral powder formulation:the adverse
reactions were generally similar to that observed in clinical studies of
REYATAZ in pediatric patients taking the capsule formulation
DRUG INTERACTIONS
EVOTAZ: Coadministration of EVOTAZ and the following drugs is
not recommended
-- efavirenz, etravirine, ritonavir, boceprevir, telaprevir, simeprevir,
apixaban, rivaroxaban, dabigatran etexilate (in specific renal
impairment groups), voriconazole, salmeterol, avanafil, inhaled or nasal
corticosteroids that are metabolized by CYP3A
-- when EVOTAZ is coadministered with tenofovir DF and an H2-receptor
antagonist in treatment-experienced patients
-- proton pump inhibitors in treatment-experienced patients
REYATAZ: Coadministration of REYATAZ and the following drugs
is not recommended
-- salmeterol
-- when REYATAZ is coadministered with ritonavir: boceprevir, other HIV
protease inhibitors, voriconazole
-- when REYATAZ is coadministered without ritonavir: carbamazepine,
phenytoin, phenobarbital, bosentan, buprenorphine
-- in treatment-experienced patients: proton pump inhibitors or efavirenz
-- in patients with renal or hepatic impairment: cholchicine
See Table 5 of the EVOTAZ Full Prescribing Information, and Table 16
of the REYATAZ Full Prescribing Information for additional established
and potentially significant Drug Interactions, and related dose
modification recommendations.
EVOTAZ and REYATAZ: Use in Renal Impairment
-- EVOTAZ and REYATAZ should not be used in treatment-experienced patients
with end-stage renal disease managed with hemodialysis
Please click
here for the EVOTAZ full prescribing information
Please click
here for the REYATAZ full prescribing information
About Bristol-Myers Squibb
Bristol-Myers Squibb is a global biopharmaceutical company whose mission
is to discover, develop and deliver innovative medicines that help
patients prevail over serious diseases. For more information, please
visit http://www.bms.com
or follow us on Twitter at http://twitter.com/bmsnews.
Bristol-Myers Squibb Forward Looking Statement
This press release contains "forward-looking statements" as that term
is defined in the Private Securities Litigation Reform Act of 1995
regarding the research, development and commercialization of
pharmaceutical products. Such forward-looking statements are based on
current expectations and involve inherent risks and uncertainties,
including factors that could delay, divert or change any of them, and
could cause actual outcomes and results to differ materially from
current expectations. No forward-looking statement can be guaranteed.
Among other risks, there can be no guarantee that Evotaz will become a
commercially successful product. Forward-looking statements in this
press release should be evaluated together with the many uncertainties
that affect Bristol-Myers Squibb's business, particularly those
identified in the cautionary factors discussion in Bristol-Myers
Squibb's Annual Report on Form 10-K for the year ended December 31, 2013
in our Quarterly Reports on Form 10-Q and our Current Reports on Form
8-K. Bristol-Myers Squibb undertakes no obligation to publicly update
any forward-looking statement, whether as a result of new information,
future events or otherwise.
*Includes patients who had HIV-1 RNA >=50 copies/mL in the Week 48
window; patients who discontinued early due to lack of efficacy;
patients who discontinued for reasons other than an adverse event,
death, or loss of efficacy and at the time of discontinuation had HIV-1
RNA >=50 copies/mL

CONTACT: Bristol-Myers Squibb
Media:
Chris Clark, 609-252-6269
chris.clark@bms.com
or
Investors:
Ranya Dajani, 609-252-5330
ranya.dajani@bms.com
or
Ryan Asay, 609-252-5020
ryan.asay@bms.com
Source: Bristol-Myers Squibb Company
Bristol-Myers Squibb
Media:
Chris Clark, 609-252-6269
chris.clark@bms.com
or
Investors:
Ranya Dajani, 609-252-5330
ranya.dajani@bms.com
or
Ryan Asay, 609-252-5020
ryan.asay@bms.com