LICENSING
ATLANTA, GEORGIA. March 15, 2010 – Portola Pharmaceuticals and Merck today announced the results of EXPLORE-Xa, a Phase 2 exploratory, dose finding study of betrixaban, an investigational oral direct Factor Xa inhibitor. Results showed that a once-daily dose of oral betrixaban, given to patients with non-valvular atrial fibrillation or atrial flutter and at least one risk factor for stroke, reduced the incidence of major and clinically relevant non-major (CRNM) bleeds* compared to dose-adjusted warfarin. The data were presented during a late-breaking clinical trials session at the American College of Cardiology (ACC) 59th Annual Scientific Session in Atlanta.
"Given that bleeding can be a significant safety issue for patients who take warfarin, there is a critical unmet need for anticoagulant therapy options," said U.S. national coordinator in the study, Michael Ezekowitz, MB, ChB, DPhil, vice president of the Lankenau Institute for Medical Research and professor at Jefferson Medical College. "The EXPLORE-Xa study accomplished its objective of providing important information to guide the betrixaban dosing strategy for future investigational studies."
In this multinational, dose-finding study of 508 patients with non-valvular atrial fibrillation or atrial flutter and at least one risk factor for stroke, a once daily dose of betrixaban 40 mg (n=127) demonstrated significantly less major and CRNM bleeding than open label warfarin (n=127, p=0.035). The risk of major and CRNM bleeding for the 60 mg (n=127) and 80 mg (n=127) doses of betrixaban was similar to warfarin.
The primary study endpoint was the time to occurrence of major or CRNM bleeding. The incidence (crude rates) of major or CRNM bleeding was 0.8 percent, 3.9 percent, 3.9 percent and 5.5 percent for the betrixaban 40 mg, 60 mg, and 80 mg and warfarin groups, respectively.
The secondary endpoints included the time to occurrence of any bleeding (major, CRNM, and minimal) and the time to occurrence of death, stroke (ischemic or hemorrhagic), myocardial infarction, or other systemic embolism. The incidence (crude rates) of any bleeding was significantly lower compared to warfarin (31.5 percent) for patients taking betrixaban 40 mg (17.3 percent, p=0.011) and 80 mg (18.9 percent, p=0.022); but not those taking betrixaban 60 mg (25.2 percent, p=0.309). The number of events in the secondary composite endpoint of death, stroke, myocardial infarction or other systemic embolism ranged from 0-1 in each of the four dosing groups, which was the expected stroke/embolic event rate for the warfarin control group. There was one stroke each in the betrixaban 60 mg and 80 mg groups, and one death each in the betrixaban 40 mg and warfarin groups. There were no myocardial infarctions or other systemic emboli in any of the four dosing groups.
The most common adverse events in the betrixaban groups combined (n=381) were diarrhea (6 percent versus 0.8 percent on warfarin); nausea (5.5 percent versus 1.6 percent on warfarin); constipation (5.2 percent versus 2.4 percent on warfarin); headache (5.2 percent versus 2.4 percent on warfarin) and peripheral edema (6.8 percent versus 7.9 percent on warfarin). A numerically higher percentage of patient discontinuations occurred in each of the three betrixaban groups than in the open label warfarin group (8.7-9.4 percent vs. 6.3 percent).
The following factors, among others, could cause actual results to differ from those set forth in the forward-looking statements: the possibility that the expected synergies from the merger of Merck and Schering-Plough will not be realized, or will not be realized within the expected time period, due to, among other things, the impact of pharmaceutical industry regulation and pending legislation that could affect the pharmaceutical industry; the risk that the businesses will not be integrated successfully; disruption from the merger making it more difficult to maintain business and operational relationships; Merck’s ability to accurately predict future market conditions; dependence on the effectiveness of Merck’s patents and other protections for innovative products; the risk of new and changing regulation and health policies in the U.S. and internationally and the exposure to litigation and/or regulatory actions.
Merck undertakes no obligation to publicly update any forward-looking statement, whether as a result of new information, future events or otherwise. Additional factors that could cause results to differ materially from those described in the forward-looking statements can be found in Merck’s 2009 Annual Report on Form 10-K and the company’s other filings with the Securities and Exchange Commission (SEC) available at the SEC’s Internet site (www.sec.gov).
* Major bleeding was defined as: a fall in hemoglobin of 2g/dL or more or a transfusion of 2 units of packed cells or whole blood or bleeding at a critical site such as intracranial bleeding.