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Bayer forced to halt huge study into key drug

Published on 06/10/17 at 09:22am

Bayer, and development partner Janssen, have been forced to stop a Phase 3 trial looking at expanding the indication of Xarelto into the treatment of recent embolic stroke of undetermined source.

The halt was called after the drug was not able to show any improvement over standard treatment, low-dose aspirin, and, additionally, caused higher rates of bleeding.

The trial was of a considerable size, containing 7,214 patients across 459 sites globally, and represented a major push to expand the indication of the drug commonly used to treat pulmonary embolism and deep thrombosis.

The trial ended in failure, for reasons that Bayer noted in a release: “the trial was halted early as it showed comparable efficacy between the rivaroxaban and aspirin arms and very little chance of showing overall benefit if the study were completed. While bleeding rates were low overall, an increase in bleeding was observed in the rivaroxaban arm compared to the low dose aspirin arm.”

The primary endpoint of the trial was a composite of stroke and system embolism, while the safety endpoint was regarding major bleeding. It will be a big disappointment to both companies involved that the trial ended in failure, with Janssen’s statement on the trial being particularly defensive:

“Xarelto is a highly effective anticoagulant for patients at risk for stroke from atrial fibrillation, as well as for the prevention and treatment of clots in a variety of approved indications,” said Paul Burton, Vice President, Medical Affairs, Janssen. “Results from ROCKET AF and emerging real-world data continue to show the positive benefit of Xarelto in preventing cardiovascular events, including stroke.”

This could be due to the release of a study emerging out of Taiwan shortly before the collapse of the trial was announced. In research from Chang Gung Memorial Hospital, in Taiwan, a study found that using nonvitamin K oral anticoagulants (NOACs), of which Xarelto is one, there was a potential for drug interactions with four other commonly prescribed medicines for other conditions.

The interactions were found to increase the risk of a bleeding event in the brain or in the gastrointestinal system, and also to reduce the efficacy of the NOACs.

"NOACs alone do not pose a significant risk of bleeding, but the concurrent use of NOACs with certain drugs that share the same metabolic pathways may cause increased risk of major bleeding," said study lead researcher Dr. Shang-Hung Chang, an Associate Professor of Cardiology with Chang Gung Memorial Hospital in Taoyuan, Taiwan.

Xarelto is a key drug for Bayer, bringing in $3.4 billion last year alone and it expects to be able to expand this to well above $5 billion per year. The company released that it expects to share the data on the trial in 2018.

Ben Hargreaves

Comments

Paul Burton is the Vice President, Medical Affairs at Johnson and Johnson -  not  at Janssen 

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