At the AASLD 2017 Liver Meeting, an abstract was presented, by Dr. van der Meer et al titled “Ursodeoxycholic Acid is Associated with Prolonged Transplant-free Survival in All Patients with Primary Biliary Cholangitis – there is no such thing as non-response” Read an article discussing the abstract in MedPage Today
On October 25, 2017, the Canadian PBC Society hosted a dinner meeting to discuss the latest in PBC news. Dr. Thomas Shaw Stiffel, Dr. Erin Kelly and Dr. Cynthia Tsien from the Ottawa Hospital were our special guest speakers. Attendees came from from both Ontario and Quebec and we had our first meeting in both French and English. For some participants, if was their first opportunity to meet others with PBC. We had a lively question and answer session and everyone agreed that it would be wonderful to meet again at upcoming PBC workshops. Check our website Calendar of Events for future dates and locations. To see more photos click here.
Phase 2 trial is now enrolling patients in 50 centers involving 102 patients worldwide. This is a 24 week long study involving 8 clinic visits. Principal Investigators in Canada: Dr. Catherine Vincent, Montreal; Dr. Giada Sebastiani, Montreal Dr. Mark Swain, Calgary; Dr. Gerald Minuk, Winnipeg. More details about the trial here.
The Canadian PBC Society traveled to Washington, DC to attend The Liver Meeting. While there, we had the privilege of hearing from world leaders in PBC research such as Dr. Robert Gish, Dr David Bernstein, Dr. Gideon Hirschfield, Dr. Chris Bowlus, Dr. John Vierling and many more. It was amazing to learn about the many new drugs in development for PBC – check our Research blog to learn about all of the new drugs currently in clinical trials. We met up with PBCers Carol and Cathy at their booth where they displayed their new brochures and information cards. We also spent some time with our friend from the UK PBC Foundation, Robert who shared the foundation’s newest “Living with PBC” booklet and PBC APP. It was great to meet Dr. Sanjaya Satapathy, from the University of Tennessee Health Science Center, whose project focused on PBC education for the medical community and patients. The PSC Partners did an amazing job of creating an info card that explains the difference between PBC and PSC. It was a great honour to join the 2016 award winners of Intercept’s Practice to Policy Awards to present the results our winning Peer to Peer and Coping Skills Workshop Project. Learn more about the AASLD Meeting here.
Currently enrolling patients for Phase 2 Study in Canada, USA, UK and Germany. No placebos will be used, while dosages may differ between participants. Health Canada and FDA approve this 52 week study. Principal investigators in Canada: Dr. Mark Swain (Calgary); Dr. Hemant Shah (Toronto)
An Update from Cymbay
CymaBay Therapeutics is a small biotech company located in the San Francisco Bay Area. So far, we have 22 employees. The company is publicly traded on the NASDAQ market (ticker symbol CBAY). For the last two years we have conducted two studies with seladelpar (formerly known as MBX-8025) for the treatment of primary biliary cholangitis (PBC).
The so-called ‘CB8025-21629’ is our second study evaluating the effects and safety of seladelpar on PBC patients. Its main objective is to define what is the appropriate dose of seladelpar to be used. The study is open to patients who have high alkaline phosphatase (AP), a marker of liver function, and are not responding well enough to UDCA (sometimes also called ‘urso’ or ‘ursodiol’) or who cannot tolerate UDCA. All patients receive treatment with seladelpar, there is no placebo, but the dose is chosen at random (5 or 10 mg/day, orally). The study treatments are not masked, so patients and physicians know the dose they receive.
When the first 24 patients enrolled in ‘CB8025-21629’ reached 12 weeks of treatment we evaluated their progress while the study is continuing. This is called an ‘interim analysis’. The goal was to get an early look to see if the dose is correct, if seladelpar is well tolerated and effective and, eventually, speed-up the program and plan its next stage.
We compared patient results before treatment and during treatment. At 12 weeks, significant AP decreases were seen in the seladelpar 5 mg and 10 mg groups, 39% and 45%, respectively. This suggests that the liver is functioning better. Total bilirubin and gamma glutamyl transferase (GGT), other tests of liver function, also improved. These results also suggest that seladelpar, at the doses used, exerts a favorable impact on cholestasis (the retention of bile). Cholestasis is a prominent issue in PBC. We also saw a decrease in an important marker of inflammation called the C-reactive protein. This protein is secreted by the liver when it is faced with an inflammatory injury such as PBC.
Overall, there were no indication of increased pruritus with seladelpar. This was something we already knew from our first study, but which was important to confirm in this second study. In addition, seladelpar seemed well tolerated. For instance, no patient reported a serious adverse event.
Based on these results, Health Canada and the US-FDA agreed that we can treat patients with seladelpar 5 mg and 10 mg for longer than six months. The CB8025-21629 study now has a 52-week seladelpar treatment period. We are also planning to extend seladelpar treatment beyond one year with a new long-term extension study that will be open to patients who have participated in a seladelpar study, assuming that they tolerate the drug well. Treatment in the long-term study will continue until seladelpar is approved in Canada or the program is discontinued.
Canadian Study Sites
Study ‘CB8025-21629’ is currently enrolling patients in 4 countries (Canada, United States, United Kingdom and Germany). We have two sites open in Canada:
University of Calgary Liver Unit, Calgary, Alberta, Canada, T2N 4Z6
Principal Investigator: Mark Swain, M.D.
Study Coordinators: Pam Crotty, Shirley Cole
Toronto Centre for Liver Disease, Toronto, Ontario, Canada, M5G 2C4
Principal Investigator: Hemant Shah, MD
Study Coordinator: Teresa Bianco
With these developments, we are now looking to the next phase of the seladelpar program. This next phase is called the ‘confirmatory’ phase, or phase 3. We need to reproduce these encouraging data on a bigger scale, with a larger study and a treatment duration of at least one year. This study is sometimes also called the ‘registration’ study. A similar study served as the basis for the registration of Ocaliva (the ‘POISE’ study).
If the results of this confirmatory study are positive, the data collected will be submitted to health authorities to file a registration package and request an authorization for physicians to prescribe seladelpar to their PBC patients outside of a clinical study. The registration package is a very comprehensive dossier that includes data from clinical studies but also data from multiple non-clinical studies (e.g. toxicology) as well as data on how the drug is made and prepared (manufacturing process).
CymaBay’s intent is to use the coming month to present its plan for the confirmatory study to health authorities. This includes Health Canada, as well as the US-FDA, the European Medicine Agency and potentially other countries around the world.
CymaBay is very thankful to the PBC patients who participated and continue to participate in our studies. We totally appreciate their dedication and we all do our best to conduct the best research possible. We will use the results of the ongoing study to justify starting the agreed upon confirmatory study as quickly as possible. Our wish, if everything goes well, is to start this study in the second part of 2018. We’ll probably need to grow beyond 22 employees to achieve this challenge!