Bristol-Myers Squibb and Gilead Sciences Expand Their Alliance to Include Commercialization of ATRIPLA(R) (efavirenz 600 mg/emtricitabine 200 mg/tenofovir disoproxil fumarate 300 mg) in Europe
Bristol-Myers Squibb Company (NYSE:BMY) and Gilead Sciences, Inc.
(Nasdaq:GILD) today announced an agreement to commercialize ATRIPLA(R)
(efavirenz 600 mg/emtricitabine 200 mg/tenofovir disoproxil fumarate
300 mg) in Europe for the treatment of virologically suppressed adults
with HIV-1 infection, subject to the product´s approval by the
European Commission. If approved, ATRIPLA would represent the first
and only once-daily single tablet regimen for HIV-1 infection in the
European Union. The companies expect the European Commission to issue
its decision by the end of the year.
Under this agreement, Bristol-Myers Squibb and Gilead share
responsibility for commercializing ATRIPLA throughout the European
Union and certain other European countries. Gilead will record
revenues from future net sales of ATRIPLA in most of the European
countries, while Bristol-Myers Squibb will record revenues in most of
the European countries at percentages relative to the contribution
represented by its individual product.
Bristol-Myers Squibb recently concluded an agreement with Merck &
Co., Inc. under which Merck granted Bristol-Myers Squibb rights to
co-commercialize ATRIPLA with Gilead in all of the European Union and
certain other European countries. Previously, Merck had the exclusive
right to market any product containing efavirenz (a component of
ATRIPLA) in all European countries other than the United Kingdom,
Germany, France, Italy, Spain and the Republic of Ireland.
Efavirenz is marketed by Bristol-Myers Squibb under the tradename
SUSTIVA(R) in the United States, Canada and six major countries of the
European Union. Efavirenz will continue to be commercialized by Merck
& Co, Inc, through its affiliate Merck Sharp & Dohme (MSD) Limited
under the tradename STOCRIN(R) in all other countries within the
European Union and many countries outside of the United States.
Emtricitabine and tenofovir disoproxil fumarate are commercialized by
Gilead under the tradenames Emtriva(R) and Viread(R), respectively,
and are commonly prescribed together as a once-daily, fixed-dose
tablet, marketed under the tradename Truvada(R) for use as part of
combination therapy.
ATRIPLA is currently sold in the United States and Canada through
a joint venture between Bristol-Myers Squibb and Gilead. ATRIPLA was
approved by the U.S. Food and Drug Administration (FDA) in July 2006
and by Health Canada in October 2007. Gilead and Merck previously
announced a collaboration to distribute ATRIPLA in developing
countries.
Important Product Safety Information (including Boxed WARNINGS)
About ATRIPLA (efavirenz 600 mg/emtricitabine 200 mg/tenofovir
disoproxil fumarate 300 mg), Emtriva (emtricitabine), Viread
(tenofovir disoproxil fumarate (DF)) and Truvada
(emtricitabine/tenofovir DF) in the United States
Lactic acidosis and severe hepatomegaly with steatosis, including
fatal cases, have been reported with the use of nucleoside analogues
alone or in combination with other antiretrovirals.
Emtriva, Viread, Truvada and ATRIPLA are not approved for the
treatment of chronic hepatitis B virus (HBV) infection and their
safety and efficacy have not been established in patients co-infected
with HBV and HIV. Severe acute exacerbations of hepatitis B have been
reported in patients who have discontinued Viread or Emtriva, which
are components of Truvada and ATRIPLA. In some of these patients
treated with Emtriva, the exacerbations of hepatitis B were associated
with liver decompensation and liver failure. Hepatic function should
be monitored closely with both clinical and laboratory follow-up for
at least several months in patients who are co-infected with HIV and
HBV and discontinue Truvada or ATRIPLA. If appropriate, initiation of
anti-hepatitis B treatment may be warranted.
It is important for patients to be aware that anti-HIV medicines
including Truvada, Viread, Emtriva, SUSTIVA and ATRIPLA do not cure
HIV infection or AIDS and do not reduce the risk of transmitting HIV
to others.
Additional Important Information About ATRIPLA in the United
States
ATRIPLA(R) (efavirenz 600 mg/emtricitabine 200 mg/tenofovir
disoproxil fumarate 300 mg) is indicated for use alone as a complete
regimen or in combination with other antiretroviral agents for the
treatment of HIV-1 infection in adults.
Coadministration of ATRIPLA with astemizole, bepridil, cisapride,
midazolam, pimozide, triazolam, ergot derivatives, or voriconazole is
contraindicated. Concomitant use of ATRIPLA with St. John´s wort
(Hypericum perforatum) or St. John´s wort-containing products is not
recommended.
Since ATRIPLA contains efavirenz, emtricitabine, and tenofovir DF,
ATRIPLA should not be coadministered with SUSTIVA(R) (efavirenz),
Emtriva, Viread, or Truvada(R) (emtricitabine/tenofovir DF). Due to
similarities between emtricitabine and lamivudine, ATRIPLA should not
be coadministered with drugs containing lamivudine, including
Combivir(R) (lamivudine/zidovudine), Epivir(R) or Epivir-HBV(R)
(lamivudine), Epzicom(TM) (abacavir sulfate/lamivudine), or
Trizivir(R) (abacavir sulfate/lamivudine/zidovudine).
Serious psychiatric adverse experiences, including severe
depression (2.4%), suicidal ideation (0.7%), nonfatal suicide attempts
(0.5%), aggressive behavior (0.4%), paranoid reactions (0.4%), and
manic reactions (0.2%), have been reported in patients receiving
efavirenz. In addition to efavirenz, factors identified in a clinical
study that were associated with an increase in psychiatric symptoms
included a history of injection drug use, psychiatric history, and use
of psychiatric medication. There have been occasional reports of
suicide, delusions, and psychosis-like behavior, but it could not be
determined if efavirenz was the cause. Patients with serious
psychiatric adverse experiences should be evaluated immediately to
determine whether the risks of continued therapy outweigh the
benefits.
Fifty-three percent of patients reported central nervous system
symptoms (including dizziness (28.1%), insomnia (16.3%), impaired
concentration (8.3%), somnolence (7.0%), abnormal dreams (6.2%), and
hallucinations (1.2%)) when taking efavirenz compared to 25% of
patients receiving control regimens. These symptoms usually begin
during Days 1-2 of therapy and generally resolve after the first 2-4
weeks of therapy; they were severe in 2.0% of patients, and 2.1% of
patients discontinued therapy.
After 4 weeks of therapy, the prevalence of nervous system
symptoms of at least moderate severity ranged from 5% to 9% in
patients treated with regimens containing efavirenz. Nervous system
symptoms are not predictive of the less frequent psychiatric symptoms.
It is recommended that creatinine clearance (CrCl) be calculated
in all patients prior to initiating therapy and as clinically
appropriate during therapy with ATRIPLA(R) (efavirenz 600
mg/emtricitabine 200 mg/tenofovir disoproxil fumarate 300 mg), and
routine monitoring of CrCl and serum phosphorous be performed for
patients at risk of renal impairment. ATRIPLA should not be given to
patients with CrCl less than 50 mL/min. Renal impairment, including
cases of acute renal failure and Fanconi syndrome (renal tubular
injury with severe hypophosphatemia), has been reported in association
with the use of tenofovir DF. ATRIPLA should be avoided with
concurrent or recent use of a nephrotoxic agent.
ATRIPLA may cause fetal harm when administered during the first
trimester to a pregnant woman. Women should not become pregnant or
breast-feed while taking ATRIPLA. Barrier contraception must always be
used in combination with other methods of contraception (e.g., oral or
other hormonal contraceptives). If the patient becomes pregnant while
taking ATRIPLA, she should be apprised of the potential harm to the
fetus.
Mild-to-moderate rash is a common side effect of efavirenz. In
controlled clinical trials, 26% of patients treated with efavirenz
experienced new-onset skin rash compared with 17% of patients treated
in control groups. ATRIPLA should be discontinued in patients
developing severe rash associated with blistering, desquamation,
mucosal involvement, or fever. Skin discoloration, associated with
emtricitabine, may also occur.
Liver enzymes should be monitored in patients with known or
suspected hepatitis B or C and when ATRIPLA is administered with
ritonavir or other medications associated with liver toxicity.
Decreases in bone mineral density (BMD) have been seen with
tenofovir DF. Cases of osteomalacia (associated with proximal renal
tubulopathy) have been reported in association with the use of
tenofovir DF.
Use ATRIPLA with caution in patients with a history of seizures.
Convulsions have been observed in patients receiving efavirenz,
generally in the presence of known medical history of seizures.
Redistribution/accumulation of body fat has been observed in
patients receiving antiretroviral therapy.
Immune reconstitution syndrome has been reported in patients
treated with combination antiretroviral therapy, including the
components of ATRIPLA.
Saquinavir should not be used as the only protease inhibitor in
combination with ATRIPLA.
Coadministration of ATRIPLA and atazanavir is not recommended due
to concerns regarding decreased atazanavir concentrations. Atazanavir
and lopinavir/ritonavir have been shown to increase tenofovir
concentrations. Patients on atazanavir or lopinavir/ritonavir plus
ATRIPLA should be monitored for tenofovir-associated adverse events.
ATRIPLA should be discontinued in patients who develop
tenofovir-associated adverse events.
Coadministration of ATRIPLA with didanosine should be undertaken
with caution. Patients receiving this combination should be monitored
closely for didanosine-associated adverse events. See U.S. Full
Prescribing Information for complete list of drug-drug interactions.
In Study 934, the most frequently reported grades 2-4 adverse
events through 48 weeks in patients receiving efavirenz +
emtricitabine + tenofovir DF were dizziness (8%), nausea (8%),
diarrhea (7%), fatigue (7%), headache (5%), rash (5%), sinusitis (4%),
depression (4%), insomnia (4%), and abnormal dreams (4%).
The dose of ATRIPLA is one tablet (containing 600 mg of efavirenz,
200 mg of emtricitabine, and 300 mg of tenofovir DF) once daily taken
orally on an empty stomach. Dosing at bedtime may improve the
tolerability of nervous system symptoms. ATRIPLA is not recommended
for use in patients less than 18 years of age.
For complete U.S. prescribing information, including Boxed
WARNINGS, for ATRIPLA, visit www.atripla.com. For complete prescribing
information for SUSTIVA, visit www.bms.com. For complete U.S.
prescribing information for Truvada, Viread and Emtriva, including
Boxed WARNINGS, visit www.gilead.com.
About Bristol-Myers Squibb
Bristol-Myers Squibb is a global pharmaceutical and related
healthcare products company. Visit Bristol-Myers Squibb on the World
Wide Web at www.bms.com.
About Gilead Sciences
Gilead Sciences is a biopharmaceutical company that discovers,
develops and commercializes innovative therapeutics in areas of unmet
medical need. The company´s mission is to advance the care of patients
suffering from life-threatening diseases worldwide. Headquartered in
Foster City, California, Gilead has operations in North America,
Europe and Australia. Visit Gilead on the World Wide Web at
www.gilead.com.
Forward-Looking Statements
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 product development. 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
ATRIPLA will receive regulatory approval in the European Union or
other geographies. Forward-looking statements in this press release
should be evaluated together with the many risks and uncertainties
that affect Bristol-Myers Squibb´s business, including those
identified in Bristol-Myers Squibb´s Annual Report on Form 10-K for
the year ended December 31, 2006 and in our Quarterly Reports on Form
10-Q, particularly under "Item 1A. Risk Factors". Bristol-Myers Squibb
undertakes no obligation to publicly update any forward-looking
statement, whether as a result of new information, future events or
otherwise.
Gilead Sciences Forward-Looking Statement
This press release includes forward-looking statements, within the
meaning of the Private Securities Litigation Reform Act of 1995, that
are subject to risks, uncertainties and other factors, including the
risk that the European Commission will not formally approve ATRIPLA
for marketing in the European Union prior to the end of the year or at
all, and any marketing approval, if granted, may have significant
limitations on its use. These risks, uncertainties and other factors
could cause actual results to differ materially from those referred to
in the forward-looking statements. The reader is cautioned not to rely
on these forward-looking statements.
These and other risks are described in detail in the Gilead´s
Annual Report on Form 10-K for the year ended December 31, 2006 and
its Quarterly Reports on Form 10-Q for the first three quarters of
2007, filed with the U.S. Securities and Exchange Commission. All
forward-looking statements are based on information currently
available to Gilead and Gilead assumes no obligation to update any
such forward-looking statements.
Full U.S. prescribing information, including Boxed WARNINGS, for
ATRIPLA is available at www.atripla.com. Full U.S. prescribing
information for SUSTIVA is available at www.bms.com. Full U.S.
prescribing information for Truvada, Viread and Emtriva, including
Boxed WARNINGS, are available at www.gilead.com.
EU Summary of Product Characteristics for Truvada, Viread,
Emtriva, SUSTIVA and STOCRIN are available at
http://www.emea.europa.eu/htms/human/epar/a.htm.
ATRIPLA is a registered trademark of Bristol-Myers Squibb & Gilead
Sciences, LLC. SUSTIVA is a registered trademark of Bristol-Myers
Squibb Pharma Company. STOCRIN is a registered trademark of Merck &
Co., Inc. Truvada, Viread and Emtriva are all registered trademarks of
Gilead Sciences, Inc.