BARACLUDE(R) (entecavir) Approved by the European Commission for the Treatment of Chronic Hepatitis B in Adult Patients With Evidence of Decompensated Liver Disease

Paris (ots/PRNewswire) - Bristol-Myers Squibb announced
today that BARACLUDE(R) (entecavir) has been approved by the European
Commission on February 28th 2011 to treat chronic hepatitis B (CHB)
in adult patients with evidence of decompensated liver disease.

BARACLUDE(r) was already approved in Europe in June 2006 for use
in adult patients with CHB with compensated liver disease and
evidence of active viral replication, persistently elevated serum
alanine aminotransferase (ALT) levels and histological evidence of
active inflammation and/or fibrosis.

This approval grants BARACLUDE(r) marketing authorisation in the
27 countries of the European Union. In the U.S., the Food and Drug
Administration (FDA) approved the decompensated indication for
BARACLUDE(r) in October 2010.

Decompensated liver disease is characterised by failure of the
liver to maintain adequate function, usually due to severe scarring,
leading to fibrosis and/or cirrhosis caused by chronic liver
inflammation.[1] It represents the end stage of hepatitis. Natural
history data demonstrate that up to 40% of patients with CHB develop
cirrhosis over their lifetimes, at a reported rate of 2-6% per
year.[1] Among CHB patients with cirrhosis, 3-5% per year progress to
decompensated cirrhosis and 2-5% develop hepatocellular carcinoma
(HCC).[2,3] Currently, the median survival rate in decompensated
patients is two to three years, with only 28% of patients surviving
for more than five years.[1,4] Once liver disease progresses to the
decompenstated stage, a liver transplant is often necessary.

"The approval of this additional indication is an important
milestone for CHB patients living with decompensated liver disease, a
difficult to treat population whose mortality rates are high," said
Professor Jorg Petersen. "The data used to support this indication
shows that BARACLUDE(r) is efficacious in treating decompensated
patients."

This approval is based on a randomised, open-label, multi-centre
study (ETV-048) that compared the efficacy & safety of BARACLUDE(r)
(1.0 mg once daily) with adefovir (10.0 mg once daily) administered
in patients with HBeAg positive or negative CHB who had evidence of
liver decompensation.

Data demonstrated that BARACLUDE(r) showed greater viral
suppression compared to adefovir at 24 and 48 weeks following
treatment initiation. At 48 weeks, 57% (57/100) of patients treated
with BARACLUDE(r) achieved an undetectable viral load (less than or
equal to 300 copies/ml) compared to 20% (18/91) of patients on
adefovir.

ETV-048 Study Results

The 048 study evaluated 191 patients who were either
HBeAG-positive or HBeAG-negative. Patients were either
treatment-naive or had been previously treated excluding
pre-treatment with BARACLUDE(r), adefovir or tenofovir.

Patients were randomised to receive BARACLUDE(r) (1.0 mg once
daily) or adefovir (10.0 mg once daily) and were analysed through 48
weeks.

Baseline demographics were similar for both groups. Importantly,
at baseline, patients had a mean CPT (child-pugh score) of 8.81 in
the BARACLUDE(r) arm and 8.35 in the adefovir arm, and the mean MELD
(Model for End stage Liver Disease) score was 17.1 and 15.3,
respectively. Both of these parameters measure the severity of
hepatic decompensation.

The mean age of the study population was 52 years and the
majority of the subjects were male (74%) and either Asian (54%) or
Caucasian (33%).[5]

In the primary efficacy endpoint of mean change from baseline in
serum HBV DNA at Week 24, BARACLUDE(r) was superior to adefovir
(-4.48 versus -3.40; p < 0.0001).

Secondary efficacy endpoints included mean change from baseline
in serum HBV DNA at Week 48 (-4.66 in the BARACLUDE(r) arm and -3.90
in the adefovir arm). In addition a greater proportion of patients on
BARACLUDE(r) achieved an undetectable viral load compared to patients
on adefovir at 48 weeks: 57% (57/100) versus 20% (18/91),
respectively. Also patients on the BARACLUDE(r) arm decreased their
MELD score from baseline by -2.6% versus -1.7% in the adefovir arm at
Week 48, even though baseline MELD score had been higher with 17.1
for BARACLUDE(r) than 15.3 for adefovir. Further the normalization of
ALT (Alanine Aminotransferase enzyme) was achieved to a higher
proportion in the BARACLUDE(r)-treated patients (less than or equal
to 1 x Upper Limit of Normal) at Week 48 [63% (49/78)] compared with
adefovir-treated patients [46% (33/71)].

The time to onset of HCC or death was comparable in the two
treatment groups; on-study cumulative death rates were 23% (23/102)
and 33% (29/89) for patients treated with BARACLUDE(r) and adefovir,
respectively; and on-study cumulative rates of HCC were 12% (12/102)
and 20% (18/89) for BARACLUDE(r) and adefovir, respectively.

BARACLUDE(r) was generally well tolerated and safety results were
comparable between the treatment groups and consistent with those
previously reported for a population with decompensated liver
disease. Serious adverse events occurred in 69% of the BARACLUDE(r)
patients and 66% of the adefovirpatientsand discontinuations due to
adverse events occurred in 7% of the Baraclude patients and 6 % of
the adefovir patients.[5]

Important Information About BARACLUDE(r)

Discovered at Bristol-Myers Squibb, BARACLUDE(r) is indicated for
the treatment of chronic hepatitis B virus (HBV) infection in adults
with:

- Compensated liver disease and evidence of active viral replication,
persistently elevated serum alanine aminotransferase (ALT) levels and
histological evidence of active inflammation and/or fibrosis.
- Decompensated liver disease.

A higher rate of serious hepatic adverse events (regardless of
causality) has been observed in patients with decompensated liver
disease, in particular in those with Child-Turcotte-Pugh (CTP) class
C disease, compared with rates in patients with compensated liver
function. In addition, patients with decompensated liver disease may
be at higher risk for lactic acidosis and specific renal adverse
events such as hepatorenal syndrome. Clinical and laboratory
parameters should be closely monitored in this patient population.

* For full prescribing information for BARACLUDE(r), please
consult the Summary of Product Characteristics.

About Chronic Hepatitis B (CHB)

Chronic hepatitis B is a serious global health issue. Worldwide,
more than 2 billion people have been in contact with the hepatitis B
virus and approximately 350 million people are chronically
infected.[6]

About Decompensated Liver Disease

Decompensated liver disease is characterised by failure of the
liver to maintain adequate function, often due to severe scarring
leading to fibrosis and/or cirrhosis caused by chronic liver
inflammation.[1] Symptoms of liver decompensation can include but are
not limited to: jaundice (yellowing of the skin or eyes), ascites
(swollen abdomen from abnormal accumulation of fluid), oesophageal
varices (distorted blood vessels that may cause potentially fatal
bleeding), and hepatic encephalopathy ( neuropsychiatric abnormality
resulting in personality changes, intellectual impairment and reduced
levels of consciousness).[1]

About Bristol-Myers Squibb

Bristol-Myers Squibb is a global biopharmaceutical company
committed to discovering, developing and delivering innovative
medicines that help patients prevail over serious diseases.

BARACLUDE(R) (entecavir) is a registered trademark of
Bristol-Myers Squibb Company.

References

1. D'Amico G, Garcia-Tsao G, Pagliaro L. Natural history and
prognostic indicators of survival in cirrhosis: a systematic review
of 118 studies. J. Hepatol. 2006; 44: 217-31.

2. Chu C-M and Liaw Y-F. Hepatitis B virus-related cirrhosis:
Natural history and treatment. Seminars in Liver Disease
2006;26(2):142-152.

3. Fattovich G, Stroffolini T, Zagni I, Donato F. Hepatocellular
carcinoma in cirrhosis: Incidence and risk factors. Gastroenterology
2004;127(5 Suppl 1):S35-S50.

4. Fattovich G, Pantalena M, Zagni I et al. Effect of hepatitis B
and C virus infections on the natural history of compensated
cirrhosis: a cohort study of 297 patients. Am. J. Gastroenterol.
2002; 97: 2886-95.

5. Y. Liaw, et al. Efficacy and Safety of Entecavir versus
Adefovir in Chronic Hepatitis B Patients with Evidence of Hepatic
Decompensation. Abstract and Poster 442. AASLD 2009.

6. World Helath Organization Web site. Fact sheet N- 204.
http://www.who.int/mediacentre/factsheets/fs204/en/. Accessed 3
December 2010.

ots Originaltext: Bristol-Myers Squibb GmbH & Co.KG aA
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Contact: Media: Annie Simond, office:
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