Janssen Therapeutics, Division of Janssen Products, LP (Janssen), has submitted a supplemental New Drug Application (sNDA) to the US Food and Drug Administration (FDA) to update the label for once-daily, all-oral Olysio (simeprevir), a hepatitis C virus (HCV) NS3/4A protease inhibitor, currently approved for use with sofosbuvir for adults with genotype 1 chronic hepatitis C (CHC) infection as a 12-week treatment for patients without cirrhosis or a 24-week treatment regimen for patients with cirrhosis.

Sofosbuvir is a nucleotide analog NS5B polymerase inhibitor marketed by Gilead Sciences, Inc.

Olysio was approved in November 2014 in combination with sofosbuvir based on the phase 2 COSMOS clinical trial. This sNDA is based on results from the phase 3 OPTIMIST-1 and OPTIMIST-2 trials, which evaluated 12 and eight weeks of therapy for treatment-naïve and treatment-experienced genotype 1 CHC adult patients without cirrhosis, and 12 weeks of therapy for treatment-naïve and treatment-experienced genotype 1 CHC adult patients with cirrhosis.

"Olysio has contributed significantly to the care of people living with hepatitis C. The availability of multiple treatment options is important to help offer an opportunity for cure, and we believe Olysio will continue to play a meaningful role going forward," said Richard Nettles, M.D., vice president, medical affairs, Janssen Therapeutics. "We're pleased to submit the data from the phase 3 OPTIMIST trials, which adds to the body of clinical information about this combination in patients with and without cirrhosis."

Results from the OPTIMIST trials were presented in April 2015 at The International Liver Congress 2015 of the European Association for the Study of the Liver (EASL) in Vienna.

OPTIMIST-1 is a phase 3, randomized, open-label trial to investigate the efficacy and safety of the all-oral regimen of simeprevir and sofosbuvir (SMV/SOF) among treatment-naive and treatment-experienced genotype 1 CHC patients without cirrhosis. The primary study endpoint is sustained virologic response (SVR) at 12 weeks after treatment (SVR12) with 12 and eight weeks of treatment with SMV/SOF versus a historical control (patients previously treated with approved regimens containing a direct-acting antiviral, pegylated interferon and ribavirin).

Ninety-seven percent of patients treated with SMV/SOF for 12 weeks (n=150/155) achieved SVR12, which was superior to the SVR12 rate of 87 per cent among the historical control.

SVR12 rates of 100 percent were seen among patients with IL28B CC genotype (n=43/43) and those with baseline NS5A and NS3 Q80K polymorphisms (n=9/9).

Patients treated with eight weeks of SMV/SOF achieved an SVR12 rate of 83 per cent (n=128/155), which was not superior to the SVR12 rate of 83 per cent in the historical control.

High SVR12 rates were seen among patients with baseline HCV RNA < 4 million IU/mL (96 percent; n=46/48), IL28B CC genotype (93 per cent; n=38/41), patients with genotype 1b CHC (92 per cent; n=36/39) and patients without baseline NS5A and Q80K polymorphisms (89 per cent; n=78/88).

The most frequently reported adverse events in the 12- and eight-week treatment arms were headache (14 and 17 per cent, respectively), fatigue (12 and 15 per cent, respectively) and nausea (15 and 9 per cent, respectively).

OPTIMIST-2 is a phase 3, open-label, single-arm trial to investigate the efficacy and safety of SMV/SOF in treatment-naive and treatment-experienced genotype 1 CHC patients with cirrhosis. The primary endpoint is SVR12 with SMV/SOF versus a historical control.

Twelve weeks of treatment with SMV/SOF resulted in SVR12 rates of 84 per cent (n=86/103), which was superior to the SVR12 rate of 70 per cent in the historical control.

Higher SVR12 rates were seen in patients with baseline NS5A polymorphisms with or without NS3 Q80K polymorphisms (100 per cent; n=13/13), patients with albumin =4 g/dL (94 per cent; n=47/50) and treatment-naïve patients (88 per cent; n=44/50).

The most common adverse events were fatigue (20 per cent), headache (20 per cent) and nausea (11 per cent).

Hepatitis C is a blood-borne infectious disease of the liver that affects approximately 2.7 million people in the United States and is a leading cause of chronic liver disease. Approximately 150 million people are infected with hepatitis C worldwide and 350,000 people per year die from the disease globally. When left untreated, hepatitis C can cause significant damage to the liver, including cirrhosis. Additionally, hepatitis C may increase the risk of developing complications from cirrhosis, which may include liver failure.

Olysio is an NS3/4A protease inhibitor which has been developed by Janssen Sciences Ireland UC in collaboration with Medivir AB.

In November 2013, Olysio was initially approved by the US FDA, and in May 2014, it was granted marketing authorisation by the European Commission. Subsequent marketing authorisations have followed in several other countries around the world. Indications vary by market.

Janssen is responsible for the global clinical development of Olysio and has exclusive, worldwide marketing rights, except in the Nordic countries. Medivir AB retains marketing rights for Olysio in these countries under the marketing authorisation held by Janssen-Cilag International NV.