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Press Release
FibroGen Provides Update on the Development of FG-2216 and FG-4592,
Oral Therapies for Anemia
South San Francisco , Calif. - November 14, 2005 - FibroGen, Inc.,
today announced that advances in the development of FG-2216 for the
treatment of anemia and FG-4592, a pioneering therapy for the anemia
of chronic disease (ACD), were reported at the American Society of
Nephrology (ASN) 38th Annual Meeting & Scientific Exposition, November
8-13, Philadelphia, Pennsylvania.
FG-2216 Advances in Multiple Phase 2 Studies
Data were presented from ongoing dose escalation studies of FG-2216 in
anemic patients with chronic kidney disease (CKD). Previously reported
results demonstrate that patients not previously treated with recombinant
erythropoietin (EPO) therapy on average exhibit significantly increased
levels of hemoglobin (Hb) in response to the low dose of FG-2216
(6 mg/kg) administered orally three times a week for four weeks. As part
of ongoing efforts to determine optimal dosing, the study protocol was
revised to reduce dosing level and frequency. Early results from the
10 mg/kg dose group demonstrate a mean increase of 2.7 g/dL Hb in patients
dosed twice a week for four weeks (1).
A second study is evaluating the ability of FG-2216 therapy to maintain
Hb levels in patients following discontinuation of recombinant EPO
therapy (1). Patients received recombinant EPO therapy for a
minimum of sixty days prior to the washout period and were randomized to
receive placebo or FG-2216. Patients receiving the low dose of FG-2216 (6
mg/kg, three times a week for four weeks) on average experienced less of a
decline in Hb (1.3 g/dL) as compared to the placebo group (1.6 g/dL). The
first patient treated with FG-2216 in the originally planned high-dose
cohort (20 mg/kg FG-2216) exhibited a 1.8 g/dL increase in Hb at day
fourteen after having received five doses of FG-2216 administered over
nine days. (This patient was removed from the study to start dialysis
for reasons unrelated to study drug.) Based on the robust Hb response
of this patient, the Company amended the protocol to reduce the high
dose to 15 mg/kg.
"We are very pleased the activity of FG-2216 was confirmed in the low-dose
cohorts of both CKD anemia studies," said David Y. Liu, Ph.D., Vice
President of Research at FibroGen. "We are now focused on a larger phase 2
study of FG-2216 evaluating optimal dosing frequency and dose levels
in order to maintain stable hemoglobin on a dose-titration schedule,
which is a common clinical practice employed with erythropoietic therapy
to account for individual responses to treatment."
Safety
To date, no serious adverse events related to FG-2216 have been observed
in more than 125 trial enrollees. The clinical data also show that CKD
patients treated with FG-2216 experienced an increase in endogenous EPO,
a key component of erythropoiesis, but not vascular endothelial growth
factor (VEGF).
- Tumor Progression Studies / Anemia of Cancer Models: In six
different tumor models of lung, colon, and prostate cancers, FG-2216 did
not increase VEGF and did not promote tumor progression (2). In
addition, FG-2216 treatment resulted in increases in circulating EPO,
red blood cells, Hb, and hematocrit, indicating that FG-2216 stimulated
erythropoiesis by overcoming functional iron deficiency and inflammatory
suppression. Similarly, FG-2216 was shown to correct anemia in a model
of inflammation-induced anemia relevant to the ACD clinical
setting (3).
- Endogenous EPO Levels at Active Dose; Thrombotic Action of
EPO: The circulating levels of endogenous EPO induced by FG-2216
were only three to five times above baseline, which is at least one
order of magnitude lower than levels reported in patients treated with
recombinant EPO products. The relatively modest elevation of endogenous
EPO observed with the low dose of FG-2216 is consistent with EPO levels in
Chuvash people who have a congenital mutation leading to constitutive HIF
stabilization and polycythemia (4). In light of an emerging body
of evidence suggesting that abnormally high levels of EPO are directly
prothrombotic, the Company believes that Hb levels could potentially be
raised to the normal range using FG-2216 employing EPO doses far lower
than current therapy and potentially with reduced risk of thrombosis
that otherwise limits the amount of anemia correction permissible with
current therapy.
FG-4592 Therapy for Anemia of Chronic Disease (ACD)
The Company also presented data on FG-4592 (5), designed for
treatment of anemia of chronic disease (ACD), which recently entered
phase 1 testing. ACD, caused primarily by inflammatory suppression
of erythropoiesis, is a common complication in millions of patients
with cancer, rheumatoid arthritis, inflammatory bowel disease and
other chronic diseases. A significant percentage of patients with ACD,
as well as patients with CKD anemia and chemotherapy-induced anemia,
are hyporesponsive (inadequate correction of low Hb levels) to current
therapy.
- Hepcidin Reduction: FG-4592 was reported to dramatically reduce
abnormally high levels of hepcidin back to normal levels and restore
the natural balance in iron regulation in an experimental model of
inflammation-induced anemia. Hepcidin, a hormone that regulates
the availability of iron for erythropoiesis, is known to be the
key mediator of anemia caused by inflammation. Inflammation causes
upregulation of hepcidin, leading to degradation of the iron transporter
protein ferroportin. Downregulation of hepcidin by FG-4592 prevents
ferroportin degradation and leads to improvement of iron mobilization and
utilization. Iron availability for erythropoiesis is an important factor
in treating anemia, which recombinant EPO therapy alone fails to address.
- Microcytosis Alleviation: In the same model as described above,
FG-4592 alleviated microcytosis (abnormally small red blood cells)
and hypochromia (lack of Hb) and corrected anemia. By comparison, a
dose of darbepoetin alfa that produced robust increases in Hb in normal
animals had no effect in animals with ACD. Microcytosis and hypochromia
are indicative of functional iron deficiency, which is symptomatic of
ACD in multiple clinical settings.
- Phase 1 Safety Study Initiated: The Company reported initiation of
a phase 1, single-dose, dose-escalation study of FG-4592 in normal
subjects. Early results demonstrate the potential for FG-4592 to treat
anemia as evidenced by increases in endogenous EPO up to eight-fold above
baseline following a single oral dose. Previous preclinical and clinical
studies demonstrate that therapeutically relevant increases in Hb are
observed following a two- to three-fold elevation in endogenous EPO
levels resulting from repeated intermittent dosing. No serious adverse
events related to FG-4592 have been reported.
"We believe the data continue to suggest that the unique ability of
FG-2216 to activate and coordinate the body's natural mechanisms for
correcting anemia could provide a safe and effective therapy for anemia
at a competitive cost to blood transfusions, which are used to treat
the majority of patients with anemia world-wide," said Thomas B. Neff,
Chief Executive Officer of FibroGen. "In addition, the advancement
of FG-4592 into human clinical trials is an important milestone that
affords us flexibility in developing novel therapies for anemia and
reduces development risk inherent in any drug discovery program. We will
continue to advance FG-2216 and FG-4592 through clinical testing and be
data-driven in our development strategy."
References
- Guenzler V, Muthukrishnan E, Neumayer HH, Sacherer K, Schmidt R,
Mitzner A, Wiecek A, Piecha G, Ignacy W, and Scigalla P (2005) FG-2216
Increases Hemoglobin Concentration in Anemic Patients with Chronic Kidney
Disease (Abstract SA-PO924). J Am Soc Nephrol 16:758A.
(Abstract).
- Seeley TW, Langsetmo I, Stephenson R, Pacleb J, Gervasi D, Lomonsgod
E, Klaus S, and Liu DY (2005) FG-2216: Tumor Progression Studies and
Correction of Anemia of Chronic Disease in Xenograft Models (Abstract
F-PO672). J Am Soc Nephrol 16:481A.
(Abstract).
- Langsetmo I, Nichols B, Seeley T, Stephenson R, Klaus S, Lin A,
and Liu DY (2005) FG-2216 Corrects Anemia and Improves Iron Utilization
in a Rat Model of Anemia of Chronic Disease: Comparison to Darbepoetin
(Abstract F-PO674). J Am Soc Nephrol 16:481A.
(Abstract).
- Gordeuk VR, Sergueeva AI, Miasnikova GY, Okhotin D, Voloshin Y,
Choyke PL, Butman JA, Jedlickova K, Prchal JT, and Polyakova LA (2004)
Congenital disorder of oxygen sensing: association of the homozygous
Chuvash polycythemia VHL mutation with thrombosis and vascular
abnormalities but not tumors. Blood 103:3924-32.
(Abstract on PubMed).
- Klaus S, Arend M, Fourney P, Flippin L, Gervasi D, Guenzler V,
Kochendoerfer G, Langsetmo I, Lin A, Lomongsod E, McDaniel D,
Meier-Davis S, Seeley T, Spong S, and Liu D (2005) Induction of
Erythropoiesis and Iron Utilization by the HIF Prolyl Hydroxylase
Inhibitor FG-4592 (Abstract F-FC050). J Am Soc Nephrol 16:49A.
(Abstract).
About FibroGen
FibroGen, Inc., is a biotechnology-based drug discovery company using
its expertise in the fields of tissue fibrosis, connective tissue growth
factor (CTGF), and hypoxia-inducible factor (HIF) biology to discover,
develop, and commercialize novel therapeutics for fibrotic disorders,
diabetic complications, anemia, ischemic disease, cancer, and other areas
of unmet medical need. FibroGen also develops and produces recombinant
human collagens and gelatins using unique production technology that
provides the basis for FibroGen's proprietary cosmetic dermal filler
and biomaterials supply business.
For more information about FibroGen, Inc., please visit
www.fibrogen.com.
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Contact: Laura Hansen 650-866-7828 or lhansen@fibrogen.com
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