New Novartis heart failure drug cuts risk by a fifth

by Reuters
Saturday, 30 August 2014 11:00 GMT

* LCZ696 reduces cardiovascular death and hospitalisations

* Has been little progress in heart failure in past decade

* Novartis sees multibillion-dollar sales opportunity

By Ben Hirschler

BARCELONA, Aug 30 (Reuters) - A new heart failure drug from Novartis cut the risk of both cardiovascular death and hospitalisation by a fifth in a keenly awaited study, boosting hopes for a product that is seen as a multibillion-dollar seller.

There has been little progress for more than a decade in treating chronic heart failure, in which the heart fails to pump enough blood around the body, so there is excitement about the new medicine among both doctors and investors.

The study, comparing LCZ696 to an older drug already known to improve survival, was stopped early five months ago because the benefit to patients was overwhelmingly positive - but the size of the effect was only disclosed on Saturday at the annual meeting of the European Society of Cardiology (ESC), the world's largest cardiology congress.

ESC officials flagged the PARADIGM-HF trial as one of the highlights of the five-day event in Barcelona, reflecting the pressing need to find better treatments than the current line-up of old generic medicines.

"Everything has been pretty stalled in heart failure," said Keith Fox, a cardiologist at the University of Edinburgh who also chairs the ESC's congress programme committee.

Novartis is looking to LCZ696 to revive its fortunes as the blood pressure pill Diovan faces generic competition. As a result, the data on the product is widely viewed as the most important catalyst for the stock over the remainder of 2014.

"This result is better than we ever could have anticipated," the company's pharmaceuticals head David Epstein told Reuters.

In addition to reducing deaths and hospital admissions, the drug also made patients feel measurably better, underscoring the case for it to replace existing treatments and bolstering expectations for multibillion-dollar sales, he said.

In the study - the largest ever undertaken in heart failure, involving more than 8,400 patients - LCZ696 was tested against enalapril, a so-called ACE inhibitor drug.

Patients who took LCZ696 were 20 percent less likely than those on enalapril to die of cardiovascular causes and were also 21 percent less likely to be admitted to hospital, according to results presented at congress and also published online by the New England Journal of Medicine (NEJM).

The relative risk reduction for a composite of both, which was the primary measure for the trial, was also 20 percent.

Industry analysts had been expecting a risk reduction with LCZ696 of between 15 percent and the low 20s percent.


Mariell Jessup, a heart failure expert at the University of Pennsylvania, who was not involved in the study, said the beneficial effects of the drug could apply to a wide spectrum of patients, even those receiving the best current therapy.

"PARADIGM-HF may well represent a new threshold of hope for patients with heart failure," she wrote in a NEJM editorial.

The size of the benefit is critical in determining how broadly LCZ696 will be used to treat millions of patients with chronic heart failure. Unlike a heart attack, heart failure develops progressively but the prognosis for sufferers is poor.

LCZ696 is a two-in-one pill, taken twice a day, combining Diovan's active ingredient valsartan and another class of drug called a neprilysin inhibitor.

In terms of side effects, patients on LCZ696 suffered more low blood pressure and non-serious swelling but less kidney impairment, high potassium and cough than the enalapril group.

Analyst forecasts for LCZ696 have been climbing in recent months and the consensus for sales in 2019 - four years after its expected launch - currently stands at $1.9 billion, according to Thomson Reuters Cortellis.

Still, analysts have found it hard to predict the drug's true potential pending the detailed data, prompting some to adopt a cautious stance while others see sales well above $5 billion.

Deutsche Bank analysts have predicted the drug could eventually sell as much as $10 billion a year, assuming it works across two broad groups of heart failure patients.

While the PARADIGM-HF study targeted patients with reduced ejection fraction, where the heart muscle does not contract effectively, Novartis is also starting a trial in a similar-sized group with preserved ejection fraction, where the ventricles do not relax as they should.

Epstein said LCZ696 could reach the market by the third quarter of 2015. He declined to comment on how much it would cost, although he said there would be a strong economic case for its use since it would save money by reducing hospital visits.

Analysts at Bernstein believe it could be priced at around $7 a day in the United States and $4 in Europe, where drug prices are lower. They noted there was very little in the pipelines of other companies in terms of competing products. (Editing by Tom Pfeiffer)

Our Standards: The Thomson Reuters Trust Principles.