The Biofreedom Surface Etching Polymer-Free DES System

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Presentation transcript:

The Biofreedom Surface Etching Polymer-Free DES System 12-month Outcomes of the BioFreedom FIM Randomized Trial John E Shulze, CTO Biosensors International Inc.

My Conflicts of interest are: Chief Technology Officer and a shareholder of Biosensors International Inc.

BioFreedom™ Selectively micro-structured surface holds drug in abluminal surface structures Hypothesis: Polymer-free drug release via porous-eluting stents may reduce late events caused by polymer stent coatings. Potential advantage Avoid long term late adverse effects that might be attributable to the polymer Improved surface integrity since there is no polymer to be sheared or peeled away from the stent struts Possible shorter need of dual antiplatelet therapy Proprietary Highly Lipophilic Limus drug

BIOLIMUS A9™ DRUG RAPAMYCIN DERIVATIVE Developed specifically for stent application by Biosensors Potent immunosuppressive and anti-inflammatory properties LIPOPHILICITY COMPARISON Highest lipophilic and hydrophobic properties of commercially available limus drugs Mainly localized effects, minimal drug release into bloodstream

Pre-Clinical Study - Efficacy BES vs. SES & BMS SD LD SES BMS 28 Days 180 Days n 28 days 180 days Standard dose Bio-freedom 24 23 Low dose Bio-freedom 26 27 Sirolimus-eluting stents 30 39 Bare metal stents Tada et al., Circ Cardiovasc Interv 2010;3;174-183

Pre-Clinical Study – Safety BES vs SES & BMS 28 days 180 days Standard dose Bio-freedom 24 23 Low dose Bio-freedom 2 27 Sirolimus-eluting stents 30 39 Bare metal stents Tada et al., Circ Cardiovasc Interv 2010;3;174-183

BioFreedom FIM Design BioFreedom FIM 4 Month Angio FU 182 patients First Cohort Second Cohort 12 Month Clinical FU 99% 4 Month Angio FU 75 patients 12 Month Angio FU 107 patients BioFreedom standard dose (BFD SD) N=25 low dose (BFD LD) N=26 TAXUS® Liberté ® N=24 Angio FU 92% BioFreedom standard dose (BFD SD) N=35 low dose (BFD LD) N=36 TAXUS® Liberté ® Angio FU 92% Enrollment Period Sept 2008 – Jan 2009 Enrollment Period Jan 2009 – Jun 2009

BioFreedom FIM Study Design Symptomatic, ischemic heart disease Native coronary artery ≥ 2.25 mm and ≤ 3.0 mm Lesion length ≤ 14 mm Lesion amenable to percutaneous treatment with DES BioFreedom™ Standard Dose 15.6 µg/mm BioFreedom™ Low Dose 7.8 µg/mm Taxus® Liberté® Clinical Follow-Up 30 d 4 mo 12 mo 2yr 3yr 4yr 5yr Angio and IVUS Follow-up Primary Endpoint: In-stent Late Lumen Loss (LL) at 12 months (2nd cohort) Non-Inferiority, margin = 0.24 mm Secondary Endpoints: In-stent Late Lumen Loss (LL) at 4 months (1st cohort) MACE and stent thrombosis rate at 30 days, 4, 12 months, 2, 3, 4 & 5 yrs Clinically-driven TLR, TVR and TVF at 4, 12 months, 2, 3, 4 & 5 yrs In-stent/In-segment binary restenosis at 4 months (1st cohort) & 12 months (2nd cohort) In-stent/In-segment Minimum Lumen Diameter (MLD) at 4 months Neointimal hyperplasia volume (IVUS) at 4 months (1st cohort) & 12 months (2nd cohort) Biolimus A9 concentrations pre/post procedure at discharge & 30 days DAPT recommended for a minimum of 6 months

Clinical Trial Organization Data Management and Co-ordination Center Cardiovascular Research Foundation, New York, USA R. Mehran, L. Gambone, H. Parise Angiographic Core Laboratory Cardiovascular Research Center, Sao Paulo, Brazil A. Abizaid, R. Costa IVUS Core Laboratory Cardiovascular Core Analysis Laboratory, Stanford, USA P. Fitzgerald ECG Core Laboratory Cardiovascular Research Foundation, ECG Core Lab, New York, USA A. Lansky EDC system KIKA Medical, Boston, USA C. Lanzillo Data Monitoring C. Czub, U. Gross, K. Kupfer, Germany Event Adjudication Committee G. Weisz, W. Gray, W. Sherman Data and Safety Monitoring Board J.A. Ambrose, P.B. Berger, T. Clayton

Patient Characteristics All Patients (1st + 2nd Cohorts) BFD SD N = 60 BFD LD N = 62 Taxus Age (mean ± SD) 68.6 ± 9.0 65.0 ± 9.4 67.9 ± 8.0 Male (%) 67 76 Diabetes mellitus (%) 28 29 25 Current Smoker (%) 17 20 12 Hypertension (%) 90 81 85 Hypercholesterolemia (%) 68 74 75 Previous MI (%) 21 18 Previous PCI (%) 32 44 46 Unstable angina (%) 13 7 All P values are non-significant. Tests were performed for BFD SD vs. Taxus and BFD LD vs. Taxus. Grube E., oral presentation, TCT 2010

Procedural Characteristics All Patients (1st + 2nd Cohorts) BFD SD N = 60 BFD LD N = 62 Taxus Stents per Patient (mean ± SD) 1.1 ± 0.3 1.1 ± 0.2 Pre-procedure Dilation (%) 88 92 Post-procedure Dilation (%) 18 23 22 Final TIMI 3 Flow (%) 100 Device Success (%) 97 Lesion Success (%) Procedure Success (%) 98* Device Success = Attainment of <50% residual stenosis of the target lesion with the study device and delivery system Lesion Success = Attainment of <50% residual stenosis of the target lesion using any percutaneous method Procedure Success = Attainment of <50% residual stenosis of the target lesion and no in-hospital MACE *Peri-procedural Non-Q wave MI All P values are non -significant. Tests were performed for BFD SD vs. Taxus and BFD LD vs. Taxus. Grube E., oral presentation, TCT 2010

Pre- Procedural QCA All Lesions (1st + 2nd Cohorts) BFD SD N = 59 BFD LD N = 63 Taxus N = 60 RVD (mm) 2.8 [2.5, 3.0] MLD (mm) 0.6 [0.3, 0.9] 0.6 [0.4, 0.9] 0.7 [0.5, 0.9] % DS 76.0 [64.3, 87.6] 77.2 [67.0, 85.8] 75.9 [67.2, 83.6] Lesion length (mm) 10.6 [9.3, 13.9] 11.3 [9.8, 13.6] 11.2 [9.5, 14.0] All values are presented as median [IQR]. All P values are non significant. Tests were performed for BFD SD vs. Taxus and BFD LD vs. Taxus. Grube E., oral presentation, TCT 2010

4 Month Angiographic FU In-Stent Late Lumen Loss: 1st Cohort Secondary Endpoint P < 0.0001 P = 0.002 (mm) N = 23 N = 25 N = 22 All values are presented as median. Grube E., oral presentation, TCT 2009

12 Month Angiographic FU In-Stent Late Lumen Loss: 2nd Cohort Primary Endpoint Non – inferiority P values P = 0.001 P = 0.21 (mm) N = 31 N = 35 N = 31 All values are presented as median [IQR] . Grube E., oral presentation, TCT 2010

Histogram of Late Lumen Loss Grube E., oral presentation, TCT 2010

12 Month Angiographic FU Late Lumen Loss: 2nd Cohort (mm) P = 0.6 P = 0.01 P = 0.61 P =0.90 All values are presented as medians. All P-values are caluculated for superiority. Grube E., oral presentation, TCT 2010

Case Example BioFreedom SD Grube E., oral presentation, TCT 2010

Case Example BioFreedom SD OCT Evaluation at 1 Year FU Grube E., oral presentation, TCT 2010

12 Month MACE – (KM Estimates) All Patients (1st + 2nd Cohorts) BFD SD N = 60 BFD LD N = 62 Taxus MACE* (All Death, MI, Emergent Bypass or TLR) 3 (6.1%) 7 (11.6%) 3 (5.5%) All Death 1 (1.8%) 0 (0.0%) MI 1 (1.6%) Q Wave MI Non-Q Wave MI 1 (1.6%)** Emergent Bypass TLR 6 (10.0%) *Time to first event **In-hospital MI All p values are non significant. Tests were performed for BFD SD vs. Taxus and BFD LD vs. Taxus.

12 Month Stent Thrombosis All Patients (1st + 2nd Cohorts) BFD SD N = 60 BFD LD N = 62 Taxus Acute (%) Sub-acute (%) Late (%) Possible, probable or definite stent thrombosis as per ARC Definition. All P values are non significant. Tests were performed for BFD SD vs. Taxus and BFD LD vs. Taxus. Grube E., oral presentation, TCT 2010

Summary & Conclusions - 1 Primary endpoint (In-Stent LL at 12 months) met: BioFreedom SD non-inferior to Taxus. In-Stent LL for BioFreedom SD (0.17 mm) demonstrated a trend towards superiority at 12 months compared to Taxus (0.35 mm). Both BioFreedom SD and BioFreedom LD demonstrated sustained safety up to 12 months, including absence of stent thrombosis. Grube E., oral presentation, TCT 2010

Summary & Conclusions - 2 BioFreedom: first polymer-free drug coated stent demonstrating comparable efficacy in inhibiting NIH (as assessed by independent QCA analysis) vs. a currently available DES with durable polymer at 12 months in a randomized clinical trial. Larger trial with longer term follow-up warranted to confirm these encouraging results. Grube E., oral presentation, TCT 2010

BioFreedom FIM IVUS RESULTS DON’T MISS Impact Trials Session First Report of BioFreedom FIM IVUS RESULTS at 12 months Tuesday, March 1 at 1:25 PM Complex Coronary Interventions II Speaker: Peter J. Fitzgerald, MD, PhD