Potency, safety, and pharmacokinetics of the NS3/4A protease inhibitor BI201335 in patients with chronic HCV genotype-1 infection

Hannover Medical School, Department of Gastroenterology, Hepatology, and Endocrinology, Center for Internal Medicine, Hannover, Germany.
Journal of Hepatology (Impact Factor: 11.34). 11/2010; 54(6):1114-22. DOI: 10.1016/j.jhep.2010.08.040
Source: PubMed


BI201335 is a highly specific and potent HCV protease inhibitor. This multiple rising dose trial evaluated antiviral activity and safety in chronic HCV genotype-1 patients.
Thirty-four treatment-naïve patients were randomized to monotherapy with placebo or BI201335 at 20-240 mg once-daily for 14 days, followed by combination with pegylated interferon alfa/ribavirin (PegIFN/RBV) through Day 28. Nineteen treatment-experienced patients received 48-240 mg BI201335 once-daily with PegIFN/RBV for 28 days. HCV-RNA was measured with Roche COBAS TaqMan.
In treatment-naïve patients, median maximal viral load (VL) reductions during 14-day monotherapy were -3.0, -3.6, -3.7, and -4.2 log(10) for the 20, 48, 120, and 240 mg groups. VL breakthroughs (≥1 log(10) from nadir) were seen in most patients on monotherapy and were caused by NS3/4A variants (R155K, D168V) conferring in vitro resistance to BI201335. Adding PegIFN/RBV at Days 15-28 led to continuous viral load reductions in most patients. In treatment-experienced patients, treatment with BI201335 and PegIFN/RBV achieved VL<25 IU/ml at Day 28 in 3/6, 4/7, and 5/6 patients in the 48, 120, and 240 mg dose groups. VL breakthroughs were observed during triple combination in only 3/19 patients. BI201335 was generally well tolerated. Mild rash or photosensitivity was detected in four patients. Mild unconjugated hyperbilirubinemia was the only dose-dependent laboratory abnormality of BI201335. BI201335 elimination half-life supports once-daily dosing.
BI201335 combined with PegIFN/RBV was well tolerated and induced strong antiviral responses. These results support further development of BI201335 in HCV genotype-1 patients.

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    • "Furthermore, both drugs also display a wide range of drug–drug interactions (DDIs), have a high pill burden, and require twice-daily (BID) or three-times-daily dosing [5] [6] [7] [8] [9]. Faldaprevir (BI 201335) is a potent HCV NS3/4A PI administered once daily [10] [11] [12]. "
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    • "Thus far, most NS3-4A inhibitors have been developed predominantly to target HCV genotype 1. Newer NS3-4A protease inhibitors than telaprevir and boceprevir, which are currently in phase 1–3 development, include for example simeprevir (TMC435), danoprevir (R7227/ ITMN191), vaniprevir (MK-7009), asunaprevir (BMS-650032), BI201335, ACH-1625, ABT-450, MK-5172, GS-9256, and GS-9451. Potential advantages of these second and third generation protease inhibitors might be improved tolerability, broader genotypic activity (e.g., MK-5172), different resistance profiles (e.g., MK-5172), and/or improved pharmacokinetics, which allow a once daily dosage (e.g., TMC435, BI201335) [14] [15] [16] [17] [18]. "
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