R1626 plus peginterferon Alfa-2a provides potent suppression of hepatitis C virus RNA and significant antiviral synergy in combination with ribavirin

Division of Gastroenterology and Hepatology, Scripps Clinic, La Jolla, CA 92037, USA.
Hepatology (Impact Factor: 11.06). 08/2008; 48(2):385-97. DOI: 10.1002/hep.22357
Source: PubMed


R1626, a prodrug of the hepatitis C virus (HCV) RNA polymerase inhibitor R1479, showed time-dependent and dose-dependent reduction of HCV RNA levels in a previous study. The present study evaluated the efficacy and safety of R1626 administered for 4 weeks in combination with peginterferon alfa-2a +/- ribavirin in HCV genotype 1-infected treatment-naive patients. Patients were randomized to: DUAL 1500 (1500 mg R1626 twice daily [bid] + peginterferon alfa-2a; n = 21); DUAL 3000 (3000 mg R1626 bid + peginterferon alfa-2a; n = 32); TRIPLE 1500 (1500 mg R1626 bid + peginterferon alfa-2a + ribavirin; n = 31); or standard of care (SOC) (peginterferon alfa-2a + ribavirin; n = 20). At 4 weeks HCV RNA was undetectable (<15 IU/mL) in 29%, 69%, and 74% of patients in the DUAL 1500, DUAL 3000, and TRIPLE 1500 arms, respectively, compared with 5% of patients receiving SOC, with respective mean reductions in HCV RNA from baseline to week 4 of 3.6, 4.5, 5.2, and 2.4 log(10) IU/mL. Synergy was observed between R1626 and peginterferon alfa-2a and between R1626 and ribavirin. There was no evidence of development of viral resistance. Adverse events (AEs) were mainly mild or moderate; seven patients had nine serious AEs (including one patient with one serious AE in SOC). The incidence of Grade 4 neutropenia was 48%, 78%, 39%, and 10% in DUAL 1500, DUAL 3000, TRIPLE 1500, and SOC, respectively, and was the main reason for dose reductions. Conclusion: A synergistic antiviral effect was observed when R1626 was combined with peginterferon alfa-2a +/- ribavirin; up to 74% of patients had undetectable HCV RNA at week 4. Dosing of R1626 was limited by neutropenia; a study of different dosages of R1626 in combination with peginterferon alfa-2a and ribavirin is underway.

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Available from: Maribel Rodríguez-Torres, Oct 01, 2014
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    • "re 3. 6 , 4 . 5 , 5 . 2 , and 2 . 4 log 10 IU / ml . A synergistic effect was observed between the three drugs , and there was no evidence of viral resistance development . The incidence of grade 4 neutropenia was 48% , 78% , 39% , and 10% in 1 500 BID , 3 000 BID , 1 500 TID , and SOC , respectively , and was the main reason for dose reductions ( Pockros et al . , 2008b ) . The highest rates of relapse were observed in the combination arm of 1 500 mg BID R1626 with weekly PEG - IFN -  ( 1 500 BID arm ; 55% , 6 of 11 ) and in the 1 500 TID arm ( 28% , 7 of 25 ) . In five of the seven subjects in the 1 500 TID arm who experienced relapse , HCV RNA breakthrough occurred during the early stages of treatme"
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