Phase 2 of new ARVs BMS , prodrug of BMS (attachment inhibitor) - AI Study
Start of combination therapy AI Study : BMS Phase II BMS mg bid + RAL + TDF N=50 BMS mg bid + RAL + TDF n = 49 BMS mg qd + RAL + TDF n = 51 BMS mg qd + RAL + TDF n = 50 ATV/r 300/100 mg qd + RAL + TDF n = 51 D1 W24 W48 Primary endpoints Secondary endpoint 7 days of BMS monotherapy : 10 patients per study arm W96 Long-term follow-up on selected dose Design – Phase IIb, randomised, active-controlled, blinded-to-BMS dose – ARV-experienced patients, > 18 years, HIV RNA > 1,000 c/mL, CD4 cell count > 50/mm 3 – Susceptibility to RAL, TDF and ATV – BMS IC 50 < 0.1 μM (100 nM) by screening Phenosense ® entry assay Partial blind (BMS dose) AI Study Lalezari J, CROI 2014, Abs. 86; Thompson M, CROI 2015, Abs. 545
Objective –Primary endpoints (W24) : –% HIV-1 RNA < 50 c/mL –% of SAEs and AEs leading to discontinuation –Secondary endpoints (W48) : –%HIV-1 RNA < 50 c/mL –Change in CD4 T-cell count from baseline –% SAEs and AEs leading to discontinuation AI Study Thompson M, CROI 2015, Abs. 545 AI Study : BMS Phase II
BMS TDF + RAL TDF + RAL + ATV/r N = mg BID N = mg BID N = mg QD N = mg QD N = 50 Median age, years Female38 %43 % 32 %43 % HIV RNA (log 10 c/mL), median HIV RNA > 100,000 c/mL46 %51 %45 %36 %35 % CD4 cell count/mm 3, median CD4 < 200 per mm 3 38 %33 %41 %42 %37 % HIV subtype B / C70 % / 16 %59 % / 25 %69 % / 22 %64 % / 20 %67 % / 18 % Discontinuation by W486 (12 %)17 (35 %)9 (18 %)16 (32 %)14 (28 %) For lack of efficacy-5152 For adverse event12-22 Lost to follow-up21252 Non-compliance142-1 Consent withdrawal12-23 Other13424 Baseline characteristics and patient disposition AI Study AI Study : BMS Phase II Lalezari J, CROI 2014, Abs. 86; Thompson M, CROI 2015, Abs. 545
BMS days of monotherapy Mean change in HIV RNA from baseline (log 10 c/ml) Lalezari J, CROI 2014, Abs mg bid (n = 7) 800 mg bid (n = 5) 600 mg qd (n = 10) mg qd (n = 10) Day 0,5 0,0 -0,5 -1,0 -1,5 -2, AI Study AI Study : BMS Phase II
Lalezari J, CROI 2014, Abs. 86 HIV RNA < 50 c/ml at W24 by baseline HIV RNA (observed) 400 mg bid 800 mg bid 600 mg qd mg qd ATV/r 300/100 mg qd BMS Baseline HIV RNA < 100,000 c/mL Baseline HIV RNA > 100,000 c/mL % BMS TDF + RAL ATV/r + TDF + RAL 400 mg bid800 mg bid600 mg qd1200 mg qd HIV RNA < 50 c/ml (mITT, snapshot)80%69,4%76,5%72%74,5% HIV RNA < 400 c/ml (mITT, snapshot)92%80%90%80%82% HIV RNA < 50 c/ml (observed)87%81%78%84% 86% HIV RNA < 50 c/mL or < 400 c/mL at W24 AI Study AI Study : BMS Phase II
BMS TDF + RAL ATV/r + TDF + RAL (n = 51) 400 mg bid (n = 50) 800 mg bid (n = 49) 600 mg qd (n = 51) mg qd (n = 50) HIV RNA < 50 c/mL, % HIV RNA > 50 c/mL, % Discontinued for lack of efficacy, % Discontinued for other reasons, % No virologic data at W48 Discontinued due to AE or death, % Discontinued for other reasons, % Missing data during window but on study, % HIV RNA < 400 c/mL, % AI Study AI Study : BMS Phase II HIV RNA < 50 c/mL or < 400 c/mL at W48, mITT snapshot Thompson M, CROI 2015, Abs. 545 HIV RNA < 50 c/ml, % HIV RNA < 50 c/mL at W48, observed
N (%) BMS TDF + RAL ATV/r + TDF + RAL (N = 51) 400 mg bid (N = 50) 800 mg bid (N = 49) 600 mg qd (N = 51) mg qd (N = 50) SAEs*3 (6.0)5 (10.2)4 (7.8)3 (6.0)5 (9.8) AEs leading to discontinuation**1 (2.0)2 (4.1)02 (4.0)2 (3.9) Grade 2-4 related clinical AEs4 (8.0)4 (8.2)3 (5.9)6 (12.0)15 (29.4) Present in > 2 subjects Abdominal pain Nausea Hyperbilirubinemia Jaundice Blood bilirubin increased Headache (2.0) (3.9) 4 (7.8) 2 (3.9) 3 (5.9) 2 (3.9) * Anal abscess, herpes encephalitis, overdose (3), extrapulmonary tuberculosis (2), herpes zoster, abdominal pain, myalgia, spontaneous abortion, acute renal failure, cellulitis (2), lymphangitis, chronic cholecystitis, back pain, pneumonia, pyelonephritis, diarrhea, cholelithiasis, migraine ** Illegal substance use, extrapulmonary tuberculosis (3), acute renal failure, abdominal distension, flatulence, nausea, jaundice ; 6/7 AE leading to discontinuation in first 24 weeks AI Study Safety data through W48 Thompson M, CROI 2015, Abs. 545 AI Study : BMS Phase II
Mean change from baseline at W48 in fasting lipids, mg/dL N (%) BMS TDF + RAL ATV/r + TDF + RAL (N = 51) 400 mg bid (N = 50) 800 mg bid (N = 49) 600 mg qd (N = 51) mg qd (N = 50) Neutrophils (absolute)1 (2.1)1 (2.0)2 (3.9)2 (2.1)1 (2.0) Alkaline phosphatase ALT AST Total bilirubin 0 1 (2.1) 0 1 (2.0) (2.1) 2 (4.2) 0 1 (2.0) 2 (4.0) 29 (58.0) Creatine kinase Glucose fasting serum Uric acid (2.0) 0 1 (2.0) 2 (3.9) 0 2 (4.2) 0 2 (4.2) 2 (4.0) 0 AI Study Grade 3-4 laboratory abnormalities (≥ 2 subjects) Thompson M, CROI 2015, Abs. 545 AI Study : BMS Phase II BMS armsATV/r Total cholesterol-7.39 to LDL-cholesterol-0.5 to Triglycerides-23 to
Conclusion –Virologic response rates (mITT and observed) and immunologic responses were similar across the BMS and ATV/r arms through Week 48 –All BMS doses were generally well tolerated with no dose- response safety signals reported –Continuation dose of BMS mg QD for the Phase IIb study –Phase III study in heavily treatment-experienced patients with limited therapeutic options Phase III dose : 600 mg BID Subjects enrolled regardless of baseline susceptibility to BMS A retrospective analysis will be conducted to determine whether a baseline phenotypic assay is necessary in the future AI Study Thompson M, CROI 2015, Abs. 545 AI Study : BMS Phase II