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Phase 2 of new ARVs BMS-663068, prodrug of BMS-626529 (attachment inhibitor) - AI438011 Study.

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Presentation on theme: "Phase 2 of new ARVs BMS-663068, prodrug of BMS-626529 (attachment inhibitor) - AI438011 Study."— Presentation transcript:

1 Phase 2 of new ARVs BMS-663068, prodrug of BMS-626529 (attachment inhibitor) - AI438011 Study

2 Start of combination therapy AI438011 Study : BMS-663068 Phase II BMS-663068 400 mg bid + RAL + TDF N=50 BMS-663068 800 mg bid + RAL + TDF n = 49 BMS-663068 600 mg qd + RAL + TDF n = 51 BMS-663068 1 200 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-663068 monotherapy : 10 patients per study arm W96 Long-term follow-up on selected dose  Design – Phase IIb, randomised, active-controlled, blinded-to-BMS-663068 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-626529 IC 50 < 0.1 μM (100 nM) by screening Phenosense ® entry assay Partial blind (BMS-663068 dose) AI438011 Study Lalezari J, CROI 2014, Abs. 86; Thompson M, CROI 2015, Abs. 545

3  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 AI438011 Study Thompson M, CROI 2015, Abs. 545 AI438011 Study : BMS-663068 Phase II

4 BMS-663068 + TDF + RAL TDF + RAL + ATV/r N = 51 400 mg BID N = 50 800 mg BID N = 49 600 mg QD N = 51 1200 mg QD N = 50 Median age, years393740 39 Female38 %43 % 32 %43 % HIV RNA (log 10 c/mL), median4.975.014.884.78 HIV RNA > 100,000 c/mL46 %51 %45 %36 %35 % CD4 cell count/mm 3, median214237226224249 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 AI438011 Study AI438011 Study : BMS-663068 Phase II Lalezari J, CROI 2014, Abs. 86; Thompson M, CROI 2015, Abs. 545

5 BMS-663068 7 days of monotherapy Mean change in HIV RNA from baseline (log 10 c/ml) Lalezari J, CROI 2014, Abs. 86 400 mg bid (n = 7) 800 mg bid (n = 5) 600 mg qd (n = 10) 1 200 mg qd (n = 10) Day 0,5 0,0 -0,5 -1,0 -1,5 -2,0 20468 - 0.69 - 1.22 - 1.47 - 1.37 AI438011 Study AI438011 Study : BMS-663068 Phase II

6 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 1 200 mg qd ATV/r 300/100 mg qd 100 80 60 40 20 0 BMS-663068 Baseline HIV RNA < 100,000 c/mL Baseline HIV RNA > 100,000 c/mL % BMS-663068 + 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 AI438011 Study AI438011 Study : BMS-663068 Phase II

7 BMS-663068 + TDF + RAL ATV/r + TDF + RAL (n = 51) 400 mg bid (n = 50) 800 mg bid (n = 49) 600 mg qd (n = 51) 1 200 mg qd (n = 50) HIV RNA < 50 c/mL, %8261.268.66870.6 HIV RNA > 50 c/mL, %418.419.6169.8 Discontinued for lack of efficacy, %04.1020 Discontinued for other reasons, %625.9125.9 No virologic data at W48 Discontinued due to AE or death, % Discontinued for other reasons, % Missing data during window but on study, % 242242 4.1 10.2 0 5.9 0 200200 3.9 9.8 0 HIV RNA < 400 c/mL, %8675.584.38074.5 AI438011 Study AI438011 Study : BMS-663068 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, %9173697988 HIV RNA < 50 c/mL at W48, observed

8 N (%) BMS-663068 + TDF + RAL ATV/r + TDF + RAL (N = 51) 400 mg bid (N = 50) 800 mg bid (N = 49) 600 mg qd (N = 51) 1 200 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 000000000000 0 1 (2.0) 000000000000 0 2 (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 AI438011 Study Safety data through W48 Thompson M, CROI 2015, Abs. 545 AI438011 Study : BMS-663068 Phase II

9 Mean change from baseline at W48 in fasting lipids, mg/dL N (%) BMS-663068 + TDF + RAL ATV/r + TDF + RAL (N = 51) 400 mg bid (N = 50) 800 mg bid (N = 49) 600 mg qd (N = 51) 1 200 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) 0 00000000 1 (2.1) 2 (4.2) 0 1 (2.0) 2 (4.0) 29 (58.0) Creatine kinase Glucose fasting serum Uric acid 000000 1 (2.0) 0 1 (2.0) 2 (3.9) 0 2 (4.2) 0 2 (4.2) 2 (4.0) 0 AI438011 Study Grade 3-4 laboratory abnormalities (≥ 2 subjects) Thompson M, CROI 2015, Abs. 545 AI438011 Study : BMS-663068 Phase II BMS-663068 armsATV/r Total cholesterol-7.39 to +0.7+10.48 LDL-cholesterol-0.5 to -9.75+6.46 Triglycerides-23 to +0.5-1.15

10  Conclusion –Virologic response rates (mITT and observed) and immunologic responses were similar across the BMS-663068 and ATV/r arms through Week 48 –All BMS-663068 doses were generally well tolerated with no dose- response safety signals reported –Continuation dose of BMS-663068 1200 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-626529 A retrospective analysis will be conducted to determine whether a baseline phenotypic assay is necessary in the future AI438011 Study Thompson M, CROI 2015, Abs. 545 AI438011 Study : BMS-663068 Phase II


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