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Phase 2 of new ARVs  Fostemsavir, prodrug of temsavir (attachment inhibitor) –AI438011 Study  TAF (TFV prodrug) –Study 292-0102 –Study 299-0102  Doravirine.

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Presentation on theme: "Phase 2 of new ARVs  Fostemsavir, prodrug of temsavir (attachment inhibitor) –AI438011 Study  TAF (TFV prodrug) –Study 292-0102 –Study 299-0102  Doravirine."— Presentation transcript:

1 Phase 2 of new ARVs  Fostemsavir, prodrug of temsavir (attachment inhibitor) –AI438011 Study  TAF (TFV prodrug) –Study 292-0102 –Study 299-0102  Doravirine (non nucleoside reverse transcriptase inhibitor) –MK1439007 Study  Cabotegravir (integrase inhibitor) –LATTE Study  BMS-955176 (maturation inhibitor) –AI468002 Study

2 LATTE Study : cabotegravir Phase II  Phase IIb Margolis D, CROI 2014, Abs. 91LB W24W48W96 2 NRTI** + CAB 30 mg QD 2 NRTI** + CAB 10 mg QD Oral induction 2 NRTI** + CAB 60 mg QD Oral maintenance (if HIV RNA < 50 c/mL at W20) RPV 25 mg + CAB 10 mg QD 2 NRTI** + EFV 600 mg QD RPV 25 mg + CAB 30 mg QD RPV 25 mg + CAB 60 mg QD D1 * Randomisation stratified by HIV RNA (≤ or > 100,000 c/mL) at screening and NRTI backbone ** NRTI backbone (TDF/FTC or ABC/3TC if exclusion of the HLA-B*5701 allele) selected by investigator Margolis DA. Lancet Infect Dis 2015; 15:1145-55  Design  Objective –Primary endpoint : % HIV-1 RNA < 50 c/mL at W48 (FDA snapshot) –Intent-to-treat exposed (ITT-E) : received ≥ 1 dose of investigational product –Intent-to-treat maintenance exposed (ITT-ME) : received ≥ 1 maintenance dose Randomisation* 1 : 1 : 1 : 1 Partial-blind (CAB dose) ARV-naïve HIV RNA > 1,000 c/mL CD4 ≥ 200/mm 3 LATTE Study

3 CAB 10 mg (N = 60) CAB 30 mg (N = 60) CAB 60 mg (N = 61) EFV 600 mg (N = 62) Median age, years3232.53632.5 Female5 %3 %7 %2 % HIV RNA (log 10 c/mL), median4.284.184.354.34 HIV RNA > 100,000 c/mL13 %12 %20 %13 % CD4 cell count/mm 3, median405404420417 HCV Ab positive0 %8 %7 %2 % Dual NRTI at D1 : TDF/FTC ; ABC/3TC62 % ; 38 % 61 % ; 39 % Discontinuation by W4810 (17 %) 7 (11 %)18 (29 %) For insufficient viral load response ♯ 3*01**1*** For virologic failure2214 For adverse event1148 Lost to follow-up12-3 Consent withdrawal / other2 / 13 / 10 / 11 / 0 Discontinuation by W9614 (23 %)12 (20 %)9 (15 %)21 (34 %) For lack of efficacy / for AE0 / 00 / 1 Baseline characteristics and patient disposition ♯ W20 HIV RNA : * : 51, 107, 189 c/mL ; ** : 108 c/mL ; *** : 146 c/mL LATTE Study LATTE Study : cabotegravir Phase II Margolis DA. Lancet Infect Dis 2015; 15:1145-55

4 0 100 48121624283236404860728496 80 60 40 20 0 84 75 68 63 EFV = 74% CAB overall 87% InductionMaintenance % HIV RNA < 50 c/ml (ITT-E, snapshot) CAB 10 mg (N = 60)CAB 30 mg (N = 60)CAB 60 mg (N = 61)EFV 600 mg (N = 62) weeks CAB overall 76% EFV = 71% CAB overall 82% LATTE Study LATTE Study : cabotegravir Phase II Margolis DA. Lancet Infect Dis 2015; 15:1145-55

5 Week 96 outcome, ITT-ME, snaphsot CAB 10 mgCAB 30 mgCAB 60 mgEFV 600 mg HIV RNA < 50 c/mL79%85%93%83% Protocol-defined virologic failure4%2%04% Failure – adverse event2%0 4% Failure – HIV RNA ≥ 50 c/mL8%2% 4% Failure other reasons* while HIV RNA ≥ 50 c/mL 2% 0 Failure other reasons* while HIV RNA < 50 c/mL 6%9%2%4% * Other reasons : missing data, protocol deviation, non-compliance, lost to follow-up, withdrawn consent, investigator discretion, ART change, ineligible for maintenance phase LATTE Study LATTE Study : cabotegravir Phase II Margolis DA. Lancet Infect Dis 2015; 15:1145-55

6 Protocol-defined virologic failures CAB 10 mgCAB 30 mgCAB 60 mgEFV 600 mg Induction phase1114 Emergence of resistance0000 Maintenance phase21**02 Emergence of resistance2*000 * CAB 10 mg : emergence of NNRTI (E138Q) and INI (Q148R) mutations at W48; CAB FC = 3, RPV FC = 2 ; CAB 10 mg : emergence of NNRTI mutations (K101K/E + E138E/A) but not to INI Additional patient on CAB 10 mg : failure at W48 not confirmed, mutation to NNRTI (K101K/E + E138E/K), no INI mutation ** CAB 30 mg : PDVF at W36 with no emergence of NNRTI mutation (integrase not amplified)  Protocol-defined virologic failure (PDVF) : – Non-response: < 1 log 10 c/mL decrease of HIV RNA by Week 4, unless < 400 c/mL; or HIV RNA ≥ 200 c/mL on or after Week 16 – Rebound: HIV RNA ≥ 200 c/mL after confirmed 0.5 log 10 c/mL above nadir (the lowest prior HIV RNA ≥ 200 c/mL) – Both non-response and rebound required consecutive confirmatory results LATTE Study LATTE Study : cabotegravir Phase II Margolis DA. Lancet Infect Dis 2015; 15:1145-55

7 CAB 10 mg (N = 60) CAB 30 mg (N = 60) CAB 60 mg (N = 61) EFV 600 mg (N = 62) Grade 2-4 drug-related events (> 3% any arm) 5 (8 %)8 (13 %)13 (21 %)12 (19 %) Insomnia1 (2 %)2 (3 %)04 (6 %) Depression002 (3 %)0 Nausea02 (3 %)3 (5 %)1 (2 %) Fatigue 02 (3 %)1 (2 %) Headache 1 (2 %) 3 (5 %)0 Rash macular 0003 (5 %) Serious AEs 7 (12 %)5 (8 %)7 (11 %)4 (6 %) AEs leading to withdrawal (> 1 subject) 1 (2 %)2 (3 %)4 (7 %)9 (15 %) Dizziness 0002 (3 %) ALT increased 002* (3 %)0 * 2 subjects with steatohepatitis developed asymptomatic grade 4 ALT elevations (meeting protocol-defined liver stopping criteria) with normal bilirubin levels, at W4 and W8, which resolved off investigations products. LATTE Study LATTE Study : cabotegravir Phase II Adverse events Margolis DA. Lancet Infect Dis 2015; 15:1145-55

8 CAB 10 mg (N = 60) CAB 30 mg (N = 60) CAB 60 mg (N = 61) EFV 600 mg (N = 62) Grade 1-4 ALT elevations8 (13 %)12 (20 %)17 (28 %)13 (21 %) Select grade 3-4 laboratory abnormalities Creatine phosphokinase7 (12 %) 5 (8 %)9 (15 %) ALT01 (2 %)2* (3 %)1 (2 %) Lipase 3 (5 %)2 (3 %)6 (10 %)1 (2 %) Total bilirubin 0000 Total neutrophils 1 (2 %) 2 (3 %) Creatinine 0000 LATTE Study Laboratory abnormalities LATTE Study : cabotegravir Phase II * 2 subjects with steatohepatitis developed asymptomatic grade 4 ALT elevations (meeting protocol-defined liver stopping criteria) with normal bilirubin levels, at W8, which resolved off investigations products. Margolis DA. Lancet Infect Dis 2015; 15:1145-55

9  Conclusion –Following 24 weeks induction therapy with 2 NRTIs and CAB, oral CAB + RPV maintained virologic suppression at a rate similar to EFV + 2 NRTIs through 96 weeks –CAB + RPV was well tolerated, with few drug-related AEs leading to discontinuation –CAB 30 mg QD dose was selected for further oral development LATTE Study LATTE Study : cabotegravir Phase II Margolis DA. Lancet Infect Dis 2015; 15:1145-55


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