Key HIV Research From ICAAC 2007: Antiretrovirals in Development and Salvage Chicago, Illinois | September 17-20, 2007 Faculty: Cal Cohen, M.D., M.S. Eric Daar, M.D. This activity is supported by an educational grant from:
Mar 26, 2015
Key HIV Research From ICAAC 2007: Antiretrovirals in Development and SalvageKey HIV Research From ICAAC 2007: Antiretrovirals in Development and Salvage
Chicago, Illinois | September 17-20, 2007
Faculty:
Cal Cohen, M.D., M.S.
Eric Daar, M.D.This activity is supported by an educational grant from:
The Body PRO
ICAAC 2007: Antiretrovirals in Development and Salvage
Cal Cohen, M.D., M.S.
Eric Daar, M.D.
Dr. Daar is the chief of HIV medicine at Harbor-UCLA Medical Center in Los Angeles, Calif., and a professor of medicine at the University of California-Los Angeles' David Geffen School of Medicine. He has been an active HIV physician and researcher since the 1980s; during the past three decades, he has led dozens of studies on a vast range of HIV-related issues, with a particular focus on coinfections and other health complications associated
with HIV and HIV treatment, including hepatitis C, metabolic complications, cardiovascular disease and psychosocial issues such as depression.
Dr. Cohen is the research director of the Community Research Initiative of New England and teaches at Harvard Medical School in Boston, Mass. In addition, he works as a HIV clinical management consultant and internist at Harvard Pilgrim Health Care, Boston, Mass., and is affiliated with Harvard Vanguard Medical Associates. Dr. Cohen was co-chair of the Scientific Advisory Committee of amfAR community-based clinical trials network, and served as co-principal investigator of the Harvard/BCH AIDS Clinical Trials Unit, AIDS Clinical Trials Group. He holds appointments at Brigham and Women's Hospital and Beth Israel Hospital, both in Boston, Mass.
Faculty for This ActivityFaculty for This Activity
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ICAAC 2007: Antiretrovirals in Development and Salvage
ICAAC 2007: Antiretrovirals in Development and SalvageICAAC 2007: Antiretrovirals in Development and Salvage
About this slide presentation
• This presentation is one of three slide sets created to accompany The Body PRO's podcast summary of key research presented at ICAAC 2007, featuring interviews with Cal Cohen, M.D., M.S., and Eric Daar, M.D. To download the remaining slide sets or learn more about this CME/CE program, please visit us on the Web at:
TheBodyPRO.com/ICAAC2007
• Please feel free to use this slide presentation for personal reference or for your own presentations; however, we ask that you not modify any aspects of the slides contained within this presentation, so proper attribution can be retained. If you would like to publish all or part of this presentation, or repost any of these slides online, permission must first be obtained from Body Health Resources Corporation.
• Our gratitude goes out to all who granted permission for their slides to be adapted for this presentation.
DisclaimerKnowledge about HIV changes rapidly. Note the date of this presentation's publication, and before treating patients or employing any therapies described in these materials, verify all information independently. If you are a patient, please consult a doctor or other medical professional before acting on any of the information presented in this presentation.
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ICAAC 2007: Antiretrovirals in Development and Salvage
Antiretrovirals in Development for Antiretrovirals in Development for Treatment-Experienced PatientsTreatment-Experienced Patients
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ICAAC 2007: Antiretrovirals in Development and Salvage
Antiretrovirals in Advanced DevelopmentAntiretrovirals in Advanced Development
Drug Name Class Development Stage
Notes
elvitegravir (GS-9137, JTK-303)
Integrase inhibitor
Phase II • Regimens including boosted PIs could have greater antiviral activity.• No clinically relevant drug interaction with etravirine.• When boosted, increases maraviroc exposure.• Showed synergistic interactions with enfuvirtide (T-20, Fuzeon), darunavir (TMC114, Prezista) and efavirenz (Sustiva, Stocrin) in vitro.
etravirine (TMC125)
NNRTI Phase III • No clinically relevant drug interaction with elvitegravir.
maraviroc (Selzentry)
CCR5 inhibitor Phase III • Patients failing regimen had higher mean CD4 increases even with D/M or X4-tropic virus.• Exposure increases when used with boosted elvitegravir; use reduced dose of 150mg twice daily.
raltegravir (MK-0518)
Integrase inhibitor
Phase III • In patients with limited treatment options, all doses had potent and durable effects.
vicriviroc (SCH 417690,
SCH-D)
CCR5 inhibitor Phase II • No adverse effect on white blood cell counts.• Not associated with an increased risk of infections.
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ICAAC 2007: Antiretrovirals in Development and Salvage
24-week primary analysis
• DUET-1 and -2 differed only in geographical location; pooled analysis was pre-specified
• Plasma viral load >5,000 HIV-1 RNA copies/mL and stable therapy for ≥8 weeks
• ≥1 NNRTI RAM, at screening or in documented historical genotype
• ≥3 primary PI mutations at screening
• Patients recruited from Thailand, Australia, Europe and the Americas
Screening6 weeks
600 patients target per trial
48-week treatment period with optional 48-week extension
*BR = darunavir/ritonavir with optimised NRTIs and optional enfuvirtide
TMC125 + BR*
Placebo + BR*
Follow up4 weeks
DUET: Study Design and Major Inclusion CriteriaDUET: Study Design and Major Inclusion Criteria
BR = background regimen; RAM = resistance-associated mutation
Pedro Cahn et al. ICAAC 2007; abstract H-717. Reprinted with permission.
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ICAAC 2007: Antiretrovirals in Development and Salvage
DUET: Viral Load Reduction From Baseline (ITT NC=F)DUET: Viral Load Reduction From Baseline (ITT NC=F)
BR = background regimen; SE = standard error; ITT = intent-to-treat population; NC=F = noncompleter equals failure imputation algorithm;
changes below the detection limit (<50 copies/mL) were imputed as 49 copies/mL
–1.7
–2.4
Mea
n c
han
ge
in v
iral
load
fro
m
bas
elin
e (l
og
10 c
op
ies/
mL
) ±
SE
0.0
–0.5
–1.0
–1.5
–2.0
–2.5
–3.0
–3.5
Time (weeks)
0 4 8 12 16 20 24
p<0.0001
TMC125 + BR (n=599)Placebo + BR (n=604)
Pedro Cahn et al. ICAAC 2007; abstract H-717. Reprinted with permission.
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ICAAC 2007: Antiretrovirals in Development and Salvage
DUET: Change in CD4 Cell Count From Baseline (ITT NC=F)DUET: Change in CD4 Cell Count From Baseline (ITT NC=F)
+86
+67
Mea
n c
han
ge
in C
D4
cell
cou
nt
fro
m b
asel
ine
(cel
ls/m
m3 )
± S
E
Time (weeks)
p<0.0001
BR = background regimen; SE = standard error; ITT = intent-to-treat population; NC=F = noncompleter equals failure imputation algorithm
100
75
50
25
00 4 8 12 16 20 24
TMC125 + BR (n=599)Placebo + BR (n=604)
Pedro Cahn et al. ICAAC 2007; abstract H-717. Reprinted with permission.
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ICAAC 2007: Antiretrovirals in Development and Salvage
DUET: Response (<50 copies/mL) According to Enfuvirtide (ENF) Use (Primary Analysis)
DUET: Response (<50 copies/mL) According to Enfuvirtide (ENF) Use (Primary Analysis)
Pat
ien
ts w
ith
vir
al lo
ad
<50
co
pie
s/m
L a
t W
eek
24 (
%)
p<0.0001
Using de novo ENF
DRV FC category, %
TMC125 + BR Placebo + BR
<2 20 27
2–10 40 39
10–40 26 26
>40 15 8
Placebo + BR (n=604)TMC125 + BR (n=599)
67%
Using de novo ENF
p=0.427
34%
56%
Unadjusted response
rates
0
20
40
60
80
Re-using or not using ENF
62%
DRV = darunavir FC = baseline fold change
Using de novo ENF
p<0.05
62%
73%
Adjusted for differences in baseline DRV FC between
groups
Pedro Cahn et al. ICAAC 2007; abstract H-717. Reprinted with permission.
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ICAAC 2007: Antiretrovirals in Development and Salvage
DUET: Response (<50 copies/mL) According to Number of Active Background Antiretrovirals
DUET: Response (<50 copies/mL) According to Number of Active Background Antiretrovirals
0 20 40 60 80 100
2
1
0
Patients with viral load <50 copies/mL at Week 24 (%)
Nu
mb
er o
f fu
lly a
ctiv
e b
ackg
rou
nd
AR
Vs
(PS
S) 45%
60%
8%a
≥
30%
67%74%
Analysis excludes patients who discontinued except for virological failure; PSS = phenotypic sensitivity score; darunavir and enfuvirtide are counted as fully active if FC<10 or used de novo, respectively
7/91
40/88
63/211
120/199
171/257
191/258
Placebo + BR (n=559)TMC125 + BR (n=545)
Pedro Cahn et al. ICAAC 2007; abstract H-717. Reprinted with permission.
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ICAAC 2007: Antiretrovirals in Development and Salvage
DUET: ConclusionsDUET: Conclusions
• In treatment-experienced patients, including those with NNRTI resistant virus, TMC125 consistently demonstrated superiority over placebo– 59% of patients achieved confirmed undetectable VL (<50 copies/mL) with TMC125
plus BR at Week 24
• Even in the absence of any other fully active background agents, with TMC125, 45% of patients achieved undetectable (<50 copies/mL)viral load– response rates increased as more active agents were used in the background regimen
• 13 TMC125 resistance-associated mutations (TMC125 RAMs) were identified– the greatest added benefit in the TMC125 versus placebo group was seen in patients
with <3 TMC125 RAMs– 86% patients had <3 TMC125 RAMs
• Except for rash, incidence and severity of AEs with TMC125 were similar to placebo
• TMC125 has the ability to extend and enhance the NNRTI class and provide a new treatment option for patients with resistance to other NNRTIs
Pedro Cahn et al. ICAAC 2007; abstract H-717. Reprinted with permission.
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ICAAC 2007: Antiretrovirals in Development and Salvage
Protocol 004: Study DesignProtocol 004: Study Design
Interim Analysis of Part I Before Initiating Part IIInterim Analysis of Part I Before Initiating Part II
Raltegravir 600 mg BIDRaltegravir 600 mg BID
Raltegravir 400 mg BIDRaltegravir 400 mg BID
Raltegravir 200 mg BIDRaltegravir 200 mg BID
Raltegravir 100 mg BIDRaltegravir 100 mg BID
Placebo BIDPlacebo BID
Part I cohort: Rx-naive patients stratified and randomized to integrase monotherapy or placebo for 10 days
Part I cohort: Rx-naive patients stratified and randomized to integrase monotherapy or placebo for 10 days
Integrase Monotherapy for 10 Days
Part II cohort: Rx-naive patients stratified and randomized to combination therapy for 48 weeks
Part II cohort: Rx-naive patients stratified and randomized to combination therapy for 48 weeks
~ 30 pts
~ 30 pts
~ 30 pts
~ 30 pts
~ 30 pts
Combination TherapyTotal
~ 38 pts
~ 38 pts
~ 38 pts
~ 38 pts
~ 38 pts
Part I Part II
~ 8 pts
~ 8 pts
~ 8 pts
~ 8 pts
~ 8 pts
Raltegravir 600 mg BID + TDF/3TCRaltegravir 600 mg BID + TDF/3TC
Raltegravir 400 mg BID + TDF/3TCRaltegravir 400 mg BID + TDF/3TC
Raltegravir 200 mg BID + TDF/3TCRaltegravir 200 mg BID + TDF/3TC
Raltegravir 100 mg BID + TDF/3TCRaltegravir 100 mg BID + TDF/3TC
Efavirenz 600 mg QD + TDF/3TCEfavirenz 600 mg QD + TDF/3TC
Adapted from Martin Markowitz et al. IAS 2007; abstract TUAB104.
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ICAAC 2007: Antiretrovirals in Development and Salvage
Protocol 005: Study DesignProtocol 005: Study Design
Raltegravir 200 mg BID* (43)Raltegravir 200 mg BID* (43)
Raltegravir 400 mg BID* (45)Raltegravir 400 mg BID* (45)
Raltegravir 600 mg BID* (45)Raltegravir 600 mg BID* (45)
Placebo BID* (45)Placebo BID* (45)
Raltegravir 400 mg BID* (178)
Raltegravir 400 mg BID* (178)
Weeks 1-24 Weeks 25-48
All 178 HIV-infected participants had anHIV RNA > 5,000 copies/mL and documented
resistance to three classes of oral ARTs at baseline.
*All patients received optimized background therapy.
All 178 HIV-infected participants had anHIV RNA > 5,000 copies/mL and documented
resistance to three classes of oral ARTs at baseline.
*All patients received optimized background therapy.
Adapted from Beatrice Grinsztejn et al. ICAAC 2007; abstract H-713.
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ICAAC 2007: Antiretrovirals in Development and Salvage
Protocol 005: Patient and Optimized Background Therapy (OBT) Characteristics
Protocol 005: Patient and Optimized Background Therapy (OBT) Characteristics
Adapted from Beatrice Grinsztejn et al. ICAAC 2007; abstract H-713.
Raltegravir (MK-0518) + OBT Placebo + OBT
200 mg
N = 43
400 mg
N = 45
600 mg
N = 45 N = 45
Percentage Male
Median Age in Years
Median Years of Prior Antiretrovirals
Mean CD4 Count in mm3
Mean HIV RNA in log10copies/mL
84
43
10
245
4.6
89
43
11
221
4.8
91
44
9
220
4.7
89
43
10
274
4.7
OBT: Median Number of Antiretrovirals
Phenotypic Sensitivity Score*: 0 to Protease Inhibitors
Phenotypic Sensitivity Score*: 0 to All Antiretrovirals
Genotypic Sensitivity Score*: 0 to All Antiretrovirals
Number of Patients With Enfuvirtide (T-20, Fuzeon) as New OBT
4
42 (98%)
20 (47%)
27 (63%)
13 (30%)
4
42 (93%)
26 (58%)
38 (84%)
8 (18%)
4
40 (89%)
22 (49%)
35 (78%)
13 (29%)
4
38 (84%)
18 (40%)
28 (62%)
10 (22%)
*By Phenosense GTNote: Enfuvirtide is not included in the phenotypic sensitivity score since there is no clinical cut-off.
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ICAAC 2007: Antiretrovirals in Development and Salvage
Protocol 005: Time to Loss of Virologic Response to Week 72: Raltegravir (MK-0518) All Doses Combined vs. Placebo
Protocol 005: Time to Loss of Virologic Response to Week 72: Raltegravir (MK-0518) All Doses Combined vs. Placebo
Adapted from Beatrice Grinsztejn et al. ICAAC 2007; abstract H-713.
Placebo
45 11 11 11 9 9 8 6 5 5 4 3 1
133122122 122 120 113 100 95 92 86 69 43 12
02 4 8 12 16 24 32 40 48 56 64 72
Week
0
20
40
60
80
100 %
of
Pat
ien
ts R
emai
nin
g
HIV
RN
A <
400
cop
ies/
mL
# of Patients at Risk
Raltegravir All Doses Combined
Placebo
Raltegravir All Doses Combined*
Placebo*
* Plus optimized background therapy.Patients who never achieved HIV RNA <400 copies/mL were considered failures. Non-responders assigned failure at time 0.
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ICAAC 2007: Antiretrovirals in Development and Salvage
Protocol 005: Analysis of Raltegravir (MK-0518) ResistanceProtocol 005: Analysis of Raltegravir (MK-0518) Resistance
Adapted from Beatrice Grinsztejn et al. ICAAC 2007; abstract H-713.
Study found no association between dose and/or drug concentration and resistance.
The factors decreasing likelihood of developing mutations at amino acids 148 alone, 155 alone, and either 148 or 155 were found to be:
• Phenotypic sensitivity score > 0.
• Lower viral load (≤ 100,000 copies/mL vs. > 100,000 copies/mL).
• New use of enfuvirtide (T-20, Fuzeon) in optimized background therapy.
From: Hazuda et al, XVI International HIV Drug Resistance Workshop, 2007, Barbados
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ICAAC 2007: Antiretrovirals in Development and Salvage
Protocol 005: Safety During Double-Blind Study PeriodProtocol 005: Safety During Double-Blind Study Period
Adapted from Beatrice Grinsztejn et al. ICAAC 2007; abstract H-713.
Raltegravir (MK-0518) safety profile for all doses similar to placebo Liver function test abnormalities were uncommon
• No grade 4 abnormalities for aspartate aminotransferase (AST), alanine transaminase (ALT) or alkaline phosphatase (ALP)
• Grade 3 AST: 2/133 patients (1.5%) in all MK-0518 groups • Grade 3 ALT: 1/133 patients (0.8%) in all MK-0518 groups
Most clinical adverse events (AEs) were mild to moderate 4 serious, drug-related clinical AEs
• Acute pancreatitis after 2 doses, considered 2º to optimized background therapy (200 mg group)
• Metabolic acidosis and renal insufficiency; sepsis; death (600 mg group)• Lacunar infarction by CT (placebo)• Worsening lipoatrophy (placebo)
2 discontinuations due to drug-related AE• Elevated AST/ALT, considered 2º to optimized background therapy (200
mg group)• Lipoatrophy (placebo)
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ICAAC 2007: Antiretrovirals in Development and Salvage
Elvitegravir (EVG) Phase 2 Study SchemaElvitegravir (EVG) Phase 2 Study Schema
Andrew Zolopa et al. ICAAC 2007; abstract H-714. Reprinted with permission.
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ICAAC 2007: Antiretrovirals in Development and Salvage
Elvitegravir Study: HIV RNA < 50 copies/mL at Week 16 for Patients With First Use of T-20
Elvitegravir Study: HIV RNA < 50 copies/mL at Week 16 for Patients With First Use of T-20
Andrew Zolopa et al. ICAAC 2007; abstract H-714. Reprinted with permission.
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Week 16 HIV RNA < 50 copies/mL for Patients Receiving EVG/r 125 mg: Impact of Gradations in Activity of Optimized Background Therapy
Week 16 HIV RNA < 50 copies/mL for Patients Receiving EVG/r 125 mg: Impact of Gradations in Activity of Optimized Background Therapy
Andrew Zolopa et al. ICAAC 2007; abstract H-714. Reprinted with permission.
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ICAAC 2007: Antiretrovirals in Development and Salvage
23
44 45
0
1020
30
4050
60
70
8090
100
* versus OBT alone† HIV-1 RNA value imputed as baseline if missing or if patient discontinued before 24 weeks
‡ Last observation carried forward
MOTIVATE 1 and 2: Summary of Week 24 Efficacy ResultsMOTIVATE 1 and 2: Summary of Week 24 Efficacy Results
Includes all patients who received at least one dose of study medication
Mea
n ch
ange
from
ba
selin
e in
CD
4 co
unt (
cells
/mm
3 )MVC QD + OBT (N=414)
MVC BID + OBT (N=426)
OBT alone (N=209)
P<0.0001* P<0.0001*57
109 106
0
20
40
60
80
100
120
Patie
nts
(%)
P<0.001* Difference: +51(95% CI: 33, 69)
P<0.001* Difference: +49(95% CI: 31, 67)
HIV-1 RNA <50 copies/mL†
Mean Change from Baseline in CD4 Count‡
Elna van der Ryst et al. ICAAC 2007; abstract H-715. Reprinted with permission.
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ICAAC 2007: Antiretrovirals in Development and Salvage
Characterization of Maraviroc Resistance in MOTIVATE 1 and 2: Study Overview
Characterization of Maraviroc Resistance in MOTIVATE 1 and 2: Study Overview
OBJECTIVE: To study changes in HIV-1 tropism in patients who experienced treatment failure in the MOTIVATE 1 and 2 studies
MOTIVATE 1 and MOTIVATE 2 Phase 3 studies in treatment-experienced patients (N=1,075)
Assessment of CD4 count at failure, time of failure, and occurrence of Category C events
by tropism result
NR/NPNon-reportable/
non-phenotypable
D/M*†
Dual/mixed tropic virus population
R5*
Only CCR5-tropic virus detected
X4†
Only CXCR4-tropic virus detected
Tropism determined for all patients at screening, baseline, and all visits where VL>500 c/mL (Trofile™
assay, Monogram Biosciences)
* CCR5-using virus; †CXCR4-using virusElna van der Ryst et al. ICAAC 2007; abstract H-715. Reprinted with permission.
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ICAAC 2007: Antiretrovirals in Development and Salvage
R5X4A) Pure
B) Mixed
MOTIVATE 1 and 2: Viral Populations That May Exist Within a Patient
MOTIVATE 1 and 2: Viral Populations That May Exist Within a Patient
R
X
XX
X
XX
XXX
XX
XX
XX X
XX
RR
RR
RR R
RRRR R
RR
RRR
RRR
DDDD
DDD D DD
DD
D DD D D D
DD
R
XX X X X XX X X X X
XX X XXXXX
XX
X X X
X XX
X X
X X X
XX
R R RRR R
R R RRRR R
RR
RR R
RR
RR R
R
R
RR
D D
DD
DD
Elna van der Ryst et al. ICAAC 2007; abstract H-715. Reprinted with permission.
Dual/mixed (D/M) tropism
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ICAAC 2007: Antiretrovirals in Development and Salvage
-100 0 100 200 300
0
100
200
300
400
500
MOTIVATE 1 and 2: CXCR4-Using Clones Were Detected at Low Frequency in the Baseline Sample
MOTIVATE 1 and 2: CXCR4-Using Clones Were Detected at Low Frequency in the Baseline Sample
Time Since First Administration (Day)
• CXCR4-using clones detected at baseline (7%)
• No CCR5-tropic clones on treatment
R5 R5 DM DM DM DM DM DM R5 R5
1
2
3
4
5
6
HIV
-1 R
NA
(lo
g10
co
pie
s/m
L)
CD
4 C
ou
nt
(ce
lls/m
m3 )
Patient T6
Lewis M et al. XVI International HIV Drug Resistance Workshop, June 2007, Abstract 56 Elna van der Ryst et al. ICAAC 2007; abstract H-715. Reprinted with permission.
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ICAAC 2007: Antiretrovirals in Development and Salvage
MOTIVATE 1 and 2: Selective Inhibition of R5 Viruses Can Lead to a Change in Tropism Result to D/M or X4
MOTIVATE 1 and 2: Selective Inhibition of R5 Viruses Can Lead to a Change in Tropism Result to D/M or X4
R R RRR R RR
R R RRR R DR
R R RRR R RR
R R RRR R DR
R R RRR R RR
R R RRR R DR
R R RRR R RR
R R RRR R DR
R R RRR R RR
R R RRR R DR
R R RRR R RR
R R RRR R XR
R R RRR R RR
R R RRR R DR
R R RRR R RR
R R RRR R DR
D
X
D
D
D
D
D
D
R5 D/M
Trofile™ (like all resistance tests) measures relative proportions (not absolute amounts) of different viruses (Panel A)
Selective inhibition of a majority virus type, increases the sensitivity to detect the minor variant (Panel B)
A B
MVC
Elna van der Ryst et al. ICAAC 2007; abstract H-715. Reprinted with permission.
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ICAAC 2007: Antiretrovirals in Development and Salvage
MOTIVATE 1 and 2: Selective Inhibition of R5 Viruses Can Lead to a Change in Tropism Result to D/M or X4
MOTIVATE 1 and 2: Selective Inhibition of R5 Viruses Can Lead to a Change in Tropism Result to D/M or X4
• Maraviroc selectively inhibits R5 virus
• If maraviroc is administered as part of a sub-optimal regimen, pre-existing low (undetected) levels of D/M or X4 virus will emerge as the dominant viral population
• Since the D/M or X4 virus is pre-existing, time to failure is shorter than with R5 virus (where maraviroc resistance must be selected de novo)
• Similar to the rapid outgrowth of pre-existing (archived) drug-resistant virus when failed ARV therapy is reinitiated after treatment interruption
• After withdrawal of maraviroc, selective pressure on R5 virus is removed, allowing R5 virus to re-emerge as the dominant population
• Reversion to R5 takes approximately 16 weeks, consistent with loss of 3TC1 or enfuvirtide2 resistance after withdrawal of these ARVs
1. Deeks S, et al. J Infect Dis 2005; 192:1537-44.2. Deeks et al. J Infect Dis 2007;195:387-91.
Elna van der Ryst et al. ICAAC 2007; abstract H-715. Reprinted with permission.
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ICAAC 2007: Antiretrovirals in Development and Salvage
Randomization 1:2:2
N=601
MOTIVATE 1: Trial DesignMOTIVATE 1: Trial Design
OBT* + maraviroc (150 mg† BID)
OBT* + maraviroc (150 mg† QD)
OBT* + placebo
0 24w
* OBT = optimized background therapy of 3–6 ARVs (PK boosting doses of RTV not counted as an ARV)† Patients receiving a PI (except TPV) and/or delavirdine in their OBT received 150 mg dose of MVC,
all other patients received 300 mg dose of MVC
Screening(6 weeks) 48w
Patients stratified by:• Enfuvirtide use in OBT • HIV-1 RNA < and ≥100,000 copies/mL at screening
Patient eligibility criteria: • R5 HIV-1 infection• HIV-1 RNA ≥5,000 copies/mL
• Stable pre-study ARV regimen, or no ARVs for ≥ 4 weeks• Resistance to and/or ≥ 6 months’ experience with ≥ one ARV from three classes (≥ two for PIs)
Jacob P. Lalezari et al. ICAAC 2007; abstract H-718a. Reprinted with permission.
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ICAAC 2007: Antiretrovirals in Development and Salvage
MOTIVATE 1 – Week 48:Mean Change From Baseline in HIV-1 RNA
MOTIVATE 1 – Week 48:Mean Change From Baseline in HIV-1 RNA
-1.03-0.80
-1.82-1.66
-1.95-1.82
-2.5
-2.0
-1.5
-1.0
-0.5
0.0
Includes all patients who received at least one dose of study medication
HIV-1 RNA value imputed as baseline if patient discontinued before 48 weeks*Treatment difference vs OBT alone
Mea
n ch
ange
in H
IV-1
RN
A f
rom
bas
elin
e (lo
g 10 c
opie
s/m
L)
Difference: -0.85* (97.5% CI: -1.22, -0.49) Difference: -1.02*
(97.5% CI: -1.39, -0.66)
MVC QD + OBT (N=232)
MVC BID + OBT (N=235)
OBT alone (N=118)
Study week
Difference: -0.79* (97.5% CI: -1.14, -0.44)
Difference: -0.92* (97.5% CI: -1.28, -0.57)
24 48
Jacob P. Lalezari et al. ICAAC 2007; abstract H-718a. Reprinted with permission.
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ICAAC 2007: Antiretrovirals in Development and Salvage
MOTIVATE 1 – Week 48:Percentage of Patients With Undetectable HIV-1 RNA
MOTIVATE 1 – Week 48:Percentage of Patients With Undetectable HIV-1 RNA
Jacob P. Lalezari et al. ICAAC 2007; abstract H-718a. Reprinted with permission.
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ICAAC 2007: Antiretrovirals in Development and Salvage
Patie
nts
(%)
N=
Maraviroc QD + OBT Maraviroc BID + OBT OBT alone
MOTIVATE 1 and 2: Proportion of Patients Receiving ENF With Undetectable HIV-1 RNA at Week 48 According to ENF First Use
MOTIVATE 1 and 2: Proportion of Patients Receiving ENF With Undetectable HIV-1 RNA at Week 48 According to ENF First Use
<400 copies/mL <50 copies/mL
3
2736
3
25
6471
35 32
61
71
43
0102030405060708090
100
Last observation carried forward
ENF first use ENF experienced/resistance
91 10859 30 75 72
ENF first use ENF experienced/resistance
91 10859 30 75 72
Jacob P. Lalezari et al. ICAAC 2007; abstract H-718a. Reprinted with permission.
The Body PRO
ICAAC 2007: Antiretrovirals in Development and Salvage
MOTIVATE 1 and 2 – Week 48: Change in CD4+ Cell Count From Baseline by Tropism Result at Time of Failure
MOTIVATE 1 and 2 – Week 48: Change in CD4+ Cell Count From Baseline by Tropism Result at Time of Failure
Tropism result, Baseline→ Treatment Failure
Mean change from baseline in CD4+ count in patients with treatment failure (cells/mm3 )
OBT aloneN=271
MVC QD + OBTN=477
MVC BID + OBTN=487
All treatment failures* +24 (n=111)
+64 (n=92)
+74 (n=96)
R5→ R5 +25(n=89)
+77(n=33)
+133(n=24)
R5→ D/M or X4 +61(n=6)
+47(n=35)
+57(n=41)
* Includes patients with non-reportable/non-phenotypable tropism result at baseline and patients with non-reportable/non-phenotypable/missing tropism result at time of failure
Jacob P. Lalezari et al. ICAAC 2007; abstract H-718a. Reprinted with permission.
The Body PRO
ICAAC 2007: Antiretrovirals in Development and Salvage
ICAAC 2007: Antiretrovirals in Development and SalvageICAAC 2007: Antiretrovirals in Development and Salvage
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