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Gottlieb J, Torres F, Haddad T, Dhillon G, Dilling DF, Knoop C, Rampolla R, Walia R, Ahya V, Kessler R, Budev M, Neurohr C, Glanville AR, Jordan R, Porter D, McKevitt M, German P, Guo Y, Chien JW, Watkins TR, Zamora MR. A randomized controlled trial of presatovir for respiratory syncytial virus after lung transplant. J Heart Lung Transplant 2023; 42:908-916. [PMID: 36964084 DOI: 10.1016/j.healun.2023.01.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 01/06/2023] [Accepted: 01/30/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) infection in lung transplant recipients is associated with high morbidity. This study evaluated the RSV fusion inhibitor presatovir in RSV-infected lung transplant recipients. METHODS In this international Phase 2b, randomized, double-blind, placebo-controlled trial (NCT02534350), adult lung transplant recipients with symptomatic confirmed RSV infection for ≤7 days received oral presatovir 200 mg on day 1 and 100 mg daily on days 2 to 14, or placebo (2:1), with follow-up through day 28. There were 2 coprimary endpoints: time-weighted average change in nasal RSV load from day 1 to 7, calculated from nasal swabs, in the full analysis set ([FAS]; all patients who received study drug and had quantifiable baseline nasal RSV load) and time-weighted average change in nasal RSV load from day 1 to 7 in the subset of patients with pretreatment symptom duration at the median or shorter of the FAS. Secondary endpoints were changes in respiratory infection symptoms assessed using the Influenza Patient-Reported Outcomes questionnaire and lung function measured by spirometry. RESULTS Sixty-one patients were randomized, 40 received presatovir, 20 placebo, and 54 were included in efficacy analyses. Presatovir did not significantly improve the primary endpoint in the FAS (treatment difference [95% CI], 0.10 [-0.43, 0.63] log10 copies/ml; p = 0.72) or the shorter symptom-duration subgroup (-0.12 [-0.94, 0.69] log10 copies/ml; p = 0.76). Secondary endpoints were not different between presatovir and placebo groups. Presatovir was generally well tolerated. CONCLUSIONS Presatovir treatment did not significantly improve change in nasal RSV load, symptoms, or lung function in lung transplant recipients.
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Affiliation(s)
- Jens Gottlieb
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Fernando Torres
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Tarik Haddad
- Pulmonary Disease and Critical Care, Tampa General Hospital, Tampa, Florida
| | - Gundeep Dhillon
- Department of Medicine, Stanford University Medical Center, Stanford, California
| | - Daniel F Dilling
- Division of Pulmonary and Critical Care, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois
| | - Christiane Knoop
- Department of Chest Medicine, Erasme University Hospital, Brussels, Belgium
| | | | - Rajat Walia
- Pulmonary and Critical Care Section, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Vivek Ahya
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Romain Kessler
- Department of Respiratory Medicine and INSERM-UMR 1260 Regenerative NanoMedicine, University of Strasbourg, Strasbourg, France
| | - Marie Budev
- Department of Pulmonary Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Claus Neurohr
- Department of Internal Medicine, University of Munich, Munich, Germany
| | - Allan R Glanville
- Department of Thoracic Medicine, St. Vincent's Hospital, Darlinghurst, New South Wales, Australia
| | | | | | | | | | - Ying Guo
- Gilead Sciences, Inc., Foster City, California
| | | | | | - Martin R Zamora
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado at Denver Anschutz Medical Center, Aurora, Colorado.
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Marty FM, Chemaly RF, Mullane KM, Lee DG, Hirsch HH, Small CB, Bergeron A, Shoham S, Ljungman P, Waghmare A, Blanchard E, Kim YJ, McKevitt M, Porter DP, Jordan R, Guo Y, German P, Boeckh M, Watkins TR, Chien JW, Dadwal SS. A Phase 2b, Randomized, Double-blind, Placebo-Controlled Multicenter Study Evaluating Antiviral Effects, Pharmacokinetics, Safety, and Tolerability of Presatovir in Hematopoietic Cell Transplant Recipients with Respiratory Syncytial Virus Infection of the Lower Respiratory Tract. Clin Infect Dis 2020; 71:2787-2795. [PMID: 31915807 PMCID: PMC7108198 DOI: 10.1093/cid/ciz1167] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 11/28/2019] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Presatovir significantly reduced nasal viral load, signs, and symptoms of respiratory syncytial virus (RSV) infection in a human challenge study. We evaluated presatovir in hematopoietic-cell transplant (HCT) recipients with RSV lower respiratory tract infection (LRTI). METHODS Patients with confirmed RSV in upper and lower respiratory tract and new chest X-ray abnormalities were randomized (1:1), stratified by supplemental oxygen and ribavirin use, to receive oral presatovir 200 mg or placebo every 4 days for 5 doses. The primary endpoint was time-weighted average change in nasal RSV viral load through day 9. Secondary endpoints included supplemental oxygen-free days, incident respiratory failure requiring mechanical ventilation, and all-cause mortality. RESULTS From January 31, 2015, to March 20, 2017, 60 patients from 17 centers were randomized (31 presatovir, 29 placebo); 59 received study treatment (50 allogeneic, 9 autologous HCT). In the efficacy population (29 presatovir, 28 placebo), presatovir treatment did not significantly reduce time-weighted average change in viral load (-1.12 vs -1.09 log10 copies/mL; treatment difference -0.02 log10 copies/mL, 95% confidence interval: -.62, .57; P = .94), median supplemental oxygen-free days (26 vs 28 days, P = .84), incident respiratory failure (10.3 vs 10.7%, P = .98), or all-cause mortality (0 vs 7.1%, P = .19) versus placebo. Adverse events were similar between arms (presatovir 80%, placebo 79%). Resistance-associated substitutions in RSV fusion protein emerged in 6/29 presatovir-treated patients. CONCLUSIONS Presatovir treatment was well tolerated in HCT patients with RSV LRTI but did not improve virologic or clinical outcomes versus placebo. CLINICAL TRIALS REGISTRATION www.clinicaltrials.gov, NCT02254421; EudraCT, #2014-002475-29.
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Affiliation(s)
- Francisco M Marty
- Division of Infectious Disease, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Roy F Chemaly
- Department of Infectious Diseases, Infection Control and Employee Health, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kathleen M Mullane
- Section of Infectious Diseases, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Dong-Gun Lee
- Department of Infectious Disease, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Hans H Hirsch
- Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Catherine B Small
- Department of Medicine/Division of Infectious Diseases, Weill Cornell Medicine, New York, New York, USA
| | - Anne Bergeron
- Service de pneumologie, Univ Paris Diderot, Hôpital Saint Louis, Paris, France
| | - Shmuel Shoham
- Department of Medicine, Division of Infectious Diseases, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Per Ljungman
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Alpana Waghmare
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Allergy and Infectious Diseases, University of Washington School of Medicine, Seattle, Washington, USA
| | - Elodie Blanchard
- Department of Respiratory Diseases, CHU de Bordeaux, Bordeaux, France
| | - Yae-Jean Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | | | | | | | - Ying Guo
- Gilead Sciences, Inc., Foster City, California, USA
| | | | - Michael Boeckh
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Allergy and Infectious Diseases, University of Washington School of Medicine, Seattle, Washington, USA
| | | | | | - Sanjeet S Dadwal
- Division of Infectious Disease, City of Hope National Medical Center, Duarte, California, USA
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Porter DP, Guo Y, Perry J, Gossage DL, Watkins TR, Chien JW, Jordan R. Assessment of Drug Resistance during Phase 2b Clinical Trials of Presatovir in Adults Naturally Infected with Respiratory Syncytial Virus. Antimicrob Agents Chemother 2020; 64:e02312-19. [PMID: 32071058 PMCID: PMC7449164 DOI: 10.1128/aac.02312-19] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/12/2020] [Indexed: 02/04/2023] Open
Abstract
This study summarizes drug resistance analyses in 4 recent phase 2b trials of the respiratory syncytial virus (RSV) fusion inhibitor presatovir in naturally infected adults. Adult hematopoietic cell transplant (HCT) recipients, lung transplant recipients, or hospitalized patients with naturally acquired, laboratory-confirmed RSV infection were enrolled in 4 randomized, double-blind, placebo-controlled studies with study-specific presatovir dosing. Full-length RSV F sequences amplified from nasal swabs obtained at baseline and postbaseline were analyzed by population sequencing. Substitutions at RSV fusion inhibitor resistance-associated positions are reported. Genotypic analyses were performed on 233 presatovir-treated and 149 placebo-treated subjects. RSV F variant V127A was present in 8 subjects at baseline. Population sequencing detected treatment-emergent substitutions in 10/89 (11.2%) HCT recipients with upper and 6/29 (20.7%) with lower respiratory tract infection, 1/35 (2.9%) lung transplant recipients, and 1/80 (1.3%) hospitalized patients treated with presatovir; placebo-treated subjects had no emergent resistance-associated substitutions. Subjects with substitutions at resistance-associated positions had smaller decreases in viral load during treatment relative to those without, but they had similar clinical outcomes. Subject population type and dosing regimen may have influenced RSV resistance development during presatovir treatment. Subjects with genotypic resistance development had decreased virologic responses compared to those without genotypic resistance but had comparable clinical outcomes.
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Affiliation(s)
| | - Ying Guo
- Gilead Sciences, Inc., Foster City, California, USA
| | - Jason Perry
- Gilead Sciences, Inc., Foster City, California, USA
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Tang W, Li M, Liu Y, Liang N, Yang Z, Zhao Y, Wu S, Lu S, Li Y, Liu F. Small molecule inhibits respiratory syncytial virus entry and infection by blocking the interaction of the viral fusion protein with the cell membrane. FASEB J 2019; 33:4287-4299. [PMID: 30571312 PMCID: PMC6404555 DOI: 10.1096/fj.201800579r] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 11/19/2018] [Indexed: 11/11/2022]
Abstract
Antiviral drug development against respiratory syncytial virus (RSV) is urgently needed due to the public health significance of the viral infection. Here, we report the anti-RSV activity of a small molecule, (1S,3R,4R,5R)-3,4- bis{[(E)-3-(3,4-dihydroxyphenyl)prop-2-enoyl]oxy}-1,5-dihydroxycyclohexane-1-carboxylic methyl ester (3,4-DCQAME) or 3,4- O-Dicaffeoylquinic acid methyl ester, which can be isolated from several plants of traditional Chinese medicine. We showed for the first time that compound 3,4-DCQAME potently inhibits RSV entry and infection. In vitro, 3,4-DCQAME can interact with F(ecto), the ectodomain of RSV fusion (F) protein. In cultured cells, the compound can block the interaction of F(ecto) protein with the cellular membrane and inhibit viral fusion during RSV entry, leading to inhibition of viral gene expression and infection. In RSV-infected mice that were treated with 3,4-DCQAME, we observed a reduction of RSV-induced pathologic changes and substantial inhibition of viral infection and growth in the lung tissues. Our results provide the first direct evidence of the anti-RSV activity of 3,4-DCQAME. Furthermore, these results suggest that 3,4-DCQAME represents a promising lead compound for anti-RSV therapeutic development.-Tang, W., Li, M., Liu, Y., Liang, N., Yang, Z., Zhao, Y., Wu, S., Lu, S., Li, Y., Liu, F. Small molecule inhibits respiratory syncytial virus entry and infection by blocking the interaction of the viral fusion protein with the cell membrane.
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Affiliation(s)
- Wei Tang
- Guangdong Province Key Laboratory of Pharmacodynamic Constituents of Traditional Chinese Medicine and New Drugs Research, College of Pharmacy, Jinan University, Guangzhou, China
- School of Public Health, University of California–Berkeley, Berkeley, California, USA
| | - Manmei Li
- Guangdong Province Key Laboratory of Pharmacodynamic Constituents of Traditional Chinese Medicine and New Drugs Research, College of Pharmacy, Jinan University, Guangzhou, China
| | - Yujun Liu
- School of Public Health, University of California–Berkeley, Berkeley, California, USA
- School of Medicine, St. George’s University, Grenada, West Indies
- Guangzhou Qinheli Biotechnolgies Incorporated, Guangzhou, Guangdong, China
| | - Ning Liang
- Guangdong Province Key Laboratory of Pharmacodynamic Constituents of Traditional Chinese Medicine and New Drugs Research, College of Pharmacy, Jinan University, Guangzhou, China
| | - Zhu Yang
- Guangzhou Qinheli Biotechnolgies Incorporated, Guangzhou, Guangdong, China
- Jiangsu Affynigen Biotechnolgies Incorporated, Taizhou, Jiangsu, China
- Taizhou Institute of Virology, Taizhou, Jiangsu, China
- School of Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China; and
| | - Yanxiang Zhao
- Department of Applied Biology and Chemical Technology, State Key Laboratory of Chirosciences, Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Shuai Wu
- Department of Applied Biology and Chemical Technology, State Key Laboratory of Chirosciences, Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Sangwei Lu
- School of Public Health, University of California–Berkeley, Berkeley, California, USA
| | - Yaolan Li
- Guangdong Province Key Laboratory of Pharmacodynamic Constituents of Traditional Chinese Medicine and New Drugs Research, College of Pharmacy, Jinan University, Guangzhou, China
| | - Fenyong Liu
- Guangdong Province Key Laboratory of Pharmacodynamic Constituents of Traditional Chinese Medicine and New Drugs Research, College of Pharmacy, Jinan University, Guangzhou, China
- School of Public Health, University of California–Berkeley, Berkeley, California, USA
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