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Jia H, Mai J, Wu M, Chen H, Li X, Li C, Liu J, Liu C, Hu Y, Zhu X, Jiang X, Hua B, Xia T, Liu G, Deng A, Liang B, Guo R, Lu H, Wang Z, Chen H, Zhang Z, Zhang H, Niu J, Ding Y. Safety, tolerability, pharmacokinetics, and antiviral activity of the novel core protein allosteric modulator ZM-H1505R (Canocapavir) in chronic hepatitis B patients: a randomized multiple-dose escalation trial. BMC Med 2023; 21:98. [PMID: 36927420 PMCID: PMC10022191 DOI: 10.1186/s12916-023-02814-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/06/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Hepatitis B virus (HBV) core protein-targeting antivirals (CpTAs) are promising therapeutic agents for treating chronic hepatitis B (CHB). In this study, the antiviral activity, pharmacokinetics (PK), and tolerability of ZM-H1505R (Canocapavir), a chemically unique HBV CpTA, were evaluated in patients with CHB. METHODS This study was a double-blind, randomized, placebo-controlled phase 1b trial in Chinese CHB patients. Noncirrhotic and treatment-naive CHB patients were divided into three cohorts (10 patients per cohort) and randomized within each cohort in a ratio of 4:1 to receive a single dose of 50, 100, or 200 mg of Canocapavir or placebo once a day for 28 consecutive days. RESULTS Canocapavir was well tolerated, with the majority of adverse reactions being grade I or II in severity. There were no serious adverse events, and no patients withdrew from the study. Corresponding to 50, 100, and 200 mg doses of Canocapavir, the mean plasma trough concentrations of the drug were 2.7-, 7.0-, and 14.6-fold of its protein-binding adjusted HBV DNA EC50 (135 ng/mL), respectively, with linear PK and a low-to-mild accumulation rate (1.26-1.99). After 28 days of treatment, the mean maximum HBV DNA declines from baseline were -1.54, -2.50, -2.75, and -0.47 log10 IU/mL for the 50, 100, and 200 mg of Canocapavir or placebo groups, respectively; and the mean maximum pregenomic RNA declines from baseline were -1.53, -2.35, -2.34, and -0.17 log10 copies/mL, respectively. CONCLUSIONS Canocapavir treatment is tolerated with efficacious antiviral activity in CHB patients, supporting its further development in treating HBV infection. TRIAL REGISTRATION ClinicalTrials.gov, number NCT05470829).
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Affiliation(s)
- Haiyan Jia
- Phase I Clinical Research Center, The First Hospital of Jilin University, No. 1 Xinmin Street, Changchun, Jilin Province, China
- Gynecology and Obstetrics Center, the First Hospital of Jilin University, Changchun, China
| | - Jiajia Mai
- Phase I Clinical Research Center, The First Hospital of Jilin University, No. 1 Xinmin Street, Changchun, Jilin Province, China
| | - Min Wu
- Phase I Clinical Research Center, The First Hospital of Jilin University, No. 1 Xinmin Street, Changchun, Jilin Province, China
| | - Hong Chen
- Phase I Clinical Research Center, The First Hospital of Jilin University, No. 1 Xinmin Street, Changchun, Jilin Province, China
| | - Xiaojiao Li
- Phase I Clinical Research Center, The First Hospital of Jilin University, No. 1 Xinmin Street, Changchun, Jilin Province, China
| | - Cuiyun Li
- Phase I Clinical Research Center, The First Hospital of Jilin University, No. 1 Xinmin Street, Changchun, Jilin Province, China
| | - Jingrui Liu
- Phase I Clinical Research Center, The First Hospital of Jilin University, No. 1 Xinmin Street, Changchun, Jilin Province, China
| | - Chengjiao Liu
- Phase I Clinical Research Center, The First Hospital of Jilin University, No. 1 Xinmin Street, Changchun, Jilin Province, China
| | - Yue Hu
- Phase I Clinical Research Center, The First Hospital of Jilin University, No. 1 Xinmin Street, Changchun, Jilin Province, China
| | - Xiaoxue Zhu
- Phase I Clinical Research Center, The First Hospital of Jilin University, No. 1 Xinmin Street, Changchun, Jilin Province, China
| | - Xiuhong Jiang
- Shanghai Zhimeng Biopharma, Inc, 1976 Gaoke Middle Road, Suite A-302, Pudong District, Shanghai, China
| | - Bo Hua
- Shanghai Zhimeng Biopharma, Inc, 1976 Gaoke Middle Road, Suite A-302, Pudong District, Shanghai, China
| | - Tian Xia
- Shanghai Zhimeng Biopharma, Inc, 1976 Gaoke Middle Road, Suite A-302, Pudong District, Shanghai, China
| | - Gang Liu
- Shanghai Zhimeng Biopharma, Inc, 1976 Gaoke Middle Road, Suite A-302, Pudong District, Shanghai, China
| | - Aiyun Deng
- Shanghai Zhimeng Biopharma, Inc, 1976 Gaoke Middle Road, Suite A-302, Pudong District, Shanghai, China
| | - Bo Liang
- Shanghai Zhimeng Biopharma, Inc, 1976 Gaoke Middle Road, Suite A-302, Pudong District, Shanghai, China
| | - Ruoling Guo
- Shanghai Zhimeng Biopharma, Inc, 1976 Gaoke Middle Road, Suite A-302, Pudong District, Shanghai, China
| | - Hui Lu
- Shanghai Zhimeng Biopharma, Inc, 1976 Gaoke Middle Road, Suite A-302, Pudong District, Shanghai, China
| | - Zhe Wang
- Shanghai Zhimeng Biopharma, Inc, 1976 Gaoke Middle Road, Suite A-302, Pudong District, Shanghai, China
| | - Huanming Chen
- Shanghai Zhimeng Biopharma, Inc, 1976 Gaoke Middle Road, Suite A-302, Pudong District, Shanghai, China
| | - Zhijun Zhang
- Shanghai Zhimeng Biopharma, Inc, 1976 Gaoke Middle Road, Suite A-302, Pudong District, Shanghai, China
| | - Hong Zhang
- Phase I Clinical Research Center, The First Hospital of Jilin University, No. 1 Xinmin Street, Changchun, Jilin Province, China.
| | - Junqi Niu
- Department of Hepatology, Center of Infectious Disease and Pathogen Biology, The First Hospital of Jilin University, Changchun, China.
| | - Yanhua Ding
- Phase I Clinical Research Center, The First Hospital of Jilin University, No. 1 Xinmin Street, Changchun, Jilin Province, China.
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Pan Y, Xia H, He Y, Zeng S, Shen Z, Huang W. The progress of molecules and strategies for the treatment of HBV infection. Front Cell Infect Microbiol 2023; 13:1128807. [PMID: 37009498 PMCID: PMC10053227 DOI: 10.3389/fcimb.2023.1128807] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/03/2023] [Indexed: 03/17/2023] Open
Abstract
Hepatitis B virus infections have always been associated with high levels of mortality. In 2019, hepatitis B virus (HBV)-related diseases resulted in approximately 555,000 deaths globally. In view of its high lethality, the treatment of HBV infections has always presented a huge challenge. The World Health Organization (WHO) came up with ambitious targets for the elimination of hepatitis B as a major public health threat by 2030. To accomplish this goal, one of the WHO's strategies is to develop curative treatments for HBV infections. Current treatments in a clinical setting included 1 year of pegylated interferon alpha (PEG-IFNα) and long-term nucleoside analogues (NAs). Although both treatments have demonstrated outstanding antiviral effects, it has been difficult to develop a cure for HBV. The reason for this is that covalently closed circular DNA (cccDNA), integrated HBV DNA, the high viral burden, and the impaired host immune responses all hinder the development of a cure for HBV. To overcome these problems, there are clinical trials on a number of antiviral molecules being carried out, all -showing promising results so far. In this review, we summarize the functions and mechanisms of action of various synthetic molecules, natural products, traditional Chinese herbal medicines, as clustered regularly interspaced short palindromic repeats and their associated proteins (CRISPR/Cas)-based systems, zinc finger nucleases (ZFNs), and transcription activator-like effector nucleases (TALENs), all of which could destroy the stability of the HBV life cycle. In addition, we discuss the functions of immune modulators, which can enhance or activate the host immune system, as well some representative natural products with anti-HBV effects.
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Affiliation(s)
| | | | | | | | | | - Wenhai Huang
- Key Laboratory of Neuropsychiatric Drug Research of Zhejiang Province, School of Pharmacy, Hangzhou Medical College, Hangzhou, Zhejiang, China
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