1
|
Goethals O, Kaptein SJF, Kesteleyn B, Bonfanti JF, Van Wesenbeeck L, Bardiot D, Verschoor EJ, Verstrepen BE, Fagrouch Z, Putnak JR, Kiemel D, Ackaert O, Straetemans R, Lachau-Durand S, Geluykens P, Crabbe M, Thys K, Stoops B, Lenz O, Tambuyzer L, De Meyer S, Dallmeier K, McCracken MK, Gromowski GD, Rutvisuttinunt W, Jarman RG, Karasavvas N, Touret F, Querat G, de Lamballerie X, Chatel-Chaix L, Milligan GN, Beasley DWC, Bourne N, Barrett ADT, Marchand A, Jonckers THM, Raboisson P, Simmen K, Chaltin P, Bartenschlager R, Bogers WM, Neyts J, Van Loock M. Blocking NS3-NS4B interaction inhibits dengue virus in non-human primates. Nature 2023; 615:678-686. [PMID: 36922586 PMCID: PMC10033419 DOI: 10.1038/s41586-023-05790-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 02/03/2023] [Indexed: 03/17/2023]
Abstract
Dengue is a major health threat and the number of symptomatic infections caused by the four dengue serotypes is estimated to be 96 million1 with annually around 10,000 deaths2. However, no antiviral drugs are available for the treatment or prophylaxis of dengue. We recently described the interaction between non-structural proteins NS3 and NS4B as a promising target for the development of pan-serotype dengue virus (DENV) inhibitors3. Here we present JNJ-1802-a highly potent DENV inhibitor that blocks the NS3-NS4B interaction within the viral replication complex. JNJ-1802 exerts picomolar to low nanomolar in vitro antiviral activity, a high barrier to resistance and potent in vivo efficacy in mice against infection with any of the four DENV serotypes. Finally, we demonstrate that the small-molecule inhibitor JNJ-1802 is highly effective against viral infection with DENV-1 or DENV-2 in non-human primates. JNJ-1802 has successfully completed a phase I first-in-human clinical study in healthy volunteers and was found to be safe and well tolerated4. These findings support the further clinical development of JNJ-1802, a first-in-class antiviral agent against dengue, which is now progressing in clinical studies for the prevention and treatment of dengue.
Collapse
Affiliation(s)
- Olivia Goethals
- Janssen Global Public Health, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Suzanne J F Kaptein
- Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Laboratory of Virology and Chemotherapy, KU Leuven, Leuven, Belgium
| | - Bart Kesteleyn
- Janssen Research & Development, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Jean-François Bonfanti
- Janssen Infectious Diseases Discovery, Janssen-Cilag, Val de Reuil, France
- Galapagos, Romainville, France
| | | | | | - Ernst J Verschoor
- Department of Virology, Biomedical Primate Research Centre, Rijswijk, The Netherlands
| | - Babs E Verstrepen
- Department of Virology, Biomedical Primate Research Centre, Rijswijk, The Netherlands
| | - Zahra Fagrouch
- Department of Virology, Biomedical Primate Research Centre, Rijswijk, The Netherlands
| | - J Robert Putnak
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Dominik Kiemel
- Heidelberg University, Medical Faculty Heidelberg, Department of Infectious Diseases, Molecular Virology, Center for Integrative Infectious Diseases Research, Heidelberg, Germany
| | - Oliver Ackaert
- Janssen Clinical Pharmacology and Pharmacometrics, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Roel Straetemans
- Statistics and Decision Sciences, Janssen Pharmaceutica NV, Beerse, Belgium
| | | | - Peggy Geluykens
- Janssen Research & Development, Janssen Pharmaceutica NV, Beerse, Belgium
- Discovery, Charles River Beerse, Beerse, Belgium
| | - Marjolein Crabbe
- Statistics and Decision Sciences, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Kim Thys
- Janssen Research & Development, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Bart Stoops
- Janssen Research & Development, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Oliver Lenz
- Janssen Research & Development, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Lotke Tambuyzer
- Janssen Research & Development, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Sandra De Meyer
- Janssen Research & Development, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Kai Dallmeier
- Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Laboratory of Virology and Chemotherapy, KU Leuven, Leuven, Belgium
| | - Michael K McCracken
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Gregory D Gromowski
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Wiriya Rutvisuttinunt
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Richard G Jarman
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Nicos Karasavvas
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Franck Touret
- Unité des Virus Émergents, Aix-Marseille Université-IRD 190-Inserm 1207, Marseille, France
| | - Gilles Querat
- Unité des Virus Émergents, Aix-Marseille Université-IRD 190-Inserm 1207, Marseille, France
| | - Xavier de Lamballerie
- Unité des Virus Émergents, Aix-Marseille Université-IRD 190-Inserm 1207, Marseille, France
| | - Laurent Chatel-Chaix
- Heidelberg University, Medical Faculty Heidelberg, Department of Infectious Diseases, Molecular Virology, Center for Integrative Infectious Diseases Research, Heidelberg, Germany
- Centre Armand-Frappier Santé Biotechnologie, Institut National de la Recherche Scientifique, Laval, Quebec, Canada
| | - Gregg N Milligan
- Sealy Institute for Vaccine Sciences, The University of Texas Medical Branch Health, Galveston, TX, USA
| | - David W C Beasley
- Sealy Institute for Vaccine Sciences, The University of Texas Medical Branch Health, Galveston, TX, USA
| | - Nigel Bourne
- Sealy Institute for Vaccine Sciences, The University of Texas Medical Branch Health, Galveston, TX, USA
| | - Alan D T Barrett
- Sealy Institute for Vaccine Sciences, The University of Texas Medical Branch Health, Galveston, TX, USA
| | | | - Tim H M Jonckers
- Janssen Research & Development, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Pierre Raboisson
- Janssen Research & Development, Janssen Pharmaceutica NV, Beerse, Belgium
- Galapagos NV, Mechelen, Belgium
| | | | - Patrick Chaltin
- Cistim Leuven vzw, Leuven, Belgium
- Centre for Drug Design and Discovery (CD3), KU Leuven, Leuven, Belgium
| | - Ralf Bartenschlager
- Heidelberg University, Medical Faculty Heidelberg, Department of Infectious Diseases, Molecular Virology, Center for Integrative Infectious Diseases Research, Heidelberg, Germany
- German Centre for Infection Research, Heidelberg Partner Site, Heidelberg, Germany
| | - Willy M Bogers
- Department of Virology, Biomedical Primate Research Centre, Rijswijk, The Netherlands
| | - Johan Neyts
- Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Laboratory of Virology and Chemotherapy, KU Leuven, Leuven, Belgium
- Global Virus Network (GVN), Baltimore, MD, USA
| | - Marnix Van Loock
- Janssen Global Public Health, Janssen Pharmaceutica NV, Beerse, Belgium.
| |
Collapse
|
2
|
Liu Z, Guo X, Guo A, Zhang S, Zou Y, Wang Y, Li X, He W, Pu L, Zhang S, Zeng Q, Cai X, Wang S. HIV protease inhibitor nelfinavir is a potent drug candidate against echinococcosis by targeting Ddi1-like protein. EBioMedicine 2022; 82:104177. [PMID: 35843171 PMCID: PMC9294487 DOI: 10.1016/j.ebiom.2022.104177] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/15/2022] [Accepted: 07/04/2022] [Indexed: 11/30/2022] Open
Abstract
Background Alveolar echinococcosis (AE), which is caused by larval Echinococcus multilocularis, is one of the world's most dangerous neglected diseases. Currently, no fully effective treatments are available to cure this disease. Methods In vitro protoscolicidal assay along with in vivo murine models was applied in repurposing drugs against AE. Genome-wide identification and homology-based modeling were used for predicting drug targets. RNAi, enzyme assay, and RNA-Seq analyses were utilized for investigating the roles in parasite survival and validations for the drug target. Findings We identified nelfinavir as the most effective HIV protease inhibitor against larval E. multilocularis. Once-daily oral administration of nelfinavir for 28 days resulted in a remarkable reduction in parasite infection in either immune-competent or immunocompromised mice. E. multilocularis DNA damage-inducible 1 protein (EmuDdi1) is predicted as a target candidate for nelfinavir. We proved that EmuDdi1 is essential for parasite survival and protein excretion and acts as a functionally active protease for this helminth. We found nelfinavir is able to inhibit the proteolytic activity of recombinant EmuDdi1 and block the EmuDdi1-related pathways for protein export. With other evidence of drug efficacy comparison, our results suggest that inhibition of EmuDdi1 is a mechanism by which this HIV proteinase inhibitor mediates its antiparasitic action on echinococcosis. Interpretation This study demonstrates that nelfinavir is a promising candidate for treating echinococcosis. This drug repurposing study proves that the widely prescribed drug for AIDS treatment is potent in combating E. multilocularis infection and thus provides valuable insights into the development of single-drug therapy for highly prevalent co-infection between HIV and helminth diseases. Funding This work was supported by the National Natural Science Foundation of China (31802179), the Natural Science Foundation of Gansu Province, China (No. 21JR7RA027), and the State Key Laboratory of Veterinary Etiological Biology (No. SKLVEB2021YQRC01).
Collapse
|
3
|
Moquin SA, Simon O, Karuna R, Lakshminarayana SB, Yokokawa F, Wang F, Saravanan C, Zhang J, Day CW, Chan K, Wang QY, Lu S, Dong H, Wan KF, Lim SP, Liu W, Seh CC, Chen YL, Xu H, Barkan DT, Kounde CS, Sim WLS, Wang G, Yeo HQ, Zou B, Chan WL, Ding M, Song JG, Li M, Osborne C, Blasco F, Sarko C, Beer D, Bonamy GMC, Sasseville VG, Shi PY, Diagana TT, Yeung BKS, Gu F. NITD-688, a pan-serotype inhibitor of the dengue virus NS4B protein, shows favorable pharmacokinetics and efficacy in preclinical animal models. Sci Transl Med 2021; 13:13/579/eabb2181. [PMID: 33536278 DOI: 10.1126/scitranslmed.abb2181] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 01/13/2021] [Indexed: 12/12/2022]
Abstract
Dengue virus (DENV) is a mosquito-borne flavivirus that poses a threat to public health, yet no antiviral drug is available. We performed a high-throughput phenotypic screen using the Novartis compound library and identified candidate chemical inhibitors of DENV. This chemical series was optimized to improve properties such as anti-DENV potency and solubility. The lead compound, NITD-688, showed strong potency against all four serotypes of DENV and demonstrated excellent oral efficacy in infected AG129 mice. There was a 1.44-log reduction in viremia when mice were treated orally at 30 milligrams per kilogram twice daily for 3 days starting at the time of infection. NITD-688 treatment also resulted in a 1.16-log reduction in viremia when mice were treated 48 hours after infection. Selection of resistance mutations and binding studies with recombinant proteins indicated that the nonstructural protein 4B is the target of NITD-688. Pharmacokinetic studies in rats and dogs showed a long elimination half-life and good oral bioavailability. Extensive in vitro safety profiling along with exploratory rat and dog toxicology studies showed that NITD-688 was well tolerated after 7-day repeat dosing, demonstrating that NITD-688 may be a promising preclinical candidate for the treatment of dengue.
Collapse
Affiliation(s)
- Stephanie A Moquin
- Novartis Institutes for Biomedical Research, Emeryville, CA 94608, USA.,Novartis Institute for Tropical Diseases, Emeryville, CA 94608, USA
| | - Oliver Simon
- Novartis (Singapore) Pte Ltd, Singapore 117432, Singapore
| | - Ratna Karuna
- Novartis Institute for Tropical Diseases, Singapore 138670, Singapore
| | | | - Fumiaki Yokokawa
- Novartis Institute for Tropical Diseases, Emeryville, CA 94608, USA
| | - Feng Wang
- Novartis Institutes for Biomedical Research, Emeryville, CA 94608, USA
| | - Chandra Saravanan
- Novartis Institutes for Biomedical Research, Translational Medicine: Preclinical Safety, Cambridge, MA 02139, USA
| | - Jin Zhang
- Novartis Institutes for Biomedical Research, Translational Medicine: Pharmacokinetics, East Hanover, NJ 07936, USA
| | - Craig W Day
- Institute for Antiviral Research, Utah State University, Logan, UT 84322, USA
| | - Katherine Chan
- Novartis Institute for Tropical Diseases, Emeryville, CA 94608, USA
| | - Qing-Yin Wang
- Novartis Institute for Tropical Diseases, Singapore 138670, Singapore
| | - Siyan Lu
- Novartis Institute for Tropical Diseases, Singapore 138670, Singapore
| | - Hongping Dong
- Novartis Institute for Tropical Diseases, Singapore 138670, Singapore
| | - Kah Fei Wan
- Novartis Institute for Tropical Diseases, Singapore 138670, Singapore
| | - Siew Pheng Lim
- Novartis Institute for Tropical Diseases, Singapore 138670, Singapore
| | - Wei Liu
- Novartis Institute for Tropical Diseases, Singapore 138670, Singapore
| | - Cheah Chen Seh
- Novartis Institute for Tropical Diseases, Singapore 138670, Singapore
| | - Yen-Liang Chen
- Novartis Institute for Tropical Diseases, Emeryville, CA 94608, USA
| | - Haoying Xu
- Novartis Institute for Tropical Diseases, Singapore 138670, Singapore
| | - David T Barkan
- Novartis Institutes for Biomedical Research, Emeryville, CA 94608, USA
| | - Cyrille S Kounde
- Novartis Institute for Tropical Diseases, Singapore 138670, Singapore
| | | | - Gang Wang
- Novartis Institute for Tropical Diseases, Singapore 138670, Singapore
| | - Hui-Quan Yeo
- Novartis Institute for Tropical Diseases, Singapore 138670, Singapore
| | - Bin Zou
- Novartis Institute for Tropical Diseases, Singapore 138670, Singapore
| | - Wai Ling Chan
- Novartis Institute for Tropical Diseases, Singapore 138670, Singapore
| | - Mei Ding
- Novartis Institute for Tropical Diseases, Singapore 138670, Singapore
| | - Jae-Geun Song
- Novartis Institutes for Biomedical Research, Emeryville, CA 94608, USA
| | - Min Li
- Novartis Institutes for Biomedical Research, Emeryville, CA 94608, USA
| | - Colin Osborne
- Novartis Institute for Tropical Diseases, Emeryville, CA 94608, USA
| | - Francesca Blasco
- Novartis Institute for Tropical Diseases, Singapore 138670, Singapore
| | | | - David Beer
- Novartis Institute for Tropical Diseases, Singapore 138670, Singapore
| | | | - Vito G Sasseville
- Novartis Institutes for Biomedical Research, Translational Medicine: Preclinical Safety, Cambridge, MA 02139, USA
| | - Pei-Yong Shi
- Novartis Institute for Tropical Diseases, Singapore 138670, Singapore
| | | | - Bryan K S Yeung
- Novartis Institute for Tropical Diseases, Singapore 138670, Singapore.
| | - Feng Gu
- Novartis Institute for Tropical Diseases, Emeryville, CA 94608, USA.
| |
Collapse
|
4
|
Prinapori R, Rosso R, Di Biagio A, Miletich F, Furfaro E, Taramasso L, Ginocchio F, Giacomet V, Nulvesu L, Sormani MP, Schiavetti I, Signori A, De Hoffer L, Viscoli C. Pharmacokinetics of lopinavir determined with an ELISA test in youths with perinatally acquired HIV. Indian J Pediatr 2014; 81:856-60. [PMID: 24014186 DOI: 10.1007/s12098-013-1198-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 07/24/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the plasma levels of lopinavir by enzyme-linked immunosorbent assay (ELISA) in a cohort of patients who were vertically infected with human immunodeficiency virus 1 (HIV). METHODS Plasma levels of lopinavir (Cmin) were determined by ELISA test in patients treated with lopinavir/ritonavir-based combined antiretroviral therapy who had achieved virological response after 4 wk of therapy. Reference lopinavir concentrations were Cmin 1-8 μg/mL. Correlation between lopinavir plasma concentration and continuous variables was evaluated by mean of Pearson correlation coefficient. Differences in lopinavir (LPV) concentration for binary categorical variables were assessed by Mann-Whitney test, while for variables with more than two categories Kruskal-Wallis test was used. RESULTS Thirty-four patients were enrolled; median age was 133 mo (15-265). The median lopinavir dose tested was 383.5 mg/kg (IQR: 266.6-400 mg/kg), with a median plasma concentration of 8.8 μg/mL (IQR: 5-14 μg/mL). Lopinavir Cmin was <1 μg/mL in only one sample (2.9 %), while 14 samples had Cmin between 1 and 8 μg/mL (41.2 %) and 19 (55.9 %) > 8 μg/mL. No significant correlations were found between plasma concentrations of lopinavir and the continuous variables considered in the study. A negative but, not completely significant, correlation was found between plasma drug concentration and body mass index (r = -0.29; p = 0.09). CONCLUSIONS The use of a simple and relatively cost-effective methodology might render therapeutic drug monitoring (TDM) appeal in the daily clinical practice.
Collapse
Affiliation(s)
- Roberta Prinapori
- Infectious Diseases Clinic, San Martino Hospital, University of Genoa, Genoa, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Mo H, Yang C, Wang K, Wang Y, Huang M, Murray B, Qi X, Sun SC, Deshpande M, Rhodes G, Miller MD. Estimation of inhibitory quotient using a comparative equilibrium dialysis assay for prediction of viral response to hepatitis C virus inhibitors. J Viral Hepat 2011; 18:338-48. [PMID: 20456634 DOI: 10.1111/j.1365-2893.2010.01314.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The relationship of inhibitory quotient (IQ) with the virologic response to specific inhibitors of human hepatitis C virus (HCV) and the best method to correct for serum protein binding in calculating IQ have not been addressed. A common method is to determine a fold shift by comparing the EC(50) values determined in cell culture in the absence and presence of human serum (fold shift in EC(50) ), but this method has a number of disadvantages. In the present study, the fold shifts in drug concentrations between 100% human plasma (HP) and cell culture medium (CCM) were directly measured using a modified comparative equilibrium dialysis (CED) assay for three HCV protease inhibitors (PIs) and for a novel HCV inhibitor GS-9132. The fold shift values in drug concentration between the HP and CCM (CED ratio) were ∼1 for SCH-503034, VX-950 and GS-9132 and 13 for BILN-2061. These values were ∼3-10-fold lower than the fold shift values calculated from the EC(50) assay for all inhibitors except BILN-2061. Using the CED values, a consistent pharmacokinetic and pharmacodynamic relationship was observed for the four HCV inhibitors analysed. Specifically, an approximate 1 log(10) reduction in HCV RNA was achieved with an IQ close to 1, while 2-3 and greater log(10) reductions in HCV RNA were achieved with IQ values of 3-5 and greater, respectively. Thus, use of CED to define IQ provides a predictive and quantitative approach for the assessment of the in vivo potency of HCV PIs and GS-9132. This method provides a framework for the evaluation of other classes of drugs that are bound by serum proteins but require the presence of serum for in vitro evaluation.
Collapse
Affiliation(s)
- H Mo
- Department of Clinical Virology, Gilead Sciences Inc., Foster City, CA, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Resino S, Larrú B, Ma Bellón J, Resino R, de José MI, Navarro M, Léon JA, Ramos JT, Mellado MJ, Muñoz-Fernández MÁ. Effects of highly active antiretroviral therapy with nelfinavir in vertically HIV-1 infected children: 3 years of follow-up. Long-term response to nelfinavir in children. BMC Infect Dis 2006; 6:107. [PMID: 16834769 PMCID: PMC1538605 DOI: 10.1186/1471-2334-6-107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2006] [Accepted: 07/11/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Antiretroviral treatment (ART) in children has special features and consequently, results obtained from clinical trials with antiretroviral drugs in adults may not be representative of children. Nelfinavir (NFV) is an HIV-1 Protease Inhibitor (PI) which has become as one of the first choices of PI for ART in children. We studied during a 3-year follow-up period the effects of highly active antiretroviral therapy with nelfinavir in vertically HIV-1 infected children. METHODS Forty-two vertically HIV-infected children on HAART with NFV were involved in a multicentre prospective study. The children were monitored at least every 3 months with physical examinations, and blood sample collection to measure viral load (VL) and CD4+ cell count. We performed a logistic regression analysis to determinate the odds ratio of baseline characteristics on therapeutic failure. RESULTS Very important increase in CD4+ was observed and VL decreased quickly and it remained low during the follow-up study. Children with CD4+ <25% at baseline achieved CD4+ >25% at 9 months of follow-up. HIV-infected children who achieved undetectable viral load (uVL) were less than 40% in each visit during follow-up. Nevertheless, HIV-infected children with VL >5000 copies/ml were less than 50% during the follow-up study. Only baseline VL was an important factor to predict VL control during follow-up. Virological failure at defined end-point was confirmed in 30/42 patients. Along the whole of follow-up, 16/42 children stopped HAART with NFV. Baseline characteristics were not associated with therapeutic change. CONCLUSION NFV is a safe drug with a good profile and able to achieve an adequate response in children.
Collapse
Affiliation(s)
- Salvador Resino
- Laboratorio de Inmuno-Biología Molecular, Hospital General Universitario "Gregorio Marañón", Madrid, Spain
| | - Beatriz Larrú
- Pediatría-Infecciosas, Hospital Universitario "La Paz", Madrid, Spain
| | - Jose Ma Bellón
- Laboratorio de Inmuno-Biología Molecular, Hospital General Universitario "Gregorio Marañón", Madrid, Spain
| | - Rosa Resino
- Laboratorio de Inmuno-Biología Molecular, Hospital General Universitario "Gregorio Marañón", Madrid, Spain
| | - Ma Isabel de José
- Pediatría-Infecciosas, Hospital Universitario "La Paz", Madrid, Spain
| | - Marisa Navarro
- Pediatría-Infecciosas, Hospital General Universitario "Gregorio Marañón", Madrid, Spain
| | - Juan Antonio Léon
- Pediatría-Infecciosas, Hospital Universitario "Virgen de Rocío", Sevilla, Spain
| | - José Tomás Ramos
- Inmuno-Pediatría, Hospital Universitario "12 de Octubre", Madrid, Spain
| | - Ma José Mellado
- Pediatría-Infecciosas, Hospital Universitario "Carlos III", Madrid, Spain
| | - Ma Ángeles Muñoz-Fernández
- Laboratorio de Inmuno-Biología Molecular, Hospital General Universitario "Gregorio Marañón", Madrid, Spain
| |
Collapse
|
7
|
Crommentuyn KML, Scherpbier HJ, Kuijpers TW, Mathôt RAA, Huitema ADR, Beijnen JH. Population pharmacokinetics and pharmacodynamics of nelfinavir and its active metabolite M8 in HIV-1-infected children. Pediatr Infect Dis J 2006; 25:538-43. [PMID: 16732153 DOI: 10.1097/01.inf.0000215242.70300.95] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The objectives of this study are to develop and validate a population pharmacokinetic model that adequately describes the pharmacokinetics of nelfinavir and its active metabolite M8 in HIV-1-infected children; to define factors involved in the pharmacokinetic variability, which could aid in defining dosing strategies; and to correlate the pharmacokinetics to the treatment response. METHODS Protease inhibitor-naive, HIV-1-infected children were included. A population pharmacokinetic model of nelfinavir and M8 was developed using NONMEM. Bayesian analysis was used to estimate pharmacokinetic values. A pharmacokinetic-pharmacodynamic analysis was performed to study relationships between these values and the virologic response to therapy. RESULTS From 38 children, 724 nelfinavir and 636 M8 plasma concentrations were available. The pharmacokinetics of both compounds were described simultaneously with a one-compartment model with first-order elimination. Clearance (CL/F) and volume of distribution (V/F) were 32.6 L/h (interindividual variability [IIV]: 31.6%) and 281 L/h (IIV: 29.7%) for nelfinavir and 86.2 L/h (IIV: 43.1%) and 42.3 L/h for M8. No factors could be defined that affected the pharmacokinetics of nelfinavir or M8. The overall virologic response was 78% (HIV-1 RNA <500 copies/mL, on-treatment analysis). No differences in exposure to nelfinavir and M8 were observed between responders and nonresponders. The only factor distinguishing the two groups was a higher baseline HIV-1 RNA concentration in nonresponders. CONCLUSION A model was developed and validated that adequately described the population pharmacokinetics of nelfinavir and M8 in a childhood population. No factors affecting dosing strategies were identified, and no correlation could be demonstrated between the exposure to nelfinavir and M8 and the virologic treatment response.
Collapse
|
8
|
Menson EN, Walker AS, Sharland M, Wells C, Tudor-Williams G, Riordan FAI, Lyall EGH, Gibb DM. Underdosing of antiretrovirals in UK and Irish children with HIV as an example of problems in prescribing medicines to children, 1997-2005: cohort study. BMJ 2006; 332:1183-7. [PMID: 16709991 PMCID: PMC1463938 DOI: 10.1136/bmj.332.7551.1183] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To measure the extent of underdosing of antiretroviral drugs in children. DESIGN Multicentre cohort study. SETTING Clinical centres in hospitals in the United Kingdom and Ireland in the collaborative HIV paediatric study (CHIPS). PARTICIPANTS 615 HIV infected children aged 2-12 years receiving antiretrovirals. MAIN OUTCOME MEASURES Doses relative to weight and height compared with current recommended doses in 2004 European guidelines. RESULTS The CHIPS cohort of 934 children comprises 80% of diagnosed HIV infected children in the UK and Ireland between January 1997 and March 2005, of which 66% (615) aged 2-12 years were prescribed antiretrovirals. Actual doses standardised to weight or surface area varied widely across individual drugs, antiretroviral class, and calendar time, with children underdosed (prescribed less than 90% of current recommended doses) from 6-62% child time at risk. Three serious issues in prescribing antiretrovirals, which may also be relevant to paediatric prescribing in general, were identified. Firstly, dosing was inadequate before incorrect recommendations at licensing were later revised when important pharmacokinetic results emerged. Secondly, guidelines stating dosage alternatives (by weight/surface area) for the same drug led to different and inconsistent doses. And, thirdly, ongoing growth was not adjusted for. CONCLUSIONS Largely inadvertently, HIV infected children in the United Kingdom and Ireland have been underdosed with antiretrovirals, highlighting problems applicable throughout paediatric prescribing.
Collapse
|
9
|
Hirt D, Urien S, Jullien V, Firtion G, Rey E, Pons G, Blanche S, Treluyer JM. Age-related effects on nelfinavir and M8 pharmacokinetics: a population study with 182 children. Antimicrob Agents Chemother 2006; 50:910-6. [PMID: 16495250 PMCID: PMC1426418 DOI: 10.1128/aac.50.3.910-916.2006] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
As a relationship between nelfinavir antiretroviral efficacy and plasma concentrations has been previously established, nelfinavir pharmacokinetics was investigated in order to optimize the individual treatment schedule in a pediatric population. A population pharmacokinetic model was developed to describe the concentration-time course of nelfinavir and its active metabolite M8. Individual characteristics were used to explain the large interindividual variability in children. Data from therapeutic drug monitoring in 182 children treated with nelfinavir were analyzed with NONMEM. Then Food and Drug Administration (FDA) current recommendations were evaluated estimating the percentage of children who reached the target minimum plasma concentration (0.8 mg/liter) by using Bayesian estimates. Nelfinavir pharmacokinetics was described by a one- compartment model with linear absorption and elimination. Pharmacokinetic estimates and the corresponding intersubject variabilities for the model were as follows: nelfinavir total clearance, 0.93 liters/h/kg (39%); volume of distribution, 6.9 liters/kg (109%); absorption rate, 0.5 h(-1); formation clearance fraction to hydroxy-tert-butylamide (M8), 0.025; M8 elimination rate, 1.88 h(-1) (49%). Apparent nelfinavir total clearance and volume of distribution decreased as a function of age. M8 elimination rate was increased by concomitant administration of nevirapine or efavirenz. Our data confirm that the FDA recommendations for children from 2 to 13 years are optimal and that the dose recommended for children younger than 2 years is adequate for the children from 2 months to 2 years old. However, in children younger than 2 months, the proposed nelfinavir newborn dose of 40 mg/kg of body weight twice daily is inadequate and we suggest increasing the dose to 50 to 60 mg/kg administered thrice daily. This assumption should be further evaluated.
Collapse
Affiliation(s)
- Déborah Hirt
- Pharmacologie Clinique, Assistance Publique--Hôpitaux Paris, France.
| | | | | | | | | | | | | | | |
Collapse
|
10
|
Olmo M, Podzamczer D. A review of nelfinavir for the treatment of HIV infection. Expert Opin Drug Metab Toxicol 2006; 2:285-300. [PMID: 16866614 DOI: 10.1517/17425255.2.2.285] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Nelfinavir (NFV) is a protease inhibitor that has been widely used for several years for the treatment of HIV infection. This has led to extensive experience with NFV-containing regimens, in which the drug has shown prolonged viral suppression, good tolerability and a unique resistance profile. In recent years, several antiretroviral drugs with some advantages over NFV have been developed. Nevertheless, NFV has favourable characteristics that make it a suitable antiretroviral compound for many HIV-infected patients. It can be used in patients who do not tolerate ritonavir even at low doses, and it is well tolerated in pregnant women, has a low-grade interaction with methadone and may be well tolerated in hepatitis C virus-co-infected patients. In addition, its new simplified posology may contribute to improved adherence.
Collapse
Affiliation(s)
- Montserrat Olmo
- Hospital Universitario de Bellvitge, Infectious Diseases Service, HIV Unit, Hospitalet de Llobregat, Barcelona, Spain.
| | | |
Collapse
|
11
|
Fraaij PLA, van Kampen JJA, Burger DM, de Groot R. Pharmacokinetics of antiretroviral therapy in HIV-1-infected children. Clin Pharmacokinet 2005; 44:935-56. [PMID: 16122281 DOI: 10.2165/00003088-200544090-00004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The initiation of antiretroviral therapy has resulted in an impressive reduction in the rate of disease progression in AIDS and HIV-1-related deaths in children; however, there are still several major challenges to be faced in order to improve therapy. A major topic that needs to be dealt with is the establishment of the optimal dosage of antiretroviral therapy for children. This review presents the currently available peer-reviewed data on the pharmacokinetics of nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs) and fusion inhibitors (FIs) in children. In addition, the data are discussed in relation to the currently available European and US guidelines and the US FDA-approved drug labels. High intra- and interpatient variability in pharmacokinetics are often observed for all antiretroviral drugs. The number of children included in the pharmacokinetic studies is often small and children are often divided into divergent groups using different dosage levels and/or drug formulations. For a substantial number of antiretroviral drugs, dosage recommendations, especially for young children, are still absent in the European and US guidelines. The recommended drug dosages in the guidelines are often different from that in the officially approved drug product label. In addition, the recommended drug dosages may deviate between the European and US guidelines. Thus, while practioners aim to meet the recommendations in the official guidelines, patients may receive highly divergent dosages of medication. The high intra- and interpatient variability in pharmacokinetics of antiretroviral drugs in children hampers the application of fixed dosages of antiretroviral drugs. For PIs and NNRTIs, plasma drug levels correlate with viral suppression and drug toxicity. NRTIs are prodrugs that are intracellularly converted to their active triphosphate form and, therefore, plasma NRTI levels correlate poorly with viral suppression. Therapeutic drug monitoring of PIs and NNRTIs should be considered to optimise HIV therapy in children.
Collapse
Affiliation(s)
- Pieter L A Fraaij
- Department of Pediatrics, Erasmus MC/Sophia Children's Hospital, Rotterdam, The Netherlands
| | | | | | | |
Collapse
|
12
|
Slish JC, Catanzaro LM, Okusanya O, Demeter LM, Albrecht M, Difrancesco R, Morse GD. Therapeutic Drug Monitoring: Role for a Pharmacist in Multidisciplinary Antiretroviral Management. J Pharm Pract 2005. [DOI: 10.1177/0897190005278501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The current treatment guidelines for HIV pharmacotherapy recommend combinations of antiretrovirals (ARVs) to achieve optimal suppression of HIV replication. However, the initiation and long-term management of ARV therapy in a patient is often complicated by variable medication adherence, complex medication use with multiple drug interactions, the occurrence of drug toxicity, and drug therapy for comorbid conditions that require additional patient education and laboratory monitoring. For these reasons, the inclusion of a well-trained pharmacist in multidisciplinary health system management strategies has been increasing. Furthermore, the use of fixed-dose ARVs is accompanied by considerable interpatient variation in pharmacokinetics yielding a range of drug exposures from any given ARV dose. One approach to overcoming this variable drug exposure is to use plasma concentration monitoring (eg, therapeutic drug monitoring [TDM]) as a clinical tool to adjust doses to achieve targeted concentration ranges, often in conjunction with HIV resistance tests. While data in support of TDM are emerging, the development of programs that include an HIV pharmaceutical care specialist and an adherence program with an integrated clinical pharmacology resource that can provide reliable TDM assays has been reported and provides the rationale for including pharmacists in the implementation of ARV TDM programs.
Collapse
Affiliation(s)
- Judianne C. Slish
- University at Buffalo, School of Pharmacy and Pharmaceutical Sciences, Erie County Medical Center, Department of Medicine, Division of Infectious Diseases; 315 Cooke Hall, Buffalo, NY 14260
| | - Linda M. Catanzaro
- University at Buffalo, School of Pharmacy and Pharmaceutical Sciences; Erie County Medical Center, Buffalo, New York
| | | | | | | | | | | |
Collapse
|
13
|
Boffito M, Acosta E, Burger D, Fletcher CV, Flexner C, Garaffo R, Gatti G, Kurowski M, Perno CF, Peytavin G, Regazzi M, Back D. Current Status and Future Prospects of Therapeutic Drug Monitoring and Applied Clinical Pharmacology in Antiretroviral Therapy. Antivir Ther 2005. [DOI: 10.1177/135965350501000307] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The consensus of current international guidelines for the treatment of HIV infection is that data on therapeutic drug monitoring (TDM) of non-nucleoside reverse transcriptase inhibitors and protease inhibitors provide a framework for the implementation of TDM in certain defined scenarios in clinical practice. However, the utility of TDM is considered to be on an individual basis until more data are obtained from large clinical trials showing the benefit of TDM. In April 2004, a panel of experts met in Rome, Italy. This followed an inaugural meeting in Perugia, Italy, in October 2000, which resulted in the article published in AIDS 2002, 16(Suppl 1):S5–S37. The objectives of this second meeting were to review the questions surrounding TDM of antiretroviral drugs and discuss the clinical utility, current concerns and future prospects of drug concentration monitoring in the care of HIV-1-infected individuals. This report, which has been updated to include material published or presented at international conferences up to the end of September 2004, reviews pharmacokinetic and pharmacodynamic data and reports the issues discussed by the panel, offering advice to clinical care providers who may be currently, or are considering incorporating TDM into the routine care of their patients. In addition, the panel formulated a series of position statements that are relevant to the interpretation of current data and can aid the design of future clinical trials. Part 2 of this Special article, Therapeutic drug monitoring and drug–drug interactions involving antiretroviral drugs, will be published in Antiviral Therapy 10(4).
Collapse
Affiliation(s)
- Marta Boffito
- Chelsea and Westminster Hospital, London, UK
- University of Turin, Department of Infectious Diseases, Turin, Italy
| | - Edward Acosta
- Division of Clinical Pharmacology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David Burger
- Department of Clinical Pharmacy & Nijmegen University Centre for Infectious Diseases, University Medical Centre, Nijmegen, The Netherlands
| | - Courtney V Fletcher
- Department of Clinical Pharmacy, University of Colorado Health Sciences Center, Denver, CO, USA
| | - Charles Flexner
- Johns Hopkins University, School of Medicine, Division of Clinical Pharmacology, Baltimore, MD, USA
| | - Rodolphe Garaffo
- Unité de Pharmacocinetique Clinique, Pasteur University Hospital, Nice, France
| | - Giorgio Gatti
- Vertex Pharmaceuticals (Europe) Ltd, Genoa, Italy and University of Genoa, c/o San Martino Hospital, Genoa, Italy
| | | | | | - Gilles Peytavin
- Département de Pharmacocinétique Clinique, Hôpital Bichat-Claude Bernard, Paris, France
| | - Mario Regazzi
- Service of Clinical Pharmacology, IRCCS Policlinico S Matteo, Pavia, Italy
| | - David Back
- Department of Pharmacology, University of Liverpool, Liverpool, UK
| |
Collapse
|
14
|
Payen S, Faye A, Compagnucci A, Giaquinto C, Gibbs D, Gomeni R, Bressolle F, Jacqz-Aigrain E. Bayesian parameter estimates of nelfinavir and its active metabolite, hydroxy-tert-butylamide, in infants perinatally infected with human immunodeficiency virus type 1. Antimicrob Agents Chemother 2005; 49:525-35. [PMID: 15673728 PMCID: PMC547202 DOI: 10.1128/aac.49.2.525-535.2005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2004] [Revised: 05/24/2004] [Accepted: 10/14/2004] [Indexed: 12/11/2022] Open
Abstract
The objective of the present study was to develop a population pharmacokinetic model for nelfinavir mesylate (NFV) and nelfinavir hydroxy-tert-butylamide (M8), the most abundant metabolite of NFV, in infants vertically infected with human immunodeficiency virus type 1 and participating in the Paediatric European Network for Treatment of AIDS 7 study. Plasma NFV concentrations were determined during repeated NFV administrations (two to three times a day). Eighteen infants younger that age 2 years participated in this study. The doses administered ranged from 71 to 203 mg/kg of body weight/day. Pharmacokinetic parameter estimates were obtained by a compartmental approach by using a kinetic model to simultaneously fit NFV and M8 (active metabolite) concentrations. M8 was shown to be formation rate limited and was characterized by first-order rate constants of formation and elimination. Body weight was found to be a more appropriate predictor than age of the changes in (i) the rate of metabolism, (ii) the elimination rate constant of NFV, and (iii) NFV clearance. Population parameters were computed to account for the relationship between the rate of metabolism and body weight. The estimated NFV and M8 elimination half-lives were 4.3 and 2.04 h, respectively. The estimated NFV clearance was 2.13 liters/h/kg. The M8 concentration-to-NFV concentration ratio was 0.64 +/- 0.44. In conclusion, the population pharmacokinetic model describing the dispositions of NFV and M8 should facilitate the design of future studies to elucidate the relative contributions of the parent compound and M8 to the pharmacological and toxic effects of NFV therapy.
Collapse
Affiliation(s)
- Salomé Payen
- Laboratoire de Pharmacocinétique Clinique, Faculté de Pharmacie, BP 14491, 34093 Montpellier Cedex 5, France
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Burger DM, Bergshoeff AS, De Groot R, Gibb D, Walker S, Tréluyer JM, Hoetelmans RMW. Maintaining the nelfinavir trough concentration above 0.8 mg/L improves virologic response in HIV-1-infected children. J Pediatr 2004; 145:403-5. [PMID: 15343199 DOI: 10.1016/j.jpeds.2004.04.048] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Differences in virologic response were compared in 32 HIV-infected children with a nelfinavir trough concentration either below (n=7) or above (n=25) 0.8 mg/L. Virologic response at week 48 was observed in 29% of children with subtherapeutic nelfinavir troughs versus 80% in children with therapeutic nelfinavir troughs (P=.02).
Collapse
Affiliation(s)
- David M Burger
- University Medical Centre Nijmegen, Nijmegen University Centre for Infectious Diseases, Geert Grooteplein 8, 6525 GA Nijmegen, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
16
|
[Recommendations for initial antiretroviral treatment in HIV-infected children. Update 2003]. An Pediatr (Barc) 2004; 60:262-8. [PMID: 14987518 DOI: 10.1016/s1695-4033(04)78261-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Highly active antiretroviral therapy in HIV-infected children has been associated with a dramatic decrease in progression to AIDS and HIV-related deaths, and infected children currently have an excellent quality of life. Antiretroviral drugs cannot eradicate the virus, although they can achieve a situation of latent infection. However, chronic use of these drugs has multiple adverse effects, the most important of which are metabolic complications. The large number of drugs required and patient characteristics such as age, tolerance to drugs, adherence, and social problems make unifying the criteria for initial therapy in HIV-infected children difficult. A balance should be sought between not delaying the start of treatment, to avoid immunologic deterioration, and minimizing the long-term adverse effects of the therapy. The present treatment recommendations are adapted from international guidelines and are based on a literature review and on our own experience. Our group previously published recommendations on the treatment of HIV-infected children and the aim of the present article is to provide an update.
Collapse
|