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Wang CY, Wong WW, Tsai HC, Chen YH, Kuo BS, Lynn S, Blazkova J, Clarridge KE, Su HW, Lin CY, Tseng FC, Lai A, Yang FH, Lin CH, Tseng W, Lin HY, Finstad CL, Wong-Staal F, Hanson CV, Chun TW, Liao MJ. Effect of Anti-CD4 Antibody UB-421 on HIV-1 Rebound after Treatment Interruption. N Engl J Med 2019; 380:1535-1545. [PMID: 30995373 DOI: 10.1056/nejmoa1802264] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Administration of a single broadly neutralizing human immunodeficiency virus (HIV)-specific antibody to HIV-infected persons leads to the development of antibody-resistant virus in the absence of antiretroviral therapy (ART). It is possible that monotherapy with UB-421, an antibody that blocks the virus-binding site on human CD4+ T cells, could induce sustained virologic suppression without induction of resistance in HIV-infected persons after analytic treatment interruption. METHODS We conducted a nonrandomized, open-label, phase 2 clinical study evaluating the safety, pharmacokinetics, and antiviral activity of UB-421 monotherapy in HIV-infected persons undergoing analytic treatment interruption. All the participants had undetectable plasma viremia (<20 copies of HIV RNA per milliliter) at the screening visit. After discontinuation of ART, participants received eight intravenous infusions of UB-421, at a dose of either 10 mg per kilogram of body weight every week (Cohort 1) or 25 mg per kilogram every 2 weeks (Cohort 2). The primary outcome was the time to viral rebound (≥400 copies per milliliter). RESULTS A total of 29 participants were enrolled, 14 in Cohort 1 and 15 in Cohort 2. Administration of UB-421 maintained virologic suppression (<20 copies per milliliter) in all the participants (94.5% of measurements at study visits 2 through 9) during analytic treatment interruption, with intermittent viral blips (range, 21 to 142 copies per milliliter) observed in 8 participants (28%). No study participants had plasma viral rebound to more than 400 copies per milliliter. CD4+ T-cell counts remained stable throughout the duration of the study. Rash, mostly of grade 1, was a common and transient adverse event; one participant discontinued the study drug owing to a rash. A decrease in the population of CD4+ regulatory T cells was observed during UB-421 monotherapy. CONCLUSIONS UB-421 maintained virologic suppression (during the 8 to 16 weeks of study) in participants in the absence of ART. One participant discontinued therapy owing to a rash. (Funded by United Biomedical and others; ClinicalTrials.gov number, NCT02369146.).
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Affiliation(s)
- Chang-Yi Wang
- From United Biomedical, Hauppauge, NY (C.-Y.W., B.-S.K., C.L.F., F.W.-S.); United Biomedical Asia (C.-Y.W., S.L.) and United BioPharma (C.-Y.W., B.-S.K., H.-W.S., C.-Y.L., F.-C.T., A.L., F.-H.Y., C.-H.L., W.T., M.-J.L.), Hsinchu, Taipei Veterans General Hospital, Taipei (W.-W.W., H.-Y.L.), and Kaohsiung Veterans General Hospital (H.-C.T.) and Kaohsiung Medical University Hospital (Y.-H.C.), Kaohsiung - all in Taiwan; National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (J.B., K.E.C., T.-W.C.); and the California Department of Public Health, Richmond (C.V.H.)
| | - Wing-Wai Wong
- From United Biomedical, Hauppauge, NY (C.-Y.W., B.-S.K., C.L.F., F.W.-S.); United Biomedical Asia (C.-Y.W., S.L.) and United BioPharma (C.-Y.W., B.-S.K., H.-W.S., C.-Y.L., F.-C.T., A.L., F.-H.Y., C.-H.L., W.T., M.-J.L.), Hsinchu, Taipei Veterans General Hospital, Taipei (W.-W.W., H.-Y.L.), and Kaohsiung Veterans General Hospital (H.-C.T.) and Kaohsiung Medical University Hospital (Y.-H.C.), Kaohsiung - all in Taiwan; National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (J.B., K.E.C., T.-W.C.); and the California Department of Public Health, Richmond (C.V.H.)
| | - Hung-Chin Tsai
- From United Biomedical, Hauppauge, NY (C.-Y.W., B.-S.K., C.L.F., F.W.-S.); United Biomedical Asia (C.-Y.W., S.L.) and United BioPharma (C.-Y.W., B.-S.K., H.-W.S., C.-Y.L., F.-C.T., A.L., F.-H.Y., C.-H.L., W.T., M.-J.L.), Hsinchu, Taipei Veterans General Hospital, Taipei (W.-W.W., H.-Y.L.), and Kaohsiung Veterans General Hospital (H.-C.T.) and Kaohsiung Medical University Hospital (Y.-H.C.), Kaohsiung - all in Taiwan; National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (J.B., K.E.C., T.-W.C.); and the California Department of Public Health, Richmond (C.V.H.)
| | - Yen-Hsu Chen
- From United Biomedical, Hauppauge, NY (C.-Y.W., B.-S.K., C.L.F., F.W.-S.); United Biomedical Asia (C.-Y.W., S.L.) and United BioPharma (C.-Y.W., B.-S.K., H.-W.S., C.-Y.L., F.-C.T., A.L., F.-H.Y., C.-H.L., W.T., M.-J.L.), Hsinchu, Taipei Veterans General Hospital, Taipei (W.-W.W., H.-Y.L.), and Kaohsiung Veterans General Hospital (H.-C.T.) and Kaohsiung Medical University Hospital (Y.-H.C.), Kaohsiung - all in Taiwan; National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (J.B., K.E.C., T.-W.C.); and the California Department of Public Health, Richmond (C.V.H.)
| | - Be-Sheng Kuo
- From United Biomedical, Hauppauge, NY (C.-Y.W., B.-S.K., C.L.F., F.W.-S.); United Biomedical Asia (C.-Y.W., S.L.) and United BioPharma (C.-Y.W., B.-S.K., H.-W.S., C.-Y.L., F.-C.T., A.L., F.-H.Y., C.-H.L., W.T., M.-J.L.), Hsinchu, Taipei Veterans General Hospital, Taipei (W.-W.W., H.-Y.L.), and Kaohsiung Veterans General Hospital (H.-C.T.) and Kaohsiung Medical University Hospital (Y.-H.C.), Kaohsiung - all in Taiwan; National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (J.B., K.E.C., T.-W.C.); and the California Department of Public Health, Richmond (C.V.H.)
| | - Shugene Lynn
- From United Biomedical, Hauppauge, NY (C.-Y.W., B.-S.K., C.L.F., F.W.-S.); United Biomedical Asia (C.-Y.W., S.L.) and United BioPharma (C.-Y.W., B.-S.K., H.-W.S., C.-Y.L., F.-C.T., A.L., F.-H.Y., C.-H.L., W.T., M.-J.L.), Hsinchu, Taipei Veterans General Hospital, Taipei (W.-W.W., H.-Y.L.), and Kaohsiung Veterans General Hospital (H.-C.T.) and Kaohsiung Medical University Hospital (Y.-H.C.), Kaohsiung - all in Taiwan; National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (J.B., K.E.C., T.-W.C.); and the California Department of Public Health, Richmond (C.V.H.)
| | - Jana Blazkova
- From United Biomedical, Hauppauge, NY (C.-Y.W., B.-S.K., C.L.F., F.W.-S.); United Biomedical Asia (C.-Y.W., S.L.) and United BioPharma (C.-Y.W., B.-S.K., H.-W.S., C.-Y.L., F.-C.T., A.L., F.-H.Y., C.-H.L., W.T., M.-J.L.), Hsinchu, Taipei Veterans General Hospital, Taipei (W.-W.W., H.-Y.L.), and Kaohsiung Veterans General Hospital (H.-C.T.) and Kaohsiung Medical University Hospital (Y.-H.C.), Kaohsiung - all in Taiwan; National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (J.B., K.E.C., T.-W.C.); and the California Department of Public Health, Richmond (C.V.H.)
| | - Katherine E Clarridge
- From United Biomedical, Hauppauge, NY (C.-Y.W., B.-S.K., C.L.F., F.W.-S.); United Biomedical Asia (C.-Y.W., S.L.) and United BioPharma (C.-Y.W., B.-S.K., H.-W.S., C.-Y.L., F.-C.T., A.L., F.-H.Y., C.-H.L., W.T., M.-J.L.), Hsinchu, Taipei Veterans General Hospital, Taipei (W.-W.W., H.-Y.L.), and Kaohsiung Veterans General Hospital (H.-C.T.) and Kaohsiung Medical University Hospital (Y.-H.C.), Kaohsiung - all in Taiwan; National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (J.B., K.E.C., T.-W.C.); and the California Department of Public Health, Richmond (C.V.H.)
| | - Hsiao-Wen Su
- From United Biomedical, Hauppauge, NY (C.-Y.W., B.-S.K., C.L.F., F.W.-S.); United Biomedical Asia (C.-Y.W., S.L.) and United BioPharma (C.-Y.W., B.-S.K., H.-W.S., C.-Y.L., F.-C.T., A.L., F.-H.Y., C.-H.L., W.T., M.-J.L.), Hsinchu, Taipei Veterans General Hospital, Taipei (W.-W.W., H.-Y.L.), and Kaohsiung Veterans General Hospital (H.-C.T.) and Kaohsiung Medical University Hospital (Y.-H.C.), Kaohsiung - all in Taiwan; National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (J.B., K.E.C., T.-W.C.); and the California Department of Public Health, Richmond (C.V.H.)
| | - Chia-Ying Lin
- From United Biomedical, Hauppauge, NY (C.-Y.W., B.-S.K., C.L.F., F.W.-S.); United Biomedical Asia (C.-Y.W., S.L.) and United BioPharma (C.-Y.W., B.-S.K., H.-W.S., C.-Y.L., F.-C.T., A.L., F.-H.Y., C.-H.L., W.T., M.-J.L.), Hsinchu, Taipei Veterans General Hospital, Taipei (W.-W.W., H.-Y.L.), and Kaohsiung Veterans General Hospital (H.-C.T.) and Kaohsiung Medical University Hospital (Y.-H.C.), Kaohsiung - all in Taiwan; National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (J.B., K.E.C., T.-W.C.); and the California Department of Public Health, Richmond (C.V.H.)
| | - Fan-Chen Tseng
- From United Biomedical, Hauppauge, NY (C.-Y.W., B.-S.K., C.L.F., F.W.-S.); United Biomedical Asia (C.-Y.W., S.L.) and United BioPharma (C.-Y.W., B.-S.K., H.-W.S., C.-Y.L., F.-C.T., A.L., F.-H.Y., C.-H.L., W.T., M.-J.L.), Hsinchu, Taipei Veterans General Hospital, Taipei (W.-W.W., H.-Y.L.), and Kaohsiung Veterans General Hospital (H.-C.T.) and Kaohsiung Medical University Hospital (Y.-H.C.), Kaohsiung - all in Taiwan; National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (J.B., K.E.C., T.-W.C.); and the California Department of Public Health, Richmond (C.V.H.)
| | - Annie Lai
- From United Biomedical, Hauppauge, NY (C.-Y.W., B.-S.K., C.L.F., F.W.-S.); United Biomedical Asia (C.-Y.W., S.L.) and United BioPharma (C.-Y.W., B.-S.K., H.-W.S., C.-Y.L., F.-C.T., A.L., F.-H.Y., C.-H.L., W.T., M.-J.L.), Hsinchu, Taipei Veterans General Hospital, Taipei (W.-W.W., H.-Y.L.), and Kaohsiung Veterans General Hospital (H.-C.T.) and Kaohsiung Medical University Hospital (Y.-H.C.), Kaohsiung - all in Taiwan; National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (J.B., K.E.C., T.-W.C.); and the California Department of Public Health, Richmond (C.V.H.)
| | - Fu-Hung Yang
- From United Biomedical, Hauppauge, NY (C.-Y.W., B.-S.K., C.L.F., F.W.-S.); United Biomedical Asia (C.-Y.W., S.L.) and United BioPharma (C.-Y.W., B.-S.K., H.-W.S., C.-Y.L., F.-C.T., A.L., F.-H.Y., C.-H.L., W.T., M.-J.L.), Hsinchu, Taipei Veterans General Hospital, Taipei (W.-W.W., H.-Y.L.), and Kaohsiung Veterans General Hospital (H.-C.T.) and Kaohsiung Medical University Hospital (Y.-H.C.), Kaohsiung - all in Taiwan; National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (J.B., K.E.C., T.-W.C.); and the California Department of Public Health, Richmond (C.V.H.)
| | - Chen-Han Lin
- From United Biomedical, Hauppauge, NY (C.-Y.W., B.-S.K., C.L.F., F.W.-S.); United Biomedical Asia (C.-Y.W., S.L.) and United BioPharma (C.-Y.W., B.-S.K., H.-W.S., C.-Y.L., F.-C.T., A.L., F.-H.Y., C.-H.L., W.T., M.-J.L.), Hsinchu, Taipei Veterans General Hospital, Taipei (W.-W.W., H.-Y.L.), and Kaohsiung Veterans General Hospital (H.-C.T.) and Kaohsiung Medical University Hospital (Y.-H.C.), Kaohsiung - all in Taiwan; National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (J.B., K.E.C., T.-W.C.); and the California Department of Public Health, Richmond (C.V.H.)
| | - William Tseng
- From United Biomedical, Hauppauge, NY (C.-Y.W., B.-S.K., C.L.F., F.W.-S.); United Biomedical Asia (C.-Y.W., S.L.) and United BioPharma (C.-Y.W., B.-S.K., H.-W.S., C.-Y.L., F.-C.T., A.L., F.-H.Y., C.-H.L., W.T., M.-J.L.), Hsinchu, Taipei Veterans General Hospital, Taipei (W.-W.W., H.-Y.L.), and Kaohsiung Veterans General Hospital (H.-C.T.) and Kaohsiung Medical University Hospital (Y.-H.C.), Kaohsiung - all in Taiwan; National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (J.B., K.E.C., T.-W.C.); and the California Department of Public Health, Richmond (C.V.H.)
| | - Hsiao-Yi Lin
- From United Biomedical, Hauppauge, NY (C.-Y.W., B.-S.K., C.L.F., F.W.-S.); United Biomedical Asia (C.-Y.W., S.L.) and United BioPharma (C.-Y.W., B.-S.K., H.-W.S., C.-Y.L., F.-C.T., A.L., F.-H.Y., C.-H.L., W.T., M.-J.L.), Hsinchu, Taipei Veterans General Hospital, Taipei (W.-W.W., H.-Y.L.), and Kaohsiung Veterans General Hospital (H.-C.T.) and Kaohsiung Medical University Hospital (Y.-H.C.), Kaohsiung - all in Taiwan; National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (J.B., K.E.C., T.-W.C.); and the California Department of Public Health, Richmond (C.V.H.)
| | - Connie L Finstad
- From United Biomedical, Hauppauge, NY (C.-Y.W., B.-S.K., C.L.F., F.W.-S.); United Biomedical Asia (C.-Y.W., S.L.) and United BioPharma (C.-Y.W., B.-S.K., H.-W.S., C.-Y.L., F.-C.T., A.L., F.-H.Y., C.-H.L., W.T., M.-J.L.), Hsinchu, Taipei Veterans General Hospital, Taipei (W.-W.W., H.-Y.L.), and Kaohsiung Veterans General Hospital (H.-C.T.) and Kaohsiung Medical University Hospital (Y.-H.C.), Kaohsiung - all in Taiwan; National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (J.B., K.E.C., T.-W.C.); and the California Department of Public Health, Richmond (C.V.H.)
| | - Flossie Wong-Staal
- From United Biomedical, Hauppauge, NY (C.-Y.W., B.-S.K., C.L.F., F.W.-S.); United Biomedical Asia (C.-Y.W., S.L.) and United BioPharma (C.-Y.W., B.-S.K., H.-W.S., C.-Y.L., F.-C.T., A.L., F.-H.Y., C.-H.L., W.T., M.-J.L.), Hsinchu, Taipei Veterans General Hospital, Taipei (W.-W.W., H.-Y.L.), and Kaohsiung Veterans General Hospital (H.-C.T.) and Kaohsiung Medical University Hospital (Y.-H.C.), Kaohsiung - all in Taiwan; National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (J.B., K.E.C., T.-W.C.); and the California Department of Public Health, Richmond (C.V.H.)
| | - Carl V Hanson
- From United Biomedical, Hauppauge, NY (C.-Y.W., B.-S.K., C.L.F., F.W.-S.); United Biomedical Asia (C.-Y.W., S.L.) and United BioPharma (C.-Y.W., B.-S.K., H.-W.S., C.-Y.L., F.-C.T., A.L., F.-H.Y., C.-H.L., W.T., M.-J.L.), Hsinchu, Taipei Veterans General Hospital, Taipei (W.-W.W., H.-Y.L.), and Kaohsiung Veterans General Hospital (H.-C.T.) and Kaohsiung Medical University Hospital (Y.-H.C.), Kaohsiung - all in Taiwan; National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (J.B., K.E.C., T.-W.C.); and the California Department of Public Health, Richmond (C.V.H.)
| | - Tae-Wook Chun
- From United Biomedical, Hauppauge, NY (C.-Y.W., B.-S.K., C.L.F., F.W.-S.); United Biomedical Asia (C.-Y.W., S.L.) and United BioPharma (C.-Y.W., B.-S.K., H.-W.S., C.-Y.L., F.-C.T., A.L., F.-H.Y., C.-H.L., W.T., M.-J.L.), Hsinchu, Taipei Veterans General Hospital, Taipei (W.-W.W., H.-Y.L.), and Kaohsiung Veterans General Hospital (H.-C.T.) and Kaohsiung Medical University Hospital (Y.-H.C.), Kaohsiung - all in Taiwan; National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (J.B., K.E.C., T.-W.C.); and the California Department of Public Health, Richmond (C.V.H.)
| | - Mei-June Liao
- From United Biomedical, Hauppauge, NY (C.-Y.W., B.-S.K., C.L.F., F.W.-S.); United Biomedical Asia (C.-Y.W., S.L.) and United BioPharma (C.-Y.W., B.-S.K., H.-W.S., C.-Y.L., F.-C.T., A.L., F.-H.Y., C.-H.L., W.T., M.-J.L.), Hsinchu, Taipei Veterans General Hospital, Taipei (W.-W.W., H.-Y.L.), and Kaohsiung Veterans General Hospital (H.-C.T.) and Kaohsiung Medical University Hospital (Y.-H.C.), Kaohsiung - all in Taiwan; National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (J.B., K.E.C., T.-W.C.); and the California Department of Public Health, Richmond (C.V.H.)
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