Antiviral activity of the hepatitis C virus polymerase inhibitor filibuvir in genotype 1–infected patients

• Published in: Hepatology (Baltimore, Md.) Vol. 54; no. 1; pp. 50 - 59
• Main Authors: Wagner, Frank, Thompson, Robert, Kantaridis, Constantino, Simpson, Paul, Troke, Philip J. F., Jagannatha, Shyla, Neelakantan, Srividya, Purohit, Vivek S., Hammond, Jennifer L.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01-07-2011; Wiley; Wiley Subscription Services, Inc
• Subjects: Adult; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiviral agents; Antiviral Agents - adverse effects; Antiviral Agents - pharmacokinetics; Antiviral Agents - therapeutic use; Biological and medical sciences; Dose-Response Relationship, Drug; Double-Blind Method; Drug Therapy, Combination; Female; Gastroenterology. Liver. Pancreas. Abdomen; Genotype; Genotype & phenotype; Hepacivirus - genetics; Hepacivirus - immunology; Hepatitis; Hepatitis C; Hepatitis C - drug therapy; Hepatitis C - genetics; Hepatitis C - metabolism; Hepatitis C virus; Hepatology; HIV; Human immunodeficiency virus; Humans; Interferon; Interferon alpha-2; Interferon-alpha - therapeutic use; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Polyethylene Glycols - therapeutic use; Pyrones - adverse effects; Pyrones - pharmacokinetics; Pyrones - therapeutic use; Recombinant Proteins; Ribavirin - therapeutic use; RNA, Viral - metabolism; Treatment Outcome; Triazoles - adverse effects; Triazoles - pharmacokinetics; Triazoles - therapeutic use; Viral Nonstructural Proteins - antagonists & inhibitors; Viral Nonstructural Proteins - genetics; Viral Nonstructural Proteins - metabolism; Virus; Human; Infection; Microbiological investigation; Typing; Gastroenterology; Antiviral; Genotype; Flaviviridae; Hepatitis C virus; Hepacivirus
• ISSN: 0270-9139; 1527-3350
• DOI: 10.1002/hep.24342

More effective and better‐tolerated therapies are needed for chronic hepatitis C virus (HCV) infection. Among the direct‐acting anti‐HCV agents in development is the nonstructural 5B protein (NS5B polymerase) non‐nucleoside inhibitor filibuvir. We investigated the antiviral activity, pharmacokinetics, safety, and tolerability of multiple doses of filibuvir in treatment‐naive and treatment‐experienced patients who were chronically infected with HCV genotype 1 in two phase 1b clinical studies (study 1 was a randomized, placebo‐controlled dose escalation study and study 2 was a nonrandomized, open‐label study). The filibuvir doses evaluated ranged from 200‐1400 mg daily, and the duration of dosing ranged from 3‐10 days. Genotypic changes in the NS5B nucleotide sequence following short‐term filibuvir therapy were also assessed. Filibuvir potently inhibited viral replication in a dose‐dependent manner. Mean maximum HCV RNA change from baseline ranged from −0.97 log10 IU/mL with filibuvir given at 100 mg twice daily to −2.30 log10 IU/mL with filibuvir given at 700 mg twice daily in treatment‐naive patients. In treatment‐experienced patients, an HCV RNA reduction of 2.20 log10 IU/mL was achieved with filibuvir given at 450 mg twice daily. Filibuvir was well tolerated in both studies. Adverse events were mild or moderate in severity. No discontinuations, serious adverse events, or deaths were reported. NS5B sequencing identified residue 423 as the predominant site of mutation after filibuvir dosing. Conclusion: Filibuvir administration resulted in significant reductions in HCV RNA concentrations at doses that were well tolerated in patients infected with HCV genotype 1. Filibuvir is currently being evaluated in combination with pegylated interferon alfa 2a plus ribavirin in treatment‐naive patients. (Hepatology 2011;)