Antiviral activity of narlaprevir combined with ritonavir and pegylated interferon in chronic hepatitis C patients.

Abstract

UNLABELLED:

Narlaprevir (SCH 900518) is a potent inhibitor of the hepatitis C virus (HCV) nonstructural protein 3 serine protease that is primarily metabolized by the cytochrome P450-3A4 system. In order to explore the use of ritonavir-based pharmacokinetic enhancement of an HCV protease inhibitor, this study investigated the safety, tolerability, pharmacokinetics, and antiviral activity of narlaprevir (with or without ritonavir) administered as monotherapy and as combination therapy with pegylated interferon-α-2b (PEG-IFN-α-2b) to HCV genotype 1-infected patients. This was a randomized, placebo-controlled, two-period, blinded study in 40 HCV genotype 1-infected patients (naïve and treatment-experienced). In period 1, narlaprevir was administered for 7 days as 800 mg three times daily without ritonavir or 400 mg twice daily with 200 mg ritonavir twice daily. In period 2, after a 4-week washout, the same dose and regimen of narlaprevir was administered in combination with PEG-IFN-α-2b for 14 days. Upon completion of period 2, all patients initiated PEG-IFN-α-2b and ribavirin treatment. A rapid and persistent decline in plasma HCV-RNA was observed in both treatment-experienced and treatment-naïve patients during period 1, with a mean viral load decline of at least 4 log₁₀ in all treatment groups. A high percentage of both treatment-experienced (50%) and treatment-naïve (≥ 60%) patients had undetectable HCV-RNA (< 25 IU/mL) after period 2. Standard of care resulted in sustained virological response (SVR) rates of 38% and 81% in treatment-experienced and treatment-naïve patients, respectively. Narlaprevir (with or without ritonavir) alone or in combination with PEG-IFN-α-2b was safe and well tolerated.

CONCLUSION:

Narlaprevir administration resulted in a robust HCV-RNA decline and high SVR rates when followed by standard of care in both treatment-experienced and treatment-naïve HCV genotype 1-infected patients.

• Authors: Joep de Bruijne, Jilling F Bergmann, Henk W Reesink, Christine J Weegink, Richard Molenkamp, Janke Schinkel, Xiao Tong, Jing Li, Michelle A Treitel, Eric A Hughes, Jan Jaap van Lier, Andre A van Vliet, Harry L A Janssen, Robert J de Knegt
• Journal: Hepatology (Baltimore, Md.) (Hepatology) Vol. 52 Issue 5 Pg. 1590-9 (Nov 2010) ISSN: 1527-3350 [Electronic] United States
• PMID: 20938912 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Antiviral Agents
• Cyclopropanes
• Dipeptides
• Interferon alpha-2
• Interferon-alpha
• RNA, Viral
• Recombinant Proteins
• Sulfones
• narlaprevir
• Polyethylene Glycols
• Urea
• Proline
• peginterferon alfa-2b
• Leucine
• Ritonavir
• peginterferon alfa-2a

Topics

• Adult
• Aged
• Antiviral Agents (administration & dosage, therapeutic use)
• Cyclopropanes
• Dipeptides (administration & dosage, pharmacokinetics, therapeutic use)
• Drug Administration Schedule
• Drug Therapy, Combination
• Female
• Genotype
• Hepacivirus (genetics)
• Hepatitis C, Chronic (drug therapy, genetics)
• Humans
• Inpatients
• Interferon alpha-2
• Interferon-alpha (therapeutic use)
• Leucine (analogs & derivatives)
• Male
• Middle Aged
• Outpatients
• Polyethylene Glycols (therapeutic use)
• Proline (analogs & derivatives)
• RNA, Viral (blood)
• Recombinant Proteins
• Recurrence
• Ritonavir (administration & dosage, therapeutic use)
• Sulfones (administration & dosage, pharmacokinetics, therapeutic use)
• Urea
• Young Adult