title: Model-Based Phase 3 Dose Selection for HIV-1 Attachment Inhibitor Prodrug BMS-663068 in HIV-1-Infected Patients: Population Pharmacokinetics/Pharmacodynamics of the Active Moiety, BMS-626529.
abstract: BMS-663068 is an oral prodrug of the HIV-1 attachment inhibitor BMS-626529, which prevents viral attachment to host CD4(+) T cells by binding to HIV-1 gp120. To guide dose selection for the phase 3 program, pharmacokinetic/pharmacodynamic modeling was performed using data from two phase 2 studies with HIV-1-infected subjects (n = 244). BMS-626529 population pharmacokinetics were described by a two-compartment model with first-order elimination from the central compartment, zero-order release of prodrug from the extended-release formulation into a hypothetical absorption compartment, and first-order absorption into the central compartment. The covariates of BMS-663068 formulation type, lean body mass, baseline CD8(+) T-cell percentage, and ritonavir coadministration were found to be significant contributors to intersubject variability. Exposure-response analyses showed a relationship between the loge-transformed concentration at the end of a dosing interval (Ctau) normalized for the protein binding-adjusted BMS-626529 half-maximal (50%) inhibitory concentration (PBAIC50) and the change in the HIV-1 RNA level from the baseline level after 7 days of BMS-663068 monotherapy. The probability of achieving a decline in HIV-1 RNA level of >0.5 or >1.0 log10 copies/ml as a function of the loge-transformed PBAIC50-adjusted Ctau after 7 days of monotherapy was 99 to 100% and 57 to 73%, respectively, for proposed BMS-663068 doses of 400 mg twice daily (BID), 600 mg BID (not studied in the phase 2b study), 800 mg BID, 600 mg once daily (QD), and 1,200 mg QD. On the basis of a slight advantage in efficacy of BID dosing over QD dosing, similar responses for the 600- and 800-mg BID doses, and prior clinical observations, BMS-663068 at 600 mg BID was predicted to have the optimal benefit-risk profile and selected for further clinical investigation. (The phase 2a proof-of-concept study AI438006 and the phase 2b study AI438011 are registered at ClinicalTrials.gov under numbers NCT01009814 and NCT01384734, respectively.).
authors.affiliation: Bristol-Myers Squibb, Research and Development, Princeton, New Jersey, USA.
authors.forename: Ishani
authors.initials: I
authors.lastname: Landry
authors.affiliation: Bristol-Myers Squibb, Research and Development, Princeton, New Jersey, USA.
authors.forename: Li
authors.initials: L
authors.lastname: Zhu
authors.affiliation: Bristol-Myers Squibb, Research and Development, Princeton, New Jersey, USA.
authors.forename: Malaz
authors.initials: M
authors.lastname: Abu Tarif
authors.affiliation: Bristol-Myers Squibb, Research and Development, Princeton, New Jersey, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Hruska
authors.affiliation: ICON plc, Cary, North Carolina, USA.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Sadler
authors.affiliation: ICON plc, Marlow, Buckinghamshire, United Kingdom.
authors.forename: Maria
authors.initials: M
authors.lastname: Pitsiu
authors.affiliation: Bristol-Myers Squibb, Research and Development, Wallingford, Connecticut, USA.
authors.forename: Samit
authors.initials: S
authors.lastname: Joshi
authors.affiliation: Bristol-Myers Squibb, Research and Development, Princeton, New Jersey, USA.
authors.forename: George J
authors.initials: GJ
authors.lastname: Hanna
authors.affiliation: Bristol-Myers Squibb, Research and Development, Wallingford, Connecticut, USA.
authors.forename: Max
authors.initials: M
authors.lastname: Lataillade
authors.affiliation: Bristol-Myers Squibb, Research and Development, Princeton, New Jersey, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Boulton
authors.affiliation: Bristol-Myers Squibb, Research and Development, Princeton, New Jersey, USA richard.bertz@bms.com.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Bertz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D005260:Female; D015658:HIV Infections / Q000188:drug therapy; D006801:Humans; D020128:Inhibitory Concentration 50; D008297:Male; D008875:Middle Aged; D010755:Organophosphates / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use*; D010879:Piperazines / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use*; D011355:Prodrugs / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use; D014230:Triazoles / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use*
chemical_list: D019380:Anti-HIV Agents; C584152:BMS-626529; D010755:Organophosphates; D010879:Piperazines; D011355:Prodrugs; D014230:Triazoles; C576364:fostemsavir