- Category: Experimental HIV Drugs
- Published on Wednesday, 17 August 2011 00:00
- Written by Liz Highleyman
The "Quad" pill -- an 4-in-1 single-tablet regimen containing the experimental integrase inhibitor elvitegravir, cobicistat (a new boosting agent), tenofovir, and emtricitabine -- was shown to be as safe and effective for first-line HIV treatment as the approved all-in-1 regimen, Atripla (efavirenz/tenofovir/emtricitabine), according to Gilead Sciences.
As recently reported in the journal AIDS, the Quad pill worked somewhat faster and better than Atripla at 24 and 48 weeks. Gilead, which makes all 4 components of the Quad pill and produces Atripla in partnership with Bristol-Myers Squibb, has now announced that the Quad met its 48-week primary endpoint of demonstrating non-inferiority to Atripla.
Below is an edited except from a Gilead press release describing Study 102 and its findings. The full announcement is available online at http://www.gilead.com/pr_1596378.
Gilead's Investigational Antiretroviral Quad Regimen Meets 48-Week Primary Objective in Pivotal Phase 3 Clinical Study 102
Foster City, CA -- August 15, 2011 -- Gilead Sciences, Inc. (Nasdaq:GILD) today announced that a Phase 3 clinical trial (Study 102) of its investigational fixed-dose, single-tablet "Quad" regimen of elvitegravir, cobicistat, emtricitabine and tenofovir disoproxil fumarate, being evaluated for HIV-1 infection in treatment-naive patients, met its primary objective, which was non-inferiority at week 48 as compared to Atripla (efavirenz 600 mg/emtricitabine 200 mg/tenofovir disoproxil fumarate 300 mg). The primary endpoint analysis indicated that 88 percent of patients in the Quad arm compared to 84 percent in the Atripla (95% CI for the difference: -1.6% to 8.8%) achieved HIV RNA (viral load) of less than 50 copies/mL through week 48. The predefined criterion for non-inferiority was a lower bound of a two sided 95% CI of -12 percent.
The mean 48-week increase in CD4 cell count from baseline was 239 cells/mm3 in the Quad arm compared to 206 cells/mm3 in the Atripla arm (p=0.009). The frequency of Grade 3-4 adverse events and laboratory abnormalities was similar between the Quad-treated and the Atripla-treated arms. Discontinuation rates due to adverse events were comparable in both arms of the study. Gilead plans to submit these data for presentation at a scientific conference early next year.
The Quad contains four Gilead compounds in a complete once-daily, single-tablet regimen: elvitegravir, an investigational integrase inhibitor; cobicistat, an investigational pharmacoenhancing or "boosting" agent that increases blood levels of certain HIV medicines; and Truvada (emtricitabine/tenofovir disoproxil fumarate). The Phase 3 clinical program for the Quad includes two studies (Studies 102 and 103) which are evaluating the Quad regimen versus a standard of care among HIV-1 infected antiretroviral treatment-naive adults. The second pivotal Quad study (Study 103), a randomized, double-blind clinical trial comparing the efficacy, safety and tolerability of the Quad versus ritonavir-boosted atazanavir and Truvada, is ongoing, and results are expected later this quarter.
"Achieving non-inferiority to the current standard of care in HIV therapy is a major developmental milestone for our Quad regimen," said Norbert Bischofberger, PhD, Executive Vice President, Research and Development and Chief Scientific Officer, Gilead Sciences. "We are very pleased with these results, which are in line with our expectations and allow us to begin preparations for a U.S. regulatory filing in the first quarter of 2012."
Cobicistat is also being evaluated as a stand-alone boosting agent for other antiretrovirals, in particular, the protease inhibitor atazanavir. Results from the Phase 3 clinical trial of cobicistat are expected in the fourth quarter of this year. Forty-eight week results from the Phase 3 trial of elvitegravir as a stand-alone agent were presented last month at the 6th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2011) in Rome, Italy.
About Study 102
Study 102 is a randomized, double-blind clinical trial comparing the efficacy, safety and tolerability of the Quad versus Atripla over a 96-week period at 130 study sites in the United States and Puerto Rico. Eligible participants were HIV-infected treatment-naive adults with HIV RNA levels greater than or equal to 5,000 copies/mL. Trial participants were randomized (1:1) to receive a once-daily tablet containing elvitegravir 150 mg/cobicistat 150 mg/emtricitabine 200 mg/tenofovir disoproxil fumarate 300 mg (n=348) or Atripla (efavirenz 600 mg/emtricitabine 200 mg/tenofovir disoproxil fumarate 300 mg) (n=352).
The primary endpoint of the study is the proportion of patients achieving HIV RNA levels of less than 50 copies/mL at 48 weeks of treatment. Secondary objectives will evaluate the efficacy, safety and tolerability of the treatment regimens through 96 weeks of treatment.
The study is ongoing in a blinded fashion. After week 96, subjects will continue to take their blinded study drug until treatment assignments have been unblinded, at which point all subjects will be given the option to participate in an open-label rollover extension and receive the Quad single-tablet regimen.
Additional information about the study can be found at www.clinicaltrials.gov.
The Quad, elvitegravir and cobicistat are investigational products and have not yet been determined safe or efficacious in humans.
Elvitegravir is an HIV integrase inhibitor. Unlike other classes of antiretroviral agents, integrase inhibitors interfere with HIV replication by blocking the ability of the virus to integrate into the genetic material of human cells. Elvitegravir was licensed by Gilead from Japan Tobacco Inc. (JT) in March 2005. Under the terms of Gilead's agreement with JT, Gilead has exclusive rights to develop and commercialize elvitegravir in all countries of the world, excluding Japan, where JT retains rights.
Cobicistat is Gilead's proprietary potent mechanism-based inhibitor of cytochrome P450 3A (CYP3A), an enzyme that metabolizes drugs in the body. In addition to studying the agent as part of an integrase-based fixed-dose regimen, Gilead is also examining cobicistat's potential stand-alone role in boosting commercially available HIV protease inhibitors, which are used in many HIV treatment regimens.
About Gilead Sciences
Gilead Sciences is a biopharmaceutical company that discovers, develops and commercializes innovative therapeutics in areas of unmet medical need. The company's mission is to advance the care of patients suffering from life-threatening diseases worldwide. Headquartered in Foster City, California, Gilead has operations in North America, Europe and Asia Pacific.
Gilead Sciences. Gilead's Investigational Antiretroviral Quad Regimen Meets 48-Week Primary Objective in Pivotal Phase 3 Clinical Study 102. Press release. August 15, 2011.