Drugs

Fostemsavir

Fostemsavir

Other Names: BMS-663068, FTR, GSK3684934, fostemsavir tromethamine, prodrug of BMS-626529, prodrug of GSK2616713, prodrug of temsavir Drug Class: Entry Inhibitor Registry Number: 864953-29-7 (CAS) Chemical Name: Piperazine, 1-benzoyl-4-((4-methoxy-7-(3-methyl-1H-1,2,4-triazol-1-yl)-1-((phosphonooxy)methyl)-1H-pyrrolo(2,3-c)pyridin-3-yl)oxoacetyl)- Organization: ViiV Healthcare Phase of Development: III

(Compound details obtained from ChemIDplus Advanced,1 NIAID Therapeutics Database,2 and GlaxoSmithKline press release3)

What is an investigational drug?

What is an investigational drug?

An investigational drug is one that is under study and is not approved by the U.S. Food and Drug Administration (FDA) for sale in the United States. Medical research studies are conducted to evaluate the safety and effectiveness of an investigational drug. These research studies are also called clinical trials. Once an investigational drug has been proven safe and effective in clinical trials, FDA may approve the drug for sale in the United States.

To learn more about investigational drugs, read the AIDSinfo What is an Investigational HIV Drug? fact sheet.

What is fostemsavir?

What is fostemsavir?

Fostemsavir (GSK3684934) is an investigational drug that is being studied for the treatment of HIV infection.4

Fostemsavir belongs to a class (group) of HIV drugs called entry and fusion inhibitors.2 Entry and fusion inhibitors block HIV from getting into and infecting certain cells of the immune system. This prevents HIV from multiplying and can reduce the amount of HIV in the body.

By attaching to the gp120 protein on the outer surface of HIV, fostemsavir blocks HIV from getting into and infecting the immune cells.5

Fostemsavir is a prodrug, which means that it is an inactive drug. Once taken, a prodrug does not work until the body converts it into an active form. In the body, fostemsavir is converted to temsavir (GSK2616713).4-6

How are clinical trials of investigational drugs conducted?

How are clinical trials of investigational drugs conducted?

Clinical trials are conducted in phases. Each phase has a different purpose and helps researchers answer different questions.7

  • Phase I trials: Researchers test an investigational drug in a small group of people (20–80) for the first time. The purpose is to evaluate its safety and identify side effects.
  • Phase II trials: The investigational drug is administered to a larger group of people (100–300) to determine its effectiveness and to further evaluate its safety.
  • Phase III trials: The investigational drug is administered to large groups of people (1,000–3,000) to confirm its effectiveness, monitor side effects, compare it with standard or equivalent treatments, and collect information that will allow the investigational drug to be used safely.7

In most cases, an investigational drug must be proven effective and must show continued safety in a Phase III clinical trial to be considered for approval by FDA for sale in the United States. Some drugs go through FDA’s accelerated approval process and are approved before a Phase III clinical trial is complete. After a drug is approved by FDA and made available to the public, researchers track its safety in Phase IV trials to seek more information about the drug’s risks, benefits, and optimal use.7

Some clinical trials are categorized as “a” or “b,” such as “Phase Ia” or “Phase IIb.” These different sublevels typically mean that a study is researching certain types of information or using a certain type of participant population. 

In what phase of testing is fostemsavir?

In what phase of testing is fostemsavir?

Fostemsavir is currently being studied in a Phase III clinical trial.2

What are some studies on fostemsavir?

What are some studies on fostemsavir?

Study Names: AI438-006; NCT01009814
Sponsor: ViiV Healthcare
Phase: IIa
Status: This study has been completed.
Location: Germany
Participants:

  • Participants were adults with subtype B HIV.
  • Some of the participants had never taken HIV medicines before or had taken an HIV medicine for less than 1 week. Other participants had previously taken HIV medicines for a longer period of time. All participants were required to be off HIV medicines for at least 8 weeks before starting fostemsavir.
  • Participants had viral load levels of at least 5,000 copies/mL. (Viral load is the amount of HIV in a blood sample.)
  • Participants had CD4 counts of at least 200 cells/mm3. (A CD4 count is a laboratory test that measures the number of CD4 cells in a sample of blood and is an important indicator of immune function.)

Purpose: The purpose of this study was to evaluate the safety and effectiveness of fostemsavir, given with and without the HIV medicine ritonavir (brand name: Norvir).5,8

Study Names: AI438-011; NCT01384734
Sponsor: ViiV Healthcare
Phase: IIb
Status: This study has been completed.
Location: Multiple countries, including United States
Participants:

  • Participants were adults with HIV who had taken HIV medicines before.
  • Participants had less than 1 week of treatment with any HIV medicines from the integrase strand transfer inhibitors drug class.
  • Participants had viral load levels of at least 1,000 copies/mL and CD4 counts greater than 50 cells/mm3 at the start of the study.

Purpose: The purpose of this study was to evaluate the safety and effectiveness of 4 different doses of fostemsavir and to compare fostemsavir to the FDA-approved protease inhibitor atazanavir (brand name: Reyataz) boosted with ritonavir.9,10

Study Names: BRIGHTE; AI438-047; NCT02362503
Sponsor: ViiV Healthcare
Phase: III
Status: This study is ongoing, but not recruiting participants.
Location: North America, South America, Europe, Asia, Africa, and Australia
Participants:

  • Participants are adults with HIV who have previously taken HIV medicines.
  • Participants are experiencing treatment failure on their current antiretroviral therapy (ART) regimen, with viral load levels of at least 400 copies/mL. (Treatment failure is when an ART regimen is unable to control HIV infection.)
  • Participants can no longer receive HIV medicines from at least 3 antiretroviral drug classes. (This may be because a participant’s HIV is not affected by certain HIV medicines, because of drug side effects that a participant cannot tolerate, or because of other reasons.)
  • Participants have 2 or fewer antiretroviral drug classes remaining to form a new ART regimen.
Purpose: The purpose of this study is to evaluate the safety and effectiveness of fostemsavir.11

What side effects might fostemsavir cause?

What side effects might fostemsavir cause?

AI438-006 study (NCT01009814):

In this Phase IIa study, the most common side effects were headache, rash, and urinary urgency. Most instances of these side effects were mild.5,8

AI438-011 study (NCT01384734):

In this Phase IIb study, mild headache was the most common side effect. Through 96 weeks of treatment, there were no cases of fostemsavir-related side effects that led to participants dropping out of the study.4,9,12

BRIGHTE (NCT02362503):

A safety analysis at Week 24 found that 91% of participants experienced at least 1 side effect during this Phase III study, though most were mild in severity. Moderate to severe side effects occurred in 18% of participants and included nausea, diarrhea, headache, vomiting, fatigue, and weakness or lack of energy. Nine participants had serious side effects that were related to treatment with fostemsavir, and 21 participants had side effects that caused them to leave the study.11,13,14

Because fostemsavir is still being studied, information on possible side effects of the drug is not complete. As testing of fostemsavir continues, additional information on possible side effects will be gathered.

Where can I get more information about clinical trials studying fostemsavir?

Where can I get more information about clinical trials studying fostemsavir?

More information about fostemsavir-related research studies is available from the AIDSinfo database of ClinicalTrials.gov study summaries. Click on the title of any trial in the list to see the ClinicalTrials.gov trial summary and more information about the study.

How can I find more information about participating in a clinical trial?

How can I find more information about participating in a clinical trial?

Participating in a clinical trial can provide benefits. For example, a volunteer participant can benefit from new research treatments before they are widely available. Participants also receive regular and careful medical attention from a research team that includes doctors and other health professionals. However, clinical trials may also involve risks of varying degrees, such as unpleasant, serious, or even life-threatening side effects from the treatment being studied.7

Your health care provider can help you decide whether participating in a clinical trial is right for you. For more information, visit NIH Clinical Research Trials and You.

References

References

  1. United States National Library of Medicine. ChemIDplus Advanced. Available at: https://chem.sis.nlm.nih.gov/chemidplus/rn/864953-29-7. Last accessed on December 15, 2017.
  2. National Institute of Allergy and Infectious Diseases (NIAID). NIAID ChemDB, HIV drugs in development. Available at: https://chemdb.niaid.nih.gov/DrugDevelopmentHIV.aspx. Last accessed on December 15, 2017.
  3. GlaxoSmithKline: Press Release, dated February 22, 2016. GSK’s global HIV business ViiV Healthcare completes transactions to acquire Bristol-Myers Squibb’s R&D HIV assets. Available at: http://www.gsk.com/en-gb/media/press-releases/2016/gsk-s-global-hiv-business-viiv-healthcare-completes-transactions-to-acquire-bristol-myers-squibb-s-randd-hiv-assets/. Last accessed on December 15, 2017. [Archived at WebCite]
  4. Llamoso C, Bogner JR, Afonina L, et al. HIV-1 attachment inhibitor prodrug BMS-663068 in antiretroviral-experienced subjects: Week 96 safety analysis. International Congress of Drug Therapy in HIV Infection (HIV Glasgow); October 23-26, 2016; Glasgow, UK. Levin: HIV-1 attachment inhibitor prodrug BMS-663068 [GSK3684934 (formerly BMS-663068)] in antiretroviral-experienced subjects: Week 96 safety analysis; Conference reports for National AIDS Treatment Advocacy Project (NATAP); 2016. Available at: http://natap.org/2016/GLASGOW/GLASGOW_32.htm. Last accessed on December 15, 2017. [Archived at WebCite]
  5. Nettles RE, Schürmann D, Zhu L, et al. Pharmacodynamics, safety, and pharmacokinetics of BMS-663068, an oral HIV-1 attachment inhibitor in HIV-1-infected subjects. J Infect Dis. 2012 Oct 1;206(7):1002-11. Available at: https://jid.oxfordjournals.org/content/206/7/1002.long. Last accessed on December 15, 2017.
  6. United States National Library of Medicine. ChemIDplus Advanced. Available at: https://chem.sis.nlm.nih.gov/chemidplus/rn/701213-36-7. Last accessed on December 15, 2017.
  7. National Institutes of Health (NIH). NIH clinical research trials and you. Available at: https://www.nih.gov/health-information/nih-clinical-research-trials-you. Last accessed on December 15, 2017.
  8. ViiV Healthcare. Randomized, open label, multiple-dose study to evaluate the pharmacodynamics, safety and pharmacokinetics of BMS-663068 in HIV-1 infected subjects. In: ClinicalTrials.gov. Bethesda (MD): National Library of Medicine (US). Registered on November 6, 2009. NLM Identifier: NCT01009814. Available at: https://www.clinicaltrials.gov/ct2/show/NCT01009814. Last accessed on December 15, 2017.
  9. ViiV Healthcare. A Phase IIb randomized, controlled, partially-blinded trial to investigate safety, efficacy and dose-response of BMS-663068 in treatment-experienced HIV-1 subjects, followed by an open-label period on the recommended dose. In: ClinicalTrials.gov. Bethesda (MD): National Library of Medicine (US). Registered on June 23, 2011. NLM Identifier: NCT01384734. Available at: https://www.clinicaltrials.gov/ct2/show/NCT01384734. Last accessed on December 15, 2017.
  10. Lalezari JP, Latiff GH, Brinson C, et al. Safety and efficacy of the HIV-1 attachment inhibitor prodrug BMS-663068 in treatment-experienced individuals: 24 week results of AI438011, a phase 2b, randomized controlled trial. Lancet HIV. 2015; 2: e427-e437. National AIDS Treatment Advocacy Project (NATAP): HIV Articles. Available at: http://www.natap.org/2015/HIV/2PIIS2352301815001770(1).pdf. Last accessed on December 15, 2017. [Archived at WebCite]
  11. ViiV Healthcare. A multi-arm Phase 3 randomized placebo controlled double blind clinical trial to investigate the efficacy and safety of BMS-663068 in heavily treatment experienced subjects infected with multi-drug resistant HIV-1. In: ClinicalTrials.gov. Bethesda (MD): National Library of Medicine (US). Registered on February 9, 2015. NLM Identifier: NCT02362503. Available at: https://www.clinicaltrials.gov/ct2/show/NCT02362503. Last accessed on December 15, 2017.
  12. DeJesus E, Martins M, Stoehr A, et al. Attachment inhibitor prodrug BMS-663068 in antiretroviral-experienced subjects: Week 96 analysis. Poster presented at: Conference on Retroviruses and Opportunistic Infections (CROI); February 22-25, 2016; Boston, MA. Poster 472. Available at: http://www.croiconference.org/sites/default/files/posters-2016/472.pdf. Last accessed on December 15, 2017. [Archived at WebCite]
  13. Lataillade M. Phase 3 study of fostemsavir in heavily treatment experienced HIV-1 infected subjects: Day 8 and Week 24 primary efficacy and safety results (BRIGHTE study, formerly AI438-047). Abstract presented at: European AIDS Clinical Society (EACS) Conference; October 25-27, 2017; Milan, Italy. Abstract PS8/5. Available at: http://resourcelibrary.eacs.cyim.com/?mediaId=34870. Last accessed on December 15, 2017.
  14. Kozal M, Aberg J, Pialoux G, et al. Phase 3 study of fostemsavir in heavily treatment-experienced HIV-1-infected participants: Day 8 and Week 24 primary efficacy and safety results (BRIGHTE study, formerly 205888/AI438-047). European AIDS Conference; October 25-27, 2017; Milan, Italy. Levin: Conference reports for National AIDS Treatment Advocacy Project (NATAP); 2017. Available at: http://www.natap.org/2017/EACS/EACS_34.htm. Last accessed on December 15, 2017. [Archived at WebCite]

Last Reviewed: December 2, 2016