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AMD-070

Other Names: AMD-11070
Drug Class: Entry Inhibitor
Molecular Formula: C21 H27 N5
Registry Number: 558447-26-0 (CAS)
Chemical Name: N'-(1H-benzimidazol-2-ylmethyl)-N'-[(8S)-5,6,7,8-tetrahydroquinolin-8-yl]butane-1,4-diamine
Chemical Class: Benzimidazoles
Company: Genzyme Corporation
Phase of Development: I/II (discontinued)
Patent Version Content

NOTE: The development of AMD-070 for HIV treatment has been discontinued.


The study of AMD-070 as an entry inhibitor HIV medicine appears to be discontinued. A search of ClinicalTrials.gov for AMD-070 trials related to HIV returns no trials that are ongoing or planned. The last published clinical trials results for AMD-070 as HIV treatment were released in 2009.3


Pharmacology


Mechanism of Action: HIV-1 entry inhibitor. AMD-070 is a selective, reversible, small molecule CXCR4 chemokine co-receptor antagonist.4,5 AMD-070 prevents CXCR4-mediated viral entry of T-cell tropic synctium-inducing HIV (associated with advanced stages of HIV-1 infection) by binding to transmembrane regions of the co-receptor, blocking the interaction of the CD4–gp120 complex with the ECL2 domain of the CXCR4 co-receptor.4-6

Half-life (T½): In healthy participants, the median estimated terminal half-life of AMD-070 ranged from 7.6 to 12.6 hours (single-dose cohorts, 50 mg to 400 mg) and from 11.2 to 15.9 hours (multiple-dose cohorts, 100 mg to 400 mg twice daily).7

Metabolism/Elimination: Metabolism is the main route of AMD-070 elimination, with less than 1% of the oral dose excreted as unchanged drug in the urine. AMD-070 is a substrate of P-gp, and in vitro studies performed with human liver microsomes have demonstrated that it is metabolized by CYP3A4. CYP2D6 is also involved in AMD-070 metabolism, though to a lesser extent than CYP3A4.4

Resistance: In a 10-day monotherapy study (NCT00361101) of twice daily AMD-070 100 mg or 200 mg in 10 HIV-infected adults, 9 participants had dual/mixed-tropic virus and 1 had X4-tropic virus at screening. One participant was determined to be nonevaluable. Of 4 responders achieving a reduction in X4 virus population of greater than or equal to 1 log10 relative luminescence units (rlu), 3 participants demonstrated a shift from dual/mixed virus to R5 virus. The shift to R5 tropism reverted back to dual/mixed tropism following completion of treatment by Day 30. Of the nonresponders, all but 1 participant maintained tropism during the study period, with the latter participant showing a shift from X4 tropism to dual/mixed on Day 5 (reverting back to X4 by Day 17).3,8,9

In another 10-day monotherapy study (NCT00089466) of twice daily AMD-070 200 mg in 6 HIV-infected adults, all 6 study participants were dual/mixed-tropic at study entry. At Day 10, all participants remained dual/mixed-tropic except for 1, who was R5-tropic.10,11


Clinical Trials


Study Identifiers: X4 Antagonist Concept Trial (XACT); NCT00361101
Sponsor: Genzyme, a Sanofi Company
Phase: I/II
Study Purpose: The purpose of this open-label study was to evaluate the safety and antiviral activity of AMD-070 monotherapy.
Study Population:
  • Participants were treatment-naive or -experienced (off ART for at least 14 days prior to study entry) adults infected with CXCR4-using virus (X4- or dual-tropic HIV).
  • Participants had HIV RNA ≥5,000 copies/mL and CD4 counts <200 cells/mm3.
Dosing: AMD-070 200 mg was administered as monotherapy orally and twice daily over 10 days. (Because of a dosing error, 2 patients received 100 mg of AMD-070 twice daily instead of the protocol-defined 200-mg dose.)3,4,9
Note: This study was previously halted because of histologic changes in the liver seen in animal toxicity studies. The study has since been completed.3,9
Selected Study Results:


Study Identifiers: ACTG A5210; NCT00089466
Sponsor: National Institute of Allergy and Infectious Diseases (NIAID)
Phase: Ib/IIa
Study Purpose: The purpose of this open-label study was to evaluate the safety and antiviral activity of AMD-070 monotherapy.
Study Population:
  • Participants were treatment-naive or -experienced (off ART for at least 14 days prior to study entry) adults infected with CXCR4-using virus (X4- or dual-tropic HIV).
  • Participants had HIV RNA ≥5,000 copies/mL within 60 days prior to study entry.
Dosing: AMD-070 200 mg was administered as monotherapy orally and twice daily over 10 days.10,11
Note: Additional dosing cohorts beyond the 200-mg twice-daily group are described in the ClinicalTrials.gov study protocol NCT00089466.11
Selected Study Results:
  • CROI, 2007: Proof of Concept of Antiretroviral Activity of AMD11070 (an Orally Administered CXCR4 Entry Inhibitor): Results of the First Dosing Cohort A Studied in ACTG Protocol A5210


Adverse Events


In the XACT study (NCT00361101), a total of 6 study drug-related adverse events (AEs) were reported by 5 study participants. All except 1 drug-related AE were of Grade 1 severity. The most common AEs were mild gastrointestinal symptoms (diarrhea and flatulence) and headache. Dizziness was reported in 1 participant. No drug-related serious adverse events (SAEs) occurred. No laboratory abnormalities of Grade 1 severity or higher were reported. Hepatotoxicity was not observed during this study.3,9

In the ACTG A5210 trial (NCT00089466), no AEs of Grade 3 severity or higher were observed during the 10-day treatment period or during the 7 days following therapy.10,11


Drug Interactions


AMD-070 is a substrate of both CYP3A4 and P-gp and shows potential for inhibition of CYP2D6, CYP3A4, and CYP1A2 enzymes.4

Coadministration of low-dose ritonavir with AMD-070 has been shown to cause weak increases in the Cmax and AUC of AMD-070.4

When coadministered with CYP probe drugs—midazolam (CYP3A4 substrate) and dextromethorphan (CYP2D6 substrate)—AMD-070 caused a significant increase in the AUC for both probe drugs and in the Cmax for the CYP2D6 probe.12


References


  1. United States National Library of Medicine. ChemIDplus Advanced. Available at: http://chem.sis.nlm.nih.gov/chemidplus/rn/558447-26-0. Last accessed on January 11, 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 January 11, 2017.
  3. Moyle G, DeJesus E, Boffito M, et al. Proof of Activity with AMD11070, an Orally Bioavailable Inhibitor of CXCR4-Tropic HIV Type 1. Clin Infect Dis. 2009 Mar 15;48(6):798-805. Available at: http://cid.oxfordjournals.org/content/48/6/798.long. Last accessed on January 11, 2017.
  4. Cao YJ, Flexner CW, Dunaway S, et al. Effect of Low-Dose Ritonavir on the Pharmacokinetics of the CXCR4 Antagonist AMD070 in Healthy Volunteers. Antimicrob Agents Chemother. 2008 May;52(5):1630-4. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2346642/. Last accessed on January 11, 2017.
  5. Wong R, Bodart V, Metz M, Labrecque J, Bridger G, Fricker S. Understanding the Interactions Between CXCR4 and AMD11070, a First-in-Class Small Molecule Antagonist of the HIV Coreceptor. Poster presented at: 14th Conference on Retroviruses and Opportunistic Infections (CROI); February 25-28, 2007; Los Angeles, CA. Poster 495. Available at: https://www.researchgate.net/publication/267229718_Understanding_the_Interactions_Between_CXCR4_and_AMD11070_a_First-in-Class_Small_Molecule_Antagonist_of_the_HIV_Coreceptor. Last accessed on January 11, 2017.
  6. Poveda E, Soriano V. Resistance to entry inhibitors. In: Geretti AM, editor. Antiretroviral Resistance in Clinical Practice. London: Mediscript; 2006. Chapter 4. Available at: http://www.ncbi.nlm.nih.gov/books/NBK2251/. Last accessed on January 11, 2017.
  7. Stone ND, Dunaway SB, Flexner C, et al. Multiple-Dose Escalation Study of the Safety, Pharmacokinetics, and Biologic Activity of Oral AMD070, a Selective CXCR4 Receptor Inhibitor, in Human Subjects. Antimicrob Agents Chemother. 2007 Jul;51(7):2351-8. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1913234/. Last accessed on January 11, 2017.
  8. Moyle G, DeJesus E, Boffito M, et al. CXCR4 Antagonism: Proof of Activity with AMD11070. Poster presented at: 14th Conference on Retroviruses and Opportunistic Infections (CROI); February 25-28, 2007; Los Angeles, CA. Poster 511. Available at: http://www.retroconference.org/2007/PDFs/511.pdf. Last accessed on May 28, 2013.
  9. Genzyme, a Sanofi Company. Multicenter, Dose-finding Safety and Activity Study of AMD11070 in HIV-infected Patients Carrying X4-tropic Virus. In: ClinicalTrials.gov. Bethesda (MD): National Library of Medicine (US). Registered on August 3, 2006. NLM Identifier: NCT00361101. Available at: http://www.clinicaltrials.gov/ct2/show/NCT00361101. Last accessed on January 11, 2017.
  10. Saag M, Rosenkranz S, Becker S, et al. Proof of Concept of Antiretroviral Activity of AMD11070 (an Orally Administered CXCR4 Entry Inhibitor): Results of the First Dosing Cohort A Studied in ACTG Protocol A5210. Paper presented at: 14th Conference on Retroviruses and Opportunistic Infections (CROI); February 25-28, 2007; Los Angeles, CA. Paper 512. Available at: http://www.retroconference.org/2007/Abstracts/30166.htm. Last accessed on May 28, 2013.
  11. National Institute of Allergy and Infectious Diseases (NIAID). Phase IB/IIA Dose-Finding Safety and Activity Study of AMD11070 (An Orally Administered CXCR4 Entry Inhibitor) in HIV-Infected Subjects. In: ClinicalTrials.gov. Bethesda (MD): National Library of Medicine (US). Registered on August 5, 2004. NLM Identifier: NCT00089466. Available at: http://www.clinicaltrials.gov/ct2/show/NCT00089466. Last accessed on January 11, 2017.
  12. Nyunt M, Becker S, MacFarland R, et al. Pharmacokinetic Interaction between AMD11070 and Substrates of CYP3A4 and 2D6 Enzymes in Healthy Volunteers. Paper presented at: 14th Conference on Retroviruses and Opportunistic Infections (CROI); February 25-28, 2007; Los Angeles. CA. Paper 569. Available at: http://www.retroconference.org/2007/Abstracts/29797.htm. Last accessed on May 28, 2013.


Last Reviewed: January 11, 2017