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Safety Profile of HIV-1 Attachment Inhibitor Prodrug BMS-663068 in Antiretroviral-Experienced Subjects: Week 24 Analysis J Lalezari 1 , GH Latiff 2 , C Brinson 3 , J Echevarría 4 , S Treviño-Pérez 5 , JR Bogner 6 , D Stock 7 , SR Joshi 7 , GJ Hanna 8 , M Lataillade 7 , for the AI438011 study team 1 Quest Clinical Research, San Francisco, CA, USA; 2 Maxwell Clinic, Durban, South Africa; 3 Central Texas Clinical Research, Austin, TX, USA; 4 Hospital Nacional Cayetano Heredia, Lima, Peru; 5 Mexico Centre for Clinical Research, Mexico City, Mexico; 6 Hospital of the University of Munich, Munich, Germany; 7 Bristol-Myers Squibb, Wallingford, CT, USA; 8 Bristol-Myers Squibb, Princeton, NJ, USA Max Lataillade, DO MPH Bristol-Myers Squibb Research and Development Wallingford CT 06492 USA Email: [email protected] Phone: 203-677-7991 Poster 1574 BACKGROUND Despite the success of combination antiretroviral therapy, some HIV-positive patients may have limited treatment options owing to: presence of viral mutants causing reduced antiretroviral (ARV) drug susceptibility emergence of drug toxicities from long-term ARV therapy contraindications from the need to manage associated co-infections and morbidities 1,2 Consequently, there is a continued need to develop novel ARVs that have: unique resistance profiles well-tolerated safety profiles limited or manageable drug–drug interactions BMS-663068 is a prodrug metabolized to the active moiety BMS-626529 (Figure 1), a first-in-class attachment inhibitor that binds to HIV-1 gp120, preventing initial viral attachment and entry into the host CD4+ T cell (Figure 2) 3,4 BMS-626529 has in vitro activity against HIV-1 viruses, with the exception of subtype AE and Group O 5 By binding directly to the virus, BMS-626529 is not affected by co-receptor tropism and is therefore active against CCR5-, CXCR4- and dual-tropic (R5X4) strains of HIV-1 4,6-8 BMS-626529 has a unique resistance profile with no in vitro cross-resistance to other classes of antiretrovirals 6 AI438011 is an ongoing Phase IIb study investigating the efficacy, safety and dose response of BMS-663068 versus atazanavir/ritonavir (ATV/r) in HIV-1-infected, treatment-experienced subjects Through Week 24, BMS-663068 + tenofovir-disoproxil fumarate (TDF) + raltegravir (RAL) demonstrated comparable efficacy to ATV/r + TDF + RAL (modified intent-to-treat SnapShot, Table 1) Gastrointestinal lumen BMS-663068 (prodrug) BMS-626529 (active moiety) BMS-626529 Blood plasma Alkaline phosphatase Figure 1. Conversion of BMS-663068 to BMS- 626529 Figure 2. BMS-626529 attachment inhibitor: Proposed mechanism of action Table 1. AI438011 efficacy summary: Week 24 SnapShot: modified intent-to-treat (Presented at CROI 2014 9 ) BMS-663068 + TDF + RAL ATV/r + TDF + RAL 400 mg BID N=50 800 mg BID N=49 600 mg QD N=51 1200 mg QD N=50 300 mg/100 mg QD N=51 HIV-1 RNA <50 c/mL, % 40 (80.0%) 34 (69.4%) 39 (76.5%) 36 (72.0%) 38 (74.5%) HIV-1 RNA ≥50 c/mL, % 8 (16.0%) 10 (20.4%) 11 (21.6%) 13 (26.0%) 9 (17.6%) No virologic data at Week 24 Discontinued due to adverse event or death, n (%) 1 (2.0%) 2 (4.1%) 0 1 (2.0%) 2 (3.9%) Discontinued for other reasons, n (%) 1 (2.0%) 3 (6.1%) 1 (2.0%) 0 2 (3.9%) Missing data during window but on-study, n (%) 0 0 0 0 0 ATV/r, ritonavir-boosted atazanavir; BID, twice daily; QD, once daily; RAL, raltegravir; TDF, tenofovir-disoproxil fumarate. Modified intent-to-treat population: all subjects receiving ≥1 dose of study drug. OBJECTIVES To assess the safety and tolerability through Week 24 of BMS-663068, when combined with RAL and TDF, in HIV-1-infected subjects by measuring frequency of: adverse events (AEs) serious AEs (SAEs) and AEs leading to discontinuation ACKNOWLEDGMENTS We would like to thank all of the AI438011 clinical trial participants and their families AI438011 Investigators: JD Altclas, PE Cahn, SH Lupo, MD Martins, AI Arango-Duque, OA Sussmann-Pena, G Amaya-Tapia, JF Andrade-Villanueva, ER Granados-Reyes, JG Sierra-Madero, SC Trevino-Perez, WM Casapia-Morales, JI Echevarria, JR Lama-Valdivia, MY Leon-Paredes, FC Mendo-Urbina, Y Pinedo-Ramirez, MR Salazar-Castro, R Bardinas-Rodriguez, C Brinson, E Dejesus, R Elion, J Ernst, J Feinberg, S Hassler, C Hicks, J Lalezari, AR Scribner, L Sloan, M Thompson, K Arastéh, J Bogner, J Rockstroh, A Stoehr, IG Diaconescu, LJ Prisacariu, S Rugina, OA Tsybakova, EE Voronin, AA Yakovlev, NG Zakharova, J Fourie, D Johnson, R Kaplan, G Latiff, B Clotet Bristol-Myers Squibb: A Rightmire, M DeGrosky, J Coumbis, N Ray, N Cusack, M Krystal, C Hwang and T Correll Other: P Lill and J Riefler (ICON CRO) Professional medical writing and editorial assistance was provided by MediTech Media and was funded by Bristol-Myers Squibb REFERENCES 1. Wainberg M et al . JAMA 1998; 279:1977–1983. 2. Wittcop L et al . Lancet Infect Dis 2011; 11:363–371. 3. Brown J et al . J Pharm Sci 2013: 102:1742–1512 4. Langley DL et al . Manuscript in development 5. Varghese V et al . J Acquir Immune Defic Syndr 2009; 52:309–315. 6. Li Z et al . AAC 2013; 57:4172–4180. 7. Nowicka-Sans B et al . AAC 2012; 56:3498–3507. 8. Ray N et al . JAIDS 2013; 64:7–15. 9. Lalezari J et al . CROI 2014: Oral Abstract 86. 10. Bristol-Myers Squibb. Reyataz prescribing information. 2013. Available at: http://packageinserts.bms.com/pi/pi_reyataz.pdf. Accessed April 2014. CONCLUSIONS BMS-663068 was generally well tolerated across all arms: no related SAEs or AEs leading to discontinuation no dose-related safety signals Across the BMS-663068 arms, there were no trends for Grade 2–4 AEs or Grade 3–4 clinical laboratory abnormalities These results support continued development of BMS-663068 An analysis of BMS-663068 efficacy by subgroup through Week 24 will be presented on Thursday, October 9 th at 3pm by Brinson et al (Oral 540) METHODS AI438011 study design Phase IIb, randomized, active-controlled, blinded-to-BMS-663068 dose trial (NCT01384734) Consisted of a 7-day elective monotherapy substudy and the main study (Figure 3) For the main study, subjects were randomized 1:1:1:1:1 into five treatment arms: four treatment groups of BMS-663068 (400 mg twice daily [BID], 800 mg BID, 600 mg once daily [QD], or 1200 mg QD), and a reference group (ATV/r 300/100 mg QD), each with a backbone of RAL 400 mg BID + TDF 300 mg QD (Figure 3) Primary endpoint Week 24 BMS - Day 1 Week 8 Data monitoring committee assessment BMS-663068 400 mg BID + RAL + TDF N=50 BMS-663068 800 mg BID + RAL + TDF N=50 BMS-663068 600 mg QD + RAL + TDF N=50 Primary study - start of combination therapy BMS-663068 monotherapy substudy: 10 patients per study arm Long-term follow-up through Week 48/96 Week 48/96 BMS-663068 1200 mg QD + RAL + TDF N=50 ATV/r 300/100 mg QD + RAL + TDF N=50 Partial blind* Figure 3. AI438011 study design * Blinded to BMS-663068 dose. ATV/r, ritonavir-boosted atazanavir; BID, twice daily; QD, once daily; RAL, raltegravir; TDF, tenofovir-disoproxil fumarate. Eligibility criteria Main inclusion criteria: antiretroviral treatment-experienced (defined as current or previous exposure to ≥1 antiretroviral for ≥1 week) plasma HIV-1 RNA ≥1000 c/mL CD4+ T-cell count >50 cells/mm 3 susceptibility to RAL, TDF and ATV BMS-626529 IC 50 <100 nM as determined by screening Phenosense ® entry assay (Monogram Biosciences - LabCorp) no other significant abnormalities on medical history, physical examination, 12-lead electrocardiograms (ECGs), and clinical laboratory evaluations aged 18–49 years body mass index 18–32 kg/m 2 Main exclusion criteria: pregnancy or breast feeding any significant acute or chronic medical illness liver enzymes (aspartate aminotransferase [ALT]/alanine aminotransferase [AST]) >5 times the upper limit of normal positive blood screen for hepatitis B surface antigen or hepatitis C antibodies/RNA Assessments Safety assessments included: vital signs and physical examinations recording of AEs (SAEs, AEs and Centers for Disease Control Class C AIDS events) measurements of changes in fasting lipids laboratory abnormalities and ECG measurements Assessments were performed at Weeks 4, 8, 12, 16, 20, 24 AEs were coded according to MedDRA version 15.1 and the severity and relationship to study drug was assessed by the corresponding investigator RESULTS Baseline characteristics Baseline demographic and disease characteristics were broadly similar across all treatment groups (Table 2) Median age range was 37–40 years; 60.0% male 66.0% of subjects had HIV-1 subtype B Median baseline HIV-1 RNA: 4.85 log 10 copies/mL Median baseline CD4+ T-cell count: 229.5 cells/µL ~ 50.0% of subjects had at least one major protease inhibitor (PI), nucleoside reverse transcriptase inhibitor or non-nucleoside reverse transcriptase inhibitor resistance-associated mutation at baseline (M184V/I, 31.0%; K103N, 29.0%; thymidine analogue mutations, 13.0%; major PI mutations, 2.0%) Table 2. Baseline characteristics BMS-663068 + TDF + RAL ATV/r + TDF + RAL 400 mg BID N=50 800 mg BID N=49 600 mg QD N=51 1200 mg QD N=50 300 mg/100 mg QD N=51 Median age, years (range) 39 (22–57) 37(23–60) 40(26–58) 40 (20–67) 39 (20–68) Male, % 62.0% 57.1% 56.9% 68.0% 56.9% Race, % White 40.0% 38.8% 33.3% 32.0% 45.1% Black/African-American 28.0% 30.6% 31.4% 36.0% 25.5% Other 32.0% 30.6% 35.3% 32.0% 29.4% HIV subtype, n (%) B 70.0% 59.2% 68.6% 64.0% 66.7% C 16.0% 24.5% 21.6% 20.0% 17.6% Other* 14.0% 16.2% 9.9% 16.0% 15.6% HIV-1 RNA Median, log 10 c/mL 4.97 5.01 4.88 4.78 4.78 ≥100,000 c/mL, % 46.0% 51.0% 45.1% 36.0% 35.3% CD4+ T-cell count Median, cells/μL 214 237 226 224 249 <200 cells/μL, % 38.0% 32.6% 41.2% 42.0% 37.3% * Majority of subjects within the “other” category reported themselves as multiracial. ATV/r, ritonavir-boosted atazanavir; BID, twice daily; QD, once daily; RAL, raltegravir; TDF, tenofovir-disoproxil fumarate. Subject disposition 581 subjects enrolled, 254 randomized and 251 treated (Figure 4) Screen failures were primarily due to failure to meet study criteria; most common reasons (not mutually exclusive) were: a screening plasma HIV-1 RNA of <1000 copies/mL failure of the resistance assay(s) to provide a genotypic and/or phenotypic result for ≥1 of the study drugs Of those receiving treatment, 32/200 (16.0%) across the BMS-663068 arms and 9/51 (17.6%) in the ATV/r arm failed to complete 24 weeks’ treatment (Figure 4) BMS-663068 (400 mg BID) + TDF + RAL Participated, n=7 Participated, n=5 Participated, n=10 Participated, n=10 BMS-663068 (800 mg BID) + TDF + RAL BMS - BMS-663068 (600 mg QD) + TDF + RAL BMS-663068 (1200 mg QD) + TDF + RAL Randomized (n=254) Assessed for eligibility (N=581) Randomized, n=52 Treated, n=50* Randomized, n=50 Treated, n=49 Randomized, n=51 Treated, n=51 Randomized, n=50 Treated, n=50 Randomized, n=51 Treated, n=51 Ongoing at time of analysis (n=44 ) Ongoing at time of analysis (n=38) Ongoing at time of analysis (n=44) Ongoing at time of analysis (n=42) Ongoing at time of analysis (n=42) Discontinued (n=6) 1 adverse event 1 withdrew consent 2 lost to follow-up 1 poor/ non-compliance 1 other Discontinued (n= 11) 2 adverse events 2 withdrew consent 2 pregnancies 1 no longer met study criteria 3 lack of efficacy 1 poor/ non-compliance Discontinued (n=7) 1 pregnancy 2 lost to follow-up 1 no longer met study criteria 2 poor/ non-compliance 1 other Discontinued (n=8) 1 adverse event 1 withdrew consent 3 lost to follow-up 1 request to discontinue 1 no longer met study criteria 1 lack of efficacy Excluded (n=327) Did not meet inclusion criteria (n=303) Declined to participate (n=9) Lost to follow-up (n=3) Other reasons (n=11) Not reported (n=1) Discontinued (n=9) 2 adverse events 3 withdrew consent 2 pregnancies 1 administration- related 1 poor/ non-compliance ATV/r (300/100 mg QD) + TDF + RAL Monotherapy substudy Assigned to receive Primary study Figure 4. Subject disposition * Two subjects did not receive allocated intervention: one withdrew consent, one randomized in error; One subject did not receive allocated intervention: withdrew consent. ATV/r, ritonavir-boosted atazanavir; BID, twice daily; QD, once daily; RAL, raltegravir; TDF, tenofovir-disoproxil fumarate. Table 3. Overall safety summary A summary of AI438011 safety data through Week 24 is shown in Table 3 BMS-663068 + TDF + RAL ATV/r + TDF + RAL Total number of subjects, n (%) 400 mg BID N=50 800 mg BID N=49 600 mg QD N=51 1200 mg QD N=50 300 mg/100 mg QD N=51 SAEs 4 (8.0%) 4 (8.2%) 3 (5.9%) 2 (4.0%) 5 (9.8%) Grade 2–4-related AEs 6 (12.0%) 3 (6.1%) 2 (3.9%) 6 (12.0%) 14 (27.5%) AEs leading to discontinuation 1 (2.0%) 2 (4.1%) 0 1 (2.0%) 2 (3.9%) AE, adverse event; SAE, serious AE; ATV/r, ritonavir-boosted atazanavir; BID, twice daily; QD, once daily; RAL, raltegravir; TDF, tenofovir-disoproxil fumarate. Grade 1–4 adverse events A summary of Grade 1–4 AEs is shown in Table 4 The most commonly reported AE across the BMS-663068 arms was headache (mostly Grade 1), which occurred in: 28/200 (14.0%) of subjects in the BMS-663068 arms versus 5/51 (9.8%) in the ATV/r arm Table 4. All Grade 1–4 adverse events occuring in ≥10% of subjects BMS-663068 + TDF + RAL ATV/r + TDF + RAL Parameter, n (%) 400 mg BID N=50 800 mg BID N=49 600 mg QD N=51 1200 mg QD N=50 300 mg/100 mg QD N=51 Total subjects with an event 44 (88.0%) 40 (81.6%) 41 (80.4%) 42 (84.0%) 48 (94.1%) Infections and infestations 32 (64.0%) 28 (57.1%) 28 (54.9%) 26 (52.0%) 31 (60.8%) Urinary tract infection 4 (8.0%) 8 (16.3%) 4 (7.8%) 5 (10.0%) 3 (5.9%) Nasopharyngitis 6 (12.0%) 3 (6.1%) 6 (11.8%) 3 (6.0%) 4 (7.8%) Bronchitis 4 (8.0%) 1 (2.0%) 4 (7.8%) 5 (10.0%) 1 (2.0%) Herpes zoster 2 (4.0%) 5 (10.2%) 1 (2.0%) 0 0 Gastrointestinal disorders 16 (32.0%) 16 (32.7%) 15 (29.4%) 20 (40.0%) 19 (37.3%) Diarrhea 7 (14.0%) 4 (8.2%) 6 (11.8%) 4 (8.0%) 8 (15.7%) Nausea 3 (6.0%) 3 (6.1%) 3 (5.9%) 5 (10.0%) 6 (11.8%) Nervous system disorders 16 (32.0%) 9 (18.4%) 11 (21.6%) 11 (22.0%) 13 (25.5%) Headache 11 (22.0%) 4 (8.2%) 7 (13.7%) 6 (12.0%) 5 (9.8%) General disorders and administration site conditions 6 (12.0%) 3 (6.1%) 4 (7.8%) 8 (16.0%) 7 (13.7%) Fatigue 2 (4.0%) 1 (2.0%) 1 (2.0%) 5 (10.0%) 3 (5.9%) ATV/r, ritonavir-boosted atazanavir; BID, twice daily; QD, once daily; RAL, raltegravir; TDF, tenofovir-disoproxil fumarate. Serious adverse events SAEs were reported in 13/200 (6.5%) subjects across the BMS-663068 treatment arms and 5/51 (9.8%) in the ATV/r arm (Table 5) Most were secondary infections and none were related to BMS-663068 or ATV/r Through Week 24, no deaths occurred Table 5. Serious adverse events* BMS-663068 + TDF + RAL ATV/r + TDF + RAL Parameter, n (%) 400 mg BID N=50 800 mg BID N=49 600 mg QD N=51 1200 mg QD N=50 300 mg/100 mg QD N=51 Total subjects with an event 4 (8.0%) 4 (8.2%) 3 (5.9%) 2 (4.0%) 5 (9.8%) Infections and infestations 2 (4.0%) 2 (4.1%) 2 (3.9%) 1 (2.0%) 3 (5.9%) Injury, poisoning and procedural complications 1 (2.0%) 0 1 (2.0%) 1 (2.0%) 0 Musculoskeletal and connective tissue disorders 0 1 (2.0%) 0 1 (2.0%) 0 Gastrointestinal disorders 0 0 0 0 1 (2.0%) Hepatobiliary disorders 0 0 0 0 1 (2.0%) Nervous system disorders 0 0 0 0 1 (2.0%) Pregnancy, puerperium and perinatal conditions 0 1 (2.0%) 0 0 0 Renal and urinary disorders 0 1 (2.0%) 0 0 0 Respiratory, thoracic and mediastinal disorders 1 (2.0%) 0 0 0 0 * A single patient may have had more than one event. ATV/r, ritonavir-boosted atazanavir; BID, twice daily; QD, once daily; RAL, raltegravir; TDF, tenofovir-disoproxil fumarate. Grade 2–4 related adverse events Across the BMS-663068 arms, 17/200 (8.5%) subjects had Grade 2–4-related AEs; however most were single instances with no relationship to dose (Table 6) In the ATV/r arm, 14/51 (27.5%) subjects had Grade 2–4-related AEs, which were mostly gastrointestinal and hepatobiliary disorders associated with hyperbilirubinemia (Table 6) Table 6. Select Grade 2–4-related adverse events* BMS-663068 + TDF + RAL ATV/r + TDF + RAL Parameter, n (%) 400 mg BID N=50 800 mg BID N=49 600 mg QD N=51 1200 mg QD N=50 300 mg/100 mg QD N=51 Total subjects with Grade 2–4-related AEs 6 (12.0%) 3 (6.1%) 2 (3.9%) 6 (12.0%) 14 (27.5%) Gastrointestinal disorders 0 1 (2.0%) 0 2 (4.0%) 5 (9.8%) Hepatobiliary disorders 0 0 0 0 7 (13.7%) Hyperbilirubinemia 0 0 0 0 4 (7.8%) Jaundice 0 0 0 0 2 (3.9%) DILI 0 0 0 0 1 (2.0%) Nervous system disorders 0 1 (2.0%) 0 1 (2.0%) 2 (3.9%) Headache 0 1 (2.0%) 0 0 2 (3.9%) Renal and urinary disorders 0 1 (2.0%) 1 (2.0%) 0 0 Hematuria 0 0 1 (2.0%) 0 0 Proteinuria 0 0 1 (2.0%) 0 0 Acute renal failure 0 1 (2.0%) 0 0 0 Injury and poisoning 1 (2.0%) 0 0 0 0 Overdose 1 (2.0%) 0 0 0 0 Skin and subcutaneous disorders 0 1 (2.0%) 0 0 0 Hyperhidrosis 0 1 (2.0%) 0 0 0 * Select events presented. A single patient may have had more than one event. TDF induced acute renal failure. AE, adverse event; ATV/r, ritonavir-boosted atazanavir; BID, twice daily; DILI, drug-induced liver injury; QD, once daily; RAL, raltegravir; TDF, tenofovir-disoproxil fumarate. Adverse events leading to discontinuation A summary of AEs leading to discontinuation is shown in Table 7 No BMS-663068-related SAEs or AEs leading to discontinuation Table 7. Adverse events leading to discontinuation* BMS-663068 + TDF + RAL ATV/r + TDF + RAL Parameter, n (%) 400 mg BID N=50 800 mg BID N=49 600 mg QD N=51 1200 mg QD N=50 300 mg/100 mg QD N=51 Total subjects: AE leading to discontinuation 1 (2.0%) 2 (4.1%) 0 1 (2.0%) 2 (3.9%) Gastrointestinal disorders 0 0 0 0 2 (3.9%) Abdominal distention 0 0 0 0 1 (2.0%) Flatulence 0 0 0 0 1 (2.0%) Nausea 0 0 0 0 1 (2.0%) Infections 0 1 (2.0%) 0 1 (2.0%) 0 Bone tuberculosis 0 1 (2.0%) 0 0 0 Disseminated tuberculosis 0 0 0 1 (2.0%) 0 Hepatobiliary 0 0 0 0 1 (2.0%) Jaundice 0 0 0 0 1 (2.0%) Musculoskeletal 0 0 0 1 (2.0%) 0 Back pain 0 0 0 1 (2.0%) 0 Renal 0 1 (2.0%) 0 0 0 Acute renal failure 0 1 (2.0%) 0 0 0 Vascular 1 (2.0%) 0 0 0 0 Ischemia (likely related to cocaine use) 1 (2.0%) 0 0 0 0 * A single patient may have had more than one event. AE, adverse event; ATV/r, ritonavir-boosted atazanavir; BID, twice daily; QD, once daily; RAL, raltegravir; TDF, tenofovir-disoproxil fumarate. Grade 3–4 laboratory abnormalities Across the BMS-663068 arms, no noticeable trend for Grade 3–4 lab abnormalities was observed (Table 8) Grade 3–4 hematologic changes (neutropenia, 5/196 [2.6%]) were uncommon Liver chemistry elevations (AST/ALT elevations, 2/196 [1.0%]) were uncommon In the ATV/r arm 25/51 (49.0%) of subjects had elevations in total bilirubin, consistent with the known profile of ATV 10 Table 8. Select Grade 3–4 laboratory abnormalities BMS-663068 + TDF + RAL ATV/r + TDF + RAL Parameter, n (%) 400 mg BID N=50 800 mg BID N=49 600 mg QD N=51 1200 mg QD N=50 300 mg/100 mg QD N=51 Hematology Hemoglobin/hematocrit 0 0 0 0 0 Platelet 0 0 0 0 0 Neutrophils 1 (2.0%) 1 (2.0%) 2 (3.9%) 1 (2.0%) 0 Liver and kidney function Alkaline phosphatase 0 0 0 1 (2.0%) 0 Alanine aminotransferase 0 0 0 2 (4.0%) 1 (2.0%) Aspartate aminotransferase 0 1 (2.0%) 0 1 (2.0%) 0 Bilirubin 0 0 0 0 25 (50.0%) Estimated creatinine clearance 0 0 0 0 0 Other chemistry testing Creatinine kinase 0 1 (2.0%) 1 (2.0%) 1 (2.0%) 0 ATV/r, ritonavir-boosted atazanavir; BID, twice daily; QD, once daily; RAL, raltegravir; TDF, tenofovir-disoproxil fumarate. Changes from baseline in fasting lipids No clinically significant changes in total cholesterol, low-density lipoprotein and triglycerides from baseline observed across the BMS-663068 arms (Figure 5) No dose relationship observed 400 mg BID 800 mg BID 600 mg QD 1200 mg QD 300 mg/100 mg QD BMS-663068 + TDF + RAL ATV/r + TDF + RAL -60 -50 -40 -30 -20 -10 0 10 20 Mean (SE) change in fasting lipids from baseline, mg/dL Total cholesterol LDL Triglycerides Figure 5. Mean change in total cholesterol, low-density lipoprotein and triglycerides from baseline through Week 24 ATV/r, ritonavir-boosted atazanavir; BID, twice daily; LDL, low-density lipoprotein; QD, once daily; RAL, raltegravir; SE, standard error; TDF, tenofovir-disoproxil fumarate. IDWeek 2014 8–12 October 2014, Philadelphia, PA, USA

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Page 1: Safety Profile of HIV-1 Attachment Inhibitor Prodrug BMS ... · Safety Profile of HIV-1 Attachment Inhibitor Prodrug BMS-663068 in Antiretroviral-Experienced Subjects: Week 24 Analysis

Safety Profile of HIV-1 Attachment Inhibitor Prodrug BMS-663068 in Antiretroviral-Experienced Subjects: Week 24 Analysis

J Lalezari1, GH Latiff2, C Brinson3, J Echevarría4, S Treviño-Pérez5, JR Bogner6, D Stock7, SR Joshi7, GJ Hanna8, M Lataillade7, for the AI438011 study team1Quest Clinical Research, San Francisco, CA, USA; 2Maxwell Clinic, Durban, South Africa; 3Central Texas Clinical Research, Austin, TX, USA; 4Hospital Nacional Cayetano Heredia, Lima, Peru; 5Mexico Centre for Clinical Research, Mexico City, Mexico;

6Hospital of the University of Munich, Munich, Germany; 7Bristol-Myers Squibb, Wallingford, CT, USA; 8Bristol-Myers Squibb, Princeton, NJ, USA

Max Lataillade, DO MPH Bristol-Myers Squibb

Research and Development Wallingford

CT 06492 USA

Email: [email protected] Phone: 203-677-7991

Poster 1574

BACKGROUND ■ Despite the success of combination antiretroviral therapy, some HIV-positive patients may have

limited treatment options owing to: — presence of viral mutants causing reduced antiretroviral (ARV) drug susceptibility — emergence of drug toxicities from long-term ARV therapy — contraindications from the need to manage associated co-infections and morbidities1,2

■ Consequently, there is a continued need to develop novel ARVs that have: — unique resistance profiles — well-tolerated safety profiles — limited or manageable drug–drug interactions

■ BMS-663068 is a prodrug metabolized to the active moiety BMS-626529 (Figure 1), a first-in-class attachment inhibitor that binds to HIV-1 gp120, preventing initial viral attachment and entry into the host CD4+ T cell (Figure 2)3,4

■ BMS-626529 has in vitro activity against HIV-1 viruses, with the exception of subtype AE and Group O5

■ By binding directly to the virus, BMS-626529 is not affected by co-receptor tropism and is therefore active against CCR5-, CXCR4- and dual-tropic (R5X4) strains of HIV-14,6-8

■ BMS-626529 has a unique resistance profile with no in vitro cross-resistance to other classes of antiretrovirals6

■ AI438011 is an ongoing Phase IIb study investigating the efficacy, safety and dose response of BMS-663068 versus atazanavir/ritonavir (ATV/r) in HIV-1-infected, treatment-experienced subjects

■ Through Week 24, BMS-663068 + tenofovir-disoproxil fumarate (TDF) + raltegravir (RAL) demonstrated comparable efficacy to ATV/r + TDF + RAL (modified intent-to-treat SnapShot, Table 1)

Gastrointestinallumen

BMS-663068(prodrug)

BMS-626529(active moiety)

BMS-626529Blood plasma

Alkalinephosphatase

Figure 1. Conversion of BMS-663068 to BMS- 626529

Figure 2. BMS-626529 attachment inhibitor: Proposed mechanism of action

Table 1. AI438011 efficacy summary: Week 24 SnapShot: modified intent-to-treat (Presented at CROI 20149)

BMS-663068 + TDF + RAL ATV/r + TDF + RAL

400 mg BIDN=50

800 mg BID N=49

600 mg QD N=51

1200 mg QD N=50

300 mg/100 mg QD N=51

HIV-1 RNA <50 c/mL, % 40 (80.0%) 34 (69.4%) 39 (76.5%) 36 (72.0%) 38 (74.5%)

HIV-1 RNA ≥50 c/mL, % 8 (16.0%) 10 (20.4%) 11 (21.6%) 13 (26.0%) 9 (17.6%)

No virologic data at Week 24

Discontinued due to adverse event or death, n (%) 1 (2.0%) 2 (4.1%) 0 1 (2.0%) 2 (3.9%)

Discontinued for other reasons, n (%) 1 (2.0%) 3 (6.1%) 1 (2.0%) 0 2 (3.9%)

Missing data during window but on-study, n (%) 0 0 0 0 0

ATV/r, ritonavir-boosted atazanavir; BID, twice daily; QD, once daily; RAL, raltegravir; TDF, tenofovir-disoproxil fumarate.Modified intent-to-treat population: all subjects receiving ≥1 dose of study drug.

OBJECTIVES ■ To assess the safety and tolerability through Week 24 of BMS-663068, when combined with RAL

and TDF, in HIV-1-infected subjects by measuring frequency of: — adverse events (AEs) — serious AEs (SAEs) and — AEs leading to discontinuation

ACKNOWLEDGMENTS ■ We would like to thank all of the AI438011 clinical trial participants and their families ■ AI438011 Investigators: JD Altclas, PE Cahn, SH Lupo, MD Martins, AI Arango-Duque, OA Sussmann-Pena, G Amaya-Tapia,

JF Andrade-Villanueva, ER Granados-Reyes, JG Sierra-Madero, SC Trevino-Perez, WM Casapia-Morales, JI Echevarria, JR Lama-Valdivia, MY Leon-Paredes, FC Mendo-Urbina, Y Pinedo-Ramirez, MR Salazar-Castro, R Bardinas-Rodriguez, C Brinson, E Dejesus, R Elion, J Ernst, J Feinberg, S Hassler, C Hicks, J Lalezari, AR Scribner, L Sloan, M Thompson, K Arastéh, J Bogner, J Rockstroh, A Stoehr, IG Diaconescu, LJ Prisacariu, S Rugina, OA Tsybakova, EE Voronin, AA Yakovlev, NG Zakharova, J Fourie, D Johnson, R Kaplan, G Latiff, B Clotet

■ Bristol-Myers Squibb: A Rightmire, M DeGrosky, J Coumbis, N Ray, N Cusack, M Krystal, C Hwang and T Correll ■ Other: P Lill and J Riefler (ICON CRO) ■ Professional medical writing and editorial assistance was provided by MediTech Media and was funded by Bristol-Myers Squibb

REFERENCES1. Wainberg M et al. JAMA 1998; 279:1977–1983.2. Wittcop L et al. Lancet Infect Dis 2011; 11:363–371.3. Brown J et al. J Pharm Sci 2013: 102:1742–15124. Langley DL et al. Manuscript in development5. Varghese V et al. J Acquir Immune Defic Syndr 2009;

52:309–315.

6. Li Z et al. AAC 2013; 57:4172–4180.7. Nowicka-Sans B et al. AAC 2012; 56:3498–3507.8. Ray N et al. JAIDS 2013; 64:7–15.9. Lalezari J et al. CROI 2014: Oral Abstract 86.10. Bristol-Myers Squibb. Reyataz prescribing information. 2013.

Available at: http://packageinserts.bms.com/pi/pi_reyataz.pdf. Accessed April 2014.

CONCLUSIONS ■ BMS-663068 was generally well tolerated across all arms:

— no related SAEs or AEs leading to discontinuation — no dose-related safety signals

■ Across the BMS-663068 arms, there were no trends for Grade 2–4 AEs or Grade 3–4 clinical laboratory abnormalities

■ These results support continued development of BMS-663068 ■ An analysis of BMS-663068 efficacy by subgroup through Week 24 will be presented on

Thursday, October 9th at 3pm by Brinson et al (Oral 540)

METHODSAI438011 study design

■ Phase IIb, randomized, active-controlled, blinded-to-BMS-663068 dose trial (NCT01384734) ■ Consisted of a 7-day elective monotherapy substudy and the main study (Figure 3) ■ For the main study, subjects were randomized 1:1:1:1:1 into five treatment arms: four treatment

groups of BMS-663068 (400 mg twice daily [BID], 800 mg BID, 600 mg once daily [QD], or 1200 mg QD), and a reference group (ATV/r 300/100 mg QD), each with a backbone of RAL 400 mg BID + TDF 300 mg QD (Figure 3)

Primary endpointWeek 24

BMS-

Day 1

Week 8 Data monitoring committee assessment

BMS-663068 400 mg BID

+ RAL + TDFN=50

BMS-663068800 mg BID

+ RAL + TDFN=50

BMS-663068600 mg QD

+ RAL + TDFN=50

Primary study - start of combination therapy

BMS-663068 monotherapy substudy: 10 patients per study arm

Long-term follow-up through Week 48/96Week 48/96

BMS-6630681200 mg QD+ RAL + TDF

N=50

ATV/r300/100 mg QD

+ RAL + TDFN=50

Part

ial b

lind*

Figure 3. AI438011 study design

* Blinded to BMS-663068 dose. ATV/r, ritonavir-boosted atazanavir; BID, twice daily; QD, once daily; RAL, raltegravir; TDF, tenofovir-disoproxil fumarate.

Eligibility criteria ■ Main inclusion criteria:

— antiretroviral treatment-experienced (defined as current or previous exposure to ≥1 antiretroviral for ≥1 week)

— plasma HIV-1 RNA ≥1000 c/mL — CD4+ T-cell count >50 cells/mm3

— susceptibility to RAL, TDF and ATV — BMS-626529 IC50 <100 nM as determined by screening Phenosense® entry assay (Monogram Biosciences - LabCorp)

— no other significant abnormalities on medical history, physical examination, 12-lead electrocardiograms (ECGs), and clinical laboratory evaluations

— aged 18–49 years — body mass index 18–32 kg/m2

■ Main exclusion criteria: — pregnancy or breast feeding — any significant acute or chronic medical illness — liver enzymes (aspartate aminotransferase [ALT]/alanine aminotransferase [AST]) >5 times the upper limit of normal

— positive blood screen for hepatitis B surface antigen or hepatitis C antibodies/RNA

Assessments ■ Safety assessments included:

— vital signs and physical examinations — recording of AEs (SAEs, AEs and Centers for Disease Control Class C AIDS events) — measurements of changes in fasting lipids — laboratory abnormalities and ECG measurements

■ Assessments were performed at Weeks 4, 8, 12, 16, 20, 24 ■ AEs were coded according to MedDRA version 15.1 and the severity and relationship to study

drug was assessed by the corresponding investigator

RESULTSBaseline characteristics

■ Baseline demographic and disease characteristics were broadly similar across all treatment groups (Table 2)

— Median age range was 37–40 years; 60.0% male — 66.0% of subjects had HIV-1 subtype B — Median baseline HIV-1 RNA: 4.85 log10 copies/mL — Median baseline CD4+ T-cell count: 229.5 cells/µL — ~ 50.0% of subjects had at least one major protease inhibitor (PI), nucleoside reverse transcriptase inhibitor or non-nucleoside reverse transcriptase inhibitor resistance-associated mutation at baseline (M184V/I, 31.0%; K103N, 29.0%; thymidine analogue mutations, 13.0%; major PI mutations, 2.0%)

Table 2. Baseline characteristics

BMS-663068 + TDF + RAL ATV/r + TDF + RAL

400 mg BIDN=50

800 mg BIDN=49

600 mg QDN=51

1200 mg QDN=50

300 mg/100 mg QD N=51

Median age, years (range) 39 (22–57) 37(23–60) 40(26–58) 40 (20–67) 39 (20–68)

Male, % 62.0% 57.1% 56.9% 68.0% 56.9%

Race, %

White 40.0% 38.8% 33.3% 32.0% 45.1%

Black/African-American 28.0% 30.6% 31.4% 36.0% 25.5%

Other 32.0% 30.6% 35.3% 32.0% 29.4%

HIV subtype, n (%)

B 70.0% 59.2% 68.6% 64.0% 66.7%

C 16.0% 24.5% 21.6% 20.0% 17.6%

Other* 14.0% 16.2% 9.9% 16.0% 15.6%

HIV-1 RNA

Median, log10 c/mL 4.97 5.01 4.88 4.78 4.78

≥100,000 c/mL, % 46.0% 51.0% 45.1% 36.0% 35.3%

CD4+ T-cell count

Median, cells/μL 214 237 226 224 249

<200 cells/μL, % 38.0% 32.6% 41.2% 42.0% 37.3%* Majority of subjects within the “other” category reported themselves as multiracial. ATV/r, ritonavir-boosted atazanavir; BID, twice daily; QD, once daily; RAL, raltegravir; TDF, tenofovir-disoproxil fumarate.

Subject disposition ■ 581 subjects enrolled, 254 randomized and 251 treated (Figure 4) ■ Screen failures were primarily due to failure to meet study criteria; most common reasons (not

mutually exclusive) were: — a screening plasma HIV-1 RNA of <1000 copies/mL — failure of the resistance assay(s) to provide a genotypic and/or phenotypic result for ≥1 of the study drugs

■ Of those receiving treatment, 32/200 (16.0%) across the BMS-663068 arms and 9/51 (17.6%) in the ATV/r arm failed to complete 24 weeks’ treatment (Figure 4)

BMS-663068 (400 mg BID) + TDF + RAL

Participated, n=7 Participated, n=5 Participated, n=10 Participated, n=10

BMS-663068(800 mg BID) + TDF + RAL

BMS-

BMS-663068(600 mg QD) + TDF + RAL

BMS-663068(1200 mg QD) + TDF + RAL

Randomized (n=254)

Assessed for eligibility (N=581)

Randomized, n=52Treated, n=50*

Randomized, n=50Treated, n=49†

Randomized, n=51Treated, n=51

Randomized, n=50Treated, n=50

Randomized, n=51Treated, n=51

Ongoing at time of analysis (n=44 )

Ongoing at time of analysis (n=38)

Ongoing at time of analysis (n=44)

Ongoing at time of analysis (n=42)

Ongoing at time of analysis (n=42)

Discontinued (n=6) 1 adverse event 1 withdrew consent 2 lost to follow-up 1 poor/ non-compliance 1 other

Discontinued (n= 11) 2 adverse events 2 withdrew consent 2 pregnancies 1 no longer met study criteria 3 lack of efficacy 1 poor/ non-compliance

Discontinued (n=7) 1 pregnancy 2 lost to follow-up 1 no longer met study criteria 2 poor/ non-compliance 1 other

Discontinued (n=8) 1 adverse event 1 withdrew consent 3 lost to follow-up 1 request to discontinue 1 no longer met study criteria 1 lack of efficacy

Excluded (n=327) Did not meet inclusion criteria (n=303) Declined to participate (n=9) Lost to follow-up (n=3) Other reasons (n=11) Not reported (n=1)

Discontinued (n=9) 2 adverse events 3 withdrew consent 2 pregnancies 1 administration- related 1 poor/ non-compliance

ATV/r(300/100 mg QD)

+ TDF + RAL

Monotherapysubstudy

Assigned to receive

Primarystudy

Figure 4. Subject disposition

* Two subjects did not receive allocated intervention: one withdrew consent, one randomized in error; † One subject did not receive allocated intervention: withdrew consent. ATV/r, ritonavir-boosted atazanavir; BID, twice daily; QD, once daily; RAL, raltegravir; TDF, tenofovir-disoproxil fumarate.

Table 3. Overall safety summary ■ A summary of AI438011 safety data through Week 24 is shown in Table 3

BMS-663068 + TDF + RAL ATV/r + TDF + RAL

Total number of subjects, n (%)

400 mg BIDN=50

800 mg BIDN=49

600 mg QDN=51

1200 mg QDN=50

300 mg/100 mg QD N=51

SAEs 4 (8.0%) 4 (8.2%) 3 (5.9%) 2 (4.0%) 5 (9.8%)

Grade 2–4-related AEs 6 (12.0%) 3 (6.1%) 2 (3.9%) 6 (12.0%) 14 (27.5%)

AEs leading to discontinuation 1 (2.0%) 2 (4.1%) 0 1 (2.0%) 2 (3.9%) AE, adverse event; SAE, serious AE; ATV/r, ritonavir-boosted atazanavir; BID, twice daily; QD, once daily; RAL, raltegravir; TDF, tenofovir-disoproxil fumarate.

Grade 1–4 adverse events ■ A summary of Grade 1–4 AEs is shown in Table 4

■ The most commonly reported AE across the BMS-663068 arms was headache (mostly Grade 1),

which occurred in:

— 28/200 (14.0%) of subjects in the BMS-663068 arms versus 5/51 (9.8%) in the ATV/r arm

Table 4. All Grade 1–4 adverse events occuring in ≥10% of subjects

BMS-663068 + TDF + RAL ATV/r + TDF + RAL

Parameter, n (%) 400 mg BIDN=50

800 mg BIDN=49

600 mg QDN=51

1200 mg QDN=50

300 mg/100 mg QD N=51

Total subjects with an event 44 (88.0%) 40 (81.6%) 41 (80.4%) 42 (84.0%) 48 (94.1%)

Infections and infestations 32 (64.0%) 28 (57.1%) 28 (54.9%) 26 (52.0%) 31 (60.8%)

Urinary tract infection 4 (8.0%) 8 (16.3%) 4 (7.8%) 5 (10.0%) 3 (5.9%)

Nasopharyngitis 6 (12.0%) 3 (6.1%) 6 (11.8%) 3 (6.0%) 4 (7.8%)

Bronchitis 4 (8.0%) 1 (2.0%) 4 (7.8%) 5 (10.0%) 1 (2.0%)

Herpes zoster 2 (4.0%) 5 (10.2%) 1 (2.0%) 0 0

Gastrointestinal disorders 16 (32.0%) 16 (32.7%) 15 (29.4%) 20 (40.0%) 19 (37.3%)

Diarrhea 7 (14.0%) 4 (8.2%) 6 (11.8%) 4 (8.0%) 8 (15.7%)

Nausea 3 (6.0%) 3 (6.1%) 3 (5.9%) 5 (10.0%) 6 (11.8%)

Nervous system disorders 16 (32.0%) 9 (18.4%) 11 (21.6%) 11 (22.0%) 13 (25.5%)

Headache 11 (22.0%) 4 (8.2%) 7 (13.7%) 6 (12.0%) 5 (9.8%)

General disorders and administration site conditions

6 (12.0%) 3 (6.1%) 4 (7.8%) 8 (16.0%) 7 (13.7%)

Fatigue 2 (4.0%) 1 (2.0%) 1 (2.0%) 5 (10.0%) 3 (5.9%)

ATV/r, ritonavir-boosted atazanavir; BID, twice daily; QD, once daily; RAL, raltegravir; TDF, tenofovir-disoproxil fumarate.

Serious adverse events

■ SAEs were reported in 13/200 (6.5%) subjects across the BMS-663068 treatment arms and 5/51 (9.8%) in the ATV/r arm (Table 5)

■ Most were secondary infections and none were related to BMS-663068 or ATV/r

■ Through Week 24, no deaths occurred

Table 5. Serious adverse events*

BMS-663068 + TDF + RAL ATV/r + TDF + RAL

Parameter, n (%) 400 mg BIDN=50

800 mg BIDN=49

600 mg QDN=51

1200 mg QDN=50

300 mg/100 mg QD N=51

Total subjects with an event 4 (8.0%) 4 (8.2%) 3 (5.9%) 2 (4.0%) 5 (9.8%)

Infections and infestations 2 (4.0%) 2 (4.1%) 2 (3.9%) 1 (2.0%) 3 (5.9%)

Injury, poisoning and procedural complications 1 (2.0%) 0 1 (2.0%) 1 (2.0%) 0

Musculoskeletal and connective tissue disorders 0 1 (2.0%) 0 1 (2.0%) 0

Gastrointestinal disorders 0 0 0 0 1 (2.0%)

Hepatobiliary disorders 0 0 0 0 1 (2.0%)

Nervous system disorders 0 0 0 0 1 (2.0%)

Pregnancy, puerperium and perinatal conditions 0 1 (2.0%) 0 0 0

Renal and urinary disorders 0 1 (2.0%) 0 0 0

Respiratory, thoracic and mediastinal disorders 1 (2.0%) 0 0 0 0

* A single patient may have had more than one event.ATV/r, ritonavir-boosted atazanavir; BID, twice daily; QD, once daily; RAL, raltegravir; TDF, tenofovir-disoproxil fumarate.

Grade 2–4 related adverse events

■ Across the BMS-663068 arms, 17/200 (8.5%) subjects had Grade 2–4-related AEs; however most were single instances with no relationship to dose (Table 6)

■ In the ATV/r arm, 14/51 (27.5%) subjects had Grade 2–4-related AEs, which were mostly gastrointestinal and hepatobiliary disorders associated with hyperbilirubinemia (Table 6)

Table 6. Select Grade 2–4-related adverse events*

BMS-663068 + TDF + RAL ATV/r + TDF + RAL

Parameter, n (%) 400 mg BIDN=50

800 mg BIDN=49

600 mg QDN=51

1200 mg QDN=50

300 mg/100 mg QD N=51

Total subjects with Grade 2–4-related AEs 6 (12.0%) 3 (6.1%) 2 (3.9%) 6 (12.0%) 14 (27.5%)

Gastrointestinal disorders 0 1 (2.0%) 0 2 (4.0%) 5 (9.8%)

Hepatobiliary disorders 0 0 0 0 7 (13.7%)

Hyperbilirubinemia 0 0 0 0 4 (7.8%)

Jaundice 0 0 0 0 2 (3.9%)

DILI 0 0 0 0 1 (2.0%)

Nervous system disorders 0 1 (2.0%) 0 1 (2.0%) 2 (3.9%)

Headache 0 1 (2.0%) 0 0 2 (3.9%)

Renal and urinary disorders 0 1 (2.0%) 1 (2.0%) 0 0

Hematuria 0 0 1 (2.0%) 0 0

Proteinuria 0 0 1 (2.0%) 0 0

Acute renal failure 0 1 (2.0%)† 0 0 0

Injury and poisoning 1 (2.0%) 0 0 0 0

Overdose 1 (2.0%) 0 0 0 0

Skin and subcutaneous disorders 0 1 (2.0%) 0 0 0

Hyperhidrosis 0 1 (2.0%) 0 0 0* Select events presented. A single patient may have had more than one event. † TDF induced acute renal failure.AE, adverse event; ATV/r, ritonavir-boosted atazanavir; BID, twice daily; DILI, drug-induced liver injury; QD, once daily; RAL, raltegravir; TDF, tenofovir-disoproxil fumarate.

Adverse events leading to discontinuation ■ A summary of AEs leading to discontinuation is shown in Table 7

— No BMS-663068-related SAEs or AEs leading to discontinuation

Table 7. Adverse events leading to discontinuation*

BMS-663068 + TDF + RAL ATV/r + TDF + RAL

Parameter, n (%) 400 mg BIDN=50

800 mg BIDN=49

600 mg QDN=51

1200 mg QDN=50

300 mg/100 mg QD N=51

Total subjects: AE leading to discontinuation 1 (2.0%) 2 (4.1%) 0 1 (2.0%) 2 (3.9%)

Gastrointestinal disorders 0 0 0 0 2 (3.9%)

Abdominal distention 0 0 0 0 1 (2.0%)

Flatulence 0 0 0 0 1 (2.0%)

Nausea 0 0 0 0 1 (2.0%)

Infections 0 1 (2.0%) 0 1 (2.0%) 0

Bone tuberculosis 0 1 (2.0%) 0 0 0

Disseminated tuberculosis 0 0 0 1 (2.0%) 0

Hepatobiliary 0 0 0 0 1 (2.0%)

Jaundice 0 0 0 0 1 (2.0%)

Musculoskeletal 0 0 0 1 (2.0%) 0

Back pain 0 0 0 1 (2.0%) 0

Renal 0 1 (2.0%) 0 0 0

Acute renal failure 0 1 (2.0%) 0 0 0

Vascular 1 (2.0%) 0 0 0 0

Ischemia (likely related to cocaine use) 1 (2.0%) 0 0 0 0

* A single patient may have had more than one event.AE, adverse event; ATV/r, ritonavir-boosted atazanavir; BID, twice daily; QD, once daily; RAL, raltegravir; TDF, tenofovir-disoproxil fumarate.

Grade 3–4 laboratory abnormalities ■ Across the BMS-663068 arms, no noticeable trend for Grade 3–4 lab abnormalities was observed

(Table 8) — Grade 3–4 hematologic changes (neutropenia, 5/196 [2.6%]) were uncommon — Liver chemistry elevations (AST/ALT elevations, 2/196 [1.0%]) were uncommon

■ In the ATV/r arm 25/51 (49.0%) of subjects had elevations in total bilirubin, consistent with the known profile of ATV10

Table 8. Select Grade 3–4 laboratory abnormalities

BMS-663068 + TDF + RAL ATV/r + TDF + RAL

Parameter, n (%) 400 mg BIDN=50

800 mg BIDN=49

600 mg QDN=51

1200 mg QDN=50

300 mg/100 mg QD N=51

HematologyHemoglobin/hematocrit 0 0 0 0 0Platelet 0 0 0 0 0Neutrophils 1 (2.0%) 1 (2.0%) 2 (3.9%) 1 (2.0%) 0

Liver and kidney functionAlkaline phosphatase 0 0 0 1 (2.0%) 0Alanine aminotransferase 0 0 0 2 (4.0%) 1 (2.0%)Aspartate aminotransferase 0 1 (2.0%) 0 1 (2.0%) 0

Bilirubin 0 0 0 0 25 (50.0%)Estimated creatinine clearance 0 0 0 0 0

Other chemistry testingCreatinine kinase 0 1 (2.0%) 1 (2.0%) 1 (2.0%) 0

ATV/r, ritonavir-boosted atazanavir; BID, twice daily; QD, once daily; RAL, raltegravir; TDF, tenofovir-disoproxil fumarate.

Changes from baseline in fasting lipids ■ No clinically significant changes in total cholesterol, low-density lipoprotein and triglycerides from

baseline observed across the BMS-663068 arms (Figure 5) — No dose relationship observed

400 mg BID

800 mg BID

600 mgQD

1200 mg QD

300 mg/100 mg QD

BMS-663068 + TDF + RAL ATV/r + TDF + RAL

-60

-50

-40

-30

-20

-10

0

10

20

Mea

n (S

E) c

hang

e in

fast

ing

lipid

s fr

om b

asel

ine,

mg/

dL Total cholesterolLDLTriglycerides

Figure 5. Mean change in total cholesterol, low-density lipoprotein and triglycerides from baseline through Week 24

ATV/r, ritonavir-boosted atazanavir; BID, twice daily; LDL, low-density lipoprotein; QD, once daily; RAL, raltegravir; SE, standard error; TDF, tenofovir-disoproxil fumarate.

IDWeek 20148–12 October 2014, Philadelphia, PA, USA