Doravirine/Islatravir

▎药明康德内容团队编辑 只需每年一针，长效HIV预防疗法挺进3期临床 吉利德科学（Gilead Sciences）公司日前公布了两种每年一次的lenacapavir配方，作为暴露前预防（PrEP）疗法，在1期临床试验中的积极结果。数据支持每年一次lenacapavir用于PrEP的未来开发。该结果已发表于医学期刊《柳叶刀》。吉利德科学公司计划于2025年下半年启动3期临床试验。 1期临床试验数据显示，每年一次、肌肉注射的两种lenacapavir配方达到并维持了超出在3期临床试验PURPOSE 1和PURPOSE 2试验中观察到的与HIV预防疗效相关的血浆浓度。此前报道的PURPOSE 1和PURPOSE 2数据显示，每年两次皮下注射lenacapavir在降低HIV感染方面显示出优于背景HIV发病率和每日一次口服Truvada。 两种配方的受试者血浆中lenacapavir浓度在至少56周内均高于95%有效浓度。此外，两种每年一次lenacapavir配方在第52周的中位谷浓度（分别为57.0 ng/mL和65.6 ng/mL）均高于PURPOSE 1和PURPOSE 2试验中每年两次lenacapavir在第26周观察到的23.4 ng/mL。 Lenacapavir是一种“first-in-class”长效HIV病毒衣壳抑制剂，可以干扰HIV病毒衣壳蛋白的组装和拆卸，在病毒生命周期的多个阶段发挥作用。它已经获得美国FDA授予的突破性疗法认定，用于HIV病毒感染暴露前预防。2024年，《科学》期刊也将lenacapavir评为年度科学突破，表示这一“first-in-class”药物为艾滋病的长效治疗与预防带来了新的曙光。 维持HIV病毒抑制48周，默沙东双药疗法达两项3期临床主要终点 默沙东（MSD）公司今日宣布，在研每日一次口服双药方案doravirine/islatravir（DOR/ISL）在两项关键性3期试验中获得积极结果。在两项试验中，DOR/ISL与活性对照组相比达到非劣效性标准。基于这些积极结果，默沙东计划在2025年中期启动向监管机构提交上市申请。 在双盲试验MK-8591A-052中，主要终点（HIV-1 RNA≥50拷贝/毫升）结果显示，在接受克替拉韦/恩曲他滨/替诺福韦艾拉酚胺（BIC/FTC/TAF）治疗下已实现病毒抑制的成人患者中，第48周切换至DOR/ISL的受试者中有1.5%病毒载量达到或超过50拷贝/毫升，而BIC/FTC/TAF组为0.6%（治疗差异0.9%，95% CI：-1.9，2.9）。第48周切换至DOR/ISL的受试者中有91.5%维持了病毒抑制，而继续接受BIC/FTC/TAF治疗的受试者中这一比例为94.2%（治疗差异-2.6%，95% CI：-7.1，2.6）。 在开放标签试验MK-8591A-051中，在接受基线抗病毒治疗（bART）并获得病毒抑制的成人患者中，第48周切换接受DOR/ISL治疗的受试者中有1.4%病毒载量达到或超过50拷贝/毫升，而继续接受bART治疗的患者这一数值为4.9%（治疗差异-3.6%，95% CI：-7.8，-0.8）。第48周切换至DOR/ISL的受试者中有95.6%维持了病毒抑制，而继续接受bART的受试者中这一比例为91.9%（治疗差异3.7%，95% CI：-0.3，8.9）。 4个月一次，长效HIV抗体疗法组合3期临床结果积极 ViiV Healthcare今日宣布，其长效HIV抗体疗法N6LS，在2b期临床试验EMBRACE中取得积极结果。数据显示，每四个月一次给药的N6LS，与每月一次长效cabotegravir（CAB LA）联用，可成功使已稳定接受治疗的HIV成年患者保持病毒抑制，并且耐受性良好。 EMBRACE研究在六个月主要终点时的结果显示，静脉注射60 mg/kg的N6LS组中96%的受试者，以及皮下注射3000 mg的N6LS组中88%的受试者维持了HIV-1 RNA水平低于50拷贝/毫升，而标准治疗组为96%。 基于试验中观察到的积极结果，ViiV Healthcare将在EMBRACE的第二部分试验中，进一步评估六个月一次静脉注射N6LS与CAB LA联用的效果。 罗氏合作开发潜在“best-in-class”胰淀素类似物 Zealand Pharma今日宣布，与罗氏（Roche）达成全球合作及许可协议，共同开发Zealand Pharma的胰淀素类似物petrelintide，作为体重管理的基石性疗法，同时迅速扩展至相关适应症。新闻稿指出，petrelintide具有成为“best-in-class”疗法的潜力。 根据协议，双方将共同开发和商业化petrelintide及其组合产品，包括petrelintide与罗氏的潜在“best-in-class”胰高血糖素样肽-1（GLP-1）、葡萄糖依赖性促胰岛素多肽（GIP）受体双重激动剂CT-388构成的固定剂量组合产品。双方将在美国和欧洲共同商业化petrelintide及本次合作产生的其他产品，而罗氏获得全球其他地区的独家商业化权益。Zealand Pharma可在美国和欧洲参与最多50%的商业化活动。 Zealand Pharma将获得16.5亿美元的前期付款。Zealand Pharma还将有资格获得12亿美元的研发里程碑付款（主要与petrelintide单药治疗3期临床试验启动相关）及24亿美元的销售里程碑付款。 Petrelintide为一种长效胰淀素类似物，适合每周一次皮下注射。该药物在设计时注重化学和物理稳定性，在中性pH值下无纤维化现象，从而可与其他肽类药物实现联合配方及联合给药。 超9亿美元助力反义寡核苷酸疗法开发 Ono Pharmaceutical（ONO）宣布已与Ionis Pharmaceuticals签订许可协议，获得反义寡核苷酸（ASO）疗法sapablursen的开发及商业化权益。Sapablursen是一种用于治疗真性红细胞增多症（PV）的在研ASO药物，目前正在2期临床试验IMPRSSION中针对成人PV患者进行评估。Sapablursen已于2024年1月获得美国FDA授予的快速通道资格，并于2024年8月获得孤儿药资格。 根据协议，ONO将获得全球范围内开发和商业化sapablursen的独家许可。Ionis将继续负责完成正在进行的2期临床试验IMPRSSION，而ONO将全权负责后续开发、监管申报及商业化工作。ONO将支付2.8亿美元前期付款，并根据达到研发、监管及销售里程碑，支付高达6.6亿美元的额外里程碑付款。 Sapablursen的设计旨在降低TMPRSS6基因编码的跨膜蛋白酶丝氨酸6的产生，从而增加铁稳态关键调控因子铁调素（hepcidin）的表达。通过提高铁调素的产生，sapablursen有望对真性红细胞增多症等血液疾病产生积极影响。 ▲欲了解更多前沿技术在生物医药产业中的应用，请长按扫描上方二维码，即可访问“药明直播间”，观看相关话题的直播讨论与精彩回放 参考资料： [1] First Clinical Data for Gilead’s Investigational Once-Yearly Lenacapavir for HIV Prevention Presented at CROI 2025 and Published in The Lancet. Retrieved March 12, 2025, from https://www.gilead.com/news/news-details/2025/first-clinical-data-for-gileads-investigational-once-yearly-lenacapavir-for-hiv-prevention-presented-at-croi-2025-and-published-in-the-lancet [2] Merck Announces Positive Data from Phase 3 Trials that Show the Investigational, Once-Daily, Oral, Two-Drug Regimen of Doravirine/Islatravir (DOR/ISL) Maintained HIV-1 Viral Suppression at Week 48. Retrieved March 12, 2025, from https://www.merck.com/news/merck-announces-positive-data-from-phase-3-trials-that-show-the-investigational-once-daily-oral-two-drug-regimen-of-doravirine-islatravir-dor-isl-maintained-hiv-1-viral-suppression-at-week-48/ [3] ViiV HEALTHCARE’S INVESTIGATIONAL BROADLY NEUTRALISING ANTIBODY - N6LS - SUCCESSFULLY MAINTAINS VIRAL SUPPRESSION IN LONG-ACTING TREATMENT OF HIV. Retrieved March 12, 2025, from https://viivhealthcare.com/hiv-news-and-media/news/press-releases/2025/march/investigational-broadly-neutralising-antibody/ [4] Zealand Pharma and Roche enter collaboration and license agreement to co-develop and co-commercialize petrelintide as a future foundational therapy for people with overweight and obesity. Retrieved March 12, 2025, from https://www.globenewswire.com/news-release/2025/03/12/3041113/0/en/Zealand-Pharma-and-Roche-enter-collaboration-and-license-agreement-to-co-develop-and-co-commercialize-petrelintide-as-a-future-foundational-therapy-for-people-with-overweight-and-o.html [5] Ono Enters into License Agreement with Ionis Pharmaceuticals for Sapablursen for the Treatment of Polycythemia Vera. Retrieved March 12, 2025, from https://www.businesswire.com/news/home/20250311080840/en 免责声明：药明康德内容团队专注介绍全球生物医药健康研究进展。本文仅作信息交流之目的，文中观点不代表药明康德立场，亦不代表药明康德支持或反对文中观点。本文也不是治疗方案推荐。如需获得治疗方案指导，请前往正规医院就诊。 版权说明：本文来自药明康德内容团队，欢迎个人转发至朋友圈，谢绝媒体或机构未经授权以任何形式转载至其他平台。转载授权请在「药明康德」微信公众号回复“转载”，获取转载须知。 分享，点赞，在看，聚焦全球生物医药健康创新

Merck & Co. is pushing forward with a simplified oral HIV treatment – a once-daily, two drug regimen that combines Pifeltro (doravirine) with its experimental nucleoside reverse transcriptase translocation inhibitor islatravir – aiming to file for regulatory approval by mid-2025.The announcement Wednesday follows positive data from two Phase III trials demonstrating that the regimen is just as effective as standard HIV therapies in maintaining viral suppression in adults with HIV-1. Merck first shared topline results in December and unveiled more detail at the Conference on Retroviruses and Opportunistic Infections (CROI) on Wednesday.In one of studies, called MK-8591A-052, the Pifeltro/islatravir combo was tested against Gilead Sciences' HIV treatment Biktarvy (bictegravir/emtricitabine/tenofovir alafenamide) in 513 HIV patients who had virologic suppression for at least three months while on Biktarvy. At 48 weeks, 91.5% of patients who switched to Merck's regimen kept their viral load under control, compared to 94.2% of those on Biktarvy, meeting the bar for non-inferiority. Although the regimen did not achieve superiority over the Gilead's drug.The second trial, dubbed MK-8591A-051, compared Pifeltro/islatravir to patients' existing antiretroviral therapy (bART). Here, 95.6% of patients on Pifeltro/islatravir maintained viral suppression at 48 weeks, versus 91.9% seen in the bART group.If approved, Merck's treatment would be the first two-drug HIV regimen that doesn't include an integrase inhibitor to demonstrate comparable efficacy and safety to the three-drug InSTI-based Biktarvy regimen in a Phase III trial, according to Eliav Barr, chief medical officer at Merck Research Laboratories."These data and our work on the longer-acting islatravir-based therapies in our pipeline show our continued commitment to help find new options that address the evolving needs of people living with HIV," Barr added.The regimen's safety profile was generally comparable to the comparator antiretroviral regimens across both trials. At week 48, the mean percent change in total lymphocyte and CD4 counts were similar between Pifeltro/islatravir and comparator treatments, an issue that had stalled the programme a few years ago. There was also no treatment-emergent resistance to Pifeltro or islatravir in either trial.Beyond this daily oral combination, Merck is also advancing a once-weekly combination of islatravir with Gilead's capsid inhibitor lenacapavir, which showed positive Phase II results in October.