TMC114 expanded access programme announced: regulatory approval to be sought early next year

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Tibotec hopes to win accelerated approval for its experimental protease inhibitor TMC114 in the United States and Europe by the middle of 2006 if drug regulators move quickly to review early data on the drug, the company announced today. TMC114 would initially be licensed for treatment-experienced patients, in the same way as Boehringer-Ingelheim’s tipranavir (Aptivus).

Tibotec also plans to launch an expanded access programme in the autumn of 2005 to enable people running out of treatment options to obtain early access to the drug.

Individuals who have extensive experience of antiretrovirals and need TMC114 to construct a viable HAART regimen will be eligible for the expanded access programme. Individuals will also need to have a CD4 cell count below 100 cells/mm3 and a viral load above 10,000 copies/ml. The drug has yet to enter its phase III clinical trial and the expanded access scheme is dependent upon the approval of regulatory authorities and recruitment to the phase III trial.

Glossary

phase III

The third and most definitive stage in the clinical evaluation of a new drug or intervention, typically a randomised control trial with the new intervention compared to an existing therapy or a placebo, in large numbers of participants (typically hundreds or thousands). Trial results are used to evaluate the overall risks and benefits of the drug and provide the information needed for regulatory approval.

treatment-experienced

A person who has previously taken treatment for a condition. Treatment-experienced people may have taken several different regimens before and may have a strain of HIV that is resistant to multiple drug classes.

boosting agent

Booster drugs are used to ‘boost’ the effects of protease inhibitors and some other antiretrovirals. Adding a small dose of a booster drug to an antiretroviral makes the liver break down the primary drug more slowly, which means that it stays in the body for longer times or at higher levels. Without the boosting agent, the prescribed dose of the primary drug would be ineffective.

resistance testing

Laboratory testing to determine if an individual’s HIV strain is resistant to anti-HIV drugs. 

phase II

The second stage in the clinical evaluation of a new drug or intervention, in which preliminary data on effectiveness and additional information about safety is collected among a few hundred people with the disease or condition.

The company is pinning its hopes for early approval on phase II trial data, which showed that nearly half of protease-experienced patients who received TMC114 in addition to a background regimen optimised by resistance testing achieved a viral load below 50 copies/ml after 24 weeks, with an average viral load reduction of -1.85log10, probably the most impressive result yet seen when a second-generation boosted protease inhibitor is used in treatment-experienced patients.

Unusually, Tibotec has announced that it will submit these data to win accelerated approval in early 2006, before it has completed phase III trials in Europe and the United States. US approval could follow within less than six months, with European approval shortly behind.

The phase II studies, which were still incomplete when interim findings were presented at February’s Twelfth Conference on Retroviruses and Opportunistic Infections, compared three doses of TMC114 plus ritonavir with a control group in which patients received a boosted protease inhibitor selected by the study investigators after resistance testing. The study showed that the highest dose of TMC114 (600mg boosted by 100mg of ritonavir, twice daily) performed best, and this dose is now being studied in phase III studies in treatment-experienced and treatment-naïve patients.