Discovery of the Human Immunodeficiency Virus Type 1 (HIV-1) Attachment Inhibitor Temsavir and Its Phosphonooxymethyl Prodrug Fostemsavir

J Med Chem. 2018 Jul 26;61(14):6308-6327. doi: 10.1021/acs.jmedchem.8b00759. Epub 2018 Jul 13.

Abstract

The optimization of the 4-methoxy-6-azaindole series of HIV-1 attachment inhibitors (AIs) that originated with 1 to deliver temsavir (3, BMS-626529) is described. The most beneficial increases in potency and pharmacokinetic (PK) properties were attained by incorporating N-linked, sp2-hybridized heteroaryl rings at the 7-position of the heterocyclic nucleus. Compounds that adhered to a coplanarity model afforded targeted antiviral potency, leading to the identification of 3 with characteristics that provided for targeted exposure and PK properties in three preclinical species. However, the physical properties of 3 limited plasma exposure at higher doses, both in preclinical studies and in clinical trials as the result of dissolution- and/or solubility-limited absorption, a deficiency addressed by the preparation of the phosphonooxymethyl prodrug 4 (BMS-663068, fostemsavir). An extended-release formulation of 4 is currently in phase III clinical trials where it has shown promise as part of a drug combination therapy in highly treatment-experienced HIV-1 infected patients.

MeSH terms

  • Animals
  • Anti-HIV Agents / metabolism
  • Anti-HIV Agents / pharmacology
  • Caco-2 Cells
  • Cell Membrane / metabolism
  • Drug Discovery*
  • HIV Envelope Protein gp120 / chemistry
  • HIV Envelope Protein gp120 / metabolism
  • HIV-1 / drug effects*
  • HIV-1 / physiology*
  • Humans
  • Molecular Docking Simulation
  • Organophosphates / metabolism*
  • Organophosphates / pharmacology
  • Permeability
  • Piperazines / metabolism*
  • Piperazines / pharmacology*
  • Prodrugs / metabolism*
  • Prodrugs / pharmacology
  • Protein Conformation
  • Rats
  • Triazoles / metabolism
  • Triazoles / pharmacology*
  • Virus Attachment / drug effects*

Substances

  • Anti-HIV Agents
  • BMS-626529
  • HIV Envelope Protein gp120
  • Organophosphates
  • Piperazines
  • Prodrugs
  • Triazoles
  • gp120 protein, Human immunodeficiency virus 1
  • fostemsavir