This large, multi-section article comprehensively reviews important developments and trends reported in 1995.
Introduction
This article summarizes and reviews some of the more significant and interesting antiviral therapeutics-related news and developments reported in 1995 issues (Volume 8) of the Antiviral Agents Bulletin. Various indexes (Organization, Agent, Virus/Disease and Keyword) of 1995 news articles are also included in this issue. Indexes of 1995 U.S. patents will be presented in an upcoming issue of the Bulletin.
In 1995, the Bulletin presented over 300 news articles and over 380 pages of news, patents, literature abstracts and other information concerning antiviral drug and vaccine development. HIV-infection remains the predominant target for antiviral therapeutics development activities, receiving the largest portion of both industry and government resources devoted to antiviral therapeutics-related research and development. Development of antiviral drugs and vaccines for other viral diseases, such as cytomegalovirus (CMV), hepatitis and herpes simplex viruses is picking up and new therapeutics for CMV and herpes were approved in 1995.
Although it is difficult to quantify decreases in private sector therapeutics research and development, a general decrease in anti-HIV drug and vaccine research and development is starting to become evident as large and small companies consolidate, disappear, leave or deemphasize this field. Companies still active in anti-HIV therapeutics R&D appear to be putting less resources into this area. However, to their credit, many of these and other companies are undertaking long-term projects involving gene therapy and novel technologies that may provide effective means for treatment and prevention of viral diseases. The federal government's AIDS therapeutics-related efforts are either being scaled back or are shifting emphasis to more fundamental research rather than drug and vaccine development and assisting industry. Yet, the opportunities and need for antiviral drugs and vaccines remain high. Even partially effective therapeutics are needed and will find substantial markets. To its credit, the FDA has made considerable progress in accelerating drug approvals, particularly drugs for AIDS-related and life-threatening diseases.
Despite new drug approvals, HIV-infection remains a terminal disease with a long-term course that is largely unaffected by available therapeutics. With our increasing knowledge about HIV and the pathogenesis of HIV-infection comes the realization that HIV is a formidable foe and very adaptable. The available anti-HIV drugs, including the newer HIV protease inhibitors, do not yet appear to offer much hope to fully halt HIV-infection progression or add many years to patient survival. The prospects for availability of prophylactic HIV vaccines are dim as progress and vaccine clinical trials move at a glacial pace, and there remains no concensus on methods for validating these vaccines. Many believe that the current candidates for large-scale HIV vaccine trials do not offer much likelihood of high levels of protective efficacy and large-scale trials continue to be delayed.
Saquinavir was the first HIV protease inhibitor to receive approval and other protease inhibitors with potentially higher efficacy are not far behind. 3TC in combination with AZT was approved as a first-line treatment for HIV-infection, and other nucleoside analogs and combinations were shown to have improved efficacy relative to AZT monotherapy. However, it remains to be proven whether HIV protease inhibitors in combination with nucleoside analogs or combinations of nucleosides can demonstrate significant clinical efficacy or whether significant problems with drug resistance will arise. With the approval of oral and implant formulations of ganciclovir for treatment of cytogmegalovirus retinitis, more choices became available for AIDS patients facing blindness. Other approvals included the first hepatitis A virus vaccine; a varicella-zoster virus (chickenpox) vaccine; and two drugs for treatment of genital herpes, increasing the choice of available drugs from one to three.
Encouraging Developments
Product approvals and filings included:
- Invirase (saquinavir mesylate) from Hoffmann-La Roche Inc. was approved for use in combination with one or more nucleoside analogs for treatment of advanced HIV-infection. This was the first HIV protease inhibitor to be approved by FDA.
- 3TC (Epivir) from Glaxo Wellcome PLC in combination with AZT (Retrovir) received accelerated approval from FDA for first-line treatment of HIV-infection.
- Oral ganciclovir (Cytovene) from Hoffmann-La Roche Inc. was approved by FDA for prevention of cytomegalovirus (CMV) disease, primarily retinitis, in patients with advanced HIV-infection. This was the first therapeutic approved for prevention of CMV disease in HIV-infected patients. It was also approved for treatment of CMV retinitis, becoming the first alternative to intravenous therapy for CMV retinitis maintenance.
- Hepatitis A Vaccine, Inactivated (Havrix) from SmithKline Beecham Biologicals was approved by FDA for prevention of hepatitis A virus infections. This is the world's first hepatitis A vaccine.
- Varivax, a live attenuated varicella-zoster virus (VZV) vaccine, from Merck & Co. was approved by FDA for prevention of chickenpox due to VZV infection.
- Valacyclovir hydrochloride (Valtrex Caplets), a prodrug of acyclovir, from Glaxo Wellcome Co. was approved by FDA for treatment of herpes zoster (shingles) due to varicella-zoster virus (VZV) infection and recurrent genital herpes simplex virus type 2 (HSV-2) infections in immune competent adults.
- Famvir (famciclovir) from SmithKline Beecham Corp. was approved for a new indication, treatment of recurrent genital herpes simplex virus type 2 (HSV-2) infections in immune competent adults.
- Intravenous Foscavir (foscarnet sodium) from Astra USA, Inc. was approved for a new indication, treatment of monocutaneous acyclovir-resistant herpes simplex virus (HSV) type 1 and 2 infections in immune compromised patients. This was the first therapy approved for treatment of acyclovir-resistant HSV in immune compromised (e.g., AIDS) patients.
- AZT from Barr Labs. was approved by FDA as a generic equivalent of Retrovir (AZT), but Barr will not be able to market generic AZT in the U.S. until Glaxo Wellcome's patents covering AZT expire in 2005.
- Merck & Co. filed for approval of Vaqta, a prophylactic highly purified, formalin-inactivated, alum-adjuvanted hepatitis A virus (HAV) vaccine.
- MedImmune, Inc. filed for approval of RSVIG-IV (respiratory syncytial virus immune globulin intravenous) for prevention of serious RSV disease in high-risk infants.
- Lotteries for expanded access to HIV protease inhibitors met with considerable demand. Hoffmann-La Roche Inc. successfully concluded a lottery for expanded access free distribution of saquinavir. Others lotteries included: Glaxo Wellcome for 3TC; Merck & Co. for indinavir sulfate; and Abbott Labs. for ritonavir.
- Matrix Pharmaceutical, Inc. filed for approval of AccuSite injectable gel containing 5-fluorouracil for treatment of genital warts.
- Gilead Sciences, Inc. filed for approval of intravenous cidofovir (Vistide; GS 504) for treatment of CMV retinitis, and the drug received a Treatment IND.
- TRAx CD4 Test Kit, a method for counting CD4+ T-cells, from T Cell Diagnostics Inc. was approved by FDA.
- HTLV-I (rp21e enhanced) immunodiagnostic assay from Cambridge Biotech Corp. was approved by FDA.
Encouraging clinical trial reports included:
- Interleukin-2 (IL-2; Proleukin) from Chiron Corp. showed efficacy for treatment of HIV-infection, with immune improvements sustained for two years. IL-2 also showed efficacy in combination with indinavir sulfate, a HIV protease inhibitor, from Merck & Co.
- Final results from Phase III trials confirmed the efficacy of D4T (stavudine; Zerit) and DDI (Videx) from Bristol-Myers Squibb Co. for treatment of HIV-infection.
- A large trial found DDI and DDI/AZT and DDC/AZT combinations more effective than AZT monotherapy.
- The Delta trial found that AZT plus either DDI or DDC offers improved clinical efficacy compared to AZT alone.
- Lamivudine (3TC) from Glaxo Wellcome PLC and BioChem Pharma showed significant indications of efficacy for treatment of chronic hepatitis B infection.
- A recombinant CMV glycoprotein B (gB) vaccine from Chiron Corp. induced potent antibody responses in a clinical trial and will be used by North American Biologicals to develop CMV immune globulin for treatment of CMV.
- AG1343 from Agouron, VX-478 from Vertex Pharmaceuticals Inc. and Glaxo Wellcome Co., ritonavir from Abbott Labs. and other second generation HIV protease inhibitors exhibited improved bioavailability and indications of anti-HIV efficacy in clinical trials, particularly in combination with anti-HIV nucleoside analogs.
- CMV retinitis prophylaxis using oral ganciclovir from Hoffmann-La Roche Inc. was reported to rarely result in viral resistance.
- Intravitreal ISIS 2922, a CMV antisense oligonucleotide, from Isis Pharmaceuticals, Inc., demonstrated efficacy for treatment of CMV retinitis.
- Two live attenuated oral rotavirus vaccines from American Home Products Corp. and NIAID demonstrated protective efficacy in large-scale trials.
- A Phase III clinical trial of topical 10% Lidakol cream from LIDAK Pharmaceuticals, Inc. demonstrated efficacy for treatment of recurrent oral herpes.
- Passive immunization with HIV immune globulin continued to show promise for treatment of HIV-infection.
- Cidofovir (Vistide) from Gilead Sciences showed efficacy for treatment of CMV retinitis in a Phase II/III trial.
- Infergen, recombinant alpha-interferon, from Amgen Corp. demonstrated efficacy in a Phase III trial for treatment of chronic hepatitis C, and the company decided to go ahead and seek marketing approval.
- Immuno AG reported positive interim trial results with its recombinant HIV gp160 immunotherapeutic vaccines.
- Interferon-beta from Biogen Corp. showed promise for treatment of chronic hepatitis B and C.
- Hydroxyurea in combination with DDI demonstrated indications of efficacy for treatment of HIV-infection.
- HIV-IT (V), a retrovirus vector HIV-1 envelope and rev protein gene therapy, from Viagene/Chiron demonstrated indications of efficacy for treatment of HIV-infection.
- Natural Alpha Interferon from Interferon Sciences Inc. showed promise for treatment of chronic hepatitis C.
- Oral famciclovir demonstrated efficacy for treatment of experimentally-induced herpes labialis.
- A recombinant influenza A subunit vaccine from MicroGeneSys, Inc. demonstrateed prophylactic efficacy.
- An epidemiological study found no linkage between AZT usage and increased non-Hodgkin's lymphoma (NHL).
- Human immune globulin from survivors of Ebola virus infection showed indications of efficacy for treatment of Ebola fever.
- An autogenous vaccine prepared from genital warts was reported effective for treatment of perianal genital warts.
New and ongoing clinical trials included:
- AR177 from Aronex Pharmaceuticals, Inc. became the first HIV integrase enzyme inhibitor to enter trials.
- MedImmune, Inc. started clinical trials with MEDI-491, the first parvovirus vaccine to enter human testing.
- Human Anti-Cytomegalovirus Antibody (MSL-109) from Protein Design Labs. Inc. entered trials for CMV infection indications.
- GENEVAX-HIV, a gene therapy immunotherapeutic HIV vaccine, from Apollon, Inc. entered clinical trials.
- HIV p17/p24:Ty-VLP, a recombinant HIV p17/p24 virus-like particle vaccine, from British Biotech Pharmaceuticals entered clinical trials in the U.S.
- VX-478, an oral HIV protease inhibitor, from Vertex Pharmaceuticals and Glaxo Wellcome entered trials.
- Genta Inc. started clinical trials with a controlled-release formulation of AZT.
- Interleukin-12 from Genetics Inst. entered trials as an immune stimulant for treatment of HIV-infection and shows promise as a vaccine adjuvant.
- HNK20, a respiratory syncytial virus (RSV) antibody, nose drops from OraVax, Inc. demonstrated potential efficacy for prevention of RSV infections in infants.
- PRO 2000, a naphthalene sulfonate polymer, from Procept, Inc. entered clinical trials for HIV-infection.
- Viral Technologies, Inc. restarted clinical trials with HGP-30, the only HIV p17 vaccine in clinical trials.
- AD-439 and AD-519, HIV monoclonal antibodies, from Tanox Biosystems entered combination clinical trials.
- The Inter-Company Collaboration (ICC) began two trials with triple combination treatments for HIV-infection.
- Intravitreal injection of cidofovir (Vistide) from Gilead Sciences entered trials for CMV retinitis, and topical cidofovir showed promise in clinical trials for treatment of genital herpes.
- A synthetic HIV-1 gp120 C4-V3 peptide vaccine from American Home Products Corp. entered trials.
- Injectable and oral liposomal HIV envelope vaccines from United Biomedical Inc. entered clinical trials.
- RBC-CD4, red blood cells impregnated with CD4, from Sheffield Medical Technologies Inc. entered trials.
- CytoDyn, Inc. began trials with cytolin, a monoclonal antibody to LFA-1 on the surface of CD8+ lymphocytes, for treatment of HIV-infection.
- A live canarypox virus vector prophylactic HIV vaccine, ALVAC-HIV (vCP205), from Pasteur-Merieux/Connaught Labs. entered clinical trials in the U.S.
- Columbia Laboratories, Inc. started Phase II/III clinical trials with SPC3, an anti-HIV gp120 peptide.
- Gilead Sciences Inc. started trials with oral GS 840, a PMEA prodrug, for treatment of chronic hepatitis B.
- An aerosolized intranasal live influenza vaccine from Aviron, Inc. entered clinical trials.
- Alferon N Gel, a topical formulation of natural interferon, from Interferon Sciences, Inc. entered trials for treatment of HPV-associated cervical dysplasia in HIV-infected women.
- Hypericin from VIMRx Pharmaceuticals Inc. entered clinical trials in Thailand for treatment of HIV-infection.
- Lidakol from LIDAK Pharmaceuticals entered a third Phase III trial for treatment of oral herpes (herpes labialis).
- The HIV Immunotherapeutic vaccine from Immune Response Corp. entered Phase III trials.
Encouraging research and preclinical results included:
- Endogenous immune modulatory proteins, chemokines and a cytokine, released by CD8+ lymphocytes that suppress HIV replication were identified. These proteins may play a role in the lack of progression of HIV-infection observed in long-term survivors.
- PMPA from Gilead Sciences, Inc. demonstrated protection against SIV infection, the first time a drug has shown complete protection against SIV-infection in primates.
- Epidemiological studies showed that HIV-2 infection provides some protection against infection with HIV-1, suggesting that live HIV vaccines may be effective.
- Genelabs Technologies, Inc. reported a new blood-transmissible human hepatitis virus, formerly called the hepatitis X virus, now called the hepatitis G virus (HGV).
- Abbott Labs. reported the discovery of several new blood-borne hepatitis viruses, designated GB viruses.
- Intracellular adhesion molecule-1 (ICAM-1) demonstrated efficacy for prevention of rhinovirus infections in chimpanzees, suggesting it may be possible to prevent the Òcommon coldÓ in humans.
- MedImmune, Inc. reported complete protection from mucosal infection in dogs with a papillomavirus vaccine.
- PathoGenesis Corp. reported a link between human herpesvirus-6 and multiple sclerosis (MS), suggesting that antiviral therapy may be useful for MS.
- Kaposi's sarcoma herpesvirus or human herpesvirus-8 was further linked as causing Kaposi's sarcoma.
- Human papillomavirus (HPV) was finally concluded to be the main etiological factor for cervical cancer.
- Intravaginal Lidakol from LIDAK Pharmaceuticals prevented transmission of SIV in female rhesus monkeys.
- The first well-documented case of an infant having cleared HIV-infection was reported.
- The National Inst. of Dental Research and Synergen, Inc. identified a protein, secretory leukocyte protease inhibitor (SLPI), in human saliva that inhibits HIV-1.
- Progenics Pharmaceuticals, Inc. is developing PRO 542, recombinant CD4-IgG2 for HIV-infection.
- A direct injected naked DNA ÒGene TherapeuticsÓ vaccine from Merck & Co./Vical Inc., showed efficacy in animals for prevention of influenza A virus infection.
- Mitotix Inc. reported two enzymes useful for screening drugs for treatment of HPV infections.
- Hypericin from VIMRx Pharmaceuticals Inc. showed activity against a surrogate for hepatitis C virus.
- Polycationic DNA analogs are a new class of antiviral drugs that strongly bind to DNA and RNA.
- Emisphere Technologies, Inc. reported oral microsphere delivery of alpha-interferon.