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https://patentimages.storage.googleapis.com/47/5f/5a/857fc179c9520a/US8410103.pdf

VH-184 (VH-4524184)


Developer(s)

ViiV Healthcare

Originator
https://viivhealthcare.com/

United Kingdom

ViiV Healthcare is a pharmaceutical company that specializes in the development of therapies for HIV infection. The company is headquartered in Brentford in the United Kingdom and was initially formed in November 2009 as a part of a joint venture between GlaxoSmithKline and Shanogi.

GSK plc

Originator
https://www.gsk.com/en-gb/home/

United Kingdom

GSK plc is a British multinational pharmaceutical and biotechnology company. It was established in 2000 by a merger of Glaxo Wellcome and SmithKline Beecham, which was itself a merger of a number of pharmaceutical companies around the Smith, Kline & French firm. It is headquartered in London, England.

Shionogi & Co., Ltd

Originator
https://www.shionogi.com/global/en/company.html

Japan

Shionogi & Company, Limited is a Japanese pharmaceutical company best known for developing Crestor. Medical supply and brand name also uses katakana. Shionogi has business roots that date back to 1878, and was incorporated in 1919.


Drug structure

(3aS,13aS)-N-[(2,4-difluorophenyl)methyl]-8-hydroxy-7,9-dioxo-1,2,3,3a,4,5,7,9,13,13a-decahydropyrido[1′,2′:4,5]pyrazino[1,2-a]pyrrolo[1,2-c]pyrimidine-10-carboxamide

(3aS,13aS)-N-[(2,4-difluorophenyl)methyl]-8-hydroxy-7,9-dioxo-1,2,3,3a,4,5,7,9,13,13a-decahydropyrido[1′,2′:4,5]pyrazino[1,2-a]pyrrolo[1,2-c]pyrimidine-10-carboxamide

https://patentimages.storage.googleapis.com/47/5f/5a/857fc179c9520a/US8410103.pdf


Drug information

Associated long-acting platforms

unknown

Administration route

Oral, To be determined, Subcutaneous, Intramuscular

Therapeutic area(s)

HIV

Use case(s)

Treatment

Use of drug

Ease of administration

To be determined
Administered by a nurse
Administered by a specialty health worker
Administered by a community health worker
Self-administered

Frequency of administration

Monthly
Every 2 months
Every 6 weeks
Every 4 months

User acceptance

Both long‑acting (LA) formulations of VH‑184 were well tolerated in healthy adults aged 18–55 years without HIV‑1 infection. The most frequently reported adverse events were injection-site reactions (ISRs), which were predominantly mild in severity. ISRs occurred in approximately 80% of participants, with injection‑site pain reported by 68%. The majority of ISRs resolved within 4–8 days, excluding injection‑site nodules. No serious adverse events were observed in the Phase 1 interim results from study NCT06310551.

Dosage

Available dose and strength

Formulation A: [240mg (0.8 mL), 420 mg (1.4mL); 750 mg (2.5 mL)] SC and [450mg (1.5 mL), 900 mg (3 mL)] IM. Formulation B: [400 mg (1 mL); 800mg (2 mL) IM and SC]

Maximum dose

900 mg (3mL) IM into the thigh muscle

Recommended dosing regimen

A Phase 2a, oral, proof‑of‑concept study in antiretroviral‑therapy (ART)–naïve people with HIV (PWH) (NCT06214052) evaluated VH‑184 administered at doses of 10 mg, 50 mg, and 300 mg every three days. Long‑acting formulations of VH‑184, including both intramuscular (IM) and subcutaneous (SC) depot preparations, are currently under evaluation in a separate clinical study (NCT06310551). Population pharmacokinetic analyses indicate that the long‑acting formulation A may be suitable for monthly or every‑two‑month administration, whereas the formulation B may enable dosing at four month and six‑month intervals.

Additional comments

Not provided

Dosage link(s)

Not provided


Drug information

Drug's link(s)

Not provided

Generic name

VH-4524184 ; VH-184

Brand name

investigational

Compound type

Small molecule

Drug class/category

Integrase strand transfer inhibitor (INSTI)

Summary

VH4524184 (VH-184) is an investigational third-generation integrase strand transfer inhibitor (INSTI) with long-acting potential, similar to dolutegravir, with a higher barrier to resistance. INSTIs exert their antiviral effect by targeting the HIV integrase enzyme, thereby inhibiting viral replication. There is an emerging resistance trend to some 2nd generation INSTIs. Preclinical in vitro studies indicate that VH-184 demonstrates antiviral potency comparable to 2nd generation INSTIs dolutegravir and cabotegravir, with a protein-adjusted 90% effective concentration (EC90) of 160 nM and an improved resistance profile. VH-184 is being pursued as injectable for subcutaneous or intramuscular administration, as a backbone for future HIV treatment regimens.

Approval status

VH4524184 (VH-184) is currently in clinical development and not yet approved in any jurisdiction. Two injectable LA formulations are evaluated. Formulation A showed a median Cmax at Day 3 and a terminal half-life of ~7 weeks, supporting Q1M/Q2M dosing. Formulation B demonstrated slower absorption with flat PK through Month 7; terminal half-life was not estimable, supporting Q6M dosing. ISRs were predominantly Grade 1–2; two Grade 3 events were reported. The VH-184 demonstrated enhanced potency versus bictegravir across key resistance mutations, retaining wild-type–level activity

Regulatory authorities

VH4524184 (VH-184) is currently in clinical development and not yet approved in any jurisdiction.

Delivery device(s)

Not provided


Scale-up and manufacturing prospects

Scale-up prospects

Detailed manufacturing information is not currently available for this compound.

Tentative equipment list for manufacturing

Detailed manufacturing information is not currently available for this compound.

Manufacturing

Detailed manufacturing information is not currently available for this compound.

Specific analytical instrument required for characterization of formulation

Detailed manufacturing information is not currently available for this compound.


Clinical trials

218804

Identifier

NCT06310551

Link

https://clinicaltrials.gov/study/NCT06310551

Phase

Phase I

Status

Recruiting

Sponsor

ViiV Healthcare

More details

The purpose of this study is to identify 1 or more doses of parenterally administered VH4524184 that are safe, well tolerated and yield a PK drug exposure profile necessary to deliver a long-acting antiretroviral therapy for the treatment of HIV-1 infection.

Purpose

First Time in Human Study of Long Acting VH4524184 Formulations

Interventions

Intervention 1

Oral VH4524184

Intervention 2

VH4524184 Formulation A SC

Intervention 3

Placebo Formulation A SC

Intervention 4

rHuPH20

Intervention 5

VH4524184 Formulation B SC

Countries

United States of America

Sites / Institutions

Not provided

Trials dates

Anticipated Start Date
Not provided

Actual Start Date
2024-03-21

Anticipated Date of Last Follow-up
2025-02-21

Estimated Primary Completion Date
2028-01-21

Estimated Completion Date
2028-01-21

Actual Primary Completion Date
Not provided

Actual Completion Date
Not provided

Studied populations

Age Cohort

  • Adults

Genders

  • All

Accepts pregnant individuals
No

Accepts lactating individuals
No

Accepts healthy individuals
Yes

Comments about the studied populations

Inclusion Criteria: Age 1. Participant must be 18 to 55 years of age inclusive, at the time of signing the informed consent. Type of Participant and Characteristics 2. Participants who are overtly healthy as determined by medical evaluation including medical history, physical examination, laboratory tests, and cardiac monitoring. 3. Participants who are negative for SARS-CoV-2, performed on admission/readmission to the Phase 1 unit, using an approved molecular test (PCR). 4. Participants who are able to understand and comply with protocol requirements and timetables, instructions, and protocol-stated restrictions. Weight 5. Body weight ≥50.0 kg (110 lbs) for men and ≥45.0 kg (99 lbs) for women and body mass index within the range 18.5 to 32.0 kg/m2 (inclusive). Sex and Contra

Health status

Negative to : HIV, HCV, HBV, COVID 19
Considered at low risk of : HIV

Study type

Interventional (clinical trial)

Enrollment

72

Allocation

Randomized

Intervention model

Parallel Assignment

Intervention model description

Not provided

Masking

Double-blind masking

Masking description

Double (Participant, Investigator)

Frequency of administration

Other/Variable/Unknown : "unknown "

Studied LA-formulation(s)

Injectable
Tablet

Studied route(s) of administration

Oral
Subcutaneous
Intra-articular

Use case

Treatment

Key resources

Not provided

218806

Identifier

NCT06214052

Link

https://clinicaltrials.gov/study/NCT06214052

Phase

Phase II

Status

Completed

Sponsor

ViiV Healthcare

More details

The purpose of this study is to evaluate the safety, tolerability, ability of VH4524184 when given alone to reduce the amount of HIV (viral load) in people with HIV-1 infection who have never received antiretroviral therapy (treatment-naïve). Data from this study will be used to decide how VH4524184 can be best included in a full-treatment regimen for HIV-1 in the future.

Purpose

VH4524184 Proof-of-Concept in Treatment-Naïve Adults Living With HIV-1

Interventions

Intervention 1

Drug: VH4524184
Dosage: 10mg, 50mg or 300mg taken once every three days.

Intervention 2

Drug: Placebo

Countries

Argentina
Canada
Italy
Spain
United States of America

Sites / Institutions

Not provided

Trials dates

Anticipated Start Date
Not provided

Actual Start Date
2024-02-07

Anticipated Date of Last Follow-up
2025-06-12

Estimated Primary Completion Date
Not provided

Estimated Completion Date
Not provided

Actual Primary Completion Date
2024-06-12

Actual Completion Date
2024-06-12

Studied populations

Age Cohort

  • Adults
  • Older Adults

Genders

  • All

Accepts pregnant individuals
No

Accepts lactating individuals
Unspecified

Accepts healthy individuals
No

Comments about the studied populations

Inclusion Criteria: * Participant must be 18 to 65 years of age inclusive at the time of signing the informed consent. * Participants who are overtly healthy (other than HIV infection) as determined by the Investigator or medically qualified designee based on a medical evaluation including medical history, physical examination, laboratory tests, and cardiac monitoring. * Positive HIV antibody test * Documented HIV infection and Screening plasma HIV-1 RNA ≥ 3,000 copies/mL. A single repeat of this test is allowed within a single Screening period to determine eligibility. * Screening CD4+ T-cell count ≥200 cells/mm3 * Treatment-naïve: No antiretrovirals (ARVs, in combination or monotherapy) received after the diagnosis of HIV-1 infection. * HIV Pre-exposure or post-exposure prophylaxis: No

Health status

Negative to : HIV, HCV, HBV

Study type

Interventional (clinical trial)

Enrollment

22

Allocation

Randomized

Intervention model

Parallel Assignment

Intervention model description

Not provided

Masking

Double-blind masking

Masking description

Double (Participant, Investigator)

Frequency of administration

Other/Variable/Unknown : "Once every three days "

Studied LA-formulation(s)

Not provided

Studied route(s) of administration

Oral

Use case

Treatment

Key resources

Not provided

218803

Identifier

NCT05631704

Link

https://clinicaltrials.gov/study/NCT05631704

Phase

Phase I

Status

Completed

Sponsor

ViiV Healthcare

More details

This study is designed to investigate the safety, tolerability and PK of VH4524184 (GSK4524184) and the potential of VH4524184 to inhibit or induce CYP3A activity in healthy participants.

Purpose

A Study to Investigate Safety, Tolerability, and Pharmacokinetics (PK) of VH4524184 and the Potential for Changes in Cytochrome P450 3A (CYP3A) Activity

Interventions

Intervention 1

Drug: VH4524184

Intervention 2

Drug: Placebo

Intervention 3

Drug: Midazolam

Countries

United States of America

Sites / Institutions

Not provided

Trials dates

Anticipated Start Date
Not provided

Actual Start Date
2022-12-02

Anticipated Date of Last Follow-up
2025-12-19

Estimated Primary Completion Date
2023-08-31

Estimated Completion Date
2023-08-31

Actual Primary Completion Date
2023-07-27

Actual Completion Date
2023-07-27

Studied populations

Age Cohort

  • Adults

Genders

  • All

Accepts pregnant individuals
No

Accepts lactating individuals
No

Accepts healthy individuals
Yes

Comments about the studied populations

Inclusion Criteria: * Participant must be 18 to 50 years of age. * Participants who are overtly healthy. * Body weight \>=50.0 kilograms (kg) (110 pounds \[lbs\]) for men and \>=45.0 kg (99 lbs) for women and body mass index within the range 18.5 to 32.0 kilograms per meter square (kg/m\^2) (inclusive). * Male or female. Male Participants: No contraceptive restrictions for male participants. Female Participants: A female participant (female sex assigned at birth) is eligible to participate if she is not pregnant, or breastfeeding and is not physically able to have a baby.

Health status

Negative to : HIV, HCV, HBV

Study type

Interventional (clinical trial)

Enrollment

84

Allocation

Randomized

Intervention model

Sequential assignment

Intervention model description

Participants will receive escalating doses of VH4524184 or placebo in Part 1 and Part 2 of the study. In Part 3, participants will receive VH4524184 under fasted and fed conditions.

Masking

Double-blind masking

Masking description

Double (Participant, Investigator)

Frequency of administration

Daily

Studied LA-formulation(s)

Tablet

Studied route(s) of administration

Oral

Use case

Treatment

Key resources

Type Title Content Link
Publication Rogg L, Underwood M, Hanan N, et al. Phase 1 Evaluation of VH4524184, a Third-Generation Integrase Strand Transfer Inhibitor With an Enhanced Resistance Profile. Clin Infect Dis. Published online March 21, 2025. doi:10.1093/cid/ciaf135 Background: Integrase strand transfer inhibitors (INSTIs) have been fundamental to HIV-1 treatment for over 15 years. VH4524184 (VH-184) is a third-generation INSTI with long-acting potential currently in development for HIV-1 treatment.Methods: This double-blind, randomized, placebo-controlled, phase 1, first-time-in-human (FTIH) study evaluated oral VH-184 in adults without HIV-1 administered as single ascending doses (10-460 mg; part 1), multiple ascending doses (160-480 mg) for 14 days with concomitant midazolam (480 mg cohort; part 2), and as a single dose (100 mg) under fasted/fed conditions (part 3) to assess safety, tolerability, and pharmacokinetics. VH-184 resistance was evaluated in vitro against pseudotyped viruses containing participant-derived integrase sequences from the SAILING and DAWNING studies that conferred reduced susceptibility to second-generation INSTIs.Results: Eighty-four participants (VH-184, n=63; placebo, n=21) were included in the FTIH study. VH-184 demonstrated a good safety and tolerability profile. Dose-proportional increases in exposures were observed after single doses of 10 to 300 mg, without further increase after 460-mg single or 480-mg multiple doses. Geometric mean half-life was ∼24 hours. Observed accumulation in exposures ranged from 1.3- to 1.9-fold after repeat VH-184 dosing of 480 and 160 mg, respectively. VH-184 had minimal impact on the pharmacokinetics of CYP3A substrates and exhibited a moderate positive food effect. The in vitro resistance profile of VH-184 was enhanced compared with prior INSTIs, retaining antiviral activity against second-generation INSTI-resistant pseudotyped viruses.Conclusions: These data support the safety and further development of VH-184 as a third-generation INSTI with long-acting potential for HIV-1 treatment

219888

Identifier

NCT06310616

Link

https://clinicaltrials.gov/study/NCT06310616

Phase

Phase I

Status

Completed

Sponsor

ViiV Healthcare

More details

This study aims to assess any impact of VH4524184 on the pharmacokinetic (PK) profile of an ethinyl estradiol (EE) and norethindrone acetate (NEA) containing oral contraceptive (OC) administered to healthy adult female participants.

Purpose

A Study to Investigate the Potential Drug-Drug Interaction Between VH4524184 and Oral Contraceptive (Loestrin) in Healthy Adult Female Participants

Interventions

Intervention 1

Drug: VH4524184

Intervention 2

Drug: Loestrin

Countries

United States of America

Sites / Institutions

Not provided

Trials dates

Anticipated Start Date
Not provided

Actual Start Date
2024-03-06

Anticipated Date of Last Follow-up
2024-12-09

Estimated Primary Completion Date
Not provided

Estimated Completion Date
Not provided

Actual Primary Completion Date
2024-08-15

Actual Completion Date
2024-08-15

Studied populations

Age Cohort

  • Adults

Genders

  • Female

Accepts pregnant individuals
No

Accepts lactating individuals
No

Accepts healthy individuals
Yes

Comments about the studied populations

Inclusion Criteria: * Healthy participants 18 to 45 years of age * POCBP with intact ovarian function by medical history and history of regular menstrual cycles for the past 12 * Body weight greater than or equal to (≥) 45 kilograms (kg) and Body mass index (BMI) within the range of 18.5 to 32.0 kg/m2 * Female participants of childbearing potential must use approved highly effective non-hormonal forms of birth control. * Capable of giving signed informed consent. Exclusion Criteria: * History or presence of clinical condition or disorder that could be capable of significantly altering the absorption, metabolism, or elimination of drugs. * Lymphoma, leukemia, or any malignancy within the past 5 years with some exceptions * Breast cancer or in remission within the past 10 years.

Health status

Negative to : HIV

Study type

Interventional (clinical trial)

Enrollment

26

Allocation

Non-randomized

Intervention model

Sequential assignment

Intervention model description

Not provided

Masking

Open label

Masking description

None (Open Label)

Frequency of administration

Daily

Studied LA-formulation(s)

Tablet

Studied route(s) of administration

Oral

Use case

Treatment

Key resources

Not provided

INNOVATE (222638)

Identifier

NCT07202546

Link

https://clinicaltrials.gov/study/NCT07202546

Phase

Phase II

Status

Not yet recruiting

Sponsor

ViiV Healthcare

More details

This clinical study is testing a new medication, VH4524184, to see if it can effectively treat HIV-1 in adults who have never received treatment for their infection. The study is comparing two different doses of VH4524184, each taken with the medications emtricitabine and tenofovir alafenamide (FTC/TAF), to a standard HIV treatment called dolutegravir and lamivudine (DTG/3TC). The purpose of the study is to provide data on the long-term antiviral activity of the VH4524184 and provide information regarding dosing formulation for further evaluations.

Purpose

A Phase 2b Study Evaluating Oral VH4524184 Regimens in Treatment Naïve Persons With HIV-1 (INNOVATE Study)

Interventions

Intervention 1

VH4524184 dose A+ TAF + FTC (month 0-12)
Dosage: daily oral VH-184 dose A (low) + FDC {25mg TAF+200mg emtricitabine}

Intervention 2

VH4524184 dose B+ TAF + FTC (month 0-12)
Dosage: daily oral VH-184 dose B (high) + FDC {25mg TAF+200mg emtricitabine}

Intervention 3

Dolutegravir / Lamivudine (DTG/3TC)
Dosage: Dolutegravir (50 mg) / Lamivudine (300 mg)

Intervention 4

VH4524184 selected dose+ TAF + FTC (month 12-24)
Dosage: VH4524184 selected dose+ TAF + FTC

Countries

Not provided

Sites / Institutions

Not provided

Trials dates

Anticipated Start Date
2026-02-06

Actual Start Date
Not provided

Anticipated Date of Last Follow-up
2025-12-19

Estimated Primary Completion Date
2027-05-20

Estimated Completion Date
2028-11-01

Actual Primary Completion Date
Not provided

Actual Completion Date
Not provided

Studied populations

Age Cohort

  • Adults
  • Older Adults

Genders

  • All

Accepts pregnant individuals
No

Accepts lactating individuals
No

Accepts healthy individuals
No

Comments about the studied populations

Inclusion Criteria: 1. Participant must be at least 18 years of age (or older, if required for adults by local regulations) at the time of signing the informed consent. 2. Screening CD4+ T-cell count \>200 cells/microlitre (µL). 3. Documented HIV-1 infection and Screening plasma HIV-1 RNA of ≥1000 copies/millilitre (mL). A single repeat of this test is allowed within a single Screening period to determine eligibility. 4. Treatment-naive: Defined as no ARVs (in combination or monotherapy) received after the diagnosis of HIV-1 infection. 5. Body weight \>=50.0 kilogram (kg) \[(110 pounds (lbs)\] for participants assigned male at birth and \>=45.0 kg (99 lbs) for participants assigned female at birth. BMI within the range 18.5-35.5 kg/m\^2 (inclusive - applies to males and females). 6. other

Health status

Positive to : HIV
Other health status: treatment naive PLHIV - no acute HIV infection

Study type

Interventional (clinical trial)

Enrollment

550

Allocation

Randomized

Intervention model

Parallel Assignment

Intervention model description

Not provided

Masking

Open label

Masking description

Not provided

Frequency of administration

Daily

Studied LA-formulation(s)

Tablet

Studied route(s) of administration

Oral

Use case

Treatment

Key resources

Not provided

219890 - DDis common medicines

Identifier

NCT07066722

Link

https://clinicaltrials.gov/study/NCT07066722

Phase

Phase I

Status

Completed

Sponsor

ViiV Healthcare

More details

The aim of the study is to gather information on how the drug behaves in healthy adults, how it is absorbed, and how it interacts when taken with other medicines.

Purpose

A Study to Evaluate VH4524184 Tablet Absorption, Effects of Food, and Interactions With Other Drugs in Healthy Adults

Interventions

Intervention 1

VH-184
Dosage: various dosages and administration sequences

Intervention 2

VH-184 + rifbutin (or mycobutin)

Intervention 3

VH-184 + Itraconazole (or Sporanox)

Intervention 4

VH-184 + phenytoin (or Dilantin)

Intervention 5

VH-184 + metformin + digoxin (or lanoxin)

Countries

United States of America

Sites / Institutions

Not provided

Trials dates

Anticipated Start Date
Not provided

Actual Start Date
2025-07-07

Anticipated Date of Last Follow-up
2026-03-05

Estimated Primary Completion Date
2025-12-15

Estimated Completion Date
2025-12-15

Actual Primary Completion Date
2025-12-17

Actual Completion Date
2025-12-17

Studied populations

Age Cohort

  • Adults

Genders

  • All

Accepts pregnant individuals
Unspecified

Accepts lactating individuals
Unspecified

Accepts healthy individuals
Yes

Comments about the studied populations

Inclusion Criteria: 1\. Participants must be 18 to 60 years of age inclusive at the time of signing the Informed consent form (ICF). 2\. Male or female 1. Male Participants: No restrictions for male participants 2. A female participant (female sex assigned at birth) is eligible to participate if she is not pregnant, or breastfeeding and the following condition applies: She is a woman of nonchildbearing potential (WONCBP). 3\. Participants who are overtly healthy as determined by medical evaluation 4. AST, ALT, alkaline phosphatase and bilirubin ≤ 1.5 x Upper Limit of Normal (ULN) 6. Capable of giving signed informed consent. Exclusion Criteria: 1. History or presence of clinical conditions affecting drug absorption, metabolism, or elimination., 2. Pre-existing clinically r

Health status

Not provided

Study type

Interventional (clinical trial)

Enrollment

126

Allocation

Randomized

Intervention model

Cross-over assignment

Intervention model description

Not provided

Masking

Open label

Masking description

Not provided

Frequency of administration

Daily

Studied LA-formulation(s)

Tablet

Studied route(s) of administration

Oral

Use case

Treatment

Key resources

Not provided

Excipients

Proprietary excipients used

Not provided

Novel excipients or existing excipients at a concentration above Inactive Ingredients Database (IID) for the specified route of administration

Not provided

Residual solvents used

Not provided


Patent info

Description

VH184 compound markush structure

Brief description

A compound represented in formula (I) is provided. (In the formula, ring A is a substituted or unsubstituted non-aromatic heterocycle; ring C is a benzene ring, etc.; Q is a 5-membered aromatic heterocycle, etc.; the R1s are independently a halogen, etc.; L is a substituted or unsubstituted alkylene; R3 is a substituted or unsubstituted alkyl, etc.; R4 is a hydrogen, etc.; and n is an integer 1 to 3.)

Representative patent

WO2019230857

Category

Compound

Patent holder

SHIONOGI & CO., LTD.

Exclusivity

Not provided

Expiration date

May 30, 2039

Status

Granted: AU, CL, CN, EAPO (AM, AZ, BY, KG, KZ, RU, TJ, TM), IL, IN, JP, KR, MX, MY, US Pending: BR, CA, CR, CO, DO, DZ, EG, EPO, ID, NG, PE, PH, SG, TH, TT, UA, VN, ZA

Description

VH184 compound markush structure

Brief description

A compound represented in formula (I) is provided. (In the formula, ring A is a substituted or unsubstituted heterocycle; ring C is a benzene ring, etc.; R1 is a halogen, etc.; R2a and R2b are independently a hydrogen, etc.; R3 is a substituted or unsubstituted alkyl, etc.; R4 is a hydrogen, etc.; and n is an integer 1 to 3.)

Representative patent

WO2019230858

Category

Compound

Patent holder

SHIONOGI & CO., LTD.

Exclusivity

Not provided

Expiration date

May 30, 2039

Status

Granted: AU, BR, CN, EA (AM, AZ, BY, KG, KZ, RU, TJ, TM), EP (AL, AT, BE, BG, CH, CY, CZ, DE, DK, EE, ES, FI, FR, GB, GR, HR, HU, IE, IS, IT, LI, LT, LU, LV, MC, MK, MT, NL, NO, PL, PT, RO, RS, SE, SI, SK, SM, TR, BA, ME), KR, IN, JP, MY, US, ZA Pending: AR, CA, CL, CO, CR, DO, DZ, EG, HK, ID, MX, NZ, PE, PH, SG, TH, TT, TW, UA, VN Not in force: KH, MA, MD, TN


Supporting material

Publications

Rogg L, Underwood M, Hanan N, et al. Phase 1 Evaluation of VH4524184, a Third-Generation Integrase Strand Transfer Inhibitor With an Enhanced Resistance Profile. Clin Infect Dis. Published online March 21, 2025. doi:10.1093/cid/ciaf135

Background: Integrase strand transfer inhibitors (INSTIs) have been fundamental to HIV-1 treatment for over 15 years. VH4524184 (VH-184) is a third-generation INSTI with long-acting potential currently in development for HIV-1 treatment.

Methods: This double-blind, randomized, placebo-controlled, phase 1, first-time-in-human (FTIH) study evaluated oral VH-184 in adults without HIV-1 administered as single ascending doses (10-460 mg; part 1), multiple ascending doses (160-480 mg) for 14 days with concomitant midazolam (480 mg cohort; part 2), and as a single dose (100 mg) under fasted/fed conditions (part 3) to assess safety, tolerability, and pharmacokinetics. VH-184 resistance was evaluated in vitro against pseudotyped viruses containing participant-derived integrase sequences from the SAILING and DAWNING studies that conferred reduced susceptibility to second-generation INSTIs.

Results: Eighty-four participants (VH-184, n=63; placebo, n=21) were included in the FTIH study. VH-184 demonstrated a good safety and tolerability profile. Dose-proportional increases in exposures were observed after single doses of 10 to 300 mg, without further increase after 460-mg single or 480-mg multiple doses. Geometric mean half-life was ∼24 hours. Observed accumulation in exposures ranged from 1.3- to 1.9-fold after repeat VH-184 dosing of 480 and 160 mg, respectively. VH-184 had minimal impact on the pharmacokinetics of CYP3A substrates and exhibited a moderate positive food effect. The in vitro resistance profile of VH-184 was enhanced compared with prior INSTIs, retaining antiviral activity against second-generation INSTI-resistant pseudotyped viruses.

Conclusions: These data support the safety and further development of VH-184 as a third-generation INSTI with long-acting potential for HIV-1 treatment

Lack of clinically significant drug–drug interactions between the third-generation integrase strand transfer inhibitor VH4524184 (VH-184) and combined oral contraceptives. Doyle, E., Kahl, L., Goodchild, J., Halliday, F., Rogg, L., Collins, J., Thaker, S. and Gartland, M. (2025). Br J Clin Pharmacol, 91: 15-16. https://doi.org/10.1002/bcp.70221

Background: Long-acting antiretroviral therapy offers people with HIV-1 more convenient and sustainable treatment options, improving quality of life and adherence. VH4524184 (VH-184) is a third-generation integrase strand transfer inhibitor (INSTI) that has potent antiviral activity, long-acting potential and an enhanced in vitro resistance profile compared with second-generation INSTIs. Since VH-184 may be administered concomitantly with combined oral contraceptives (COCs), it is important to understand any clinically relevant drug–drug interactions. In this study, we assessed the impact of VH-184 on the pharmacokinetics (PK) of a common COC containing ethinyl estradiol (EE) and norethindrone acetate (NEA).

Material and Methods: We conducted a phase 1, open-label, single-sequence, 1-way study in female participants without HIV aged 18 to 45 years. Participants received once-daily oral EE 30 μg/NEA 1.5 mg alone (treatment period 1; Days 1–10) or with once-daily oral VH-184200 mg (treatment period 2; Days 11–20) after a 21-day run-in period of EE/NEA followed by a 7-day washout period. The primary endpoint was maximum plasma concentration (Cmax) and area under the concentration-time curve from time 0 to the end of the dosing interval (AUC₀-τ) for EE and NEA. Secondary endpoints included VH-184 PK parameters, safety and tolerability.

Results: Of the 26 participants enrolled, 20 completed the study. Five participants discontinued before treatment Period 1, and one participant withdrew after completing treatment Period 2 but before the follow-up visit. Geometric least squares mean ratios (90% CI) with vs. without VH-184 of Cmax and AUC₀-τ were 1.041 (0.974–1.112) and 1.107 (1.062–1.153) for EE, respectively, and 1.210 (1.133–1.293) and 1.234 (1.194–1.274) for NEA, respectively. Steady-state VH-184 concentrations were achieved in ~10 days, consistent with prior studies. Overall, 12 (46%) participants reported 16 treatment-emergent adverse events (TEAEs). The only TEAEs reported by >1 participant were headache (n = 3), abdominal pain (n = 2), fatigue (n = 2) and positive SARS-CoV-2 test (n = 2). All TEAEs had a maximum intensity of Grade 1. Five (19%) participants reported six drug-related TEAEs, none of which were reported by >1 participant. The four drug-related TEAEs reported during treatment period 2 were labelled events for EE/NEA and/or INSTIs. No TEAEs led to discontinuation during either treatment period. No serious AEs or deaths were reported. Five participants experienced asymptomatic Grade 1 or 2 transaminase elevations after treatment period 2 (Day 21). There were no clinically relevant changes in other laboratory parameters, electrocardiograms or vital signs.

Conclusions: VH-184 had no effect on the steady-state PK of EE after repeat oral administration with a common COC containing EE/NEA. A slight increase in NEA exposure was observed with VH-184 coadministration, which was not considered clinically significant. EE/NEA did not meaningfully affect the steady-state PK of VH-184. VH-184 combined with EE/NEA was well tolerated in female participants without HIV. These results indicate that VH-184 can be administered with COCs containing EE/NEA without impacting the efficacy of COCs or the PK of VH-184.

H. Back et al. Pharmacokinetics and Evaluation of Potential Dosing Regimens for Long-Acting VH4524184. Presented at the 33rd Conference on Retroviruses and Opportunistic Infections (CROI). February 2026.

Background: VH4524184 (VH-184) is a third-generation integrase strand transfer inhibitor (INSTI) with an enhanced in vitro resistance profile compared with second-generation INSTIs. Previously, oral VH-184 demonstrated potent antiviral activity in people with HIV-1 in a proof-of-concept study. Here, we present results from the first-time-in-human study of injectable formulations in adults without HIV to assess the long-acting potential of VH-184. Methods: In this ongoing phase 1, double-blind, placebo-controlled, randomized study (ClinicalTrials.gov, NCT06310551), we are evaluating the safety, tolerability, and pharmacokinetics (PK) of parenterally administered VH-184 in adults without HIV for up to 52 weeks. PK data were collected after subcutaneous (SC) or intramuscular (IM) administration of escalating doses of VH-184 formulations. Observed PK data were integrated into a population PK (PopPK) model to simulate multiple dosing regimens including monthly (Q1M), every 2 months (Q2M), and every 6 months (Q6M). Results: In the first 7 study cohorts, 39 participants (33 male) received a single dose of 1 of 2 formulations (A and B) under evaluation. The majority of injection site reactions (ISRs) were grade 1, with fewer grade 2 ISRs and 2 grade 3 ISRs. The most common ISRs were erythema, pain, and nodules. Formulation A reached maximum plasma concentration (Cmax) a median of 3 days after SC or IM injection, and terminal half-life after SC dosing was a median of 7 weeks. Formulation B showed a wider range of time to reach Cmax due to slow absorption and maintained a flat PK profile through Month 7; thus, terminal half-life has not been defined. The PopPK analysis adequately characterized the observed PK profile for both formulations, and simulation results suggest that VH-184 long-acting injectable (LAI) formulations may maintain VH-184 PK above clinically effective concentrations with Q1M or Q2M dosing for formulation A and Q6M dosing for formulation B.Conclusions: VH-184 LAI formulations were well tolerated and demonstrated a favorable PK profile, with both formulations showing an extended half-life, supporting long-acting dosing. The emerging safety profile of VH-184 is similar to that of marketed INSTIs. Data from the ongoing study and the PopPK model will be used to further optimize dosing regimens and inform the phase 2b LAI VH-184 study design

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