Pharmacokinetics, safety, and tolerability of the 2- and 3-direct-acting antiviral combination of AL-335, odalasvir, and simeprevir in healthy subjects

This Phase I, open-label, two-group, fixed-sequence study evaluated the pharmacokinetics and safety of AL-335, odalasvir, and simeprevir in healthy subjects. Group 1 (n=16) received AL-335 800mg once daily (QD) (days 1-3, 11-13, and 21-23), simeprevir 150mg QD (days 4-23), and odalasvir 150mg (day14) followed by 50mg QD (days 15-23). Group 2 (n=16) received the same AL-335 regimen as in Group 1 plus odalasvir 150mg (day 4) followed by 50mg QD (days 5-23) and simeprevir 150mg QD (days 14-23). Blood samples were collected to determine plasma concentrations of AL-335 (prodrug) and its metabolites, ALS-022399 (monophosphate precursor) and ALS-022227 (parent nucleoside), odalasvir, and simeprevir. Thirty-two subjects were enrolled. Odalasvir and simeprevir given alone, or in combination, increased AL-335 area under plasma concentration-time curve over 24hours (AUC(0-24h)) 3-, 4-, and 7- to 8-fold, respectively; ALS-022399 AUC(0-24h) increased 2-, 2-, and 3-fold, respectively. Simeprevir had no effect on ALS-022227 AUC(0-24h), whereas odalasvir with/without simeprevir increased ALS-022227 AUC(0-24h) 1.5-fold. AL-335 had no effect on odalasvir or simeprevir pharmacokinetics. Odalasvir and simeprevir AUC(0-24h) increased 1.5- to 2-fold for both drugs when coadministered irrespective of AL-335 coadministration. Study medications were well tolerated with no serious adverse events. One subject prematurely discontinued study drugs (unrelated event). This study defined the preliminary pharmacokinetic and safety profiles of the combination of AL-335, odalasvir, and simeprevir in healthy subjects. These data support the further evaluation of this combination for the treatment of chronic hepatitis C virus infection.