Phase I study, and dosing regimen selection for a pivotal COVID-19 trial of GST-HG171

• Published in: Antimicrobial agents and chemotherapy 2024-01, Vol.68 (1), p.e0111523
• Main Authors: Zhang, Hong, Zhou, Jing, Chen, Hong, Mao, John, Tang, Yanan, Yan, Wenhao, Zhang, Tianxiang, Li, Chuanjing, Chen, Shikui, Li, Guoping, Zhang, George, Ding, Yanhua, Liu, Li
• Format: Article
• Language: English
• Subjects: Administration, Oral; Antimicrobial Chemotherapy; Antiviral Agents; Antiviral Agents - therapeutic use; COVID-19; Dose-Response Relationship, Drug; Double-Blind Method; Drug Interactions; Humans; Ritonavir - therapeutic use
• ISSN: 0066-4804; 1098-6596; 1098-6596
• DOI: 10.1128/aac.01115-23

This study is aimed to evaluate the safety, tolerability, and pharmacokinetics (PK), as well as to select an appropriate dosing regimen for the pivotal clinical trial of GST-HG171, an orally bioavailable, potent, and selective 3CL protease inhibitor by a randomized, double-blind, and placebo-controlled phase I trial in healthy subjects. We conducted a Ph1 study involving 78 healthy subjects to assess the safety, tolerability, and PK of single ascending doses (150-900 mg) as well as multiple ascending doses (MADs) (150 and 300 mg) of GST-HG171. Additionally, we examined the food effect and drug-drug interaction of GST-HG171 in combination with ritonavir through a MAD regimen of GST-HG171/ritonavir (BID or TID) for 5 days. Throughout the course of these studies, no serious AEs or deaths occurred, and no AEs necessitated study discontinuation. We observed that food had no significant impact on the exposure of GST-HG171. However, the presence of ritonavir substantially increased the exposure of GST-HG171, which facilitated the selection of the GST-HG171/ritonavir dose and regimen (150/100 mg BID) for subsequent phase II/III trials. The selected dose regimen was achieved through concentrations continuously at 6.2-9.9-fold above the levels required for protein-binding adjusted 50% inhibition (IC50) of viral replication . The combination of 150 mg GST-HG171/100 mg ritonavir demonstrated favorable safety and tolerability profiles. The PK data obtained from GST-HG171/ritonavir administration guided the selection of appropriate dose for a pivotal phase II/III trial currently in progress. (This study has been registered at ClinicalTrials.gov under identifier NCT05668897).