U.S. patent application number 12/769449 was filed with the patent office on 2010-08-19 for novel inhibitors of hepatitis c virus replication.
This patent application is currently assigned to INTERMUNE, INC.. Invention is credited to STEVEN W. ANDREWS, LEONID BEIGELMAN, LAWRENCE M. BLATT, APRIL L. KENNEDY, TIMOTHY KERCHER, SCOTT SEIWERT.
Application Number | 20100209391 12/769449 |
Document ID | / |
Family ID | 38752388 |
Filed Date | 2010-08-19 |
United States Patent
Application |
20100209391 |
Kind Code |
A1 |
SEIWERT; SCOTT ; et
al. |
August 19, 2010 |
NOVEL INHIBITORS OF HEPATITIS C VIRUS REPLICATION
Abstract
The embodiments provide compounds of the general Formula II, as
well as compositions, including pharmaceutical compositions,
comprising a subject compound. The embodiments also provide
treatment methods, including methods of treating a hepatitis C
virus infection and methods of treating liver fibrosis, the methods
generally involving administering to an individual in need thereof
an effective amount of a subject compound or composition.
Inventors: |
SEIWERT; SCOTT; (PACIFICA,
CA) ; BEIGELMAN; LEONID; (SAN MATEO, CA) ;
BLATT; LAWRENCE M.; (SAN FRANCISCO, CA) ; KERCHER;
TIMOTHY; (BOULDER, CO) ; KENNEDY; APRIL L.;
(DENVER, CO) ; ANDREWS; STEVEN W.; (LONGMONT,
CO) |
Correspondence
Address: |
KNOBBE MARTENS OLSON & BEAR LLP
2040 MAIN STREET, FOURTEENTH FLOOR
IRVINE
CA
92614
US
|
Assignee: |
INTERMUNE, INC.
Brisbane
CA
|
Family ID: |
38752388 |
Appl. No.: |
12/769449 |
Filed: |
April 28, 2010 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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11773912 |
Jul 5, 2007 |
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12769449 |
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60819128 |
Jul 6, 2006 |
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60818914 |
Jul 5, 2006 |
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Current U.S.
Class: |
424/85.5 ;
424/85.7; 514/365; 514/414; 514/43; 514/49; 514/50; 548/467 |
Current CPC
Class: |
C07D 231/56 20130101;
C07D 471/04 20130101; C07D 403/14 20130101; A61P 31/12 20180101;
A61P 43/00 20180101; A61P 31/14 20180101; A61P 1/16 20180101 |
Class at
Publication: |
424/85.5 ;
548/467; 514/414; 514/43; 514/365; 424/85.7; 514/50; 514/49 |
International
Class: |
A61K 31/404 20060101
A61K031/404; C07D 403/12 20060101 C07D403/12; A61K 31/7052 20060101
A61K031/7052; A61K 31/427 20060101 A61K031/427; A61K 38/21 20060101
A61K038/21; A61K 31/7072 20060101 A61K031/7072; A61K 31/7068
20060101 A61K031/7068; A61P 1/16 20060101 A61P001/16 |
Claims
1. A compound of the formula (II): ##STR00042## or a
pharmaceutically acceptable salt, prodrug, or ester thereof
wherein: (a) Z.sub.1 is a group configured to hydrogen bond to an
NS3 protease His57 imidazole moiety and to hydrogen bond to a NS3
protease Gly137 nitrogen atom; (b) P.sub.1' is a group configured
to form a non-polar interaction with at least one NS3 protease S1'
pocket moiety selected from the group consisting of Lys136, Gly137,
Ser138, His57, Gly58, Gln41, Gly42, and Phe43; (c) L is a linker
group consisting of from 1 to 5 atoms selected from the group
consisting of carbon, oxygen, nitrogen, hydrogen, and sulfur; (d)
P.sub.2 is selected from the group consisting of unsubstituted
aryl, substituted aryl, unsubstituted heteroaryl, substituted
heteroaryl, unsubstituted heterocyclic and substituted
heterocyclic; P.sub.2 being positioned by L to form a non-polar
interaction with at least one NS3 protease S2 pocket moiety
selected from the group consisting of His57, Arg155, Va178, Asp79,
and Gln80; and (e) R.sup.5 is a substituted or unsubstituted moiety
selected from the group consisting of H, C.sub.1-8 alkyl, C.sub.3-7
cycloalkyl, C.sub.4-10 cycloalkyl-alkyl, aryl, C.sub.7-10
arylalkyl, heteroaryl, C.sub.6-12 heteroarylalkyl, --C.sub.1-8
alkyl-NHC(O)OR.sup.1a, --C.sub.3-7 cycloalkyl-NHC(O)OR.sup.1a,
--C.sub.4-10 cycloalkyl-alkyl-NHC(O)OR.sup.1a,
-aryl-NHC(O)OR.sup.1a, --C.sub.7-10 arylalkyl-NHC(O)OR.sup.1a,
--heteroaryl-NHC(O)OR.sup.1a, and --C.sub.6-12
heteroarylalkyl-NHC(O)OR.sup.1a; wherein R.sup.1a is a substituted
or unsubstituted group selected from the group consisting of H,
C.sub.1-6 alkyl, C.sub.3-7 cycloalkyl, C.sub.4-10 cycloalkyl-alkyl,
aryl, C.sub.7-10 arylalkyl, heteroaryl, and C.sub.6-12
heteroarylalkyl.
2. The compound of claim 1 in which L consists of from 2 to 5
atoms.
3. The compound of claim 1 in which L comprises a --W--C(.dbd.V)--
group, where V and W are each individually selected from O, S or
NH.
4. The compound of claim 1 in which L is selected from the group
consisting of ester, amide, carbamate, thioester, and
thioamide.
5. The compound of claim 1 in which P.sub.2 is further positioned
by L to form a hydrogen bonding interaction with at least one NS3
protease S2 pocket moiety selected from the group consisting of
His57, Arg155, Va178, Asp79, and Gln80.
6. A pharmaceutical composition comprising a pharmaceutically
acceptable excipient and a compound according to claim 1.
7. A method of inhibiting NS3/NS4 protease activity comprising
contacting a NS3/NS4 protease with a compound according to claim
1.
8. The method of claim 7 in which the contacting is conducted in
vivo.
9. The method of claim 8, further comprising identifying a subject
suffering from a hepatitis C infection and administering the
compound to the subject in an amount effective to treat the
infection.
10. The method of claim 7, wherein the method further comprises
administering to an individual an effective amount of a nucleoside
analog.
11. The method of claim 10, wherein the nucleoside analog is
selected from ribavirin, levovirin, viramidine, an L-nucleoside,
and isatoribine.
12. The method of claim 9, wherein the method further comprises
administering to the subject an effective amount of a human
immunodeficiency virus 1 protease inhibitor.
13. The method of claim 12, wherein the protease inhibitor is
ritonavir.
14. The method of claim 9, wherein the method further comprises
administering to the subject an effective amount of an NS5B
RNA-dependent RNA polymerase inhibitor.
15. The method of claim 9, wherein the method further comprises
administering to the subject an effective amount of
interferon-gamma (IFN-.gamma.).
16. The method of claim 15, wherein the IFN-.gamma. is administered
subcutaneously in an amount of from about 10 .mu.g to about 300
.mu.g.
17. The method of claim 9, wherein the method further comprises
administering to the subject an effective amount of
interferon-alpha (IFN-.alpha.).
18. The method of claim 17, wherein the IFN-.alpha. is
monoPEG-ylated consensus IFN-.alpha. administered at a dosing
interval of every 8 days to every 14 days.
19. The method of claim 17, wherein the IFN-.alpha. is
monoPEG-ylated consensus IFN-.alpha. administered at a dosing
interval of once every 7 days.
20. The method of claim 17, wherein the IFN-.alpha. is INFERGEN
consensus IFN-.alpha..
21. The method of claim 9, further comprising administering an
effective amount of an agent selected from 3'-azidothymidine,
2',3'-dideoxyinosine, 2',3'-dideoxycytidine,
2-,3-didehydro-2',3'-dideoxythymidine, combivir, abacavir, adefovir
dipoxil, cidofovir, and an inosine monophosphate dehydrogenase
inhibitor.
22. The method of claim 9, wherein a sustained viral response is
achieved.
23. The method of claim 7, in which the contacting is conducted ex
vivo.
24. A method of of treating liver fibrosis in an individual, the
method comprising administering to the individual an effective
amount of a composition of claim 6.
25. The method of claim 24, wherein the method further comprises
administering to the individual an effective amount of a nucleoside
analog.
26. The method of claim 25, wherein the nucleoside analog is
selected from ribavirin, levovirin, viramidine, an L-nucleoside,
and isatoribine.
27. The method of claim 24, wherein the method further comprises
administering to the individual an effective amount of a human
immunodeficiency virus 1 protease inhibitor.
28. The method of method of claim 27, wherein the protease
inhibitor is ritonavir.
29. The method of claim 24, wherein the method further comprises
administering to the individual an effective amount of an NS5B
RNA-dependent RNA polymerase inhibitor.
30. The method of claim 24, wherein the method further comprises
administering to the individual an effective amount of
interferon-gamma (IFN-.gamma.).
31. The method of claim 30, wherein the IFN-.gamma. is administered
subcutaneously in an amount of from about 10 .mu.g to about 300
.mu.g.
32. The method of claim 24, wherein the method further comprises
administering to the individual an effective amount of
interferon-alpha (IFN-.alpha.).
33. The method of claim 32, wherein the IFN-.alpha. is
monoPEG-ylated consensus IFN-.alpha. administered at a dosing
interval of every 8 days to every 14 days.
34. The method of claim 32, wherein the IFN-.alpha. is
monoPEG-ylated consensus IFN-.alpha. administered at a dosing
interval of once every 7 days.
35. The method of claim 32, wherein the IFN-.alpha. is INFERGEN
consensus IFN-.alpha..
36. The method of claim 24, further comprising administering an
effective amount of an agent selected from 3'-azidothymidine,
2',3'-dideoxyinosine, 2',3'-dideoxycytidine,
2-,3-didehydro-2',3'-dideoxythymidine, combivir, abacavir, adefovir
dipoxil, cidofovir, and an inosine monophosphate dehydrogenase
inhibitor.
37. A method of increasing liver function in an individual having a
hepatitis C virus infection, the method comprising administering to
the individual an effective amount of a composition of claim 6.
38. The method of claim 37, wherein the method further comprises
administering to the individual an effective amount of a nucleoside
analog.
39. The method of claim 38, wherein the nucleoside analog is
selected from ribavirin, levovirin, viramidine, an L-nucleoside,
and isatoribine.
40. The method of claim 37, wherein the method further comprises
administering to the individual an effective amount of a human
immunodeficiency virus 1 protease inhibitor.
41. The method of method of claim 40, wherein the protease
inhibitor is ritonavir.
42. The method of claim 37, wherein the method further comprises
administering to the individual an effective amount of an NS5B
RNA-dependent RNA polymerase inhibitor.
43. The method of claim 37, wherein the method further comprises
administering to the individual an effective amount of
interferon-gamma (IFN-.gamma.).
44. The method of claim 43, wherein the IFN-.gamma. is administered
subcutaneously in an amount of from about 10 .mu.g to about 300
.mu.g.
45. The method of claim 37, wherein the method further comprises
administering to the individual an effective amount of
interferon-alpha (IFN-.alpha.).
46. The method of claim 45, wherein the IFN-.alpha. is
monoPEG-ylated consensus IFN-.alpha. administered at a dosing
interval of every 8 days to every 14 days.
47. The method of claim 45, wherein the IFN-.alpha. is
monoPEG-ylated consensus IFN-.alpha. administered at a dosing
interval of once every 7 days.
48. The method of claim 45, wherein the IFN-.alpha. is INFERGEN
consensus IFN-.alpha..
49. The method of claim 37, further comprising administering an
effective amount of an agent selected from 3'-azidothymidine,
2',3'-dideoxyinosine, 2',3'-dideoxycytidine,
2-,3-didehydro-2',3'-dideoxythymidine, combivir, abacavir, adefovir
dipoxil, cidofovir, and an inosine monophosphate dehydrogenase
inhibitor.
Description
RELATED APPLICATION
[0001] This application is a divisional of U.S. application Ser.
No. 11/773,912 filed Jul. 5, 2007, which claims the benefit of U.S.
Provisional Application Nos. 60/819,128, filed Jul. 6, 2006, and
60/818,914, filed Jul. 5, 2006, all of which are incorporated
herein by reference in their entirety.
BACKGROUND OF THE INVENTION
[0002] 1. Field of the Invention
[0003] The present invention relates to compounds, processes for
their synthesis, compositions and methods for the treatment of
hepatitis C virus (HCV) infection.
[0004] 2. Description of the Related Art
[0005] Hepatitis C virus (HCV) infection is the most common chronic
blood borne infection in the United States. Although the numbers of
new infections have declined, the burden of chronic infection is
substantial, with Centers for Disease Control estimates of 3.9
million (1.8%) infected persons in the United States. Chronic liver
disease is the tenth leading cause of death among adults in the
United States, and accounts for approximately 25,000 deaths
annually, or approximately 1% of all deaths. Studies indicate that
40% of chronic liver disease is HCV-related, resulting in an
estimated 8,000-10,000 deaths each year. HCV-associated end-stage
liver disease is the most frequent indication for liver
transplantation among adults.
[0006] Antiviral therapy of chronic hepatitis C has evolved rapidly
over the last decade, with significant improvements seen in the
efficacy of treatment. Nevertheless, even with combination therapy
using pegylated IFN-.alpha. plus ribavirin, 40% to 50% of patients
fail therapy, i.e., are nonresponders or relapsers. These patients
currently have no effective therapeutic alternative. In particular,
patients who have advanced fibrosis or cirrhosis on liver biopsy
are at significant risk of developing complications of advanced
liver disease, including ascites, jaundice, variceal bleeding,
encephalopathy, and progressive liver failure, as well as a
markedly increased risk of hepatocellular carcinoma.
[0007] The high prevalence of chronic HCV infection has important
public health implications for the future burden of chronic liver
disease in the United States. Data derived from the National Health
and Nutrition Examination Survey (NHANES III) indicate that a large
increase in the rate of new HCV infections occurred from the late
1960s to the early 1980s, particularly among persons between 20 to
40 years of age. It is estimated that the number of persons with
long-standing HCV infection of 20 years or longer could more than
quadruple from 1990 to 2015, from 750,000 to over 3 million. The
proportional increase in persons infected for 30 or 40 years would
be even greater. Since the risk of HCV-related chronic liver
disease is related to the duration of infection, with the risk of
cirrhosis progressively increasing for persons infected for longer
than 20 years, this will result in a substantial increase in
cirrhosis-related morbidity and mortality among patients infected
between the years of 1965-1985.
[0008] HCV is an enveloped positive strand RNA virus in the
Flaviviridae family. The single strand HCV RNA genome is
approximately 9500 nucleotides in lingth and has a single open
reading frame (ORF) encoding a single large polyprotein of about
3000 amino acids. In infected cells, this polyprotein is cleaved at
multiple sites by cellular and viral proteases to produce the
structural and non-structural (NS) proteins of the virus. In the
case of HCV, the generation of mature nonstructural proteins (NS2,
NS3, NS4, NS4A, NS4B, NS5A, and NS5B) is effected by two viral
proteases. The first viral protease cleaves at the NS2-NS3 junction
of the polyprotein. The second viral protease is serine protease
contained within the N-terminal region of NS3 (herein referred to
as "NS3 protease"). NS3 protease mediates all of the subsequent
cleavage events at sites downstream relative to the position of NS3
in the polyprotein (i.e., sites located between the C-terminus of
NS3 and the C-terminus of the polyprotein). NS3 protease exhibits
activity both in cis, at the NS3-NS4 cleavage site, and in trans,
for the remaining NS4A-NS4B, NS4B-NS5A, and NS5A-NS5B sites. The
NS4A protein is believed to serve multiple functions, acting as a
cofactor for the NS3 protease and possibly assisting in the
membrane localization of NS3 and other viral replicase components.
Apparently, the formation of the complex between NS3 and NS4A is
necessary for NS53-mediated processing events and enhances
proteolytic efficiency at all sites recognized by NS3. The NS3
protease also exhibits nucleoside triphosphatase and RNA helicase
activities. NS5B is an RNA-dependent RNA polymerase involved in the
replication of HCV RNA.
Literature
[0009] METAVIR (1994) Hepatology 20:15-20; Brunt (2000) Hepatol.
31:241-246; Alpini (1997) J. Hepatol. 27:371-380; Baroni et al.
(1996) Hepatol. 23:1189-1199; Czaja et al. (1989) Hepatol.
10:795-800; Grossman et al. (1998) J. Gastroenterol. Hepatol.
13:1058-1060; Rockey and Chung (1994) J. Invest. Med. 42:660-670;
Sakaida et al. (1998) J. Hepatol. 28:471-479; Shi et al. (1997)
Proc. Natl. Acad. Sci. USA 94:10663-10668; Baroni et al. (1999)
Liver 19:212-219; Lortat-Jacob et al. (1997) J. Hepatol.
26:894-903; Llorent et al. (1996) J. Hepatol. 24:555-563; U.S. Pat.
No. 5,082,659; European Patent Application EP 294,160; U.S. Pat.
No. 4,806,347; Balish et al. (1992) J. Infect. Diseases
166:1401-1403; Katayama et al. (2001) J. Viral Hepatitis 8:180-185;
U.S. Pat. No. 5,082,659; U.S. Pat. No. 5,190,751; U.S. Pat. No.
4,806,347; Wandl et al. (1992) Br. J. Haematol. 81:516-519;
European Patent Application No. 294,160; Canadian Patent No.
1,321,348; European Patent Application No. 276,120; Wandl et al.
(1992) Sem. Oncol. 19:88-94; Balish et al. (1992) J. Infectious
Diseases 166:1401-1403; Van Dijk et al. (1994) Int. J. Cancer
56:262-268; Sundmacher et al. (1987) Current Eye Res. 6:273-276;
U.S. Pat. Nos. 6,172,046; 6,245,740; 5,824,784; 5,372,808;
5,980,884; published international patent applications WO 96/21468;
WO 96/11953; WO 00/59929; WO 00/66623; WO2003/064416;
WO2003/064455; WO2003/064456; WO 97/06804; WO 98/17679; WO
98/22496; WO 97/43310; WO 98/46597; WO 98/46630; WO 99/07733; WO
99/07734, WO 00/09543; WO 00/09558; WO 99/38888; WO 99/64442; WO
99/50230; WO 95/33764; Torre et al. (2001) J. Med. Virol.
64:455-459; Bekkering et al. (2001) J. Hepatol. 34:435-440; Zeuzem
et al. (2001) Gastroenterol. 120:1438-1447; Zeuzem (1999) J.
Hepatol. 31:61-64; Keeffe and Hollinger (1997) Hepatol.
26:101S-107S; Wills (1990) Clin. Pharmacokinet. 19:390-399;
Heathcote et al. (2000) New Engl. J. Med. 343:1673-1680; Husa and
Husova (2001) Bratisl. Lek. Listy 102:248-252; Glue et al. (2000)
Clin. Pharmacol. 68:556-567; Bailon et al. (2001) Bioconj. Chem.
12:195-202; and Neumann et al. (2001) Science 282:103; Zalipsky
(1995) Adv. Drug Delivery Reviews S. 16, 157-182; Mann et al.
(2001) Lancet 358:958-965; Zeuzem et al. (2000) New Engl. J Med.
343:1666-1672; U.S. Pat. Nos. 5,633,388; 5,866,684; 6,018,020;
5,869,253; 6,608,027; 5,985,265; 5,908,121; 6,177,074; 5,985,263;
5,711,944; 5,382,657; and 5,908,121; Osborn et al. (2002) J.
Pharmacol. Exp. Therap. 303:540-548; Sheppard et al. (2003) Nat.
Immunol. 4:63-68; Chang et al. (1999) Nat. Biotechnol. 17:793-797;
Adolf (1995) Multiple Sclerosis 1 Suppl. 1:S44-S47; Chu et al.,
Tet. Lett. (1996), 7229-7232; Ninth Conference on Antiviral
Research, Urabandai, Fukyshima, Japan (1996) (Antiviral Research,
(1996), 30: 1, A23 (abstract 19)); Steinkuhler et al., Biochem.,
37: 8899-8905; Ingallinella et al., Biochem., 37: 8906-8914.
SUMMARY OF THE INVENTION
[0010] The present embodiments provide compounds of the general
Formula I:
##STR00001## [0011] or a pharmaceutically acceptable salt, prodrug,
or ester thereof wherein: [0012] R.sup.1 and R.sup.2 are each
independently substituted or unsubstituted groups selected from H,
halogen, CN, CF.sub.3, C.sub.1-8 alkoxyl, C.sub.1-8 alkyl,
C.sub.3-7 cycloalkyl, C.sub.4-10 cycloalkyl-alkyl, C.sub.7-10
arylalkyl, or C.sub.6-12 heteroarylalkyl, or R.sup.1 and R.sup.2
taken together form a substituted or unsubstituted C.sub.3-7
cycloalkyl, aryl or heteroaryl ring; [0013] R.sup.3 and R.sup.4 are
each independently substituted or unsubstituted moieties selected
from the group consisting of H, C.sub.1-8 alkyl, C.sub.3-7
cycloalkyl, C.sub.4-10 cycloalkyl-alkyl, C.sub.7-10 arylalkyl, and
C.sub.6-12 heteroarylalkyl, or R.sup.3 and R.sup.4 taken together
form a substituted or unsubstituted C.sub.3-7 cycloalkyl ring;
[0014] R.sup.5 is a substituted or unsubstituted moiety selected
from the group consisting of H, C.sub.1-8 alkyl, C.sub.3-7
cycloalkyl, C.sub.4-10 cycloalkyl-alkyl, aryl, C.sub.7-10
arylalkyl, heteroaryl, C.sub.6-12 heteroarylalkyl, --C.sub.1-8
alkyl-NHC(O)OR.sup.1a, --C.sub.3-7 cycloalkyl-NHC(O)OR.sup.1a,
--C.sub.4-10 cycloalkyl-alkyl-NHC(O)OR.sup.1a,
-aryl-NHC(O)OR.sup.1a, --C.sub.7-10 arylalkyl-NHC(O)OR.sup.1a,
-heteroaryl-NHC(O)OR.sup.1a, and --C.sub.6-12
heteroarylalkyl-NHC(O)OR.sup.1a; [0015] Y has a formula selected
from the group consisting of --C(O)NHS(O).sub.2R.sup.1a,
--C(O)NHS(O).sub.2NR.sup.1aR.sup.1b, --C(O)C(O)NR.sup.1aR.sup.1b,
C(O)C(O)OH, --C(O)NHR.sup.1a, --C(O)R.sup.1a, --C(O)OR.sup.1a,
--C(O)NHC(O)R.sup.1a and --C(O)OH; [0016] wherein R.sup.1a and
R.sup.1b are each independently substituted or unsubstituted groups
selected from the group consisting of H, C.sub.1-6 alkyl, C.sub.3-7
cycloalkyl, C.sub.4-10 cycloalkyl-alkyl, aryl, C.sub.7-10
arylalkyl, heteroaryl, and C.sub.6-12 heteroarylalkyl, or
NR.sup.1aR.sup.1b forms a substituted or unsubstituted three- to
six-membered alkyl cyclic secondary amine, or NR.sup.1aR.sup.1b is
a heteroaryl or heterocyclic ring.
[0017] The present embodiments provide compounds of the general
Formula II:
##STR00002## [0018] or a pharmaceutically acceptable salt, prodrug,
or ester thereof wherein: [0019] (a) Z.sub.1 is a group configured
to hydrogen bond to an NS3 protease His57 imidazole moiety and to
hydrogen bond to a NS3 protease G1y137 nitrogen atom; [0020] (b)
P.sub.1' is a group configured to form a non-polar interaction with
at least one NS3 protease S1' pocket moiety selected from the group
consisting of Lys136, Gly137, Ser138, His57, Gly58, Gln41, Gly42,
and Phe43; [0021] (c) L is a linker group consisting of from 1 to 5
atoms selected from the group consisting of carbon, oxygen,
nitrogen, hydrogen, and sulfur; [0022] (d) P.sub.2 is selected from
the group consisting of unsubstituted aryl, substituted aryl,
unsubstituted heteroaryl, substituted heteroaryl, unsubstituted
heterocyclic and substituted heterocyclic; P.sub.2 being positioned
by L to form a non-polar interaction with at least one NS3 protease
S2 pocket moiety selected from the group consisting of His57,
Arg155, Va178, Asp79, and Gln80; and [0023] (e) R.sup.5 is a
substituted or unsubstituted moiety selected from the group
consisting of H, C.sub.1-8 alkyl, C.sub.3-7 cycloalkyl, C.sub.4-10
cycloalkyl-alkyl, aryl, C.sub.7-10 arylalkyl, heteroaryl,
C.sub.6-12 heteroarylalkyl, --C.sub.1-8 alkyl-NHC(O)OR.sup.1a,
--C.sub.3-7 cycloalkyl-NHC(O)OR.sup.1a, --C.sub.4-10
cycloalkyl-alkyl-NHC(O)OR.sup.1a, --aryl-NHC(O)OR.sup.1a,
--C.sub.7-10 arylalkyl-NHC(O)OR.sup.1a,
--heteroaryl-NHC(O)OR.sup.1a, and --C.sub.6-12
heteroarylalkyl-NHC(O)OR.sup.1a; [0024] wherein R.sup.1a is a
substituted or unsubstituted group selected from the group
consisting of H, C.sub.1-6 alkyl, C.sub.3-7 cycloalkyl, C.sub.4-10
cycloalkyl-alkyl, aryl, C.sub.7-10 arylalkyl, heteroaryl, and
C.sub.6-12 heteroarylalkyl.
[0025] The present embodiments provide compounds of the general
Formula III:
##STR00003## [0026] or a pharmaceutically acceptable salt, prodrug,
or ester thereof wherein: [0027] A is OH or
[0027] ##STR00004## [0028] R.sup.3 and R.sup.4 are each
independently substituted or unsubstituted moieties selected from
the group consisting of H, C.sub.1-8 alkyl, C.sub.3-7 cycloalkyl,
C.sub.4-10 cycloalkyl-alkyl, C.sub.7-10 arylalkyl, and C.sub.6-12
heteroarylalkyl, or R.sup.3 and R.sup.4 taken together form a
substituted or unsubstituted C.sub.3-7 cycloalkyl ring; [0029]
R.sup.5a is a substituted or unsubstituted moiety selected from the
group consisting of H, C.sub.1-8 alkyl, C.sub.3-7 cycloalkyl,
C.sub.4-10 cycloalkyl-alkyl, aryl, C.sub.7-10 arylalkyl,
heteroaryl, and C.sub.6-12 heteroarylalkyl; [0030] Y has a formula
selected from the group consisting of --C(O)NHS(O).sub.2R.sup.1a,
--C(O)NHS(O).sub.2NR.sup.1aR.sup.1b, --C(O)C(O)NR.sup.1aR.sup.1b,
C(O)C(O)OH, --C(O)NHR.sup.1a, --C(O)R.sup.1a, --C(O)OR.sup.1a,
--C(O)NHC(O)R.sup.1a and --C(O)OH; [0031] wherein R.sup.1a and
R.sup.1b are each independently substituted or unsubstituted groups
selected from the group consisting of H, C.sub.1-6 alkyl, C.sub.3-7
cycloalkyl, C.sub.4-10 cycloalkyl-alkyl, aryl, C.sub.7-10
arylalkyl, heteroaryl, and C.sub.6-12 heteroarylalkyl, or
NR.sup.1aR.sup.1b forms a substituted or unsubstituted three- to
six-membered alkyl cyclic secondary amine, or NR.sup.1aR.sup.1b is
a heteroaryl or heterocyclic ring; and [0032] Z is CH.sub.2 or has
a formula selected from the group consisting of >NC(O)R.sup.2a,
>NC(O)OR.sup.2a, >NC(O)NR.sup.2aR.sup.2b,
>NS(O).sub.2NR.sup.2aR.sup.2b, and >NR.sup.2a; [0033] wherein
R.sup.2a and R.sup.2b are each independently substituted or
unsubstituted groups selected from the group consisting of H,
C.sub.1-6 alkyl, C.sub.3-7 cycloalkyl, C.sub.4-10 cycloalkyl-alkyl,
aryl, C.sub.7-10 arylalkyl, heteroaryl, and C.sub.6-12
heteroarylalkyl, or NR.sup.2aR.sup.2b forms a substituted or
unsubstituted three- to six-membered alkyl cyclic secondary amine,
or NR.sup.2aR.sup.2b is a heteroaryl or heterocyclic ring.
[0034] The present embodiments provide for a method of inhibiting
NS3/NS4 protease activity comprising contacting a NS3/NS4 protease
with a compound disclosed herein.
[0035] The present embodiments provide for a method of treating
hepatitis by modulating NS3/NS4 protease comprising contacting a
NS3/NS4 protease with a compound disclosed herein.
[0036] Preferred embodiments provide a pharmaceutical composition
comprising: a) a preferred compound; and b) a pharmaceutically
acceptable carrier.
[0037] Preferred embodiments provide a method of treating a
hepatitis C virus infection in an individual, the method comprising
administering to the individual an effective amount of a
composition comprising a preferred compound.
[0038] Preferred embodiments provide a method of treating liver
fibrosis in an individual, the method comprising administering to
the individual an effective amount of a composition comprising a
preferred compound.
[0039] Preferred embodiments provide a method of increasing liver
function in an individual having a hepatitis C virus infection, the
method comprising administering to the individual an effective
amount of a composition comprising a preferred compound.
DETAILED DESCRIPTION OF THE EMBODIMENTS
Definitions
[0040] As used herein, the term "hepatic fibrosis," used
interchangeably herein with "liver fibrosis," refers to the growth
of scar tissue in the liver that can occur in the context of a
chronic hepatitis infection.
[0041] The terms "individual," "host," "subject," and "patient" are
used interchangeably herein, and refer to a mammal, including, but
not limited to, primates, including simians and humans.
[0042] As used herein, the term "liver function" refers to a normal
function of the liver, including, but not limited to, a synthetic
function, including, but not limited to, synthesis of proteins such
as serum proteins (e.g., albumin, clotting factors, alkaline
phosphatase, aminotransferases (e.g., alanine transaminase,
aspartate transaminase), 5'-nucleosidase,
.gamma.-glutaminyltranspeptidase, etc.), synthesis of bilirubin,
synthesis of cholesterol, and synthesis of bile acids; a liver
metabolic function, including, but not limited to, carbohydrate
metabolism, amino acid and ammonia metabolism, hormone metabolism,
and lipid metabolism; detoxification of exogenous drugs; a
hemodynamic function, including splanchnic and portal hemodynamics;
and the like.
[0043] The term "sustained viral response" (SVR; also referred to
as a "sustained response" or a "durable response"), as used herein,
refers to the response of an individual to a treatment regimen for
HCV infection, in terms of serum HCV titer. Generally, a "sustained
viral response" refers to no detectable HCV RNA (e.g., less than
about 500, less than about 200, or less than about 100 genome
copies per milliliter serum) found in the patient's serum for a
period of at least about one month, at least about two months, at
least about three months, at least about four months, at least
about five months, or at least about six months following cessation
of treatment.
[0044] "Treatment failure patients" as used herein generally refers
to HCV-infected patients who failed to respond to previous therapy
for HCV (referred to as "non-responders") or who initially
responded to previous therapy, but in whom the therapeutic response
was not maintained (referred to as "relapsers"). The previous
therapy generally can include treatment with IFN-.alpha.
monotherapy or IFN-.alpha. combination therapy, where the
combination therapy may include administration of IFN-.alpha. and
an antiviral agent such as ribavirin.
[0045] As used herein, the terms "treatment," "treating," and the
like, refer to obtaining a desired pharmacologic and/or physiologic
effect. The effect may be prophylactic in terms of completely or
partially preventing a disease or symptom thereof and/or may be
therapeutic in terms of a partial or complete cure for a disease
and/or adverse affect attributable to the disease. "Treatment," as
used herein, covers any treatment of a disease in a mammal,
particularly in a human, and includes: (a) preventing the disease
from occurring in a subject which may be predisposed to the disease
but has not yet been diagnosed as having it; (b) inhibiting the
disease, i.e., arresting its development; and (c) relieving the
disease, i.e., causing regression of the disease.
[0046] The terms "individual," "host," "subject," and "patient" are
used interchangeably herein, and refer to a mammal, including, but
not limited to, murines, simians, humans, mammalian farm animals,
mammalian sport animals, and mammalian pets.
[0047] As used herein, the term "a Type I interferon receptor
agonist" refers to any naturally occurring or non-naturally
occurring ligand of human Type I interferon receptor, which binds
to and causes signal transduction via the receptor. Type I
interferon receptor agonists include interferons, including
naturally-occurring interferons, modified interferons, synthetic
interferons, pegylated interferons, fusion proteins comprising an
interferon and a heterologous protein, shuffled interferons;
antibody specific for an interferon receptor; non-peptide chemical
agonists; and the like.
[0048] As used herein, the term "Type II interferon receptor
agonist" refers to any naturally occurring or non-naturally
occurring ligand of human Type II interferon receptor that binds to
and causes signal transduction via the receptor. Type II interferon
receptor agonists include native human interferon-y, recombinant
IFN-.gamma. species, glycosylated IFN-.gamma. species, pegylated
IFN-.gamma. species, modified or variant IFN-.gamma. species,
IFN-.gamma. fusion proteins, antibody agonists specific for the
receptor, non-peptide agonists, and the like.
[0049] As used herein, the term "a Type III interferon receptor
agonist" refers to any naturally occurring or non-naturally
occurring ligand of humanlL-28 receptor .alpha. ("IL-28R"), the
amino acid sequence of which is described by Sheppard, et al.,
infra., that binds to and causes signal transduction via the
receptor.
[0050] As used herein, the term "interferon receptor agonist"
refers to any Type I interferon receptor agonist, Type II
interferon receptor agonist, or Type III interferon receptor
agonist.
[0051] The term "dosing event" as used herein refers to
administration of an antiviral agent to a patient in need thereof,
which event may encompass one or more releases of an antiviral
agent from a drug dispensing device. Thus, the term "dosing event,"
as used herein, includes, but is not limited to, installation of a
continuous delivery device (e.g., a pump or other controlled
release injectible system); and a single subcutaneous injection
followed by installation of a continuous delivery system.
[0052] "Continuous delivery" as used herein (e.g., in the context
of "continuous delivery of a substance to a tissue") is meant to
refer to movement of drug to a delivery site, e.g., into a tissue
in a fashion that provides for delivery of a desired amount of
substance into the tissue over a selected period of time, where
about the same quantity of drug is received by the patient each
minute during the selected period of time.
[0053] "Controlled release" as used herein (e.g., in the context of
"controlled drug release") is meant to encompass release of
substance (e.g., a Type I or Type III interferon receptor agonist,
e.g., IFN-.alpha.) at a selected or otherwise controllable rate,
interval, and/or amount, which is not substantially influenced by
the environment of use. "Controlled release" thus encompasses, but
is not necessarily limited to, substantially continuous delivery,
and patterned delivery (e.g., intermittent delivery over a period
of time that is interrupted by regular or irregular time
intervals).
[0054] "Patterned" or "temporal" as used in the context of drug
delivery is meant delivery of drug in a pattern, generally a
substantially regular pattern, over a pre-selected period of time
(e.g., other than a period associated with, for example a bolus
injection). "Patterned" or "temporal" drug delivery is meant to
encompass delivery of drug at an increasing, decreasing,
substantially constant, or pulsatile, rate or range of rates (e.g.,
amount of drug per unit time, or volume of drug formulation for a
unit time), and further encompasses delivery that is continuous or
substantially continuous, or chronic.
[0055] The term "controlled drug delivery device" is meant to
encompass any device wherein the release (e.g., rate, timing of
release) of a drug or other desired substance contained therein is
controlled by or determined by the device itself and not
substantially influenced by the environment of use, or releasing at
a rate that is reproducible within the environment of use.
[0056] By "substantially continuous" as used in, for example, the
context of "substantially continuous infusion" or "substantially
continuous delivery" is meant to refer to delivery of drug in a
manner that is substantially uninterrupted for a pre-selected
period of drug delivery, where the quantity of drug received by the
patient during any 8 hour interval in the pre-selected period never
falls to zero. Furthermore, "substantially continuous" drug
delivery can also encompass delivery of drug at a substantially
constant, pre-selected rate or range of rates (e.g., amount of drug
per unit time, or volume of drug formulation for a unit time) that
is substantially uninterrupted for a pre-selected period of drug
delivery.
[0057] By "substantially steady state" as used in the context of a
biological parameter that may vary as a function of time, it is
meant that the biological parameter exhibits a substantially
constant value over a time course, such that the area under the
curve defined by the value of the biological parameter as a
function of time for any 8 hour period during the time course
(AUC8hr) is no more than about 20% above or about 20% below, and
preferably no more than about 15% above or about 15% below, and
more preferably no more than about 10% above or about 10% below,
the average area under the curve of the biological parameter over
an 8 hour period during the time course (AUC8hr average). The
AUC8hr average is defined as the quotient (q) of the area under the
curve of the biological parameter over the entirety of the time
course (AUCtotal) divided by the number of 8 hour intervals in the
time course (total/3 days), i.e., q=(AUCtotal)/(total/3days). For
example, in the context of a serum concentration of a drug, the
serum concentration of the drug is maintained at a substantially
steady state during a time course when the area under the curve of
serum concentration of the drug over time for any 8 hour period
during the time course (AUC8hr) is no more than about 20% above or
about 20% below the average area under the curve of serum
concentration of the drug over an 8 hour period in the time course
(AUC8hr average), i.e., the AUC8hr is no more than 20% above or 20%
below the AUC8hr average for the serum concentration of the drug
over the time course.
[0058] The term "alkyl" used herein refers to a monovalent straight
or branched chain radical of from one to twenty carbon atoms,
including, but not limited to, methyl, ethyl, n-propyl, isopropyl,
n-butyl, isobutyl, tert-butyl, n-hexyl, and the like.
[0059] The term "halo" used herein refers to fluoro, chloro, bromo,
or iodo.
[0060] The term "alkoxy" used herein refers to straight or branched
chain alkyl radical covalently bonded to the parent molecule
through an --O-- linkage. Examples of alkoxy groups include, but
are not limited to, methoxy, ethoxy, propoxy, isopropoxy, butoxy,
n-butoxy, sec-butoxy, t-butoxy and the like.
[0061] The term "alkenyl" used herein refers to a monovalent
straight or branched chain radical of from two to twenty carbon
atoms containing a carbon double bond including, but not limited
to, 1-propenyl, 2-propenyl, 2-methyl-1-propenyl, 1-butenyl,
2-butenyl, and the like.
[0062] The term "alkynyl" used herein refers to a monovalent
straight or branched chain radical of from two to twenty carbon
atoms containing a carbon triple bond including, but not limited
to, 1-propynyl, 1-butynyl, 2-butynyl, and the like.
[0063] The term "aryl" used herein refers to homocyclic aromatic
radical whether fused or not fused. Examples of aryl groups
include, but are not limited to, phenyl, naphthyl, biphenyl,
phenanthrenyl, naphthacenyl, and the like.
[0064] The term "cycloalkyl" used herein refers to saturated
aliphatic ring system radical having three to twenty carbon atoms
including, but not limited to, cyclopropyl, cyclopentyl,
cyclohexyl, cycloheptyl, and the like.
[0065] The term "cycloalkenyl" used herein refers to aliphatic ring
system radical having three to twenty carbon atoms having at least
one carbon-carbon double bond in the ring. Examples of cycloalkenyl
groups include, but are not limited to, cyclopropenyl,
cyclopentenyl, cyclohexenyl, cycloheptenyl, and the like.
[0066] The term "polycycloalkyl" used herein refers to saturated
aliphatic ring system radical having at least two rings that are
fused with or without bridgehead carbons. Examples of
polycycloalkyl groups include, but are not limited to,
bicyclo[4.4.0]decanyl, bicyclo[2.2.1]heptanyl, adamantyl,
norbornyl, and the like.
[0067] The term "polycycloalkenyl" used herein refers to aliphatic
ring system radical having at least two rings that are fused with
or without bridgehead carbons in which at least one of the rings
has a carbon-carbon double bond. Examples of polycycloalkenyl
groups include, but are not limited to, norbornylenyl,
1,1'-bicyclopentenyl, and the like.
[0068] The term "polycyclic hydrocarbon" used herein refers to a
ring system radical in which all of the ring members are carbon
atoms. Polycyclic hydrocarbons can be aromatic or can contain less
than the maximum number of non-cumulative double bonds. Examples of
polycyclic hydrocarbon include, but are not limited to, naphthyl,
dihydronaphthyl, indenyl, fluorenyl, and the like.
[0069] The term "heterocyclic" or "heterocyclyl" used herein refers
to cyclic ring system radical having at least one ring system in
which one or more ring atoms are not carbon, namely heteroatom.
Heterocycles can be nonaromatic or aromatic. Examples of
heterocyclic groups include, but are not limited to, morpholinyl,
tetrahydrofuranyl, dioxolanyl, pyrolidinyl, oxazolyl, pyranyl,
pyridyl, pyrimidinyl, pyrrolyl, and the like.
[0070] The term "heteroaryl" used herein refers to heterocyclic
group, whether one or more rings, formally derived from an arene by
replacement of one or more methine and/or vinylene groups by
trivalent or divalent heteroatoms, respectively, in such a way as
to maintain the aromatic system in one or more rings. Examples of
heteroaryl groups include, but are not limited to, pyridyl,
pyrrolyl, oxazolyl, indolyl, and the like.
[0071] The term "arylalkyl" used herein refers to one or more aryl
groups appended to an alkyl radical. Examples of arylalkyl groups
include, but are not limited to, benzyl, phenethyl, phenpropyl,
phenbutyl, and the like.
[0072] The term "cycloalkylalkyl" used herein refers to one or more
cycloalkyl groups appended to an alkyl radical. Examples of
cycloalkylalkyl include, but are not limited to, cyclohexylmethyl,
cyclohexylethyl, cyclopentylmethyl, cyclopentylethyl, and the
like.
[0073] The term "heteroarylalkyl" used herein refers to one or more
heteroaryl groups appended to an alkyl radical. Examples of
heteroarylalkyl include, but are not limited to, pyridylmethyl,
furanylmethyl, thiophenylethyl, and the like.
[0074] The term "heterocyclylalkyl" used herein refers to one or
more heterocyclyl groups appended to an alkyl radical. Examples of
heterocyclylalkyl include, but are not limited to,
morpholinylmethyl, morpholinylethyl, morpholinylpropyl,
tetrahydrofuranylmethyl, pyrrolidinylpropyl, and the like.
[0075] he term "aryloxy" used herein refers to an aryl radical
covalently bonded to the parent molecule through an --O--
linkage.
[0076] The term "alkylthio" used herein refers to straight or
branched chain alkyl radical covalently bonded to the parent
molecule through an --S-- linkage. Examples of alkoxy groups
include, but are not limited to, methoxy, ethoxy, propoxy,
isopropoxy, butoxy, n-butoxy, sec-butoxy, t-butoxy and the
like.
[0077] The term "arylthio" used herein refers to an aryl radical
covalently bonded to the parent molecule through an --S--
linkage.
[0078] The term "alkylamino" used herein refers to nitrogen radical
with one or more alkyl groups attached thereto. Thus,
monoalkylamino refers to nitrogen radical with one alkyl group
attached thereto and dialkylamino refers to nitrogen radical with
two alkyl groups attached thereto.
[0079] The term "cyanoamino" used herein refers to nitrogen radical
with nitrile group attached thereto.
[0080] The term "carbamyl" used herein refers to RNHCOO--.
[0081] The term "keto" and "carbonyl" used herein refers to
C.dbd.O.
[0082] The term "carboxy" used herein refers to --COOH.
[0083] The term "sulfamyl" used herein refers to
--SO.sub.2NH.sub.2.
[0084] The term "sulfonyl" used herein refers to --SO.sub.2--.
[0085] The term "sulfinyl" used herein refers to --SO--.
[0086] The term "thiocarbonyl" used herein refers to C.dbd.S.
[0087] The term "thiocarboxy" used herein refers to CSOH.
[0088] As used herein, a radical indicates species with a single,
unpaired electron such that the species containing the radical can
be covalently bonded to another species. Hence, in this context, a
radical is not necessarily a free radical. Rather, a radical
indicates a specific portion of a larger molecule. The term
"radical" can be used interchangeably with the term "group."
[0089] As used herein, a substituted group is derived from the
unsubstituted parent structure in which there has been an exchange
of one or more hydrogen atoms for another atom or group. When
substituted, the substituent group(s) is (are) one or more group(s)
individually and independently selected from C.sub.1-C.sub.6 alkyl,
C.sub.1-C.sub.6 alkenyl, C.sub.1-C.sub.6 alkynyl, C.sub.3-C.sub.6
cycloalkyl, C.sub.3-C.sub.6 heterocycloalkyl (e.g.,
tetrahydrofuryl), aryl, heteroaryl, halo (e.g., chloro, bromo, iodo
and fluoro), cyano, hydroxy, C.sub.1-C.sub.6 alkoxy, aryloxy,
sulfhydryl (mercapto), C.sub.1-C.sub.6 alkylthio, arylthio, mono-
and di-(C.sub.1-C.sub.6)alkyl amino, quaternary ammonium salts,
amino(C.sub.1-C.sub.6)alkoxy, hydroxy(C.sub.1-C.sub.6)alkylamino,
amino(C.sub.1-C.sub.6)alkylthio, cyanoamino, nitro, carbamyl,
keto(oxy), carbonyl, carboxy, glycolyl, glycyl, hydrazino, guanyl,
sulfamyl, sulfonyl, sulfinyl, thiocarbonyl, thiocarboxy, and
combinations thereof. The protecting groups that can form the
protective derivatives of the above substituents are known to those
of skill in the art and can be found in references such as Greene
and Wuts Protective Groups in Organic Synthesis; John Wiley and
Sons: New York, 1999. Wherever a substituent is described as
"optionally substituted" that substituent can be substituted with
the above substituents.
[0090] As used herein, "hydrogen bond" refers to an attractive
force between an electronegative atom (such as oxygen, nitrogen,
sulfur or halogen) and a hydrogen atom which is linked covalently
to another electronegative atom (such as oxygen, nitrogen, sulfur
or halogen). See, e.g., Stryer et. al. "Biochemistry", Fith Edition
2002, Freeman & Co. N.Y. Typically, the hydrogen bond is
between a hydrogen atom and two unshared electrons of another atom.
A hydrogen bond between hydrogen and an electronegative atom not
covalently bound to the hydrogen may be present when the hydrogen
atom is at a distance of about 2.5 angstroms to about 3.8 angstroms
from the not-covalently bound electronegative atom, and the angle
formed by the three atoms (electronegative atom covalently bound to
hydrogen, hydrogen, and electronegative atom not-covalently bound
electronegative atom) deviates from 180 degrees by about 45 degrees
or less. The distance between the hydrogen atom and the
not-covalently bound electronegative atom may be referred to herein
as the "hydrogen bond length," and the the angle formed by the
three atoms (electronegative atom covalently bound to hydrogen,
hydrogen, and electronegative atom not-covalently bound
electronegative atom) may be referred to herein as the "hydrogen
bond angle." In some instances, stronger hydrogen bonds are formed
when the hydrogen bond length is shorter; thus, in some instances,
hydrogen bond lengths may range from about 2.7 angstroms to about
3.6 angstroms, or about 2.9 angstroms to about 3.4 angstroms. In
some instances, stronger hydrogen bonds are formed when the
hydrogen bond angle is closer to being linear; thus, in some
instances, hydrogen bond angles may deviate from 180 degrees by
about 25 degrees or less, or by about 10 degrees or less.
[0091] As used herein, "non-polar interaction" refers to proximity
of non-polar molecules or moieties, or proximity of molecules or
moieties with low polarity, sufficient for van der Waals
interaction between the moieties and/or sufficient to exclude polar
solvent molecules such as water molecules. See, e.g., Stryer et.
al. "Biochemistry", Fith Edition 2002, Freeman & Co. N.Y.
Typically, the distance between atoms (excluding hydrogen atoms) of
non-polar interacting moieties may range from about 2.9 angstroms
to about 6 angstroms. In some instances, the space separating
non-polar interacting moieties is less than the space that would
accommodate a water molecule. As used herein a non-polar moiety or
moiety with low polarity refers to moieties with low dipolar
moments (typically dipolar moments less than the dipolar moment of
O--H bonds of H.sub.2O and N--H bonds of NH.sub.3) and/or moieties
that are not typically present in hydrogen bonding or electrostatic
interactions. Exemplary moieties with low polarity are alkyl,
alkenyl, and unsubstituted aryl moieties.
[0092] As used herein, an NS3 protease S1' pocket moiety refers to
a moiety of the NS3 protease that interacts with the amino acid
positioned one residue C-terminal to the cleavage site of the
substrate polypeptide cleaved by NS3 protease (e.g., the NS3
protease moieties that interact with amino acid S in the
polypeptide substrate DLEVVT-STWVLV). Exemplary moieties include,
but are not limited to, atoms of the peptide backbone or side
chains of amino acids Lys136, Gly137, Ser139, His57, Gly58, Gln41,
Ser42, and Phe43, see Yao. et. al., Structure 1999, 7, 1353.
[0093] As used herein, an NS3 protease S2 pocket moiety refers to a
moiety of the NS3 protease that interacts with the amino acid
positioned two residues N-terminal to the cleavage site of the
substrate polypeptide cleaved by NS3 protease (e.g., the NS3
protease moieties that interact with amino acid V in the
polypeptide substrate DLEVVT-STWVLV). Exemplary moieties include,
but are not limited to, atoms of the peptide backbone or side
chains of amino acids His57, Arg155, Va178, Asp79, Gln80 and Asp81,
see Yao. et. al., Structure 1999, 7, 1353.
[0094] As used herein, a first moiety "positioned by" a second
moiety refers to the spatial orientation of a first moiety as
determined by the properties of a second moiety to which the first
atom or moiety is covalently bound. For example, a phenyl carbon
may position an oxygen atom bonded to the phenyl carbon in a
spatial position such that the oxygen atom hydrogen bonds with a
hydroxyl moiety in an NS3 active site.
[0095] As employed herein, the following terms have their accepted
meaning in the chemical literature.
[0096] anhyd. anhydrous
[0097] aq. aqueous
[0098] Boc tert-Butoxycarbonyl
[0099] Bu n-Butyl
[0100] Bz benzoyl
[0101] Cat. Catalytic
[0102] CDI 1,1' -carbonyldiimidazole
[0103] .degree. C. Temperature in degrees Centigrade
[0104] DBU 1,8-Diazabicyclo(5.4.0)undec-7-Ene
[0105] DCC 1,3-Dicyclohexylcarbodiimide
[0106] DCE 1,2-Dichloroethane
[0107] DCM Dichloromethane
[0108] DIEA Diisopropylethylamine
[0109] DMF N,N-Dimethylformamide
[0110] DMF N,N-Dimethylformamide
[0111] DMSO Dimethyl sulfoxide
[0112] Et.sub.2O Diethyl ether
[0113] EtOAc Ethyl acetate
[0114] EtOH Ethanol
[0115] HATU N,N,N,N-Tetramethyl-O-(7-azabenzotriazol-1-yl)uronium
hexafluorophosphate
[0116] MeOH Methanol
[0117] MeCN Acetonitrile
[0118] NBS N-bromosuccinimide
[0119] NH.sub.4OAc Ammonium acetate
[0120] Ph Phenyl
[0121] R.sub.f Retardation factor (chromatography)
[0122] rt room temperature
[0123] TEA Triethylamine
[0124] Tert tertiary
[0125] THF Tetrahydrofuran
[0126] TLC Thin-layer chromatography
[0127] Asymmetric carbon atoms may be present in the compounds
described. All such isomers, including diastereomers and
enantiomers, as well as the mixtures thereof are intended to be
included in the scope of the recited compound. In certain cases,
compounds can exist in tautomeric forms. All tautomeric forms are
intended to be included in the scope. Likewise, when compounds
contain an alkenyl or alkenylene group, there exists the
possibility of cis- and trans-isomeric forms of the compounds. Both
cis- and trans-isomers, as well as the mixtures of cis- and
trans-isomers, are contemplated. Thus, reference herein to a
compound includes all of the aforementioned isomeric forms unless
the context clearly dictates otherwise.
[0128] Various forms are included in the embodiments, including
polymorphs, solvates, hydrates, conformers, salts, and prodrug
derivatives. A polymorph is a composition having the same chemical
formula, but a different structure. A solvate is a composition
formed by solvation (the combination of solvent molecules with
molecules or ions of the solute). A hydrate is a compound formed by
an incorporation of water. A conformer is a structure that is a
conformational isomer. Conformational isomerism is the phenomenon
of molecules with the same structural formula but different
conformations (conformers) of atoms about a rotating bond. Salts of
compounds can be prepared by methods known to those skilled in the
art. For example, salts of compounds can be prepared by reacting
the appropriate base or acid with a stoichiometric equivalent of
the compound. A prodrug is a compound that undergoes
biotransformation (chemical conversion) before exhibiting its
pharmacological effects. For example, a prodrug can thus be viewed
as a drug containing specialized protective groups used in a
transient manner to alter or to eliminate undesirable properties in
the parent molecule. Thus, reference herein to a compound includes
all of the aforementioned forms unless the context clearly dictates
otherwise.
[0129] Where a range of values is provided, it is understood that
each intervening value, to the tenth of the unit of the lower limit
unless the context clearly dictates otherwise, between the upper
and lower limit of that range and any other stated or intervening
value in that stated range is encompassed within the embodiments.
The upper and lower limits of these smaller ranges may
independently be included in the smaller ranges is also encompassed
within the invention, subject to any specifically excluded limit in
the stated range. Where the stated range includes one or both of
the limits, ranges excluding either both of those included limits
are also included in the embodiments.
[0130] Unless defined otherwise, all technical and scientific terms
used herein have the same meaning as commonly understood by one of
ordinary skill in the art to which the embodiments belong. Although
any methods and materials similar or equivalent to those described
herein can also be used in the practice or testing of the
embodiments, the preferred methods and materials are now described.
All publications mentioned herein are incorporated herein by
reference to disclose and describe the methods and/or materials in
connection with which the publications are cited.
[0131] It must be noted that as used herein and in the appended
claims, the singular forms "a," "and," and "the" include plural
referents unless the context clearly dictates otherwise. Thus, for
example, reference to "a method" includes a plurality of such
methods and reference to "a dose" includes reference to one or more
doses and equivalents thereof known to those skilled in the art,
and so forth.
[0132] The present embodiments provide compounds of Formula I, as
well as pharmaceutical compositions and formulations comprising any
compound of Formula I. A subject compound is useful for treating
HCV infection and other disorders, as discussed below.
[0133] The present embodiments provide compounds of Formula II, as
well as pharmaceutical compositions and formulations comprising any
compound of Formula II. A subject compound is useful for treating
HCV infection and other disorders, as discussed below.
[0134] The present embodiments provide compounds of Formula III, as
well as pharmaceutical compositions and formulations comprising any
compound of Formula III. A subject compound is useful for treating
HCV infection and other disorders, as discussed below.
Compositions
[0135] The present embodiments provide compounds of the general
Formula I:
##STR00005## [0136] or a pharmaceutically acceptable salt, prodrug,
or ester thereof wherein: [0137] R.sup.1 and R.sup.2 are each
independently substituted or unsubstituted groups selected from H,
halogen, CN, CF.sub.3, C.sub.1-8 alkoxyl, C.sub.1-8 alkyl,
C.sub.3-7 cycloalkyl, C.sub.4-10 cycloalkyl-alkyl, C.sub.7-10
arylalkyl, or C.sub.6-12 heteroarylalkyl, or R.sup.1 and R.sup.2
taken together form a substituted or unsubstituted C.sub.3-7
cycloalkyl, aryl or heteroaryl ring; [0138] R.sup.3 and R.sup.4 are
each independently substituted or unsubstituted moieties selected
from the group consisting of H, C.sub.1-8 alkyl, C.sub.3-7
cycloalkyl, C.sub.4-10 cycloalkyl-alkyl, C.sub.7-10 arylalkyl, and
C.sub.6-12 heteroarylalkyl, or R.sup.3 and R.sup.4 taken together
form a substituted or unsubstituted C.sub.3-7 cycloalkyl ring;
[0139] R.sup.5 is a substituted or unsubstituted moiety selected
from the group consisting of H, C.sub.1-8 alkyl, C.sub.3-7
cycloalkyl, C.sub.4-10 cycloalkyl-alkyl, aryl, C.sub.7-10
arylalkyl, heteroaryl, C.sub.6-12 heteroarylalkyl, --C.sub.1-8
alkyl-NHC(O)OR.sup.1a, --C.sub.3-7 cycloalkyl-NHC(O)OR.sup.1a,
--C.sub.4-10 cycloalkyl-alkyl-NHC(O)OR.sup.1a,
-aryl-NHC(O)OR.sup.1a, --C.sub.7-10 arylalkyl-NHC(O)OR.sup.1a,
--heteroaryl-NHC(O)OR.sup.1a, and --C.sub.6-12
heteroarylalkyl-NHC(O)OR.sup.1a; [0140] Y has a formula selected
from the group consisting of --C(O)NHS(O).sub.2R.sup.1a,
--C(O)NHS(O).sub.2NR.sup.1aR.sup.1b, --C(O)C(O)NR.sup.1aR.sup.1b,
C(O)C(O)OH, --C(O)NHR.sup.1a, --C(O)R.sup.1a, --C(O)OR.sup.1a,
--C(O)NHC(O)R.sup.1a and --C(O)OH; [0141] wherein R.sup.1a and
R.sup.1b are each independently substituted or unsubstituted groups
selected from the group consisting of H, C.sub.1-6 alkyl, C.sub.3-7
cycloalkyl, C.sub.4-10 cycloalkyl-alkyl, aryl, C.sub.7-10
arylalkyl, heteroaryl, and C.sub.6-12 heteroarylalkyl, or
NR.sup.1aR.sup.1b forms a substituted or unsubstituted three- to
six-membered alkyl cyclic secondary amine, or NR.sup.1aR.sup.1b is
a heteroaryl or heterocyclic ring.
[0142] The present embodiments provide for a method of inhibiting
NS3/NS4 protease activity comprising contacting a NS3/NS4 protease
with a compound disclosed herein.
[0143] The present embodiments provide for a method of treating
hepatitis by modulating NS3/NS4 protease comprising contacting a
NS3/NS4 protease with a compound disclosed herein.
[0144] The embodiments provide compounds having the general Formula
II:
##STR00006## [0145] or a pharmaceutically acceptable salt, prodrug,
or ester thereof wherein: [0146] (a) Z.sub.1 is a group configured
to hydrogen bond to an NS3 protease His57 imidazole moiety and to
hydrogen bond to a NS3 protease Gly137 nitrogen atom; [0147] (b)
P.sub.1' is a group configured to form a non-polar interaction with
at least one NS3 protease S1' pocket moiety selected from the group
consisting of Lys136, Gly137, Ser138, His57, Gly58, Gln41, Gly42,
and Phe43; [0148] (c) L is a linker group consisting of from 1 to 5
atoms selected from the group consisting of carbon, oxygen,
nitrogen, hydrogen, and sulfur; [0149] (d) P.sub.2 is selected from
the group consisting of unsubstituted aryl, substituted aryl,
unsubstituted heteroaryl, substituted heteroaryl, unsubstituted
heterocyclic and substituted heterocyclic; P.sub.2 being positioned
by L to form a non-polar interaction with at least one NS3 protease
S2 pocket moiety selected from the group consisting of His57,
Arg155, Va178, Asp79, and Gln80; and [0150] (e) R.sup.5 is a
substituted or unsubstituted moiety selected from the group
consisting of H, C.sub.1-8 alkyl, C.sub.3-7 cycloalkyl, C.sub.4-10
cycloalkyl-alkyl, aryl, C.sub.7-10 arylalkyl, heteroaryl,
C.sub.6-12 heteroarylalkyl, --C.sub.1-8 alkyl-NHC(O)OR.sup.1a,
--C.sub.3-7 cycloalkyl-NHC(O)OR.sup.1a,
cycloalkyl-alkyl-NHC(O)OR.sup.1a, -aryl-NHC(O)OR.sup.1a,
--C.sub.7-10 arylalkyl-NHC(O)OR.sup.1a,
--heteroaryl-NHC(O)OR.sup.1a, and --C.sub.6-12
heteroarylalkyl-NHC(O)OR.sup.1a; [0151] wherein R.sup.1a is a
substituted or unsubstituted group selected from the group
consisting of H, C.sub.1-6 alkyl, C.sub.3-7 cycloalkyl, C.sub.4-10
cycloalkyl-alkyl, aryl, C.sub.7-10 arylalkyl, heteroaryl, and
C.sub.6-12 heteroarylalkyl.
[0152] Also provided herein are compounds containing moieties
configured to interact with particular regions, particular amino
acid residues, or particular atoms of NS3 protease. Some compounds
provided herein contain one or more moieties configured to form a
hydrogen bond with NS3 protease at a particular region, amino acid
residue, or atom. Some compounds provided herein contain one or
more moieties configured to form a non-polar interaction with NS3
protease at a particular region, amino acid residue, or atom. For
example, the compound having the general Formula II may contain one
or more moieties that form a hydrogen bond with a peptide backbone
atom or side chain moiety located in the substrate binding pocket
of NS3 protease. In another example, the compound having the
general Formula II may contain one or more moieties that form
non-polar interactions with peptide backbone or side chain atom or
atoms located in the substrate binding pocket of NS3 protease.
[0153] As provided in the compound having the general Formula II,
Z.sub.i may be configured to form a hydrogen bond with a peptide
backbone atom or side chain moiety located in the substrate binding
pocket of NS3 protease, including, but not limited to, NS3 protease
His57 imidazole moiety and NS3 protease Gly137 nitrogen atom. In
some instances, Z.sub.1 may be configured to form a hydrogen bond
with both the NS3 protease His57 imidazole moiety and the NS3
protease Gly137 nitrogen atom.
[0154] The P.sub.1' group of the compound having the general
Formula II may be configured to form a non-polar interaction with
peptide backbone or side chain atom or atoms located in the
substrate binding pocket of NS3 protease, including, but not
limited to amino acid residues that form the NS3 protease S1'
pocket. For example the P.sub.1' group may form a non-polar
interaction with at least one amino acid selected from Lys136,
Gly137, Ser139, His57, Gly58, Gln41, Ser42, and Phe43.
[0155] The P.sub.2 group of the compound having the general Formula
II may be configured to form a non-polar interaction with peptide
backbone or side chain atom or atoms located in the substrate
binding pocket of NS3 protease, including, but not limited to amino
acid residues that form the NS3 protease S2 pocket. For example the
P.sub.2 group may form a non-polar interaction with at least one
amino acid selected from His57, Arg155, Va178, Asp79, Gln80 and
Asp81. The P.sub.2 group also may be configured to form a hydrogen
bond with peptide backbone or side chain atom or atoms located in
the substrate binding pocket of NS3 protease, including, but not
limited to amino acid residues that form the NS3 protease S2
pocket. For example the P.sub.2 group may form a hydrogen bond with
at least one amino acid selected from His57, Arg155, Va178, Asp79,
Gln80 and Asp81. In some instances, P.sub.2 may form both a
non-polar interaction and a hydrogen bond with peptide backbone or
side chain moieties or atoms located in the substrate binding
pocket of NS3 protease, such amino acids selected from His57,
Arg155, Va178, Asp79, Gln80 and Asp81. Such hydrogen bond and
non-polar interactions may occur with the same amino acid residue
or with different amino acid residues in the NS3 protease S2
pocket. In some embodiments, P.sub.2 may be selected from the group
consisting of unsubstituted aryl, substituted aryl, unsubstituted
heteroaryl, substituted heteroaryl, unsubstituted heterocyclic and
substituted heterocyclic.
[0156] In some embodiments, the position of the P.sub.2 group is
determined by the linker L. For example, P.sub.2 may be positioned
by linker L to form a non-polar interaction with peptide backbone
or side chain atom or atoms located in the substrate binding pocket
of NS3 protease, including, but not limited to amino acid residues
that form the NS3 protease S2 pocket. For example the P.sub.2 group
may be positioned by L to form a non-polar interaction with at
least one amino acid selected from His57, Arg155, Va178, Asp79,
Gln80 and Asp81. In another example, P.sub.2 may be positioned by
linker L to form a hydrogen bond with peptide backbone or side
chain atom or atoms located in the substrate binding pocket of NS3
protease, including, but not limited to amino acid residues that
form the NS3 protease S2 pocket. For example the P.sub.2 group may
be positioned by L to form a hydrogen bond with at least one amino
acid selected from His57, Arg155, Va178, Asp79, Gln80 and Asp81. In
some instances, P.sub.2 may be positioned to form both a non-polar
interaction and a hydrogen bond peptide backbone or side chain atom
or atoms located in the substrate binding pocket of NS3 protease,
such as an amino acid selected from His57, Arg155, Va178, Asp79,
Gln80 and Asp81. Such hydrogen bond and non-polar interactions may
occur with the same amino acid residue or with different amino acid
residues in the NS3 protease S2 pocket.
[0157] As provided in the compound having the general Formula II, L
may be a linker group that links P.sub.2 to the heterocyclic
backbone of the compound of Formula II. Linker L may contain any of
a variety of atoms and moieties suitable for positioning P.sub.2 in
the NS3 protease substrate binding pocket. In one embodiment, L may
contain 1 to 5 atoms selected from the group consisting of carbon,
oxygen, nitrogen, hydrogen, and sulfur. In another embodiment, L
may contain 2 to 5 atoms selected from the group consisting of
carbon, oxygen, nitrogen, hydrogen, and sulfur. For example, L may
contain a group having the formula --W--C(.dbd.V)--, where V and W
are each individually selected from O, S or NH. Specific exemplary
groups for L include, but are not limited to, ester, amide,
carbamate, thioester, and thioamide.
[0158] The compound of Formula II also may contain an R.sup.5
group, where the R.sup.5 group may be an aliphatic, cyclic
aliphatic, aromatic, or heteroaromatic moiety with any such moiety
being substituted or unsubstituted. The R.sup.5 moiety may be
selected from the group consisting of H, C.sub.1-8 alkyl, C.sub.3-7
cycloalkyl, C.sub.4-10 cycloalkyl-alkyl, aryl, C.sub.7-10
arylalkyl, heteroaryl, C.sub.6-12 heteroarylalkyl, --C.sub.1-8
alkyl-NHC(O)OR.sup.1a, --C.sub.3-7 cycloalkyl-NHC(O)OR.sup.1a,
--C.sub.4-10 cycloalkyl-alkyl-NHC(O)OR.sup.1a,
-aryl-NHC(O)OR.sup.1a, --C.sub.7-10 arylalkyl-NHC(O)OR.sup.1a,
--heteroaryl-NHC(O)OR.sup.1a, and --C.sub.6-12
heteroarylalkyl-NHC(O)OR.sup.1a, --C.sub.1-8 alkyl-NHC(O)OR.sup.1a,
In one embodiment, R.sup.5 is --CH.sub.2NHC(O)OR.sup.1a. In one
embodiment, R.sup.5 is --CH.sub.2NHC(O)O-tert-butyl.
[0159] The present embodiments provide compounds of the general
Formula III:
##STR00007## [0160] or a pharmaceutically acceptable salt, prodrug,
or ester thereof wherein: [0161] A is OH or
[0161] ##STR00008## [0162] R.sup.3 and R.sup.4 are each
independently substituted or unsubstituted moieties selected from
the group consisting of H, C.sub.1-8 alkyl, C.sub.3-7 cycloalkyl,
C.sub.4-10 cycloalkyl-alkyl, C.sub.7-10 arylalkyl, and C.sub.6-12
heteroarylalkyl, or R.sup.3 and R.sup.4 taken together form a
substituted or unsubstituted C.sub.3-7 cycloalkyl ring; [0163]
R.sup.5a is a substituted or unsubstituted moiety selected from the
group consisting of H, C.sub.1-8 alkyl, C.sub.3-7 cycloalkyl,
C.sub.4-10 cycloalkyl-alkyl, aryl, C.sub.7-10 arylalkyl,
heteroaryl, an C.sub.6-12 heteroarylalkyl; [0164] Y has a formula
selected from the group consisting of --C(O)NHS(O).sub.2R.sup.1a,
--C(O)NHS(O).sub.2NR.sup.1aR.sup.1b, --C(O)C(O)NR.sup.1aR.sup.1b,
--C(O)C(O)OH, --C(O)NHR.sup.1a, --C(O)R.sup.1a, --C(O)OR.sup.1a,
--C(O)NHC(O)R.sup.1a and --C(O)OH; [0165] wherein R.sup.1a and
R.sup.1b are each independently substituted or unsubstituted groups
selected from the group consisting of H, C.sub.1-6 alkyl, C.sub.3-7
cycloalkyl, C.sub.4-10 cycloalkyl-alkyl, aryl, C.sub.7-10
arylalkyl, heteroaryl, and C.sub.6-12 heteroarylalkyl, or
NR.sup.1aR.sup.1b forms a substituted or unsubstituted three- to
six-membered alkyl cyclic secondary amine, or NR.sup.1aR.sup.1b is
a heteroaryl or heterocyclic ring; and [0166] Z is CH.sub.2 or has
a formula selected from the group consisting of >NC(O)R.sup.2a,
>NC(O)OR.sup.2a, >NC(O)NR.sup.2aR.sup.2b,
>NS(O).sub.2NR.sup.2aR.sup.2b, and >NR.sup.2a; [0167] wherein
R.sup.2a and R.sup.2b are each independently substituted or
unsubstituted groups selected from the group consisting of H,
C.sub.1-6 alkyl, C.sub.3-7 cycloalkyl, C.sub.4-10 cycloalkyl-alkyl,
aryl, C.sub.7-10 arylalkyl, heteroaryl, and C.sub.6-12
heteroarylalkyl, or NR.sup.2aR.sup.2b forms a substituted or
unsubstituted three- to six-membered alkyl cyclic secondary amine,
or NR.sup.2aR.sup.2b is a heteroaryl or heterocyclic ring.
[0168] The present embodiments provide for a method of inhibiting
NS3/NS4 protease activity comprising contacting a NS3/NS4 protease
with a compound disclosed herein.
[0169] The present embodiments provide for a method of treating
hepatitis by modulating NS3/NS4 protease comprising contacting a
NS3/NS4 protease with a compound disclosed herein.
[0170] Exemplary compounds of Formula I are set forth in Table 1
and compounds 90-91 below.
[0171] Preferred compounds include Compounds 90-91.
[0172] In some embodiments, several atoms of the compound of
Formula II may have a particular chirality.
[0173] Exemplary compounds of Formula III are set forth in Table 2
and compounds 101-112 below.
[0174] Preferred compounds of Formula III include Compounds
101-112.
[0175] Preferred embodiments provide a method of treating a
hepatitis C virus infection in an individual, the method comprising
administering to the individual an effective amount of a
composition comprising a preferred compound.
[0176] Preferred embodiments provide a method of treating liver
fibrosis in an individual, the method comprising administering to
the individual an effective amount of a composition comprising a
preferred compound.
[0177] Preferred embodiments provide a method of increasing liver
function in an individual having a hepatitis C virus infection, the
method comprising administering to the individual an effective
amount of a composition comprising a preferred compound.
[0178] Preferred embodiments of compounds of Formula II provide
compounds in which L consists of from 2 to 5 atoms.
[0179] In preferred embodiments, compounds of Formula II
embodiments provide compounds having the general Formula II, in
which L comprises a --W--C(.dbd.V)-- group, where V and W are each
individually selected from O, S or NH.
[0180] In preferred embodiments, compounds of Formula II
embodiments provide compounds having the general Formula II, in
which L is selected from the group consisting of ester, amide,
carbamate, thioester, and thioamide.
[0181] In preferred embodiments, compounds of Formula II
embodiments provide compounds having the general Formula II, in
which P.sub.2 is further positioned by L to form a hydrogen bonding
interaction with at least one NS3 protease S2 pocket moiety
selected from the group consisting of His57, Arg155, Va178, Asp79,
Gln80 and Asp81.
[0182] The present embodiments further provide compositions,
including pharmaceutical compositions, comprising compounds of the
general Formula I or general Formula III, including salts, esters,
or other derivatives thereof. The present embodiments further
provide compositions, including pharmaceutical compositions,
comprising compounds of the general Formula II, including salts,
esters, or other derivatives thereof. A subject pharmaceutical
composition comprises a subject compound; and a pharmaceutically
acceptable excipient. A wide variety of pharmaceutically acceptable
excipients is known in the art and need not be discussed in detail
herein. Pharmaceutically acceptable excipients have been amply
described in a variety of publications, including, for example, A.
Gennaro (2000) "Remington: The Science and Practice of Pharmacy,"
20th edition, Lippincott, Williams, & Wilkins; Pharmaceutical
Dosage Forms and Drug Delivery Systems (1999) H.C. Ansel et al.,
eds., 7.sup.th ed., Lippincott, Williams, & Wilkins; and
Handbook of Pharmaceutical Excipients (2000) A. H. Kibbe et al.,
eds., 3.sup.rd ed. Amer. Pharmaceutical Assoc.
[0183] The pharmaceutically acceptable excipients, such as
vehicles, adjuvants, carriers or diluents, are readily available to
the public. Moreover, pharmaceutically acceptable auxiliary
substances, such as pH adjusting and buffering agents, tonicity
adjusting agents, stabilizers, wetting agents and the like, are
readily available to the public.
[0184] In many embodiments, a subject compound inhibits the
enzymatic activity of a hepatitis virus C (HCV) NS3 protease.
Whether a subject compound inhibits HCV NS3 protease can be readily
determined using any known method. Typical methods involve a
determination of whether an HCV polyprotein or other polypeptide
comprising an NS3 recognition site is cleaved by NS3 in the
presence of the agent. In many embodiments, a subject compound
inhibits NS3 enzymatic activity by at least about 10%, at least
about 15%, at least about 20%, at least about 25%, at least about
30%, at least about 40%, at least about 50%, at least about 60%, at
least about 70%, at least about 80%, or at least about 90%, or
more, compared to the enzymatic activity of NS3 in the absence of
the compound.
[0185] In many embodiments, a subject compound inhibits enzymatic
activity of an HCV NS3 protease with an IC.sub.50 of less than
about 50 .mu.M, e.g., a subject compound inhibits an HCV NS3
protease with an IC.sub.50 of less than about 40 .mu.M, less than
about 25 .mu.M, less than about 10 .mu.M, less than about 1 .mu.M,
less than about 100 nM, less than about 80 nM, less than about 60
nM, less than about 50 nM, less than about 25 nM, less than about
10 nM, or less than about 1 nM, or less.
[0186] In many embodiments, a subject compound inhibits the
enzymatic activity of a hepatitis virus C (HCV) NS3 helicase.
Whether a subject compound inhibits HCV NS3 helicase can be readily
determined using any known method. In many embodiments, a subject
compound inhibits NS3 enzymatic activity by at least about 10%, at
least about 15%, at least about 20%, at least about 25%, at least
about 30%, at least about 40%, at least about 50%, at least about
60%, at least about 70%, at least about 80%, or at least about 90%,
or more, compared to the enzymatic activity of NS3 in the absence
of the compound.
[0187] In many embodiments, a subject compound inhibits HCV viral
replication. For example, a subject compound inhibits HCV viral
replication by at least about 10%, at least about 15%, at least
about 20%, at least about 25%, at least about 30%, at least about
40%, at least about 50%, at least about 60%, at least about 70%, at
least about 80%, or at least about 90%, or more, compared to HCV
viral replication in the absence of the compound. Whether a subject
compound inhibits HCV viral replication can be determined using
methods known in the art, including an in vitro viral replication
assay.
[0188] Treating a Hepatitis Virus Infection
[0189] The methods and compositions described herein are generally
useful in treatment of an of HCV infection.
[0190] Whether a subject method is effective in treating an HCV
infection can be determined by a reduction in viral load, a
reduction in time to seroconversion (virus undetectable in patient
serum), an increase in the rate of sustained viral response to
therapy, a reduction of morbidity or mortality in clinical
outcomes, or other indicator of disease response.
[0191] In general, an effective amount of a compound of Formula I,
Formula II, or Formula III, and optionally one or more additional
antiviral agents, is an amount that is effective to reduce viral
load or achieve a sustained viral response to therapy.
[0192] Whether a subject method is effective in treating an HCV
infection can be determined by measuring viral load, or by
measuring a parameter associated with HCV infection, including, but
not limited to, liver fibrosis, elevations in serum transaminase
levels, and necroinflammatory activity in the liver. Indicators of
liver fibrosis are discussed in detail below.
[0193] The method involves administering an effective amount of a
compound of Formula I, Formula II, or Formula III, optionally in
combination with an effective amount of one or more additional
antiviral agents. In some embodiments, an effective amount of a
compound of Formula I, Formula II, or Formula III, and optionally
one or more additional antiviral agents, is an amount that is
effective to reduce viral titers to undetectable levels, e.g., to
about 1000 to about 5000, to about 500 to about 1000, or to about
100 to about 500 genome copies/mL serum. In some embodiments, an
effective amount of a compound of Formula I, Formula II, or Formula
III, and optionally one or more additional antiviral agents, is an
amount that is effective to reduce viral load to lower than 100
genome copies/mL serum.
[0194] In some embodiments, an effective amount of a compound of
Formula I, Formula II, or Formula III, and optionally one or more
additional antiviral agents, is an amount that is effective to
achieve a 1.5-log, a 2-log, a 2.5-log, a 3-log, a 3.5-log, a 4-log,
a 4.5-log, or a 5-log reduction in viral titer in the serum of the
individual.
[0195] In many embodiments, an effective amount of a compound of
Formula I, Formula II, or Formula III, and optionally one or more
additional antiviral agents, is an amount that is effective to
achieve a sustained viral response, e.g., non-detectable or
substantially non-detectable HCV RNA (e.g., less than about 500,
less than about 400, less than about 200, or less than about 100
genome copies per milliliter serum) is found in the patient's serum
for a period of at least about one month, at least about two
months, at least about three months, at least about four months, at
least about five months, or at least about six months following
cessation of therapy.
[0196] As noted above, whether a subject method is effective in
treating an HCV infection can be determined by measuring a
parameter associated with HCV infection, such as liver fibrosis.
Methods of determining the extent of liver fibrosis are discussed
in detail below. In some embodiments, the level of a serum marker
of liver fibrosis indicates the degree of liver fibrosis.
[0197] As one non-limiting example, levels of serum alanine
aminotransferase (ALT) are measured, using standard assays. In
general, an ALT level of less than about 45 international units is
considered normal. In some embodiments, an effective amount of a
compound of Formula I, Formula II, or Formula III, and optionally
one or more additional antiviral agents, is an amount effective to
reduce ALT levels to less than about 45 IU/ml serum.
[0198] A therapeutically effective amount of a compound of Formula
I, Formula II, or Formula III, and optionally one or more
additional antiviral agents, is an amount that is effective to
reduce a serum level of a marker of liver fibrosis by at least
about 10%, at least about 20%, at least about 25%, at least about
30%, at least about 35%, at least about 40%, at least about 45%, at
least about 50%, at least about 55%, at least about 60%, at least
about 65%, at least about 70%, at least about 75%, or at least
about 80%, or more, compared to the level of the marker in an
untreated individual, or to a placebo-treated individual. Methods
of measuring serum markers include immunological-based methods,
e.g., enzyme-linked immunosorbent assays (ELISA),
radioimmunoassays, and the like, using antibody specific for a
given serum marker.
[0199] In many embodiments, an effective amount of a compound of
Formula I, Formula II, or Formula III and an additional antiviral
agent is a synergistic amount. As used herein, a "synergistic
combination" or a "synergistic amount" of a compound of Formula I,
Formula II, or Formula III and an additional antiviral agent is a
combined dosage that is more effective in the therapeutic or
prophylactic treatment of an HCV infection than the incremental
improvement in treatment outcome that could be predicted or
expected from a merely additive combination of (i) the therapeutic
or prophylactic benefit of the compound of Formula I, Formula II,
or Formula III when administered at that same dosage as a
monotherapy and (ii) the therapeutic or prophylactic benefit of the
additional antiviral agent when administered at the same dosage as
a monotherapy.
[0200] In some embodiments, a selected amount of a compound of
Formula I, Formula II, or Formula III and a selected amount of an
additional antiviral agent are effective when used in combination
therapy for a disease, but the selected amount of the compound of
Formula I, Formula II, or Formula III and/or the selected amount of
the additional antiviral agent is ineffective when used in
monotherapy for the disease. Thus, the embodiments encompass (1)
regimens in which a selected amount of the additional antiviral
agent enhances the therapeutic benefit of a selected amount of the
compound of Formula I, Formula II, or Formula III when used in
combination therapy for a disease, where the selected amount of the
additional antiviral agent provides no therapeutic benefit when
used in monotherapy for the disease (2) regimens in which a
selected amount of the compound of Formula I, Formula II, or
Formula III enhances the therapeutic benefit of a selected amount
of the additional antiviral agent when used in combination therapy
for a disease, where the selected amount of the compound of Formula
I, Formula II, or Formula III provides no therapeutic benefit when
used in monotherapy for the disease and (3) regimens in which a
selected amount of the compound of Formula I, Formula II, or
Formula III and a selected amount of the additional antiviral agent
provide a therapeutic benefit when used in combination therapy for
a disease, where each of the selected amounts of the compound of
Formula I, Formula II, or Formula III and the additional antiviral
agent, respectively, provides no therapeutic benefit when used in
monotherapy for the disease. As used herein, a "synergistically
effective amount" of a compound of Formula I, Formula II, or
Formula III and an additional antiviral agent, and its grammatical
equivalents, shall be understood to include any regimen encompassed
by any of (1)-(3) above.
Fibrosis
[0201] The embodiments provides methods for treating liver fibrosis
(including forms of liver fibrosis resulting from, or associated
with, HCV infection), generally involving administering a
therapeutic amount of a compound of Formula I, Formula II, or
Formula III, and optionally one or more additional antiviral
agents. Effective amounts of compounds of Formula I, Formula II, or
Formula III, with and without one or more additional antiviral
agents, as well as dosing regimens, are as discussed below.
[0202] Whether treatment with a compound of Formula I, Formula II,
or Formula III, and optionally one or more additional antiviral
agents, is effective in reducing liver fibrosis is determined by
any of a number of well-established techniques for measuring liver
fibrosis and liver function. Liver fibrosis reduction is determined
by analyzing a liver biopsy sample. An analysis of a liver biopsy
comprises assessments of two major components: necroinflammation
assessed by "grade" as a measure of the severity and ongoing
disease activity, and the lesions of fibrosis and parenchymal or
vascular remodeling as assessed by "stage" as being reflective of
long-term disease progression. See, e.g., Brunt (2000) Hepatol.
31:241-246; and METAVIR (1994) Hepatology 20:15-20. Based on
analysis of the liver biopsy, a score is assigned. A number of
standardized scoring systems exist which provide a quantitative
assessment of the degree and severity of fibrosis. These include
the METAVIR, Knodell, Scheuer, Ludwig, and Ishak scoring
systems.
[0203] The METAVIR scoring system is based on an analysis of
various features of a liver biopsy, including fibrosis (portal
fibrosis, centrilobular fibrosis, and cirrhosis); necrosis
(piecemeal and lobular necrosis, acidophilic retraction, and
ballooning degeneration); inflammation (portal tract inflammation,
portal lymphoid aggregates, and distribution of portal
inflammation); bile duct changes; and the Knodell index (scores of
periportal necrosis, lobular necrosis, portal inflammation,
fibrosis, and overall disease activity). The definitions of each
stage in the METAVIR system are as follows: score: 0, no fibrosis;
score: 1, stellate enlargement of portal tract but without septa
formation; score: 2, enlargement of portal tract with rare septa
formation; score: 3, numerous septa without cirrhosis; and score:
4, cirrhosis.
[0204] Knodell's scoring system, also called the Hepatitis Activity
Index, classifies specimens based on scores in four categories of
histologic features: I. Periportal and/or bridging necrosis; II.
Intralobular degeneration and focal necrosis; III. Portal
inflammation; and IV. Fibrosis. In the Knodell staging system,
scores are as follows: score: 0, no fibrosis; score: 1, mild
fibrosis (fibrous portal expansion); score: 2, moderate fibrosis;
score: 3, severe fibrosis (bridging fibrosis); and score: 4,
cirrhosis. The higher the score, the more severe the liver tissue
damage. Knodell (1981) Hepatol. 1:431.
[0205] In the Scheuer scoring system scores are as follows: score:
0, no fibrosis; score: 1, enlarged, fibrotic portal tracts; score:
2, periportal or portal-portal septa, but intact architecture;
score: 3, fibrosis with architectural distortion, but no obvious
cirrhosis; score: 4, probable or definite cirrhosis. Scheuer (1991)
J. Hepatol. 13:372.
[0206] The Ishak scoring system is described in Ishak (1995) J.
Hepatol. 22:696-699. Stage 0, No fibrosis; Stage 1, Fibrous
expansion of some portal areas, with or without short fibrous
septa; stage 2, Fibrous expansion of most portal areas, with or
without short fibrous septa; stage 3, Fibrous expansion of most
portal areas with occasional portal to portal (P-P) bridging; stage
4, Fibrous expansion of portal areas with marked bridging (P-P) as
well as portal-central (P-C); stage 5, Marked bridging (P-P and/or
P-C) with occasional nodules (incomplete cirrhosis); stage 6,
Cirrhosis, probable or definite.
[0207] The benefit of anti-fibrotic therapy can also be measured
and assessed by using the Child-Pugh scoring system which comprises
a multicomponent point system based upon abnormalities in serum
bilirubin level, serum albumin level, prothrombin time, the
presence and severity of ascites, and the presence and severity of
encephalopathy. Based upon the presence and severity of abnormality
of these parameters, patients may be placed in one of three
categories of increasing severity of clinical disease: A, B, or
C.
[0208] In some embodiments, a therapeutically effective amount of a
compound of Formula I, Formula II, or Formula III, and optionally
one or more additional antiviral agents, is an amount that effects
a change of one unit or more in the fibrosis stage based on pre-
and post-therapy liver biopsies. In particular embodiments, a
therapeutically effective amount of a compound of Formula I,
Formula II, or Formula III, and optionally one or more additional
antiviral agents, reduces liver fibrosis by at least one unit in
the METAVIR, the Knodell, the Scheuer, the Ludwig, or the Ishak
scoring system.
[0209] Secondary, or indirect, indices of liver function can also
be used to evaluate the efficacy of treatment with a compound of
Formula I, Formula II, or Formula III. Morphometric computerized
semi-automated assessment of the quantitative degree of liver
fibrosis based upon specific staining of collagen and/or serum
markers of liver fibrosis can also be measured as an indication of
the efficacy of a subject treatment method. Secondary indices of
liver function include, but are not limited to, serum transaminase
levels, prothrombin time, bilirubin, platelet count, portal
pressure, albumin level, and assessment of the Child-Pugh
score.
[0210] An effective amount of a compound of Formula I, Formula II,
or Formula III, and optionally one or more additional antiviral
agents, is an amount that is effective to increase an index of
liver function by at least about 10%, at least about 20%, at least
about 25%, at least about 30%, at least about 35%, at least about
40%, at least about 45%, at least about 50%, at least about 55%, at
least about 60%, at least about 65%, at least about 70%, at least
about 75%, or at least about 80%, or more, compared to the index of
liver function in an untreated individual, or to a placebo-treated
individual. Those skilled in the art can readily measure such
indices of liver function, using standard assay methods, many of
which are commercially available, and are used routinely in
clinical settings.
[0211] Serum markers of liver fibrosis can also be measured as an
indication of the efficacy of a subject treatment method. Serum
markers of liver fibrosis include, but are not limited to,
hyaluronate, N-terminal procollagen III peptide, 7S domain of type
IV collagen, C-terminal procollagen I peptide, and laminin.
Additional biochemical markers of liver fibrosis include
.alpha.-2-macroglobulin, haptoglobin, gamma globulin,
apolipoprotein A, and gamma glutamyl transpeptidase.
[0212] A therapeutically effective amount of a compound of Formula
I, Formula II, or Formula III, and optionally one or more
additional antiviral agents, is an amount that is effective to
reduce a serum level of a marker of liver fibrosis by at least
about 10%, at least about 20%, at least about 25%, at least about
30%, at least about 35%, at least about 40%, at least about 45%, at
least about 50%, at least about 55%, at least about 60%, at least
about 65%, at least about 70%, at least about 75%, or at least
about 80%, or more, compared to the level of the marker in an
untreated individual, or to a placebo-treated individual. Those
skilled in the art can readily measure such serum markers of liver
fibrosis, using standard assay methods, many of which are
commercially available, and are used routinely in clinical
settings. Methods of measuring serum markers include
immunological-based methods, e.g., enzyme-linked immunosorbent
assays (ELISA), radioimmunoassays, and the like, using antibody
specific for a given serum marker.
[0213] Quantitative tests of functional liver reserve can also be
used to assess the efficacy of treatment with an interferon
receptor agonist and pirfenidone (or a pirfenidone analog). These
include: indocyanine green clearance (ICG), galactose elimination
capacity (GEC), aminopyrine breath test (ABT), antipyrine
clearance, monoethylglycine-xylidide (MEG-X) clearance, and
caffeine clearance.
[0214] As used herein, a "complication associated with cirrhosis of
the liver" refers to a disorder that is a sequellae of
decompensated liver disease, i.e., or occurs subsequently to and as
a result of development of liver fibrosis, and includes, but it not
limited to, development of ascites, variceal bleeding, portal
hypertension, jaundice, progressive liver insufficiency,
encephalopathy, hepatocellular carcinoma, liver failure requiring
liver transplantation, and liver-related mortality.
[0215] A therapeutically effective amount of a compound of Formula
I, Formula II, or Formula III, and optionally one or more
additional antiviral agents, is an amount that is effective in
reducing the incidence (e.g., the likelihood that an individual
will develop) of a disorder associated with cirrhosis of the liver
by at least about 10%, at least about 20%, at least about 25%, at
least about 30%, at least about 35%, at least about 40%, at least
about 45%, at least about 50%, at least about 55%, at least about
60%, at least about 65%, at least about 70%, at least about 75%, or
at least about 80%, or more, compared to an untreated individual,
or to a placebo-treated individual.
[0216] Whether treatment with a compound of Formula I, Formula II,
or Formula III, and optionally one or more additional antiviral
agents, is effective in reducing the incidence of a disorder
associated with cirrhosis of the liver can readily be determined by
those skilled in the art.
[0217] Reduction in liver fibrosis increases liver function. Thus,
the embodiments provide methods for increasing liver function,
generally involving administering a therapeutically effective
amount of a compound of Formula I, Formula II, or Formula III, and
optionally one or more additional antiviral agents. Liver functions
include, but are not limited to, synthesis of proteins such as
serum proteins (e.g., albumin, clotting factors, alkaline
phosphatase, aminotransferases (e.g., alanine transaminase,
aspartate transaminase), 5'-nucleosidase,
.gamma.-glutaminyltranspeptidase, etc.), synthesis of bilirubin,
synthesis of cholesterol, and synthesis of bile acids; a liver
metabolic function, including, but not limited to, carbohydrate
metabolism, amino acid and ammonia metabolism, hormone metabolism,
and lipid metabolism; detoxification of exogenous drugs; a
hemodynamic function, including splanchnic and portal hemodynamics;
and the like.
[0218] Whether a liver function is increased is readily
ascertainable by those skilled in the art, using well-established
tests of liver function. Thus, synthesis of markers of liver
function such as albumin, alkaline phosphatase, alanine
transaminase, aspartate transaminase, bilirubin, and the like, can
be assessed by measuring the level of these markers in the serum,
using standard immunological and enzymatic assays. Splanchnic
circulation and portal hemodynamics can be measured by portal wedge
pressure and/or resistance using standard methods. Metabolic
functions can be measured by measuring the level of ammonia in the
serum.
[0219] Whether serum proteins normally secreted by the liver are in
the normal range can be determined by measuring the levels of such
proteins, using standard immunological and enzymatic assays. Those
skilled in the art know the normal ranges for such serum proteins.
The following are non-limiting examples. The normal level of
alanine transaminase is about 45 IU per milliliter of serum. The
normal range of aspartate transaminase is from about 5 to about 40
units per liter of serum. Bilirubin is measured using standard
assays. Normal bilirubin levels are usually less than about 1.2
mg/dL. Serum albumin levels are measured using standard assays.
Normal levels of serum albumin are in the range of from about 35 to
about 55 g/L. Prolongation of prothrombin time is measured using
standard assays. Normal prothrombin time is less than about 4
seconds longer than control.
[0220] A therapeutically effective amount of a compound of Formula
I, Formula II, or Formula III, and optionally one or more
additional antiviral agents, is one that is effective to increase
liver function by at least about 10%, at least about 20%, at least
about 30%, at least about 40%, at least about 50%, at least about
60%, at least about 70%, at least about 80%, or more. For example,
a therapeutically effective amount of a compound of Formula I,
Formula II, or Formula III, and optionally one or more additional
antiviral agents, is an amount effective to reduce an elevated
level of a serum marker of liver function by at least about 10%, at
least about 20%, at least about 30%, at least about 40%, at least
about 50%, at least about 60%, at least about 70%, at least about
80%, or more, or to reduce the level of the serum marker of liver
function to within a normal range. A therapeutically effective
amount of a compound of Formula I, Formula II, or Formula III, and
optionally one or more additional antiviral agents, is also an
amount effective to increase a reduced level of a serum marker of
liver function by at least about 10%, at least about 20%, at least
about 30%, at least about 40%, at least about 50%, at least about
60%, at least about 70%, at least about 80%, or more, or to
increase the level of the serum marker of liver function to within
a normal range.
Dosages, Formulations, and Routes of Administration
[0221] In the subject methods, the active agent(s) (e.g., compound
of Formula I, Formula II, or Formula III, and optionally one or
more additional antiviral agents) may be administered to the host
using any convenient means capable of resulting in the desired
therapeutic effect. Thus, the agent can be incorporated into a
variety of formulations for therapeutic administration. More
particularly, the agents of the embodiments can be formulated into
pharmaceutical compositions by combination with appropriate,
pharmaceutically acceptable carriers or diluents, and may be
formulated into preparations in solid, semi-solid, liquid or
gaseous forms, such as tablets, capsules, powders, granules,
ointments, solutions, suppositories, injections, inhalants and
aerosols.
Formulations
[0222] The above-discussed active agent(s) can be formulated using
well-known reagents and methods. Compositions are provided in
formulation with a pharmaceutically acceptable excipient(s). A wide
variety of pharmaceutically acceptable excipients is known in the
art and need not be discussed in detail herein. Pharmaceutically
acceptable excipients have been amply described in a variety of
publications, including, for example, A. Gennaro (2000) "Remington:
The Science and Practice of Pharmacy," 20th edition, Lippincott,
Williams, & Wilkins; Pharmaceutical Dosage Forms and Drug
Delivery Systems (1999) H.C. Ansel et al., eds., 7.sup.th ed.,
Lippincott, Williams, & Wilkins; and Handbook of Pharmaceutical
Excipients (2000) A. H. Kibbe et al., eds., 3.sup.rd ed. Amer.
Pharmaceutical Assoc.
[0223] The pharmaceutically acceptable excipients, such as
vehicles, adjuvants, carriers or diluents, are readily available to
the public. Moreover, pharmaceutically acceptable auxiliary
substances, such as pH adjusting and buffering agents, tonicity
adjusting agents, stabilizers, wetting agents and the like, are
readily available to the public.
[0224] In some embodiments, an agent is formulated in an aqueous
buffer. Suitable aqueous buffers include, but are not limited to,
acetate, succinate, citrate, and phosphate buffers varying in
strengths from about 5 mM to about 100 mM. In some embodiments, the
aqueous buffer includes reagents that provide for an isotonic
solution. Such reagents include, but are not limited to, sodium
chloride; and sugars e.g., mannitol, dextrose, sucrose, and the
like. In some embodiments, the aqueous buffer further includes a
non-ionic surfactant such as polysorbate 20 or 80. Optionally the
formulations may further include a preservative. Suitable
preservatives include, but are not limited to, a benzyl alcohol,
phenol, chlorobutanol, benzalkonium chloride, and the like. In many
cases, the formulation is stored at about 4.degree. C. Formulations
may also be lyophilized, in which case they generally include
cryoprotectants such as sucrose, trehalose, lactose, maltose,
mannitol, and the like. Lyophilized formulations can be stored over
extended periods of time, even at ambient temperatures.
[0225] As such, administration of the agents can be achieved in
various ways, including oral, buccal, rectal, parenteral,
intraperitoneal, intradermal, subcutaneous, intramuscular,
transdermal, intratracheal, etc., administration. In many
embodiments, administration is by bolus injection, e.g.,
subcutaneous bolus injection, intramuscular bolus injection, and
the like.
[0226] The pharmaceutical compositions of the embodiments can be
administered orally, parenterally or via an implanted reservoir.
Oral administration or administration by injection is
preferred.
[0227] Subcutaneous administration of a pharmaceutical composition
of the embodiments is accomplished using standard methods and
devices, e.g., needle and syringe, a subcutaneous injection port
delivery system, and the like. See, e.g., U.S. Pat. Nos. 3,547,119;
4,755,173; 4,531,937; 4,311,137; and 6,017,328. A combination of a
subcutaneous injection port and a device for administration of a
pharmaceutical composition of the embodiments to a patient through
the port is referred to herein as "a subcutaneous injection port
delivery system." In many embodiments, subcutaneous administration
is achieved by bolus delivery by needle and syringe.
[0228] In pharmaceutical dosage forms, the agents may be
administered in the form of their pharmaceutically acceptable
salts, or they may also be used alone or in appropriate
association, as well as in combination, with other pharmaceutically
active compounds. The following methods and excipients are merely
exemplary and are in no way limiting.
[0229] For oral preparations, the agents can be used alone or in
combination with appropriate additives to make tablets, powders,
granules or capsules, for example, with conventional additives,
such as lactose, mannitol, corn starch or potato starch; with
binders, such as crystalline cellulose, cellulose derivatives,
acacia, corn starch or gelatins; with disintegrators, such as corn
starch, potato starch or sodium carboxymethylcellulose; with
lubricants, such as talc or magnesium stearate; and if desired,
with diluents, buffering agents, moistening agents, preservatives
and flavoring agents.
[0230] The agents can be formulated into preparations for injection
by dissolving, suspending or emulsifying them in an aqueous or
nonaqueous solvent, such as vegetable or other similar oils,
synthetic aliphatic acid glycerides, esters of higher aliphatic
acids or propylene glycol; and if desired, with conventional
additives such as solubilizers, isotonic agents, suspending agents,
emulsifying agents, stabilizers and preservatives.
[0231] Furthermore, the agents can be made into suppositories by
mixing with a variety of bases such as emulsifying bases or
water-soluble bases. The compounds of the embodiments can be
administered rectally via a suppository. The suppository can
include vehicles such as cocoa butter, carbowaxes and polyethylene
glycols, which melt at body temperature, yet are solidified at room
temperature.
[0232] Unit dosage forms for oral or rectal administration such as
syrups, elixirs, and suspensions may be provided wherein each
dosage unit, for example, teaspoonful, tablespoonful, tablet or
suppository, contains a predetermined amount of the composition
containing one or more inhibitors. Similarly, unit dosage forms for
injection or intravenous administration may comprise the
inhibitor(s) in a composition as a solution in sterile water,
normal saline or another pharmaceutically acceptable carrier.
[0233] The term "unit dosage form," as used herein, refers to
physically discrete units suitable as unitary dosages for human and
animal subjects, each unit containing a predetermined quantity of
compounds of the embodiments calculated in an amount sufficient to
produce the desired effect in association with a pharmaceutically
acceptable diluent, carrier or vehicle. The specifications for the
novel unit dosage forms of the embodiments depend on the particular
compound employed and the effect to be achieved, and the
pharmacodynamics associated with each compound in the host.
[0234] The pharmaceutically acceptable excipients, such as
vehicles, adjuvants, carriers or diluents, are readily available to
the public. Moreover, pharmaceutically acceptable auxiliary
substances, such as pH adjusting and buffering agents, tonicity
adjusting agents, stabilizers, wetting agents and the like, are
readily available to the public.
Other Antiviral or Antifibrotic Agents
[0235] As discussed above, a subject method will in some
embodiments be carried out by administering an NS3 inhibitor that
is a compound of Formula I, Formula II, or Formula III, and
optionally one or more additional antiviral agent(s).
[0236] In some embodiments, the method further includes
administration of one or more interferon receptor agonist(s).
Interferon receptor agonists are described herein.
[0237] In other embodiments, the method further includes
administration of pirfenidone or a pirfenidone analog. Pirfenidone
and pirfenidone analogs are described herein.
[0238] Additional antiviral agents that are suitable for use in
combination therapy include, but are not limited to, nucleotide and
nucleoside analogs. Non-limiting examples include azidothymidine
(AZT) (zidovudine), and analogs and derivatives thereof;
2',3'-dideoxyinosine (DDI) (didanosine), and analogs and
derivatives thereof; 2',3'-dideoxycytidine (DDC) (dideoxycytidine),
and analogs and derivatives thereof;
2'3,'-didehydro-2',3'-dideoxythymidine (D4T) (stavudine), and
analogs and derivatives thereof; combivir; abacavir; adefovir
dipoxil; cidofovir; ribavirin; ribavirin analogs; and the like.
[0239] In some embodiments, the method further includes
administration of ribavirin. Ribavirin,
1-.beta.-D-ribofuranosyl-1H-1,2,4-triazole-3-carboxamide, available
from ICN Pharmaceuticals, Inc., Costa Mesa, Calif., is described in
the Merck Index, compound No. 8199, Eleventh Edition. Its
manufacture and formulation is described in U.S. Pat. No.
4,211,771. Some embodiments also involve use of derivatives of
ribavirin (see, e.g., U.S. Pat. No. 6,277,830). The ribavirin may
be administered orally in capsule or tablet form, or in the same or
different administration form and in the same or different route as
the NS-3 inhibitor compound. Of course, other types of
administration of both medicaments, as they become available are
contemplated, such as by nasal spray, transdermally, intravenously,
by suppository, by sustained release dosage form, etc. Any form of
administration will work so long as the proper dosages are
delivered without destroying the active ingredient.
[0240] In some embodiments, the method further includes
administration of ritonavir. Ritonavir,
10-hydroxy-2-methyl-5-(1-methylethyl)-1-[2-(1-methylethyl)-4-thiazolyl]-3-
,6-dioxo-8,11-bis(phenylmethyl)-2,4,7,12-tetraazatridecan-13-oic
acid, 5-thiazolylmethyl ester [5S-(5R*,8R*,10R*,11R*)], available
from Abbott Laboratories, is an inhibitor of the protease of the
human immunodeficiency virus and also of the cytochrome P450 3A and
P450 2D6 liver enzymes frequently involved in hepatic metabolism of
therapeutic molecules in man. Because of its strong inhibitory
effect on cytochrome P450 3A and the inhibitory effect on
cytochrome P450 2D6, ritonavir at doses below the normal
therapeutic dosage may be combined with other protease inhibitors
to achieve therapeutic levels of the second protease inhibitor
while reducing the number of dosage units required, the dosing
frequency, or both.
[0241] Coadministration of low-dose ritonavir may also be used to
compensate for drug interactions that tend to decrease levels of a
protease inhibitor metabolized by CYP3A. Its structure, synthesis,
manufacture and formulation are described in U.S. Pat. No.
5,541,206 U.S. Pat. No. 5,635,523 U.S. Pat. No. 5,648,497 U.S. Pat.
No. 5,846,987 and U.S. Pat. No. 6,232,333. The ritonavir may be
administered orally in capsule or tablet or oral solution form, or
in the same or different administration form and in the same or
different route as the NS-3 inhibitor compound. Of course, other
types of administration of both medicaments, as they become
available are contemplated, such as by nasal spray, transdermally,
intravenously, by suppository, by sustained release dosage form,
etc. Any form of administration will work so long as the proper
dosages are delivered without destroying the active ingredient.
[0242] In some embodiments, an additional antiviral agent is
administered during the entire course of NS3 inhibitor compound
treatment. In other embodiments, an additional antiviral agent is
administered for a period of time that is overlapping with that of
the NS3 inhibitor compound treatment, e.g., the additional
antiviral agent treatment can begin before the NS3 inhibitor
compound treatment begins and end before the NS3 inhibitor compound
treatment ends; the additional antiviral agent treatment can begin
after the NS3 inhibitor compound treatment begins and end after the
NS3 inhibitor compound treatment ends; the additional antiviral
agent treatment can begin after the NS3 inhibitor compound
treatment begins and end before the NS3 inhibitor compound
treatment ends; or the additional antiviral agent treatment can
begin before the NS3 inhibitor compound treatment begins and end
after the NS3 inhibitor compound treatment ends.
Methods of Treatment
Monotherapies
[0243] The NS3 inhibitor compounds described herein may be used in
acute or chronic therapy for HCV disease. In many embodiments, the
NS3 inhibitor compound is administered for a period of about 1 day
to about 7 days, or about 1 week to about 2 weeks, or about 2 weeks
to about 3 weeks, or about 3 weeks to about 4 weeks, or about 1
month to about 2 months, or about 3 months to about 4 months, or
about 4 months to about 6 months, or about 6 months to about 8
months, or about 8 months to about 12 months, or at least one year,
and may be administered over longer periods of time. The NS3
inhibitor compound can be administered 5 times per day, 4 times per
day, tid, bid, qd, qod, biw, tiw, qw, qow, three times per month,
or once monthly. In other embodiments, the NS3 inhibitor compound
is administered as a continuous infusion.
[0244] In many embodiments, an NS3 inhibitor compound of the
embodiments is administered orally.
[0245] In connection with the above-described methods for the
treatment of HCV disease in a patient, an NS3 inhibitor compound as
described herein may be administered to the patient at a dosage
from about 0.01 mg to about 100 mg/kg patient bodyweight per day,
in 1 to 5 divided doses per day. In some embodiments, the NS3
inhibitor compound is administered at a dosage of about 0.5 mg to
about 75 mg/kg patient bodyweight per day, in 1 to 5 divided doses
per day.
[0246] The amount of active ingredient that may be combined with
carrier materials to produce a dosage form can vary depending on
the host to be treated and the particular mode of administration. A
typical pharmaceutical preparation can contain from about 5% to
about 95% active ingredient (w/w). In other embodiments, the
pharmaceutical preparation can contain from about 20% to about 80%
active ingredient.
[0247] Those of skill will readily appreciate that dose levels can
vary as a function of the specific NS3 inhibitor compound, the
severity of the symptoms and the susceptibility of the subject to
side effects. Preferred dosages for a given NS3 inhibitor compound
are readily determinable by those of skill in the art by a variety
of means. A preferred means is to measure the physiological potency
of a given interferon receptor agonist.
[0248] In many embodiments, multiple doses of NS3 inhibitor
compound are administered. For example, an NS3 inhibitor compound
is administered once per month, twice per month, three times per
month, every other week (qow), once per week (qw), twice per week
(biw), three times per week (tiw), four times per week, five times
per week, six times per week, every other day (qod), daily (qd),
twice a day (qid), or three times a day (tid), over a period of
time ranging from about one day to about one week, from about two
weeks to about four weeks, from about one month to about two
months, from about two months to about four months, from about four
months to about six months, from about six months to about eight
months, from about eight months to about 1 year, from about 1 year
to about 2 years, or from about 2 years to about 4 years, or more.
Combination therapies with ribavirin
[0249] In some embodiments, the methods provide for combination
therapy comprising administering an NS3 inhibitor compound as
described above, and an effective amount of ribavirin. Ribavirin
can be administered in dosages of about 400 mg, about 800 mg, about
1000 mg, or about 1200 mg per day.
[0250] One embodiment provides any of the above-described methods
modified to include co-administering to the patient a
therapeutically effective amount of ribavirin for the duration of
the desired course of NS3 inhibitor compound treatment.
[0251] Another embodiment provides any of the above-described
methods modified to include co-administering to the patient about
800 mg to about 1200 mg ribavirin orally per day for the duration
of the desired course of NS3 inhibitor compound treatment. In
another embodiment, any of the above-described methods may be
modified to include co-administering to the patient (a) 1000 mg
ribavirin orally per day if the patient has a body weight less than
75 kg or (b) 1200 mg ribavirin orally per day if the patient has a
body weight greater than or equal to 75 kg, where the daily dosage
of ribavirin is optionally divided into to 2 doses for the duration
of the desired course of NS3 inhibitor compound treatment.
Combination Therapies with Levovirin
[0252] In some embodiments, the methods provide for combination
therapy comprising administering an NS3 inhibitor compound as
described above, and an effective amount of levovirin. Levovirin is
generally administered in an amount ranging from about 30 mg to
about 60 mg, from about 60 mg to about 125 mg, from about 125 mg to
about 200 mg, from about 200 mg to about 300 gm, from about 300 mg
to about 400 mg, from about 400 mg to about 1200 mg, from about 600
mg to about 1000 mg, or from about 700 to about 900 mg per day, or
about 10 mg/kg body weight per day. In some embodiments, levovirin
is administered orally in dosages of about 400, about 800, about
1000, or about 1200 mg per day for the desired course of NS3
inhibitor compound treatment.
Combination Therapies with Viramidine
[0253] In some embodiments, the methods provide for combination
therapy comprising administering an NS3 inhibitor compound as
described above, and an effective amount of viramidine. Viramidine
is generally administered in an amount ranging from about 30 mg to
about 60 mg, from about 60 mg to about 125 mg, from about 125 mg to
about 200 mg, from about 200 mg to about 300 gm, from about 300 mg
to about 400 mg, from about 400 mg to about 1200 mg, from about 600
mg to about 1000 mg, or from about 700 to about 900 mg per day, or
about 10 mg/kg body weight per day. In some embodiments, viramidine
is administered orally in dosages of about 800, or about 1600 mg
per day for the desired course of NS3 inhibitor compound
treatment.
Combination Therapies with Ritonavir
[0254] In some embodiments, the methods provide for combination
therapy comprising administering an NS3 inhibitor compound as
described above, and an effective amount of ritonavir. Ritonavir is
generally administered in an amount ranging from about 50 mg to
about 100 mg, from about 100 mg to about 200 mg, from about 200 mg
to about 300 mg, from about 300 mg to about 400 mg, from about 400
mg to about 500 mg, or from about 500 mg to about 600 mg, twice per
day. In some embodiments, ritonavir is administered orally in
dosages of about 300 mg, or about 400 mg, or about 600 mg twice per
day for the desired course of NS3 inhibitor compound treatment.
Combination Therapies with Alpha-Glucosidase Inhibitors
[0255] Suitable .alpha.-glucosidase inhibitors include any of the
above-described imino-sugars, including long-alkyl chain
derivatives of imino sugars as disclosed in U.S. Patent Publication
No. 2004/0110795; inhibitors of endoplasmic reticulum-associated
.alpha.-glucosidases; inhibitors of membrane bound
.alpha.-glucosidase; miglitol (Glyset.RTM.), and active
derivatives, and analogs thereof; and acarbose (Precose.RTM.), and
active derivatives, and analogs thereof.
[0256] In many embodiments, the methods provide for combination
therapy comprising administering an NS3 inhibitor compound as
described above, and an effective amount of an .alpha.-glucosidase
inhibitor administered for a period of about 1 day to about 7 days,
or about 1 week to about 2 weeks, or about 2 weeks to about 3
weeks, or about 3 weeks to about 4 weeks, or about 1 month to about
2 months, or about 3 months to about 4 months, or about 4 months to
about 6 months, or about 6 months to about 8 months, or about 8
months to about 12 months, or at least one year, and may be
administered over longer periods of time.
[0257] An .alpha.-glucosidase inhibitor can be administered 5 times
per day, 4 times per day, tid (three times daily), bid, qd, qod,
biw, tiw, qw, qow, three times per month, or once monthly. In other
embodiments, an .alpha.-glucosidase inhibitor is administered as a
continuous infusion.
[0258] In many embodiments, an .alpha.-glucosidase inhibitor is
administered orally.
[0259] In connection with the above-described methods for the
treatment of a flavivirus infection, treatment of HCV infection,
and treatment of liver fibrosis that occurs as a result of an HCV
infection, the methods provide for combination therapy comprising
administering an NS3 inhibitor compound as described above, and an
effective amount of .alpha.-glucosidase inhibitor administered to
the patient at a dosage of from about 10 mg per day to about 600 mg
per day in divided doses, e.g., from about 10 mg per day to about
30 mg per day, from about 30 mg per day to about 60 mg per day,
from about 60 mg per day to about 75 mg per day, from about 75 mg
per day to about 90 mg per day, from about 90 mg per day to about
120 mg per day, from about 120 mg per day to about 150 mg per day,
from about 150 mg per day to about 180 mg per day, from about 180
mg per day to about 210 mg per day, from about 210 mg per day to
about 240 mg per day, from about 240 mg per day to about 270 mg per
day, from about 270 mg per day to about 300 mg per day, from about
300 mg per day to about 360 mg per day, from about 360 mg per day
to about 420 mg per day, from about 420 mg per day to about 480 mg
per day, or from about 480 mg to about 600 mg per day.
[0260] In some embodiments, the methods provide for combination
therapy comprising administering an NS3 inhibitor compound as
described above, and an effective amount of .alpha.-glucosidase
inhibitor administered in a dosage of about 10 mg three times
daily. In some embodiments, an .alpha.-glucosidase inhibitor is
administered in a dosage of about 15 mg three times daily. In some
embodiments, an .alpha.-glucosidase inhibitor is administered in a
dosage of about 20 mg three times daily. In some embodiments, an
.alpha.-glucosidase inhibitor is administered in a dosage of about
25 mg three times daily. In some embodiments, an
.alpha.-glucosidase inhibitor is administered in a dosage of about
30 mg three times daily. In some embodiments, an
.alpha.-glucosidase inhibitor is administered in a dosage of about
40 mg three times daily. In some embodiments, an
.alpha.-glucosidase inhibitor is administered in a dosage of about
50 mg three times daily. In some embodiments, an
.alpha.-glucosidase inhibitor is administered in a dosage of about
100 mg three times daily. In some embodiments, an
.alpha.-glucosidase inhibitor is administered in a dosage of about
75 mg per day to about 150 mg per day in two or three divided
doses, where the individual weighs 60 kg or less. In some
embodiments, an .alpha.-glucosidase inhibitor is administered in a
dosage of about 75 mg per day to about 300 mg per day in two or
three divided doses, where the individual weighs 60 kg or more.
[0261] The amount of active ingredient (e.g., .alpha.-glucosidase
inhibitor) that may be combined with carrier materials to produce a
dosage form can vary depending on the host to be treated and the
particular mode of administration. A typical pharmaceutical
preparation can contain from about 5% to about 95% active
ingredient (w/w). In other embodiments, the pharmaceutical
preparation can contain from about 20% to about 80% active
ingredient.
[0262] Those of skill will readily appreciate that dose levels can
vary as a function of the specific .alpha.-glucosidase inhibitor,
the severity of the symptoms and the susceptibility of the subject
to side effects. Preferred dosages for a given .alpha.-glucosidase
inhibitor are readily determinable by those of skill in the art by
a variety of means. A typical means is to measure the physiological
potency of a given active agent.
[0263] In many embodiments, multiple doses of an
.alpha.-glucosidase inhibitor are administered. For example, the
methods provide for combination therapy comprising administering an
NS3 inhibitor compound as described above, and an effective amount
of .alpha.-glucosidase inhibitor administered once per month, twice
per month, three times per month, every other week (qow), once per
week (qw), twice per week (biw), three times per week (tiw), four
times per week, five times per week, six times per week, every
other day (qod), daily (qd), twice a day (qid), or three times a
day (tid), over a period of time ranging from about one day to
about one week, from about two weeks to about four weeks, from
about one month to about two months, from about two months to about
four months, from about four months to about six months, from about
six months to about eight months, from about eight months to about
1 year, from about 1 year to about 2 years, or from about 2 years
to about 4 years, or more.
Combination Therapies with Thymosin-.alpha.
[0264] In some embodiments, the methods provide for combination
therapy comprising administering an NS3 inhibitor compound as
described above, and an effective amount of thymosin-.alpha..
Thymosin-.alpha. (Zadaxin.TM.) is generally administered by
subcutaneous injection. Thymosin-.alpha. can be administered tid,
bid, qd, qod, biw, tiw, qw, qow, three times per month, once
monthly, substantially continuously, or continuously for the
desired course of NS3 inhibitor compound treatment. In many
embodiments, thymosin-a is administered twice per week for the
desired course of NS3 inhibitor compound treatment. Effective
dosages of thymosin-a range from about 0.5 mg to about 5 mg, e.g.,
from about 0.5 mg to about 1.0 mg, from about 1.0 mg to about 1.5
mg, from about 1.5 mg to about 2.0 mg, from about 2.0 mg to about
2.5 mg, from about 2.5 mg to about 3.0 mg, from about 3.0 mg to
about 3.5 mg, from about 3.5 mg to about 4.0 mg, from about 4.0 mg
to about 4.5 mg, or from about 4.5 mg to about 5.0 mg. In
particular embodiments, thymosin-a is administered in dosages
containing an amount of 1.0 mg or 1.6 mg.
[0265] Thymosin-.alpha. can be administered over a period of time
ranging from about one day to about one week, from about two weeks
to about four weeks, from about one month to about two months, from
about two months to about four months, from about four months to
about six months, from about six months to about eight months, from
about eight months to about 1 year, from about 1 year to about 2
years, or from about 2 years to about 4 years, or more. In one
emobidment, thymosin-.alpha. is administered for the desired course
of NS3 inhibitor compound treatment.
Combination Therapies with Interferon(s)
[0266] In many embodiments, the methods provide for combination
therapy comprising administering an NS3 inhibitor compound as
described above, and an effective amount of an interferon receptor
agonist. In some embodiments, a compound of Formula I, Formula II,
or Formula III and a Type I or III interferon receptor agonist are
co-administered in the treatment methods described herein. Type I
interferon receptor agonists suitable for use herein include any
interferon-.alpha. (IFN-.alpha.). In certain embodiments, the
interferon-.alpha. is a PEGylated interferon-.alpha.. In certain
other embodiments, the interferon-.alpha. is a consensus
interferon, such as INFERGEN.RTM. interferon alfacon-1. In still
other embodiments, the interferon-.alpha. is a monoPEG (30 kD,
linear)-ylated consensus interferon.
[0267] Effective dosages of an IFN-.alpha. range from about 3 .mu.g
to about 27 .mu.g, from about 3 MU to about 10 MU, from about 90
.mu.g to about 180 or from about 18 .mu.g to about 90 .mu.g.
Effective dosages of Infergen.RTM. consensus IFN-.alpha. include
about 3 about 6 about 9 about 12 about 15 about 18 about 21 about
24 about 27 or about 30 of drug per dose. Effective dosages of
IFN-.alpha.2a and IFN-.alpha.2b range from 3 million Units (MU) to
10 MU per dose. Effective dosages of PEGASYS.RTM.PEGylated
IFN-.alpha.2a contain an amount of about 90 .mu.g to 270 or about
180 of drug per dose. Effective dosages of PEG-INTRON.RTM.PEGylated
IFN-.alpha.2b contain an amount of about 0.5 .mu.g to 3.0 .mu.g of
drug per kg of body weight per dose. Effective dosages of PEGylated
consensus interferon (PEG-CIFN) contain an amount of about 18 .mu.g
to about 90 or from about 27 .mu.g to about 60 or about 45 of CIFN
amino acid weight per dose of PEG-CIFN. Effective dosages of
monoPEG (30 kD, linear)-ylated CIFN contain an amount of about 45
.mu.g to about 270 .mu.g, or about 60 .mu.g to about 180 .mu.g, or
about 90 .mu.g to about 120 .mu.g, of drug per dose. IFN-.alpha.
can be administered daily, every other day, once a week, three
times a week, every other week, three times per month, once
monthly, substantially continuously or continuously.
[0268] In many embodiments, the Type I or Type III interferon
receptor agonist and/or the Type II interferon receptor agonist is
administered for a period of about 1 day to about 7 days, or about
1 week to about 2 weeks, or about 2 weeks to about 3 weeks, or
about 3 weeks to about 4 weeks, or about 1 month to about 2 months,
or about 3 months to about 4 months, or about 4 months to about 6
months, or about 6 months to about 8 months, or about 8 months to
about 12 months, or at least one year, and may be administered over
longer periods of time. Dosage regimens can include tid, bid, qd,
qod, biw, tiw, qw, qow, three times per month, or monthly
administrations. Some embodiments provide any of the
above-described methods in which the desired dosage of IFN-.alpha.
is administered subcutaneously to the patient by bolus delivery qd,
qod, tiw, biw, qw, qow, three times per month, or monthly, or is
administered subcutaneously to the patient per day by substantially
continuous or continuous delivery, for the desired treatment
duration. In other embodiments, any of the above-described methods
may be practiced in which the desired dosage of PEGylated
IFN-.alpha. (PEG-IFN-.alpha.) is administered subcutaneously to the
patient by bolus delivery qw, qow, three times per month, or
monthly for the desired treatment duration.
[0269] In other embodiments, an NS3 inhibitor compound and a Type
II interferon receptor agonist are co-administered in the treatment
methods of the embodiments. Type II interferon receptor agonists
suitable for use herein include any interferon-.gamma.
(IFN-.gamma.).
[0270] Effective dosages of IFN-.gamma. can range from about 0.5
.mu.g/m.sup.2 to about 500 .mu.g/m.sup.2, usually from about 1.5
.mu.g/m.sup.2 to 200 .mu.g/m.sup.2, depending on the size of the
patient. This activity is based on 10.sup.6 international units (U)
per 50 .mu.g of protein. IFN-.gamma. can be administered daily,
every other day, three times a week, or substantially continuously
or continuously.
[0271] In specific embodiments of interest, IFN-.gamma. is
administered to an individual in a unit dosage form of from about
25 .mu.g to about 500 .mu.g, from about 50 .mu.g to about 400
.mu.g, or from about 100 .mu.g to about 300 .mu.g. In particular
embodiments of interest, the dose is about 200 .mu.g IFN-.gamma..
In many embodiments of interest, IFN-.gamma.1b is administered.
[0272] Where the dosage is 200 .mu.g IFN-.gamma. per dose, the
amount of IFN-.gamma. per body weight (assuming a range of body
weights of from about 45 kg to about 135 kg) is in the range of
from about 4.4 .mu.g IFN-.gamma. per kg body weight to about 1.48
.mu.g IFN-.gamma. per kg body weight.
[0273] The body surface area of subject individuals generally
ranges from about 1.33 m.sup.2 to about 2.50 m.sup.2. Thus, in many
embodiments, an IFN-.gamma. dosage ranges from about 150
.mu.g/m.sup.2 to about 20 .mu.g/m.sup.2. For example, an
IFN-.gamma. dosage ranges from about 20 .mu.g/m.sup.2 to about 30
.mu.g/m.sup.2, from about 30 .mu.g/m.sup.2 to about 40
.mu.g/m.sup.2, from about 40 .mu.g/m.sup.2 to about 50
.mu.g/m.sup.2, from about 50 .mu.g/m.sup.2 to about 60
.mu.g/m.sup.2, from about 60 .mu.g/m.sup.2 to about 70
.mu.g/m.sup.2, from about 70 .mu.g/m.sup.2 to about 80
.mu.g/m.sup.2, from about 80 .mu.g/m.sup.2 to about 90
.mu.g/m.sup.2, from about 90 .mu.g/m.sup.2 to about 100
.mu.g/m.sup.2, from about 100 .mu.g/m.sup.2to about 110
.mu.g/m.sup.2, from about 110 .mu.g/m.sup.2 to about 120
.mu.g/m.sup.2, from about 120 .mu.g/m.sup.2 to about 130
.mu.g/m.sup.2, from about 130 .mu.g/m.sup.2 to about 140
.mu.g/m.sup.2, or from about 140 .mu.g/m.sup.2 to about 150
.mu.g/m.sup.2. In some embodiments, the dosage groups range from
about 25 .mu.g/m.sup.2 to about 100 .mu.g/m.sup.2. In other
embodiments, the dosage groups range from about 25 .mu.g/m.sup.2 to
about 50 .mu.g/m.sup.2.
[0274] In some embodiments, a Type I or a Type III interferon
receptor agonist is administered in a first dosing regimen,
followed by a second dosing regimen. The first dosing regimen of
Type I or a Type III interferon receptor agonist (also referred to
as "the induction regimen") generally involves administration of a
higher dosage of the Type I or Type III interferon receptor
agonist. For example, in the case of Infergen.RTM. consensus
IFN-.alpha. (CIFN), the first dosing regimen comprises
administering CIFN at about 9 about 15 about 18 or about 27 .mu.g.
The first dosing regimen can encompass a single dosing event, or at
least two or more dosing events. The first dosing regimen of the
Type I or Type III interferon receptor agonist can be administered
daily, every other day, three times a week, every other week, three
times per month, once monthly, substantially continuously or
continuously.
[0275] The first dosing regimen of the Type I or Type III
interferon receptor agonist is administered for a first period of
time, which time period can be at least about 4 weeks, at least
about 8 weeks, or at least about 12 weeks.
[0276] The second dosing regimen of the Type I or Type III
interferon receptor agonist (also referred to as "the maintenance
dose") generally involves administration of a lower amount of the
Type I or Type III interferon receptor agonist. For example, in the
case of CIFN, the second dosing regimen comprises administering
CIFN at a dose of at least about at least about 9 .mu.g, at least
about 15 or at least about 18 .mu.g. The second dosing regimen can
encompass a single dosing event, or at least two or more dosing
events.
[0277] The second dosing regimen of the Type I or Type III
interferon receptor agonist can be administered daily, every other
day, three times a week, every other week, three times per month,
once monthly, substantially continuously or continuously.
[0278] In some embodiments, where an "induction"/"maintenance"
dosing regimen of a Type I or a Type III interferon receptor
agonist is administered, a "priming" dose of a Type II interferon
receptor agonist (e.g., IFN-.gamma.) is included. In these
embodiments, IFN-.gamma. is administered for a period of time from
about 1 day to about 14 days, from about 2 days to about 10 days,
or from about 3 days to about 7 days, before the beginning of
treatment with the Type I or Type III interferon receptor agonist.
This period of time is referred to as the "priming" phase.
[0279] In some of these embodiments, the Type II interferon
receptor agonist treatment is continued throughout the entire
period of treatment with the Type I or Type III interferon receptor
agonist. In other embodiments, the Type II interferon receptor
agonist treatment is discontinued before the end of treatment with
the Type I or Type III interferon receptor agonist. In these
embodiments, the total time of treatment with Type II interferon
receptor agonist (including the "priming" phase) is from about 2
days to about 30 days, from about 4 days to about 25 days, from
about 8 days to about 20 days, from about 10 days to about 18 days,
or from about 12 days to about 16 days. In still other embodiments,
the Type II interferon receptor agonist treatment is discontinued
once Type I or a Type III interferon receptor agonist treatment
begins.
[0280] In other embodiments, the Type I or Type III interferon
receptor agonist is administered in single dosing regimen. For
example, in the case of CIFN, the dose of CIFN is generally in a
range of from about 3 .mu.g to about 15 .mu.g, or from about 9
.mu.g to about 15 .mu.g. The dose of Type I or a Type III
interferon receptor agonist is generally administered daily, every
other day, three times a week, every other week, three times per
month, once monthly, or substantially continuously. The dose of the
Type I or Type III interferon receptor agonist is administered for
a period of time, which period can be, for example, from at least
about 24 weeks to at least about 48 weeks, or longer.
[0281] In some embodiments, where a single dosing regimen of a Type
I or a Type III interferon receptor agonist is administered, a
"priming" dose of a Type II interferon receptor agonist (e.g.,
IFN-.gamma.) is included. In these embodiments, IFN-.gamma. is
administered for a period of time from about 1 day to about 14
days, from about 2 days to about 10 days, or from about 3 days to
about 7 days, before the beginning of treatment with the Type I or
Type III interferon receptor agonist. This period of time is
referred to as the "priming" phase. In some of these embodiments,
the Type II interferon receptor agonist treatment is continued
throughout the entire period of treatment with the Type I or Type
III interferon receptor agonist. In other embodiments, the Type II
interferon receptor agonist treatment is discontinued before the
end of treatment with the Type I or Type III interferon receptor
agonist. In these embodiments, the total time of treatment with the
Type II interferon receptor agonist (including the "priming" phase)
is from about 2 days to about 30 days, from about 4 days to about
25 days, from about 8 days to about 20 days, from about 10 days to
about 18 days, or from about 12 days to about 16 days. In still
other embodiments, Type II interferon receptor agonist treatment is
discontinued once Type I or a Type III interferon receptor agonist
treatment begins.
[0282] In additional embodiments, an NS3 inhibitor compound, a Type
I or III interferon receptor agonist, and a Type II interferon
receptor agonist are co-administered for the desired duration of
treatment in the methods described herein. In some embodiments, an
NS3 inhibitor compound, an interferon-.alpha., and an
interferon-.gamma. are co-administered for the desired duration of
treatment in the methods described herein.
[0283] In some embodiments, the invention provides methods using an
amount of a Type I or Type III interferon receptor agonist, a Type
II interferon receptor agonist, and an NS3 inhibitor compound,
effective for the treatment of HCV infection in a patient. Some
embodiments provide methods using an effective amount of an
IFN-.alpha., IFN-.gamma., and an NS3 inhibitor compound in the
treatment of HCV infection in a patient. One embodiment provides a
method using an effective amount of a consensus IFN-.alpha.,
IFN-.gamma. and an NS3 inhibitor compound in the treatment of HCV
infection in a patient.
[0284] In general, an effective amount of a consensus interferon
(CIFN) and IFN-.gamma. suitable for use in the methods of the
embodiments is provided by a dosage ratio of 1 .mu.g CIFN: 10 .mu.g
IFN-.gamma., where both CIFN and IFN-.gamma. are unPEGylated and
unglycosylated species.
[0285] In one embodiment, the invention provides any of the
above-described methods modified to use an effective amount of
INFERGEN.RTM.consensus IFN-.alpha. and IFN-.gamma. in the treatment
of HCV infection in a patient comprising administering to the
patient a dosage of INFERGEN.RTM. containing an amount of about 1
.mu.g to about 30 of drug per dose of INFERGEN.RTM., subcutaneously
qd, qod, tiw, biw, qw, qow, three times per month, once monthly, or
per day substantially continuously or continuously, in combination
with a dosage of IFN-.gamma. containing an amount of about 10 .mu.g
to about 300 .mu.g of drug per dose of IFN-.gamma., subcutaneously
qd, qod, tiw, biw, qw, qow, three times per month, once monthly, or
per day substantially continuously or continuously, for the desired
duration of treatment with an NS3 inhibitor compound.
[0286] Another embodiment provides any of the above-described
methods modified to use an effective amount of
INFERGEN.RTM.consensus IFN-.alpha. and IFN-.gamma. in the treatment
of virus infection in a patient comprising administering to the
patient a dosage of INFERGEN.RTM. containing an amount of about 1
.mu.g to about 9 .mu.g, of drug per dose of INFERGEN.RTM.,
subcutaneously qd, qod, tiw, biw, qw, qow, three times per month,
once monthly, or per day substantially continuously or
continuously, in combination with a dosage of IFN-.gamma.
containing an amount of about 10 .mu.g to about 100 .mu.g of drug
per dose of IFN-.gamma., subcutaneously qd, qod, tiw, biw, qw, qow,
three times per month, once monthly, or per day substantially
continuously or continuously, for the desired duration of treatment
with an NS3 inhibitor compound.
[0287] Another embodiment provides any of the above-described
methods modified to use an effective amount of
INFERGEN.RTM.consensus IFN-.alpha. and IFN-.gamma. in the treatment
of virus infection in a patient comprising administering to the
patient a dosage of INFERGEN.RTM. containing an amount of about 1
.mu.g of drug per dose of INFERGEN.RTM., subcutaneously qd, qod,
tiw, biw, qw, qow, three times per month, once monthly, or per day
substantially continuously or continuously, in combination with a
dosage of IFN-.gamma. containing an amount of about 10 .mu.g to
about 50 .mu.g of drug per dose of IFN-.gamma., subcutaneously qd,
qod, tiw, biw, qw, qow, three times per month, once monthly, or per
day substantially continuously or continuously, for the desired
duration of treatment with an NS3 inhibitor compound.
[0288] Another embodiment provides any of the above-described
methods modified to use an effective amount of
INFERGEN.RTM.consensus IFN-.alpha. and IFN-.gamma. in the treatment
of a virus infection in a patient comprising administering to the
patient a dosage of INFERGEN.RTM. containing an amount of about 9
.mu.g of drug per dose of INFERGEN.RTM., subcutaneously qd, qod,
tiw, biw, qw, qow, three times per month, once monthly, or per day
substantially continuously or continuously, in combination with a
dosage of IFN-.gamma. containing an amount of about 90 .mu.g to
about 100 .mu.g of drug per dose of IFN-.gamma., subcutaneously qd,
qod, tiw, biw, qw, qow, three times per month, once monthly, or per
day substantially continuously or continuously, for the desired
duration of treatment with an NS3 inhibitor compound.
[0289] Another embodiment provides any of the above-described
methods modified to use an effective amount of
INFERGEN.RTM.consensus IFN-.alpha. and IFN-.gamma. in the treatment
of a virus infection in a patient comprising administering to the
patient a dosage of INFERGEN.RTM. containing an amount of about 30
.mu.g of drug per dose of INFERGEN.RTM., subcutaneously qd, qod,
tiw, biw, qw, qow, three times per month, once monthly, or per day
substantially continuously or continuously, in combination with a
dosage of IFN-.gamma. containing an amount of about 200 .mu.g to
about 300 .mu.g of drug per dose of IFN-.gamma., subcutaneously qd,
qod, tiw, biw, qw, qow, three times per month, once monthly, or per
day substantially continuously or continuously, for the desired
duration of treatment with an NS3 inhibitor compound.
[0290] Another embodiment provides any of the above-described
methods modified to use an effective amount of PEGylated consensus
IFN-.alpha. and IFN-.gamma. in the treatment of a virus infection
in a patient comprising administering to the patient a dosage of
PEGylated consensus IFN-.alpha. (PEG-CIFN) containing an amount of
about 4 .mu.g to about 60 .mu.g of CIFN amino acid weight per dose
of PEG-CIFN, subcutaneously qw, qow, three times per month, or
monthly, in combination with a total weekly dosage of IFN-.gamma.
containing an amount of about 30 .mu.g to about 1,000 .mu.g of drug
per week in divided doses administered subcutaneously qd, qod, tiw,
biw, or administered substantially continuously or continuously,
for the desired duration of treatment with an NS3 inhibitor
compound.
[0291] Another embodiment provides any of the above-described
methods modified to use an effective amount of PEGylated consensus
IFN-.alpha. and IFN-.gamma. in the treatment of a virus infection
in a patient comprising administering to the patient a dosage of
PEGylated consensus IFN-.alpha. (PEG-CIFN) containing an amount of
about 18 .mu.g to about 24 .mu.g of CIFN amino acid weight per dose
of PEG-CIFN, subcutaneously qw, qow, three times per month, or
monthly, in combination with a total weekly dosage of IFN-.gamma.
containing an amount of about 100 .mu.g to about 300 .mu.g of drug
per week in divided doses administered subcutaneously qd, qod, tiw,
biw, or substantially continuously or continuously, for the desired
duration of treatment with an NS3 inhibitor compound.
[0292] In general, an effective amount of IFN-.alpha.2a or 2b or 2c
and IFN-.gamma. suitable for use in the methods of the embodiments
is provided by a dosage ratio of 1 million Units (MU) IFN-.alpha.2a
or 2b or 2c : 30 .mu.g IFN-.gamma., where both IFN-.alpha. 2a or 2b
or 2c and IFN-.gamma. are unPEGylated and unglycosylated
species.
[0293] Another embodiment provides any of the above-described
methods modified to use an effective amount of IFN-.alpha. 2a or 2b
or 2c and IFN-.gamma. in the treatment of a virus infection in a
patient comprising administering to the patient a dosage of
IFN-.alpha.2a, 2b or 2c containing an amount of about 1 MU to about
20 MU of drug per dose of IFN-.alpha.2a, 2b or 2c subcutaneously
qd, qod, tiw, biw, or per day substantially continuously or
continuously, in combination with a dosage of IFN-.gamma.
containing an amount of about 30 .mu.g to about 600 .mu.g of drug
per dose of IFN-.gamma., subcutaneously qd, qod, tiw, biw, or per
day substantially continuously or continuously, for the desired
duration of treatment with an NS3 inhibitor compound.
[0294] Another embodiment provides any of the above-described
methods modified to use an effective amount of IFN-.alpha. 2a or 2b
or 2c and IFN-.gamma. in the treatment of a virus infection in a
patient comprising administering to the patient a dosage of
IFN-.alpha. 2a, 2b or 2c containing an amount of about 3 MU of drug
per dose of IFN-.alpha.2a, 2b or 2c subcutaneously qd, qod, tiw,
biw, or per day substantially continuously or continuously, in
combination with a dosage of IFN-.gamma. containing an amount of
about 100 .mu.g of drug per dose of IFN-.gamma., subcutaneously qd,
qod, tiw, biw, or per day substantially continuously or
continuously, for the desired duration of treatment with an NS3
inhibitor compound.
[0295] Another embodiment provides any of the above-described
methods modified to use an effective amount of IFN-.alpha.2a or 2b
or 2c and IFN-.gamma. in the treatment of a virus infection in a
patient comprising administering to the patient a dosage of
IFN-.alpha.2a, 2b or 2c containing an amount of about 10 MU of drug
per dose of IFN-.alpha.2a, 2b or 2c subcutaneously qd, qod, tiw,
biw, or per day substantially continuously or continuously, in
combination with a dosage of IFN-.gamma. containing an amount of
about 300 .mu.g of drug per dose of IFN-.gamma., subcutaneously qd,
qod, tiw, biw, or per day substantially continuously or
continuously, for the desired duration of treatment with an NS3
inhibitor compound.
[0296] Another embodiment provides any of the above-described
methods modified to use an effective amount of
PEGASYS.RTM.PEGylated IFN-.alpha.2a and IFN-.gamma. in the
treatment of a virus infection in a patient comprising
administering to the patient a dosage of PEGASYS.RTM. containing an
amount of about 90 .mu.g to about 360 .mu.g, of drug per dose of
PEGASYS.RTM., subcutaneously qw, qow, three times per month, or
monthly, in combination with a total weekly dosage of IFN-.gamma.
containing an amount of about 30 .mu.g to about 1,000 .mu.g, of
drug per week administered in divided doses subcutaneously qd, qod,
tiw, or biw, or administered substantially continuously or
continuously, for the desired duration of treatment with an NS3
inhibitor compound.
[0297] Another embodiment provides any of the above-described
methods modified to use an effective amount of
PEGASYS.RTM.PEGylated IFN-.alpha.2a and IFN-.gamma. in the
treatment of a virus infection in a patient comprising
administering to the patient a dosage of PEGASYS.RTM. containing an
amount of about 180 .mu.g of drug per dose of PEGASYS.RTM.,
subcutaneously qw, qow, three times per month, or monthly, in
combination with a total weekly dosage of IFN-.gamma. containing an
amount of about 100 .mu.g to about 300 .mu.g, of drug per week
administered in divided doses subcutaneously qd, qod, tiw, or biw,
or administered substantially continuously or continuously, for the
desired duration of treatment with an NS3 inhibitor compound.
[0298] Another embodiment provides any of the above-described
methods modified to use an effective amount of
PEG-INTRON.RTM.PEGylated IFN-.alpha.2b and IFN-.gamma. in the
treatment of a virus infection in a patient comprising
administering to the patient a dosage of PEG-INTRON.RTM. containing
an amount of about 0.75 .mu.g to about 3.0 .mu.g of drug per
kilogram of body weight per dose of PEG-INTRON.RTM., subcutaneously
qw, qow, three times per month, or monthly, in combination with a
total weekly dosage of IFN-.gamma. containing an amount of about 30
.mu.g to about 1,000 .mu.g of drug per week administered in divided
doses subcutaneously qd, qod, tiw, or biw, or administered
substantially continuously or continuously, for the desired
duration of treatment with an NS3 inhibitor compound.
[0299] Another embodiment provides any of the above-described
methods modified to use an effective amount of
PEG-INTRON.RTM.PEGylated IFN-.alpha.2b and IFN-.gamma. in the
treatment of a virus infection in a patient comprising
administering to the patient a dosage of PEG-INTRON.RTM. containing
an amount of about 1.5 .mu.g of drug per kilogram of body weight
per dose of PEG-INTRON.RTM., subcutaneously qw, qow, three times
per month, or monthly, in combination with a total weekly dosage of
IFN-.gamma. containing an amount of about 100 .mu.g to about 300
.mu.g of drug per week administered in divided doses subcutaneously
qd, qod, tiw, or biw, or administered substantially continuously or
continuously, for the desired duration of treatment with an NS3
inhibitor compound.
[0300] One embodiment provides any of the above-described methods
modified to comprise administering to an individual having an HCV
infection an effective amount of an NS3 inhibitor; and a regimen of
9 .mu.g INFERGEN.RTM. consensus IFN-.alpha. administered
subcutaneously qd or tiw, and ribavirin administered orally qd,
where the duration of therapy is 48 weeks. In this embodiment,
ribavirin is administered in an amount of 1000 mg for individuals
weighing less than 75 kg, and 1200 mg for individuals weighing 75
kg or more.
[0301] One embodiment provides any of the above-described methods
modified to comprise administering to an individual having an HCV
infection an effective amount of an NS3 inhibitor; and a regimen of
9 .mu.g INFERGEN.RTM. consensus IFN-.alpha. administered
subcutaneously qd or tiw; 50 .mu.g Actimmune.RTM. human
IFN-.gamma.1b administered subcutaneously tiw; and ribavirin
administered orally qd, where the duration of therapy is 48 weeks.
In this embodiment, ribavirin is administered in an amount of 1000
mg for individuals weighing less than 75 kg, and 1200 mg for
individuals weighing 75 kg or more.
[0302] One embodiment provides any of the above-described methods
modified to comprise administering to an individual having an HCV
infection an effective amount of an NS3 inhibitor; and a regimen of
9 .mu.g INFERGEN.RTM. consensus IFN-.alpha. administered
subcutaneously qd or tiw; 100 .mu.g Actimmune.RTM. human
IFN-.gamma.1b administered subcutaneously tiw; and ribavirin
administered orally qd, where the duration of therapy is 48 weeks.
In this embodiment, ribavirin is administered in an amount of 1000
mg for individuals weighing less than 75 kg, and 1200 mg for
individuals weighing 75 kg or more.
[0303] One embodiment provides any of the above-described methods
modified to comprise administering to an individual having an HCV
infection an effective amount of an NS3 inhibitor; and a regimen of
9 .mu.g INFERGEN.RTM. consensus IFN-.alpha. administered
subcutaneously qd or tiw; and 50 .mu.g Actimmune.RTM. human
IFN-.gamma.1b administered subcutaneously tiw, where the duration
of therapy is 48 weeks.
[0304] One embodiment provides any of the above-described methods
modified to comprise administering to an individual having an HCV
infection an effective amount of an NS3 inhibitor; and a regimen of
9 .mu.g INFERGEN.RTM. consensus IFN-.alpha. administered
subcutaneously qd or tiw; and 100 .mu.g Actimmune.RTM. human
IFN-.gamma.1b administered subcutaneously tiw, where the duration
of therapy is 48 weeks.
[0305] One embodiment provides any of the above-described methods
modified to comprise administering to an individual having an HCV
infection an effective amount of an NS3 inhibitor; and a regimen of
9 .mu.g INFERGEN.RTM. consensus IFN-.alpha. administered
subcutaneously qd or tiw; 25 .mu.g Actimmune.RTM. human
IFN-.gamma.1b administered subcutaneously tiw; and ribavirin
administered orally qd, where the duration of therapy is 48 weeks.
In this embodiment, ribavirin is administered in an amount of 1000
mg for individuals weighing less than 75 kg, and 1200 mg for
individuals weighing 75 kg or more.
[0306] One embodiment provides any of the above-described methods
modified to comprise administering to an individual having an HCV
infection an effective amount of an NS3 inhibitor; and a regimen of
9 .mu.g INFERGEN.RTM. consensus IFN-.alpha. administered
subcutaneously qd or tiw; 200 .mu.g Actimmune.RTM. human
IFN-.gamma.1b administered subcutaneously tiw; and ribavirin
administered orally qd, where the duration of therapy is 48 weeks.
In this embodiment, ribavirin is administered in an amount of 1000
mg for individuals weighing less than 75 kg, and 1200 mg for
individuals weighing 75 kg or more.
[0307] One embodiment provides any of the above-described methods
modified to comprise administering to an individual having an HCV
infection an effective amount of an NS3 inhibitor; and a regimen of
9 .mu.g INFERGEN.RTM. consensus IFN-.alpha. administered
subcutaneously qd or tiw; and 25 .mu.g Actimmune.RTM. human
IFN-.gamma.1b administered subcutaneously tiw, where the duration
of therapy is 48 weeks.
[0308] One embodiment provides any of the above-described methods
modified to comprise administering to an individual having an HCV
infection an effective amount of an NS3 inhibitor; and a regimen of
9 .mu.g INFERGEN.RTM. consensus IFN-.alpha. administered
subcutaneously qd or tiw; and 200 .mu.g Actimmune.RTM. human
IFN-.gamma.1b administered subcutaneously tiw, where the duration
of therapy is 48 weeks.
[0309] One embodiment provides any of the above-described methods
modified to comprise administering to an individual having an HCV
infection an effective amount of an NS3 inhibitor; and a regimen of
100 .mu.g monoPEG (30 kD, linear)-ylated consensus IFN-.alpha.
administered subcutaneously every 10 days or qw, and ribavirin
administered orally qd, where the duration of therapy is 48 weeks.
In this embodiment, ribavirin is administered in an amount of 1000
mg for individuals weighing less than 75 kg, and 1200 mg for
individuals weighing 75 kg or more.
[0310] One embodiment provides any of the above-described methods
modified to comprise administering to an individual having an HCV
infection an effective amount of an NS3 inhibitor; and a regimen of
100 .mu.g monoPEG (30 kD, linear)-ylated consensus IFN-.alpha.
administered subcutaneously every 10 days or qw; 50 .mu.g
Actimmune.RTM. human IFN-.gamma.1b administered subcutaneously tiw;
and ribavirin administered orally qd, where the duration of therapy
is 48 weeks. In this embodiment, ribavirin is administered in an
amount of 1000 mg for individuals weighing less than 75 kg, and
1200 mg for individuals weighing 75 kg or more.
[0311] One embodiment provides any of the above-described methods
modified to comprise administering to an individual having an HCV
infection an effective amount of an NS3 inhibitor; and a regimen of
100 .mu.g monoPEG (30 kD, linear)-ylated consensus IFN-.alpha.
IFN-.alpha. administered subcutaneously every 10 days or qw; 100
.mu.g Actimmune.RTM. human IFN-.gamma.1b administered
subcutaneously tiw; and ribavirin administered orally qd, where the
duration of therapy is 48 weeks. In this embodiment, ribavirin is
administered in an amount of 1000 mg for individuals weighing less
than 75 kg, and 1200 mg for individuals weighing 75 kg or more.
[0312] One embodiment provides any of the above-described methods
modified to comprise administering to an individual having an HCV
infection an effective amount of an NS3 inhibitor; and a regimen of
100 .mu.g monoPEG(30 kD, linear)-ylated consensus IFN-.alpha.
administered subcutaneously every 10 days or qw; and 50 .mu.g
Actimmune.RTM. human IFN-.gamma.1b administered subcutaneously tiw,
where the duration of therapy is 48 weeks.
[0313] One embodiment provides any of the above-described methods
modified to comprise administering to an individual having an HCV
infection an effective amount of an NS3 inhibitor; and a regimen of
100 .mu.g monoPEG(30 kD, linear)-ylated consensus IFN-.alpha.
administered subcutaneously every 10 days or qw; and 100 .mu.g
Actimmune.RTM. human IFN-.gamma.1b administered subcutaneously tiw,
where the duration of therapy is 48 weeks.
[0314] One embodiment provides any of the above-described methods
modified to comprise administering to an individual having an HCV
infection an effective amount of an NS3 inhibitor; and a regimen of
150 .mu.g monoPEG(30 kD, linear)-ylated consensus IFN-.alpha.
administered subcutaneously every 10 days or qw, and ribavirin
administered orally qd, where the duration of therapy is 48 weeks.
In this embodiment, ribavirin is administered in an amount of 1000
mg for individuals weighing less than 75 kg, and 1200 mg for
individuals weighing 75 kg or more.
[0315] One embodiment provides any of the above-described methods
modified to comprise administering to an individual having an HCV
infection an effective amount of an NS3 inhibitor; and a regimen of
150 .mu.g monoPEG(30 kD, linear)-ylated consensus IFN-.alpha.
administered subcutaneously every 10 days or qw; 50 .mu.g
Actimmune.RTM. human IFN-.gamma.1b administered subcutaneously tiw;
and ribavirin administered orally qd, where the duration of therapy
is 48 weeks. In this embodiment, ribavirin is administered in an
amount of 1000 mg for individuals weighing less than 75 kg, and
1200 mg for individuals weighing 75 kg or more.
[0316] One embodiment provides any of the above-described methods
modified to comprise administering to an individual having an HCV
infection an effective amount of an NS3 inhibitor; and a regimen of
150 .mu.g monoPEG(30 kD, linear)-ylated consensus IFN-.alpha.
administered subcutaneously every 10 days or qw; 100 .mu.g
Actimmune.RTM. human IFN-.gamma.1b administered subcutaneously tiw;
and ribavirin administered orally qd, where the duration of therapy
is 48 weeks. In this embodiment, ribavirin is administered in an
amount of 1000 mg for individuals weighing less than 75 kg, and
1200 mg for individuals weighing 75 kg or more.
[0317] One embodiment provides any of the above-described methods
modified to comprise administering to an individual having an HCV
infection an effective amount of an NS3 inhibitor; and a regimen of
150 .mu.g monoPEG(30 kD, linear)-ylated consensus IFN-.alpha.
administered subcutaneously every 10 days or qw; and 50 .mu.g
Actimmune.RTM. human IFN-.gamma.1b administered subcutaneously tiw,
where the duration of therapy is 48 weeks.
[0318] One embodiment provides any of the above-described methods
modified to comprise administering to an individual having an HCV
infection an effective amount of an NS3 inhibitor; and a regimen of
150 .mu.g monoPEG(30 kD, linear)-ylated consensus IFN-.alpha.
administered subcutaneously every 10 days or qw; and 100 .mu.g
Actimmune.RTM. human IFN-.gamma.1b administered subcutaneously tiw,
where the duration of therapy is 48 weeks.
[0319] One embodiment provides any of the above-described methods
modified to comprise administering to an individual having an HCV
infection an effective amount of an NS3 inhibitor; and a regimen of
200 .mu.g monoPEG(30 kD, linear)-ylated consensus IFN-.alpha.
administered subcutaneously every 10 days or qw, and ribavirin
administered orally qd, where the duration of therapy is 48 weeks.
In this embodiment, ribavirin is administered in an amount of 1000
mg for individuals weighing less than 75 kg, and 1200 mg for
individuals weighing 75 kg or more.
[0320] One embodiment provides any of the above-described methods
modified to comprise administering to an individual having an HCV
infection an effective amount of an NS3 inhibitor; and a regimen of
200 .mu.g monoPEG(30 kD, linear)-ylated consensus IFN-.alpha.
administered subcutaneously every 10 days or qw; 50 .mu.g
Actimmune.RTM. human IFN-.gamma.1b administered subcutaneously tiw;
and ribavirin administered orally qd, where the duration of therapy
is 48 weeks. In this embodiment, ribavirin is administered in an
amount of 1000 mg for individuals weighing less than 75 kg, and
1200 mg for individuals weighing 75 kg or more.
[0321] One embodiment provides any of the above-described methods
modified to comprise administering to an individual having an HCV
infection an effective amount of an NS3 inhibitor; and a regimen of
200 .mu.g monoPEG(30 kD, linear)-ylated consensus IFN-.alpha.
administered subcutaneously every 10 days or qw; 100 .mu.g
Actimmune.RTM. human IFN-.gamma.1b administered subcutaneously tiw;
and ribavirin administered orally qd, where the duration of therapy
is 48 weeks. In this embodiment, ribavirin is administered in an
amount of 1000 mg for individuals weighing less than 75 kg, and
1200 mg for individuals weighing 75 kg or more.
[0322] One embodiment provides any of the above-described methods
modified to comprise administering to an individual having an HCV
infection an effective amount of an NS3 inhibitor; and a regimen of
200 .mu.g monoPEG(30 kD, linear)-ylated consensus IFN-.alpha.
administered subcutaneously every 10 days or qw; and 50 .mu.g
Actimmune.RTM. human IFN-.gamma.1b administered subcutaneously tiw,
where the duration of therapy is 48 weeks.
[0323] One embodiment provides any of the above-described methods
modified to comprise administering to an individual having an HCV
infection an effective amount of an NS3 inhibitor; and a regimen of
200 .mu.g monoPEG(30 kD, linear)-ylated consensus IFN-.alpha.
administered subcutaneously every 10 days or qw; and 100 .mu.g
Actimmune.RTM. human IFN-.gamma.1b administered subcutaneously tiw,
where the duration of therapy is 48 weeks.
[0324] Any of the above-described methods involving administering
an NS3 inhibitor, a Type I interferon receptor agonist (e.g., an
IFN-.alpha.), and a Type II interferon receptor agonist (e.g., an
IFN-.gamma.), can be augmented by administration of an effective
amount of a TNF-.alpha. antagonist (e.g., a TNF-.alpha. antagonist
other than pirfenidone or a pirfenidone analog). Exemplary,
non-limiting TNF-.alpha. antagonists that are suitable for use in
such combination therapies include ENBREL.RTM., REMICADE.RTM., and
HUMIRA.TM..
[0325] One embodiment provides a method using an effective amount
of ENBREL.RTM.; an effective amount of IFN-.alpha.; an effective
amount of IFN-.gamma.; and an effective amount of an NS3 inhibitor
in the treatment of an HCV infection in a patient, comprising
administering to the patient a dosage ENBREL.RTM. containing an
amount of from about 0.1 .mu.g to about 23 mg per dose, from about
0.1 .mu.g to about 1 .mu.g, from about 1 .mu.g to about 10 .mu.g,
from about 10 .mu.g to about 100 .mu.g, from about 100 .mu.g to
about 1 mg, from about 1 mg to about 5 mg, from about 5 mg to about
10 mg, from about 10 mg to about 15 mg, from about 15 mg to about
20 mg, or from about 20 mg to about 23 mg of ENBREL.RTM.,
subcutaneously qd, qod, tiw, biw, qw, qow, three times per month,
once monthly, or once every other month, or per day substantially
continuously or continuously, for the desired duration of
treatment.
[0326] One embodiment provides a method using an effective amount
of REMICADE.RTM., an effective amount of IFN-.alpha.; an effective
amount of IFN-.gamma.; and an effective amount of an NS3 inhibitor
in the treatment of an HCV infection in a patient, comprising
administering to the patient a dosage of REMICADE.RTM. containing
an amount of from about 0.1 mg/kg to about 4.5 mg/kg, from about
0.1 mg/kg to about 0.5 mg/kg, from about 0.5 mg/kg to about 1.0
mg/kg, from about 1.0 mg/kg to about 1.5 mg/kg, from about 1.5
mg/kg to about 2.0 mg/kg, from about 2.0 mg/kg to about 2.5 mg/kg,
from about 2.5 mg/kg to about 3.0 mg/kg, from about 3.0 mg/kg to
about 3.5 mg/kg, from about 3.5 mg/kg to about 4.0 mg/kg, or from
about 4.0 mg/kg to about 4.5 mg/kg per dose of REMICADE.RTM.,
intravenously qd, qod, tiw, biw, qw, qow, three times per month,
once monthly, or once every other month, or per day substantially
continuously or continuously, for the desired duration of
treatment.
[0327] One embodiment provides a method using an effective amount
of HUMIRA.TM., an effective amount of IFN-.alpha.; an effective
amount of IFN-.gamma.; and an effective amount of an NS3 inhibitor
in the treatment of an HCV infection in a patient, comprising
administering to the patient a dosage of HUMIRA.TM. containing an
amount of from about 0.1 .mu.g to about 35 mg, from about 0.1 .mu.g
to about 1 .mu.g, from about 1 .mu.g to about 10 .mu.g, from about
10 .mu.g to about 100 .mu.g, from about 100 .mu.g to about 1 mg,
from about 1 mg to about 5 mg, from about 5 mg to about 10 mg, from
about 10 mg to about 15 mg, from about 15 mg to about 20 mg, from
about 20 mg to about 25 mg, from about 25 mg to about 30 mg, or
from about 30 mg to about 35 mg per dose of a HUMIRA.TM.,
subcutaneously qd, qod, tiw, biw, qw, qow, three times per month,
once monthly, or once every other month, or per day substantially
continuously or continuously, for the desired duration of
treatment. Combination therapies with pirfenidone
[0328] In many embodiments, the methods provide for combination
therapy comprising administering an NS3 inhibitor compound as
described above, and an effective amount of pirfenidone or a
pirfenidone analog. In some embodiments, an NS3 inhibitor compound,
one or more interferon receptor agonist(s), and pirfenidone or
pirfenidone analog are co-administered in the treatment methods of
the embodiments. In certain embodiments, an NS3 inhibitor compound,
a Type I interferon receptor agonist, and pirfenidone (or a
pirfenidone analog) are co-administered. In other embodiments, an
NS3 inhibitor compound, a Type I interferon receptor agonist, a
Type II interferon receptor agonist, and pirfenidone (or a
pirfenidone analog) are co-administered. Type I interferon receptor
agonists suitable for use herein include any IFN-.alpha. , such as
interferon alfa-2a, interferon alfa-2b, interferon alfacon-1, and
PEGylated IFN-.alpha.'s, such as peginterferon alfa-2a,
peginterferon alfa-2b, and PEGylated consensus interferons, such as
monoPEG (30 kD, linear)-ylated consensus interferon. Type II
interferon receptor agonists suitable for use herein include any
interferon-.gamma..
[0329] Pirfenidone or a pirfenidone analog can be administered once
per month, twice per month, three times per month, once per week,
twice per week, three times per week, four times per week, five
times per week, six times per week, daily, or in divided daily
doses ranging from once daily to 5 times daily over a period of
time ranging from about one day to about one week, from about two
weeks to about four weeks, from about one month to about two
months, from about two months to about four months, from about four
months to about six months, from about six months to about eight
months, from about eight months to about 1 year, from about 1 year
to about 2 years, or from about 2 years to about 4 years, or
more.
[0330] Effective dosages of pirfenidone or a specific pirfenidone
analog include a weight-based dosage in the range from about 5
mg/kg/day to about 125 mg/kg/day, or a fixed dosage of about 400 mg
to about 3600 mg per day, or about 800 mg to about 2400 mg per day,
or about 1000 mg to about 1800 mg per day, or about 1200 mg to
about 1600 mg per day, administered orally in one to five divided
doses per day. Other doses and formulations of pirfenidone and
specific pirfenidone analogs suitable for use in the treatment of
fibrotic diseases are described in U.S. Pat. Nos., 5,310,562;
5,518,729; 5,716,632; and 6,090,822.
[0331] One embodiment provides any of the above-described methods
modified to include co-administering to the patient a
therapeutically effective amount of pirfenidone or a pirfenidone
analog for the duration of the desired course of NS3 inhibitor
compound treatment.
Combination Therapies with TNF-.alpha. Antagonists
[0332] In many embodiments, the methods provide for combination
therapy comprising administering an effective amount of an NS3
inhibitor compound as described above, and an effective amount of
TNF-.alpha. antagonist, in combination therapy for treatment of an
HCV infection.
[0333] Effective dosages of a TNF-.alpha. antagonist range from 0.1
.mu.g to 40 mg per dose, e.g., from about 0.1 .mu.g to about 0.5
.mu.g per dose, from about 0.5 .mu.g to about 1.0 .mu.g per dose,
from about 1.0 .mu.g per dose to about 5.0 .mu.g per dose, from
about 5.0 .mu.g to about 10 .mu.g per dose, from about 10 .mu.g to
about 20 .mu.g per dose, from about 20 .mu.g per dose to about 30
.mu.g per dose, from about 30 .mu.g per dose to about 40 .mu.g per
dose, from about 40 .mu.g per dose to about 50 .mu.g per dose, from
about 50 .mu.g per dose to about 60 .mu.g per dose, from about 60
.mu.g per dose to about 70 .mu.g per dose, from about 70 .mu.g to
about 80 .mu.g per dose, from about 80 .mu.g per dose to about 100
.mu.g per dose, from about 100 .mu.g to about 150 .mu.g per dose
about 150 .mu.g to about 200 .mu.g per dose, from about 200 .mu.g
per dose to about 250 .mu.g per dose, from about 250 .mu.g to about
300 .mu.g per dose, from about 300 .mu.g to about 400 .mu.g per
dose, from about 400 .mu.g to about 500 .mu.g per dose, from about
500 .mu.g to about 600 .mu.g per dose, from about 600 .mu.g to
about 700 .mu.g per dose, from about 700 .mu.g to about 800 .mu.g
per dose, from about 800 .mu.g to about 900 .mu.g per dose, from
about 900 .mu.g to about 1000 .mu.g, per dose, from about 1 mg to
about 10 mg per dose, from about 10 mg to about 15 mg per dose,
from about 15 mg to about 20 mg per dose, from about 20 mg to about
25 mg per dose, from about 25 mg to about 30 mg per dose, from
about 30 mg to about 35 mg per dose, or from about 35 mg to about
40 mg per dose.
[0334] In some embodiments, effective dosages of a TNF-.alpha.
antagonist are expressed as mg/kg body weight. In these
embodiments, effective dosages of a TNF-.alpha. antagonist are from
about 0.1 mg/kg body weight to about 10 mg/kg body weight, e.g.,
from about 0.1 mg/kg body weight to about 0.5 mg/kg body weight,
from about 0.5 mg/kg body weight to about 1.0 mg/kg body weight,
from about 1.0 mg/kg body weight to about 2.5 mg/kg body weight,
from about 2.5 mg/kg body weight to about 5.0 mg/kg body weight,
from about 5.0 mg/kg body weight to about 7.5 mg/kg body weight, or
from about 7.5 mg/kg body weight to about 10 mg/kg body weight.
[0335] In many embodiments, a TNF-.alpha. antagonist is
administered for a period of about 1 day to about 7 days, or about
1 week to about 2 weeks, or about 2 weeks to about 3 weeks, or
about 3 weeks to about 4 weeks, or about 1 month to about 2 months,
or about 3 months to about 4 months, or about 4 months to about 6
months, or about 6 months to about 8 months, or about 8 months to
about 12 months, or at least one year, and may be administered over
longer periods of time. The TNF-.alpha. antagonist can be
administered tid, bid, qd, qod, biw, tiw, qw, qow, three times per
month, once monthly, substantially continuously, or
continuously.
[0336] In many embodiments, multiple doses of a TNF-.alpha.
antagonist are administered. For example, a TNF-.alpha. antagonist
is administered once per month, twice per month, three times per
month, every other week (qow), once per week (qw), twice per week
(biw), three times per week (tiw), four times per week, five times
per week, six times per week, every other day (qod), daily (qd),
twice a day (bid), or three times a day (tid), substantially
continuously, or continuously, over a period of time ranging from
about one day to about one week, from about two weeks to about four
weeks, from about one month to about two months, from about two
months to about four months, from about four months to about six
months, from about six months to about eight months, from about
eight months to about 1 year, from about 1 year to about 2 years,
or from about 2 years to about 4 years, or more.
[0337] A TNF-.alpha. antagonist and an NS3 inhibitor are generally
administered in separate formulations. A TNF-.alpha. antagonist and
an NS3 inhibitor may be administered substantially simultaneously,
or within about 30 minutes, about 1 hour, about 2 hours, about 4
hours, about 8 hours, about 16 hours, about 24 hours, about 36
hours, about 72 hours, about 4 days, about 7 days, or about 2 weeks
of one another.
[0338] One embodiment provides a method using an effective amount
of a TNF-.alpha. antagonist and an effective amount of an NS3
inhibitor in the treatment of an HCV infection in a patient,
comprising administering to the patient a dosage of a TNF-.alpha.
antagonist containing an amount of from about 0.1 .mu.g to about 40
mg per dose of a TNF-.alpha. antagonist, subcutaneously qd, qod,
tiw, or biw, or per day substantially continuously or continuously,
for the desired duration of treatment with an NS3 inhibitor
compound.
[0339] One embodiment provides a method using an effective amount
of ENBREL.RTM. and an effective amount of an NS3 inhibitor in the
treatment of an HCV infection in a patient, comprising
administering to the patient a dosage ENBREL.RTM. containing an
amount of from about 0.1 .mu.g to about 23 mg per dose, from about
0.1 .mu.g to about 1 .mu.g, from about 1 .mu.g to about 10 .mu.g,
from about 10 .mu.g to about 100 .mu.g, from about 100 .mu.g to
about 1 mg, from about 1 mg to about 5 mg, from about 5 mg to about
10 mg, from about 10 mg to about 15 mg, from about 15 mg to about
20 mg, or from about 20 mg to about 23 mg of ENBREL.RTM.,
subcutaneously qd, qod, tiw, biw, qw, qow, three times per month,
once monthly, or once every other month, or per day substantially
continuously or continuously, for the desired duration of treatment
with an NS3 inhibitor compound.
[0340] One embodiment provides a method using an effective amount
of REMICADE.RTM. and an effective amount of an NS3 inhibitor in the
treatment of an HCV infection in a patient, comprising
administering to the patient a dosage of REMICADE.RTM. containing
an amount of from about 0.1 mg/kg to about 4.5 mg/kg, from about
0.1 mg/kg to about 0.5 mg/kg, from about 0.5 mg/kg to about 1.0
mg/kg, from about 1.0 mg/kg to about 1.5 mg/kg, from about 1.5
mg/kg to about 2.0 mg/kg, from about 2.0 mg/kg to about 2.5 mg/kg,
from about 2.5 mg/kg to about 3.0 mg/kg, from about 3.0 mg/kg to
about 3.5 mg/kg, from about 3.5 mg/kg to about 4.0 mg/kg, or from
about 4.0 mg/kg to about 4.5 mg/kg per dose of REMICADE.RTM.,
intravenously qd, qod, tiw, biw, qw, qow, three times per month,
once monthly, or once every other month, or per day substantially
continuously or continuously, for the desired duration of treatment
with an NS3 inhibitor compound.
[0341] One embodiment provides a method using an effective amount
of HUMIRA.TM. and an effective amount of an NS3 inhibitor in the
treatment of an HCV infection in a patient, comprising
administering to the patient a dosage of HUMIRA.TM. containing an
amount of from about 0.1 .mu.g to about 35 mg, from about 0.1 .mu.g
to about 1 .mu.g, from about 1 .mu.g to about 10 .mu.g, from about
10 .mu.g to about 100 .mu.g, from about 100 .mu.g to about 1 mg,
from about 1 mg to about 5 mg, from about 5 mg to about 10 mg, from
about 10 mg to about 15 mg, from about 15 mg to about 20 mg, from
about 20 mg to about 25 mg, from about 25 mg to about 30 mg, or
from about 30 mg to about 35 mg per dose of a HUMIRA.TM.,
subcutaneously qd, qod, tiw, biw, qw, qow, three times per month,
once monthly, or once every other month, or per day substantially
continuously or continuously, for the desired duration of treatment
with an NS3 inhibitor compound.
Combination Therapies with Thymosin-.alpha.
[0342] In many embodiments, the methods provide for combination
therapy comprising administering an effective amount of an NS3
inhibitor compound as described above, and an effective amount of
thymosin-.alpha., in combination therapy for treatment of an HCV
infection.
[0343] Effective dosages of thymosin-.alpha. range from about 0.5
mg to about 5 mg, e.g., from about 0.5 mg to about 1.0 mg, from
about 1.0 mg to about 1.5 mg, from about 1.5 mg to about 2.0 mg,
from about 2.0 mg to about 2.5 mg, from about 2.5 mg to about 3.0
mg, from about 3.0 mg to about 3.5 mg, from about 3.5 mg to about
4.0 mg, from about 4.0 mg to about 4.5 mg, or from about 4.5 mg to
about 5.0 mg. In particular embodiments, thymosin-.alpha. is
administered in dosages containing an amount of 1.0 mg or 1.6
mg.
[0344] One embodiment provides a method using an effective amount
of ZADAXIN.TM. thymosin-.alpha. and an effective amount of an NS3
inhibitor in the treatment of an HCV infection in a patient,
comprising administering to the patient a dosage of ZADAXIN.TM.
containing an amount of from about 1.0 mg to about 1.6 mg per dose,
subcutaneously twice per week for the desired duration of treatment
with the NS3 inhibitor compound.
Combination Therapies with a TNF-.alpha. Antagonist and an
Interferon
[0345] Some embodiments provide a method of treating an HCV
infection in an individual having an HCV infection, the method
comprising administering an effective amount of an NS3 inhibitor,
and effective amount of a TNF-.alpha. antagonist, and an effective
amount of one or more interferons.
[0346] One embodiment provides any of the above-described methods
modified to use an effective amount of IFN-.gamma. and an effective
amount of a TNF-.alpha. antagonist in the treatment of HCV
infection in a patient comprising administering to the patient a
dosage of IFN-.gamma. containing an amount of about 10 .mu.g to
about 300 .mu.g of drug per dose of IFN-.gamma., subcutaneously qd,
qod, tiw, biw, qw, qow, three times per month, once monthly, or per
day substantially continuously or continuously, in combination with
a dosage of a TNF-.alpha. antagonist containing an amount of from
about 0.1 .mu.g to about 40 mg per dose of a TNF-.alpha.
antagonist, subcutaneously qd, qod, tiw, or biw, or per day
substantially continuously or continuously, for the desired
duration of treatment with an NS3 inhibitor compound.
[0347] One embodiment provides any of the above-described methods
modified to use an effective amount of IFN-.gamma. and an effective
amount of a TNF-.alpha. antagonist in the treatment of HCV
infection in a patient comprising administering to the patient a
dosage of IFN-.gamma. containing an amount of about 10 .mu.g to
about 100 .mu.g of drug per dose of IFN-.gamma., subcutaneously qd,
qod, tiw, biw, qw, qow, three times per month, once monthly, or per
day substantially continuously or continuously, in combination with
a dosage of a TNF-.alpha. antagonist containing an amount of from
about 0.1 .mu.g to about 40 mg per dose of a TNF-.alpha.
antagonist, subcutaneously qd, qod, tiw, or biw, or per day
substantially continuously or continuously, for the desired
duration of treatment with an NS3 inhibitor compound.
[0348] Another embodiment provides any of the above-described
methods modified to use an effective amount of IFN-.gamma. and an
effective amount of a TNF-.alpha. antagonist in the treatment of a
virus infection in a patient comprising administering to the
patient a total weekly dosage of IFN-.gamma. containing an amount
of about 30 .mu.g to about 1,000 .mu.g of drug per week in divided
doses administered subcutaneously qd, qod, tiw, biw, or
administered substantially continuously or continuously, in
combination with a dosage of a TNF-.alpha. antagonist containing an
amount of from about 0.1 .mu.g to about 40 mg per dose of a
TNF-.alpha. antagonist, subcutaneously qd, qod, tiw, or biw, or per
day substantially continuously or continuously, for the desired
duration of treatment with an NS3 inhibitor compound.
[0349] Another embodiment provides any of the above-described
methods modified to use an effective amount of IFN-.gamma. and an
effective amount of a TNF-.alpha. antagonist in the treatment of a
virus infection in a patient comprising administering to the
patient a total weekly dosage of IFN-.gamma. containing an amount
of about 100 .mu.g to about 300 .mu.g of drug per week in divided
doses administered subcutaneously qd, qod, tiw, biw, or
administered substantially continuously or continuously, in
combination with a dosage of a TNF-.alpha. antagonist containing an
amount of from about 0.1 .mu.g to about 40 mg per dose of a
TNF-.alpha. antagonist, subcutaneously qd, qod, tiw, or biw, or per
day substantially continuously or continuously, for the desired
duration of treatment with an NS3 inhibitor compound.
[0350] One embodiment provides any of the above-described methods
modified to use an effective amount of INFERGEN.RTM. consensus
IFN-.alpha. and a TNF-.alpha. antagonist in the treatment of HCV
infection in a patient comprising administering to the patient a
dosage of INFERGEN.RTM. containing an amount of about 1 .mu.g to
about 30 .mu.g, of drug per dose of INFERGEN.RTM., subcutaneously
qd, qod, tiw, biw, qw, qow, three times per month, once monthly, or
per day substantially continuously or continuously, in combination
with a dosage of a TNF-.alpha. antagonist containing an amount of
from about 0.1 .mu.g to about 40 mg per dose of a TNF-.alpha.
antagonist, subcutaneously qd, qod, tiw, or biw, or per day
substantially continuously or continuously, for the desired
duration of treatment with an NS3 inhibitor compound.
[0351] One embodiment provides any of the above-described methods
modified to use an effective amount of INFERGEN.RTM. consensus
IFN-.alpha. and a TNF-.alpha. antagonist in the treatment of HCV
infection in a patient comprising administering to the patient a
dosage of INFERGEN.RTM. containing an amount of about 1 .mu.g to
about 9 .mu.g, of drug per dose of INFERGEN.RTM., subcutaneously
qd, qod, tiw, biw, qw, qow, three times per month, once monthly, or
per day substantially continuously or continuously, in combination
with a dosage of a TNF-.alpha. antagonist containing an amount of
from about 0.1 .mu.g to about 40 mg per dose of a TNF-.alpha.
antagonist, subcutaneously qd, qod, tiw, or biw, or per day
substantially continuously or continuously, for the desired
duration of treatment with an NS3 inhibitor compound.
[0352] Another embodiment provides any of the above-described
methods modified to use an effective amount of PEGylated consensus
IFN-.alpha. and an effective amount of a TNF-.alpha. antagonist in
the treatment of a virus infection in a patient comprising
administering to the patient a dosage of PEGylated consensus
IFN-.alpha. (PEG-CIFN) containing an amount of about 4 .mu.g to
about 60 .mu.g of CIFN amino acid weight per dose of PEG-CIFN,
subcutaneously qw, qow, three times per month, or monthly, in
combination with a dosage of a TNF-.alpha. antagonist containing an
amount of from about 0.1 .mu.g to about 40 mg per dose of a
TNF-.alpha. antagonist, subcutaneously qd, qod, tiw, or biw, or per
day substantially continuously or continuously, for the desired
duration of treatment with an NS3 inhibitor compound.
[0353] Another embodiment provides any of the above-described
methods modified to use an effective amount of PEGylated consensus
IFN-.alpha. and an effective amount of a TNF-.alpha. antagonist in
the treatment of a virus infection in a patient comprising
administering to the patient a dosage of PEGylated consensus
IFN-.alpha. (PEG-CIFN) containing an amount of about 18 .mu.g to
about 24 .mu.g of CIFN amino acid weight per dose of PEG-CIFN,
subcutaneously qw, qow, three times per month, or monthly, in
combination with a dosage of a TNF-.alpha. antagonist containing an
amount of from about 0.1 .mu.g to about 40 mg per dose of a
TNF-.alpha. antagonist, subcutaneously qd, qod, tiw, or biw, or per
day substantially continuously or continuously, for the desired
duration of treatment with an NS3 inhibitor compound.
[0354] Another embodiment provides any of the above-described
methods modified to use an effective amount of IFN-.alpha. 2a or 2b
or 2c and an effective amount of a TNF-.alpha. antagonist in the
treatment of a virus infection in a patient comprising
administering to the patient a dosage of IFN-.alpha. 2a, 2b or 2c
containing an amount of about 1 MU to about 20 MU of drug per dose
of IFN-.alpha. 2a, 2b or 2c subcutaneously qd, qod, tiw, biw, or
per day substantially continuously or continuously, in combination
with a dosage of a TNF-.alpha. antagonist containing an amount of
from about 0.1 .mu.g to about 40 mg per dose of a TNF-.alpha.
antagonist, subcutaneously qd, qod, tiw, or biw, or per day
substantially continuously or continuously, for the desired
duration of treatment with an NS3 inhibitor compound.
[0355] Another embodiment provides any of the above-described
methods modified to use an effective amount of IFN-.alpha. 2a or 2b
or 2c and an effective amount of a TNF-.alpha. antagonist in the
treatment of a virus infection in a patient comprising
administering to the patient a dosage of IFN-.alpha. 2a, 2b or 2c
containing an amount of about 3 MU of drug per dose of IFN-.alpha.
2a, 2b or 2c subcutaneously qd, qod, tiw, biw, or per day
substantially continuously or continuously, in combination with a
dosage of a TNF-.alpha. antagonist containing an amount of from
about 0.1 .mu.g to about 40 mg per dose of a TNF-.alpha.
antagonist, subcutaneously qd, qod, tiw, or biw, or per day
substantially continuously or continuously, for the desired
duration of treatment with an NS3 inhibitor compound.
[0356] Another embodiment provides any of the above-described
methods modified to use an effective amount of IFN-.alpha. 2a or 2b
or 2c and an effective amount of a TNF-.alpha. antagonist in the
treatment of a virus infection in a patient comprising
administering to the patient a dosage of IFN-.alpha. 2a, 2b or 2c
containing an amount of about 10 MU of drug per dose of IFN-.alpha.
2a, 2b or 2c subcutaneously qd, qod, tiw, biw, or per day
substantially continuously or continuously, in combination with a
dosage of a TNF-.alpha. antagonist containing an amount of from
about 0.1 .mu.g to about 40 mg per dose of a TNF-.alpha.
antagonist, subcutaneously qd, qod, tiw, or biw, or per day
substantially continuously or continuously, for the desired
duration of treatment with an NS3 inhibitor compound.
[0357] Another embodiment provides any of the above-described
methods modified to use an effective amount of
PEGASYS.RTM.PEGylated IFN-.alpha.2a and an effective amount of a
TNF-.alpha. antagonist in the treatment of a virus infection in a
patient comprising administering to the patient a dosage of
PEGASYS.RTM. containing an amount of about 90 .mu.g to about 360
.mu.g, of drug per dose of PEGASYS.RTM., subcutaneously qw, qow,
three times per month, or monthly, in combination with a dosage of
a TNF-.alpha. antagonist containing an amount of from about 0.1
.mu.g to about 40 mg per dose of a TNF-.alpha. antagonist,
subcutaneously qd, qod, tiw, or biw, or per day substantially
continuously or continuously, for the desired duration of treatment
with an NS3 inhibitor compound.
[0358] Another embodiment provides any of the above-described
methods modified to use an effective amount of
PEGASYS.RTM.PEGylated IFN-.alpha.2a and an effective amount of a
TNF-.alpha. antagonist in the treatment of a virus infection in a
patient comprising administering to the patient a dosage of
PEGASYS.RTM. containing an amount of about 180 .mu.g, of drug per
dose of PEGASYS.RTM., subcutaneously qw, qow, three times per
month, or monthly, in combination with a dosage of a TNF-.alpha.
antagonist containing an amount of from about 0.1 .mu.g to about 40
mg per dose of a TNF-.alpha. antagonist, subcutaneously qd, qod,
tiw, or biw, or per day substantially continuously or continuously,
for the desired duration of treatment with an NS3 inhibitor
compound.
[0359] Another embodiment provides any of the above-described
methods modified to use an effective amount of
PEG-INTRON.RTM.PEGylated IFN-.alpha.2b and an effective amount of a
TNF-.alpha. antagonist in the treatment of a virus infection in a
patient comprising administering to the patient a dosage of
PEG-INTRON.RTM. containing an amount of about 0.75 .mu.g to about
3.0 .mu.g of drug per kilogram of body weight per dose of
PEG-INTRON.RTM., subcutaneously qw, qow, three times per month, or
monthly, in combination with a dosage of a TNF-.alpha. antagonist
containing an amount of from about 0.1 .mu.g to about 40 mg per
dose of a TNF-.alpha. antagonist, subcutaneously qd, qod, tiw, or
biw, or per day substantially continuously or continuously, for the
desired duration of treatment with an NS3 inhibitor compound.
[0360] Another embodiment provides any of the above-described
methods modified to use an effective amount of
PEG-INTRON.RTM.PEGylated IFN-.alpha.2b and an effective amount of a
TNF-.alpha. antagonist in the treatment of a virus infection in a
patient comprising administering to the patient a dosage of
PEG-INTRON.RTM. containing an amount of about 1.5 .mu.g of drug per
kilogram of body weight per dose of PEG-INTRON.RTM., subcutaneously
qw, qow, three times per month, or monthly, in combination with a
dosage of a TNF-.alpha. antagonist containing an amount of from
about 0.1 .mu.g to about 40 mg per dose of a TNF-.alpha.
antagonist, subcutaneously qd, qod, tiw, or biw, or per day
substantially continuously or continuously, for the desired
duration of treatment with an NS3 inhibitor compound.
Combination Therapies with Other Antiviral Agents
[0361] Other agents such as inhibitors of HCV NS3 helicase are also
attractive drugs for combinational therapy, and are contemplated
for use in combination therapies described herein. Ribozymes such
as Heptazyme.TM. and phosphorothioate oligonucleotides which are
complementary to HCV protein sequences and which inhibit the
expression of viral core proteins are also suitable for use in
combination therapies described herein.
[0362] In some embodiments, the additional antiviral agent(s) is
administered during the entire course of treatment with the NS3
inhibitor compound described herein, and the beginning and end of
the treatment periods coincide. In other embodiments, the
additional antiviral agent(s) is administered for a period of time
that is overlapping with that of the NS3 inhibitor compound
treatment, e.g., treatment with the additional antiviral agent(s)
begins before the NS3 inhibitor compound treatment begins and ends
before the NS3 inhibitor compound treatment ends; treatment with
the additional antiviral agent(s) begins after the NS3 inhibitor
compound treatment begins and ends after the NS3 inhibitor compound
treatment ends; treatment with the additional antiviral agent(s)
begins after the NS3 inhibitor compound treatment begins and ends
before the NS3 inhibitor compound treatment ends; or treatment with
the additional antiviral agent(s) begins before the NS3 inhibitor
compound treatment begins and ends after the NS3 inhibitor compound
treatment ends.
[0363] The NS3 inhibitor compound can be administered together with
(i.e., simultaneously in separate formulations; simultaneously in
the same formulation; administered in separate formulations and
within about 48 hours, within about 36 hours, within about 24
hours, within about 16 hours, within about 12 hours, within about 8
hours, within about 4 hours, within about 2 hours, within about 1
hour, within about 30 minutes, or within about 15 minutes or less)
one or more additional antiviral agents.
[0364] As non-limiting examples, any of the above-described methods
featuring an IFN-.alpha. regimen can be modified to replace the
subject IFN-.alpha. regimen with a regimen of monoPEG (30 kD,
linear)-ylated consensus IFN-.alpha. comprising administering a
dosage of monoPEG (30 kD, linear)-ylated consensus IFN-.alpha.
containing an amount of 100 .mu.g of drug per dose, subcutaneously
once weekly, once every 8 days, or once every 10 days for the
desired treatment duration with an NS3 inhibitor compound.
[0365] As non-limiting examples, any of the above-described methods
featuring an IFN-.alpha. regimen can be modified to replace the
subject IFN-.alpha. regimen with a regimen of monoPEG (30 kD,
linear)-ylated consensus IFN-.alpha. comprising administering a
dosage of monoPEG (30 kD, linear)-ylated consensus IFN-.alpha.
containing an amount of 150 .mu.g of drug per dose, subcutaneously
once weekly, once every 8 days, or once every 10 days for the
desired treatment duration with an NS3 inhibitor compound.
[0366] As non-limiting examples, any of the above-described methods
featuring an IFN-.alpha. regimen can be modified to replace the
subject IFN-.alpha. regimen with a regimen of monoPEG (30 kD,
linear)-ylated consensus IFN-.alpha. comprising administering a
dosage of monoPEG (30 kD, linear)-ylated consensus IFN-.alpha.
containing an amount of 200 .mu.g of drug per dose, subcutaneously
once weekly, once every 8 days, or once every 10 days for the
desired treatment duration with an NS3 inhibitor compound.
[0367] As non-limiting examples, any of the above-described methods
featuring an IFN-.alpha. regimen can be modified to replace the
subject IFN-.alpha. regimen with a regimen of INFERGEN.RTM.
interferon alfacon-1 comprising administering a dosage of
INFERGEN.RTM. interferon alfacon-1 containing an amount of 9 .mu.g
of drug per dose, subcutaneously once daily or three times per week
for the desired treatment duration with an NS3 inhibitor
compound.
[0368] As non-limiting examples, any of the above-described methods
featuring an IFN-.alpha. regimen can be modified to replace the
subject IFN-.alpha. regimen with a regimen of INFERGEN.RTM.
interferon alfacon-1 comprising administering a dosage of
INFERGEN.RTM. interferon alfacon-1 containing an amount of 15 .mu.g
of drug per dose, subcutaneously once daily or three times per week
for the desired treatment duration with an NS3 inhibitor
compound.
[0369] As non-limiting examples, any of the above-described methods
featuring an IFN-.gamma. regimen can be modified to replace the
subject IFN-.gamma. regimen with a regimen of IFN-.gamma.
comprising administering a dosage of IFN-.gamma. containing an
amount of 25 .mu.g of drug per dose, subcutaneously three times per
week for the desired treatment duration with an NS3 inhibitor
compound.
[0370] As non-limiting examples, any of the above-described methods
featuring an IFN-.gamma. regimen can be modified to replace the
subject IFN-.gamma. regimen with a regimen of IFN-.gamma.
comprising administering a dosage of IFN-.gamma. containing an
amount of 50 .mu.g of drug per dose, subcutaneously three times per
week for the desired treatment duration with an NS3 inhibitor
compound.
[0371] As non-limiting examples, any of the above-described methods
featuring an IFN-.gamma. regimen can be modified to replace the
subject IFN-.gamma. regimen with a regimen of IFN-.gamma.
comprising administering a dosage of IFN-.gamma. containing an
amount of 100 .mu.g of drug per dose, subcutaneously three times
per week for the desired treatment duration with an NS3 inhibitor
compound.
[0372] As non-limiting examples, any of the above-described methods
featuring an IFN-.alpha. and IFN-.gamma. combination regimen can be
modified to replace the subject IFN-.alpha. and IFN-.gamma.
combination regimen with an IFN-.alpha. and IFN-.gamma. combination
regimen comprising: (a) administering a dosage of monoPEG (30 kD,
linear)-ylated consensus IFN-.alpha. containing an amount of 100
.mu.g of drug per dose, subcutaneously once weekly, once every 8
days, or once every 10 days; and (b) administering a dosage of
IFN-.gamma. containing an amount of 50 .mu.g of drug per dose,
subcutaneously three times per week; for the desired treatment
duration with an NS3 inhibitor compound.
[0373] As non-limiting examples, any of the above-described methods
featuring a TNF antagonist regimen can be modified to replace the
subject TNF antagonist regimen with a TNF antagonist regimen
comprising administering a dosage of a TNF antagonist selected from
the group of: (a) etanercept in an amount of 25 mg of drug per dose
subcutaneously twice per week, (b) infliximab in an amount of 3 mg
of drug per kilogram of body weight per dose intravenously at weeks
0, 2 and 6, and every 8 weeks thereafter, or (c) adalimumab in an
amount of 40 mg of drug per dose subcutaneously once weekly or once
every 2 weeks; for the desired treatment duration with an NS3
inhibitor compound.
[0374] As non-limiting examples, any of the above-described methods
featuring an IFN-.alpha. and IFN-.gamma. combination regimen can be
modified to replace the subject IFN-.alpha. and IFN-.gamma.
combination regimen with an IFN-.alpha. and IFN-.gamma. combination
regimen comprising: (a) administering a dosage of monoPEG (30 kD,
linear)-ylated consensus IFN-.alpha. containing an amount of 100
.mu.g of drug per dose, subcutaneously once weekly, once every 8
days, or once every 10 days; and (b) administering a dosage of
IFN-.gamma. containing an amount of 100 .mu.g of drug per dose,
subcutaneously three times per week; for the desired treatment
duration with an NS3 inhibitor compound.
[0375] As non-limiting examples, any of the above-described methods
featuring an IFN-.alpha. and IFN-.gamma. combination regimen can be
modified to replace the subject IFN-.alpha. and IFN-.gamma.
combination regimen with an IFN-.alpha. and IFN-.gamma. combination
regimen comprising: (a) administering a dosage of monoPEG (30 kD,
linear)-ylated consensus IFN-.alpha. containing an amount of 150
.mu.g of drug per dose, subcutaneously once weekly, once every 8
days, or once every 10 days; and (b) administering a dosage of
IFN-.gamma. containing an amount of 50 .mu.g of drug per dose,
subcutaneously three times per week; for the desired treatment
duration with an NS3 inhibitor compound.
[0376] As non-limiting examples, any of the above-described methods
featuring an IFN-.alpha. and IFN-.gamma. combination regimen can be
modified to replace the subject IFN-.alpha. and IFN-.gamma.
combination regimen with an IFN-.alpha. and IFN-.gamma. combination
regimen comprising: (a) administering a dosage of monoPEG (30 kD,
linear)-ylated consensus IFN-.alpha. containing an amount of 150
.mu.g of drug per dose, subcutaneously once weekly, once every 8
days, or once every 10 days; and (b) administering a dosage of
IFN-.gamma. containing an amount of 100 .mu.g of drug per dose,
subcutaneously three times per week; for the desired treatment
duration with an NS3 inhibitor compound.
[0377] As non-limiting examples, any of the above-described methods
featuring an IFN-.alpha. and IFN-.gamma. combination regimen can be
modified to replace the subject IFN-.alpha. and IFN-.gamma.
combination regimen with an IFN-.alpha. and IFN-.gamma. combination
regimen comprising: (a) administering a dosage of monoPEG (30 kD,
linear)-ylated consensus IFN-.alpha. containing an amount of 200
.mu.g of drug per dose, subcutaneously once weekly, once every 8
days, or once every 10 days; and (b) administering a dosage of
IFN-.gamma. containing an amount of 50 .mu.g of drug per dose,
subcutaneously three times per week; for the desired treatment
duration with an NS3 inhibitor compound.
[0378] As non-limiting examples, any of the above-described methods
featuring an IFN-.alpha. and IFN-.gamma. combination regimen can be
modified to replace the subject IFN-.alpha. and IFN-.gamma.
combination regimen with an IFN-.alpha. and IFN-.gamma. combination
regimen comprising: (a) administering a dosage of monoPEG (30 kD,
linear)-ylated consensus IFN-.alpha. containing an amount of 200
.mu.g of drug per dose, subcutaneously once weekly, once every 8
days, or once every 10 days; and (b) administering a dosage of
IFN-.gamma. containing an amount of 100 .mu.g of drug per dose,
subcutaneously three times per week; for the desired treatment
duration with an NS3 inhibitor compound.
[0379] As non-limiting examples, any of the above-described methods
featuring an IFN-.alpha. and IFN-.gamma. combination regimen can be
modified to replace the subject IFN-.alpha. and IFN-.gamma.
combination regimen with an IFN-.alpha. and IFN-.gamma. combination
regimen comprising: (a) administering a dosage of INFERGEN.RTM.
interferon alfacon-1 containing an amount of 9 .mu.g of drug per
dose, subcutaneously three times per week; and (b) administering a
dosage of IFN-.gamma. containing an amount of 25 .mu.g of drug per
dose, subcutaneously three times per week; for the desired
treatment duration with an NS3 inhibitor compound.
[0380] As non-limiting examples, any of the above-described methods
featuring an IFN-.alpha. and IFN-.gamma. combination regimen can be
modified to replace the subject IFN-.alpha. and IFN-.gamma.
combination regimen with an IFN-.alpha. and IFN-.gamma. combination
regimen comprising: (a) administering a dosage of INFERGEN.RTM.
interferon alfacon-1 containing an amount of 9 .mu.g of drug per
dose, subcutaneously three times per week; and (b) administering a
dosage of IFN-.gamma. containing an amount of 50 .mu.g of drug per
dose, subcutaneously three times per week; for the desired
treatment duration with an NS3 inhibitor compound.
[0381] As non-limiting examples, any of the above-described methods
featuring an IFN-.alpha. and IFN-.gamma. combination regimen can be
modified to replace the subject IFN-.alpha. and IFN-.gamma.
combination regimen with an IFN-.alpha. and IFN-.gamma. combination
regimen comprising: (a) administering a dosage of INFERGEN.RTM.
interferon alfacon-1 containing an amount of 9 .mu.g of drug per
dose, subcutaneously three times per week; and (b) administering a
dosage of IFN-.gamma. containing an amount of 100 .mu.g of drug per
dose, subcutaneously three times per week; for the desired
treatment duration with an NS3 inhibitor compound.
[0382] As non-limiting examples, any of the above-described methods
featuring an IFN-.alpha. and IFN-.gamma. combination regimen can be
modified to replace the subject IFN-.alpha. and IFN-.gamma.
combination regimen with an IFN-.alpha. and IFN-.gamma. combination
regimen comprising: (a) administering a dosage of INFERGEN.RTM.
interferon alfacon-1 containing an amount of 9 .mu.g of drug per
dose, subcutaneously once daily; and (b) administering a dosage of
IFN-.gamma. containing an amount of 25 .mu.g of drug per dose,
subcutaneously three times per week; for the desired treatment
duration with an NS3 inhibitor compound.
[0383] As non-limiting examples, any of the above-described methods
featuring an IFN-.alpha. and IFN-.gamma. combination regimen can be
modified to replace the subject IFN-.alpha. and IFN-.gamma.
combination regimen with an IFN-.alpha. and IFN-.gamma. combination
regimen comprising: (a) administering a dosage of INFERGEN.RTM.
interferon alfacon-1 containing an amount of 9 .mu.g of drug per
dose, subcutaneously once daily; and (b) administering a dosage of
IFN-.gamma. containing an amount of 50 .mu.g of drug per dose,
subcutaneously three times per week; for the desired treatment
duration with an NS3 inhibitor compound.
[0384] As non-limiting examples, any of the above-described methods
featuring an IFN-.alpha. and IFN-.gamma. combination regimen can be
modified to replace the subject IFN-.alpha. and IFN-.gamma.
combination regimen with an IFN-.alpha. and IFN-.gamma. combination
regimen comprising: (a) administering a dosage of INFERGEN.RTM.
interferon alfacon-1 containing an amount of 9 .mu.g of drug per
dose, subcutaneously once daily; and (b) administering a dosage of
IFN-.gamma. containing an amount of 100 .mu.g of drug per dose,
subcutaneously three times per week; for the desired treatment
duration with an NS3 inhibitor compound.
[0385] As non-limiting examples, any of the above-described methods
featuring an IFN-.alpha. and IFN-.gamma. combination regimen can be
modified to replace the subject IFN-.alpha. and IFN-.gamma.
combination regimen with an IFN-.alpha. and IFN-.gamma. combination
regimen comprising: (a) administering a dosage of INFERGEN.RTM.
interferon alfacon-1 containing an amount of 15 .mu.g of drug per
dose, subcutaneously three times per week; and (b) administering a
dosage of IFN-.gamma. containing an amount of 25 .mu.g of drug per
dose, subcutaneously three times per week; for the desired
treatment duration with an NS3 inhibitor compound.
[0386] As non-limiting examples, any of the above-described methods
featuring an IFN-.alpha. and IFN-.gamma. combination regimen can be
modified to replace the subject IFN-.alpha. and IFN-.gamma.
combination regimen with an IFN-.alpha. and IFN-.gamma. combination
regimen comprising: (a) administering a dosage of INFERGEN.RTM.
interferon alfacon-1 containing an amount of 15 .mu.g of drug per
dose, subcutaneously three times per week; and (b) administering a
dosage of IFN-.gamma. containing an amount of 50 .mu.g of drug per
dose, subcutaneously three times per week; for the desired
treatment duration with an NS3 inhibitor compound.
[0387] As non-limiting examples, any of the above-described methods
featuring an IFN-.alpha. and IFN-.gamma. combination regimen can be
modified to replace the subject IFN-.alpha. and IFN-.gamma.
combination regimen with an IFN-.alpha. and IFN-.gamma. combination
regimen comprising: (a) administering a dosage of INFERGEN.RTM.
interferon alfacon-1 containing an amount of 15 .mu.g of drug per
dose, subcutaneously three times per week; and (b) administering a
dosage of IFN-.gamma. containing an amount of 100 .mu.g of drug per
dose, subcutaneously three times per week; for the desired
treatment duration with an NS3 inhibitor compound.
[0388] As non-limiting examples, any of the above-described methods
featuring an IFN-.alpha. and IFN-.gamma. combination regimen can be
modified to replace the subject IFN-.alpha. and IFN-.gamma.
combination regimen with an IFN-.alpha. and IFN-.gamma. combination
regimen comprising: (a) administering a dosage of INFERGEN.RTM.
interferon alfacon-1 containing an amount of 15 .mu.g of drug per
dose, subcutaneously once daily; and (b) administering a dosage of
IFN-.gamma. containing an amount of 25 .mu.g of drug per dose,
subcutaneously three times per week; for the desired treatment
duration with an NS3 inhibitor compound.
[0389] As non-limiting examples, any of the above-described methods
featuring an IFN-.alpha. and IFN-.gamma. combination regimen can be
modified to replace the subject IFN-.alpha. and IFN-.gamma.
combination regimen with an IFN-.alpha. and IFN-.gamma. combination
regimen comprising: (a) administering a dosage of INFERGEN.RTM.
interferon alfacon-1 containing an amount of 15 .mu.g of drug per
dose, subcutaneously once daily; and (b) administering a dosage of
IFN-.gamma. containing an amount of 50 .mu.g of drug per dose,
subcutaneously three times per week; for the desired treatment
duration with an NS3 inhibitor compound.
[0390] As non-limiting examples, any of the above-described methods
featuring an IFN-.alpha. and IFN-.gamma. combination regimen can be
modified to replace the subject IFN-.alpha. and IFN-.gamma.
combination regimen with an IFN-.alpha. and IFN-.gamma. combination
regimen comprising: (a) administering a dosage of INFERGEN.RTM.
interferon alfacon-1 containing an amount of 15 .mu.g of drug per
dose, subcutaneously once daily; and (b) administering a dosage of
IFN-.gamma. containing an amount of 100 .mu.g of drug per dose,
subcutaneously three times per week; for the desired treatment
duration with an NS3 inhibitor compound.
[0391] As non-limiting examples, any of the above-described methods
featuring an IFN-.alpha., IFN-.gamma. and TNF antagonist
combination regimen can be modified to replace the subject
IFN-.alpha., IFN-.gamma. and TNF antagonist combination regimen
with an IFN-.alpha., IFN-.gamma. and TNF antagonist combination
regimen comprising: (a) administering a dosage of monoPEG (30 kD,
linear)-ylated consensus IFN-.alpha. containing an amount of 100
.mu.g of drug per dose, subcutaneously once weekly, once every 8
days, or once every 10 days; (b) administering a dosage of
IFN-.gamma. containing an amount of 100 .mu.g of drug per dose,
subcutaneously three times per week; and (c) administering a dosage
of a TNF antagonist selected from (i) etanercept in an amount of 25
mg subcutaneously twice per week, (ii) infliximab in an amount of 3
mg of drug per kilogram of body weight intravenously at weeks 0, 2
and 6, and every 8 weeks thereafter or (iii) adalimumab in an
amount of 40 mg subcutaneously once weekly or once every other
week; for the desired treatment duration with an NS3 inhibitor
compound.
[0392] As non-limiting examples, any of the above-described methods
featuring an IFN-.alpha., IFN-.gamma. and TNF antagonist
combination regimen can be modified to replace the subject
IFN-.alpha., IFN-.gamma. and TNF antagonist combination regimen
with an IFN-.alpha., IFN-.gamma. and TNF antagonist combination
regimen comprising: (a) administering a dosage of monoPEG (30 kD,
linear)-ylated consensus IFN-.alpha. containing an amount of 100
.mu.g of drug per dose, subcutaneously once weekly, once every 8
days, or once every 10 days; (b) administering a dosage of
IFN-.gamma. containing an amount of 50 .mu.g of drug per dose,
subcutaneously three times per week; and (c) administering a dosage
of a TNF antagonist selected from (i) etanercept in an amount of 25
mg subcutaneously twice per week, (ii) infliximab in an amount of 3
mg of drug per kilogram of body weight intravenously at weeks 0, 2
and 6, and every 8 weeks thereafter or (iii) adalimumab in an
amount of 40 mg subcutaneously once weekly or once every other
week; for the desired treatment duration with an NS3 inhibitor
compound.
[0393] As non-limiting examples, any of the above-described methods
featuring an IFN-.alpha., IFN-.gamma. and TNF antagonist
combination regimen can be modified to replace the subject
IFN-.alpha., IFN-.gamma. and TNF antagonist combination regimen
with an IFN-.alpha., IFN-.gamma. and TNF antagonist combination
regimen comprising: (a) administering a dosage of monoPEG (30 kD,
linear)-ylated consensus IFN-.alpha. containing an amount of 150
.mu.g of drug per dose, subcutaneously once weekly, once every 8
days, or once every 10 days; (b) administering a dosage of
IFN-.gamma. containing an amount of 50 .mu.g of drug per dose,
subcutaneously three times per week; and (c) administering a dosage
of a TNF antagonist selected from (i) etanercept in an amount of 25
mg subcutaneously twice per week, (ii) infliximab in an amount of 3
mg of drug per kilogram of body weight intravenously at weeks 0, 2
and 6, and every 8 weeks thereafter or (iii) adalimumab in an
amount of 40 mg subcutaneously once weekly or once every other
week; for the desired treatment duration with an NS3 inhibitor
compound.
[0394] As non-limiting examples, any of the above-described methods
featuring an IFN-.alpha., IFN-.gamma. and TNF antagonist
combination regimen can be modified to replace the subject
IFN-.alpha., IFN-.gamma. and TNF antagonist combination regimen
with an IFN-.alpha., IFN-.gamma. and TNF antagonist combination
regimen comprising: (a) administering a dosage of monoPEG (30 kD,
linear)-ylated consensus IFN-.alpha. containing an amount of 150
.mu.g of drug per dose, subcutaneously once weekly, once every 8
days, or once every 10 days; (b) administering a dosage of
IFN-.gamma. containing an amount of 100 .mu.g of drug per dose,
subcutaneously three times per week; and (c) administering a dosage
of a TNF antagonist selected from (i) etanercept in an amount of 25
mg subcutaneously twice per week, (ii) infliximab in an amount of 3
mg of drug per kilogram of body weight intravenously at weeks 0, 2
and 6, and every 8 weeks thereafter or (iii) adalimumab in an
amount of 40 mg subcutaneously once weekly or once every other
week; for the desired treatment duration with an NS3 inhibitor
compound.
[0395] As non-limiting examples, any of the above-described methods
featuring an IFN-.alpha., IFN-.gamma. and TNF antagonist
combination regimen can be modified to replace the subject
IFN-.alpha., IFN-.gamma. and TNF antagonist combination regimen
with an IFN-.alpha., IFN-.gamma. and TNF antagonist combination
regimen comprising: (a) administering a dosage of monoPEG (30 kD,
linear)-ylated consensus IFN-.alpha. containing an amount of 200
.mu.g of drug per dose, subcutaneously once weekly, once every 8
days, or once every 10 days; (b) administering a dosage of
IFN-.gamma. containing an amount of 50 .mu.g of drug per dose,
subcutaneously three times per week; and (c) administering a dosage
of a TNF antagonist selected from (i) etanercept in an amount of 25
mg subcutaneously twice per week, (ii) infliximab in an amount of 3
mg of drug per kilogram of body weight intravenously at weeks 0, 2
and 6, and every 8 weeks thereafter or (iii) adalimumab in an
amount of 40 mg subcutaneously once weekly or once every other
week; for the desired treatment duration with an NS3 inhibitor
compound.
[0396] As non-limiting examples, any of the above-described methods
featuring an IFN-.alpha., IFN-.gamma. and TNF antagonist
combination regimen can be modified to replace the subject
IFN-.alpha., IFN-.gamma. and TNF antagonist combination regimen
with an IFN-.alpha., IFN-.gamma. and TNF antagonist combination
regimen comprising: (a) administering a dosage of monoPEG (30 kD,
linear)-ylated consensus IFN-.alpha. containing an amount of 200
.mu.g of drug per dose, subcutaneously once weekly, once every 8
days, or once every 10 days; (b) administering a dosage of
IFN-.gamma. containing an amount of 100 .mu.g of drug per dose,
subcutaneously three times per week; and (c) administering a dosage
of a TNF antagonist selected from (i) etanercept in an amount of 25
mg subcutaneously twice per week, (ii) infliximab in an amount of 3
mg of drug per kilogram of body weight intravenously at weeks 0, 2
and 6, and every 8 weeks thereafter or (iii) adalimumab in an
amount of 40 mg subcutaneously once weekly or once every other
week; for the desired treatment duration with an NS3 inhibitor
compound.
[0397] As non-limiting examples, any of the above-described methods
featuring an IFN-.alpha., IFN-.gamma. and TNF antagonist
combination regimen can be modified to replace the subject
IFN-.alpha., IFN-.gamma. and TNF antagonist combination regimen
with an IFN-.alpha., IFN-.gamma. and TNF antagonist combination
regimen comprising: (a) administering a dosage of INFERGEN.RTM.
interferon alfacon-1 containing an amount of 9 .mu.g of drug per
dose, subcutaneously three times per week; (b) administering a
dosage of IFN-.gamma. containing an amount of 25 .mu.g of drug per
dose, subcutaneously three times per week; and (c) administering a
dosage of a TNF antagonist selected from (i) etanercept in an
amount of 25 mg subcutaneously twice per week, (ii) infliximab in
an amount of 3 mg of drug per kilogram of body weight intravenously
at weeks 0, 2 and 6, and every 8 weeks thereafter or (iii)
adalimumab in an amount of 40 mg subcutaneously once weekly or once
every other week; for the desired treatment duration with an NS3
inhibitor compound.
[0398] As non-limiting examples, any of the above-described methods
featuring an IFN-.alpha., IFN-.gamma. and TNF antagonist
combination regimen can be modified to replace the subject
IFN-.alpha., IFN-.gamma. and TNF antagonist combination regimen
with an IFN-.alpha., IFN-.gamma. and TNF antagonist combination
regimen comprising: (a) administering a dosage of INFERGEN.RTM.
interferon alfacon-1 containing an amount of 9 .mu.g of drug per
dose, subcutaneously three times per week; (b) administering a
dosage of IFN-.gamma. containing an amount of 50 .mu.g of drug per
dose, subcutaneously three times per week; and (c) administering a
dosage of a TNF antagonist selected from (i) etanercept in an
amount of 25 mg subcutaneously twice per week, (ii) infliximab in
an amount of 3 mg of drug per kilogram of body weight intravenously
at weeks 0, 2 and 6, and every 8 weeks thereafter or (iii)
adalimumab in an amount of 40 mg subcutaneously once weekly or once
every other week; for the desired treatment duration with an NS3
inhibitor compound.
[0399] As non-limiting examples, any of the above-described methods
featuring an IFN-.alpha., IFN-.gamma. and TNF antagonist
combination regimen can be modified to replace the subject
IFN-.alpha., IFN-.gamma. and TNF antagonist combination regimen
with an IFN-.alpha., IFN-.gamma. and TNF antagonist combination
regimen comprising: (a) administering a dosage of INFERGEN.RTM.
interferon alfacon-1 containing an amount of 9 .mu.g of drug per
dose, subcutaneously three times per week; (b) administering a
dosage of IFN-.gamma. containing an amount of 100 .mu.g of drug per
dose, subcutaneously three times per week; and (c) administering a
dosage of a TNF antagonist selected from (i) etanercept in an
amount of 25 mg subcutaneously twice per week, (ii) infliximab in
an amount of 3 mg of drug per kilogram of body weight intravenously
at weeks 0, 2 and 6, and every 8 weeks thereafter or (iii)
adalimumab in an amount of 40 mg subcutaneously once weekly or once
every other week; for the desired treatment duration with an NS3
inhibitor compound.
[0400] As non-limiting examples, any of the above-described methods
featuring an IFN-.alpha., IFN-.gamma. and TNF antagonist
combination regimen can be modified to replace the subject
IFN-.alpha., IFN-.gamma. and TNF antagonist combination regimen
with an IFN-.alpha., IFN-.gamma. and TNF antagonist combination
regimen comprising: (a) administering a dosage of INFERGEN.RTM.
interferon alfacon-1 containing an amount of 9 .mu.g of drug per
dose, subcutaneously once daily; (b) administering a dosage of
IFN-.gamma. containing an amount of 25 .mu.g of drug per dose,
subcutaneously three times per week; and (c) administering a dosage
of a TNF antagonist selected from (i) etanercept in an amount of 25
mg subcutaneously twice per week, (ii) infliximab in an amount of 3
mg of drug per kilogram of body weight intravenously at weeks 0, 2
and 6, and every 8 weeks thereafter or (iii) adalimumab in an
amount of 40 mg subcutaneously once weekly or once every other
week; for the desired treatment duration with an NS3 inhibitor
compound.
[0401] As non-limiting examples, any of the above-described methods
featuring an IFN-.alpha., IFN-.gamma. and TNF antagonist
combination regimen can be modified to replace the subject
IFN-.alpha., IFN-.gamma. and TNF antagonist combination regimen
with an IFN-.alpha., IFN-.gamma. and TNF antagonist combination
regimen comprising: (a) administering a dosage of INFERGEN.RTM.
interferon alfacon-1 containing an amount of 9 .mu.g of drug per
dose, subcutaneously once daily; (b) administering a dosage of
IFN-.gamma. containing an amount of 50 .mu.g of drug per dose,
subcutaneously three times per week; and (c) administering a dosage
of a TNF antagonist selected from (i) etanercept in an amount of 25
mg subcutaneously twice per week, (ii) infliximab in an amount of 3
mg of drug per kilogram of body weight intravenously at weeks 0, 2
and 6, and every 8 weeks thereafter or (iii) adalimumab in an
amount of 40 mg subcutaneously once weekly or once every other
week; for the desired treatment duration with an NS3 inhibitor
compound.
[0402] As non-limiting examples, any of the above-described methods
featuring an IFN-.alpha., IFN-.gamma. and TNF antagonist
combination regimen can be modified to replace the subject
IFN-.alpha., IFN-.gamma. and TNF antagonist combination regimen
with an IFN-.alpha., IFN-.gamma. and TNF antagonist combination
regimen comprising: (a) administering a dosage of INFERGEN.RTM.
interferon alfacon-1 containing an amount of 9 .mu.g of drug per
dose, subcutaneously once daily; (b) administering a dosage of
IFN-.gamma. containing an amount of 100 .mu.g of drug per dose,
subcutaneously three times per week; and (c) administering a dosage
of a TNF antagonist selected from (i) etanercept in an amount of 25
mg subcutaneously twice per week, (ii) infliximab in an amount of 3
mg of drug per kilogram of body weight intravenously at weeks 0, 2
and 6, and every 8 weeks thereafter or (iii) adalimumab in an
amount of 40 mg subcutaneously once weekly or once every other
week; for the desired treatment duration with an NS3 inhibitor
compound.
[0403] As non-limiting examples, any of the above-described methods
featuring an IFN-.alpha., IFN-.gamma. and TNF antagonist
combination regimen can be modified to replace the subject
IFN-.alpha., IFN-.gamma. and TNF antagonist combination regimen
with an IFN-.alpha., IFN-.gamma. and TNF antagonist combination
regimen comprising: (a) administering a dosage of INFERGEN.RTM.
interferon alfacon-1 containing an amount of 15 .mu.g of drug per
dose, subcutaneously three times per week; (b) administering a
dosage of IFN-.gamma. containing an amount of 25 .mu.g of drug per
dose, subcutaneously three times per week; and (c) administering a
dosage of a TNF antagonist selected from (i) etanercept in an
amount of 25 mg subcutaneously twice per week, (ii) infliximab in
an amount of 3 mg of drug per kilogram of body weight intravenously
at weeks 0, 2 and 6, and every 8 weeks thereafter or (iii)
adalimumab in an amount of 40 mg subcutaneously once weekly or once
every other week; for the desired treatment duration with an NS3
inhibitor compound.
[0404] As non-limiting examples, any of the above-described methods
featuring an IFN-.alpha., IFN-.gamma. and TNF antagonist
combination regimen can be modified to replace the subject
IFN-.alpha., IFN-.gamma. and TNF antagonist combination regimen
with an IFN-.alpha., IFN-.gamma. and TNF antagonist combination
regimen comprising: (a) administering a dosage of INFERGEN.RTM.
interferon alfacon-1 containing an amount of 15 .mu.g of drug per
dose, subcutaneously three times per week; (b) administering a
dosage of IFN-.gamma. containing an amount of 50 .mu.g of drug per
dose, subcutaneously three times per week; and (c) administering a
dosage of a TNF antagonist selected from (i) etanercept in an
amount of 25 mg subcutaneously twice per week, (ii) infliximab in
an amount of 3 mg of drug per kilogram of body weight intravenously
at weeks 0, 2 and 6, and every 8 weeks thereafter or (iii)
adalimumab in an amount of 40 mg subcutaneously once weekly or once
every other week; for the desired treatment duration with an NS3
inhibitor compound.
[0405] As non-limiting examples, any of the above-described methods
featuring an IFN-.alpha., IFN-.gamma. and TNF antagonist
combination regimen can be modified to replace the subject
IFN-.alpha., IFN-.gamma. and TNF antagonist combination regimen
with an IFN-.alpha., IFN-.gamma. and TNF antagonist combination
regimen comprising: (a) administering a dosage of INFERGEN.RTM.
interferon alfacon-1 containing an amount of 15 .mu.g of drug per
dose, subcutaneously three times per week; (b) administering a
dosage of IFN-.gamma. containing an amount of 100 .mu.g of drug per
dose, subcutaneously three times per week; and (c) administering a
dosage of a TNF antagonist selected from (i) etanercept in an
amount of 25 mg subcutaneously twice per week, (ii) infliximab in
an amount of 3 mg of drug per kilogram of body weight intravenously
at weeks 0, 2 and 6, and every 8 weeks thereafter or (iii)
adalimumab in an amount of 40 mg subcutaneously once weekly or once
every other week; for the desired treatment duration with an NS3
inhibitor compound.
[0406] As non-limiting examples, any of the above-described methods
featuring an IFN-.alpha., IFN-.gamma. and TNF antagonist
combination regimen can be modified to replace the subject
IFN-.alpha., IFN-.gamma. and TNF antagonist combination regimen
with an IFN-.alpha., IFN-.gamma. and TNF antagonist combination
regimen comprising: (a) administering a dosage of INFERGEN.RTM.
interferon alfacon-1 containing an amount of 15 .mu.g of drug per
dose, subcutaneously once daily; (b) administering a dosage of
IFN-.gamma. containing an amount of 25 .mu.g of drug per dose,
subcutaneously three times per week; and (c) administering a dosage
of a TNF antagonist selected from (i) etanercept in an amount of 25
mg subcutaneously twice per week, (ii) infliximab in an amount of 3
mg of drug per kilogram of body weight intravenously at weeks 0, 2
and 6, and every 8 weeks thereafter or (iii) adalimumab in an
amount of 40 mg subcutaneously once weekly or once every other
week; for the desired treatment duration with an NS3 inhibitor
compound.
[0407] As non-limiting examples, any of the above-described methods
featuring an IFN-.alpha., IFN-.gamma. and TNF antagonist
combination regimen can be modified to replace the subject
IFN-.alpha., IFN-.gamma. and TNF antagonist combination regimen
with an IFN-.alpha., IFN-.gamma. and TNF antagonist combination
regimen comprising: (a) administering a dosage of INFERGEN.RTM.
interferon alfacon-1 containing an amount of 15 .mu.g of drug per
dose, subcutaneously once daily; (b) administering a dosage of
IFN-.gamma. containing an amount of 50 .mu.g of drug per dose,
subcutaneously three times per week; and (c) administering a dosage
of a TNF antagonist selected from (i) etanercept in an amount of 25
mg subcutaneously twice per week, (ii) infliximab in an amount of 3
mg of drug per kilogram of body weight intravenously at weeks 0, 2
and 6, and every 8 weeks thereafter or (iii) adalimumab in an
amount of 40 mg subcutaneously once weekly or once every other
week; for the desired treatment duration with an NS3 inhibitor
compound.
[0408] As non-limiting examples, any of the above-described methods
featuring an IFN-.alpha., IFN-.gamma. and TNF antagonist
combination regimen can be modified to replace the subject
IFN-.alpha., IFN-.gamma. and TNF antagonist combination regimen
with an IFN-.alpha., IFN-.gamma. and TNF antagonist combination
regimen comprising: (a) administering a dosage of INFERGEN.RTM.
interferon alfacon-1 containing an amount of 15 .mu.g of drug per
dose, subcutaneously once daily; (b) administering a dosage of
IFN-.gamma. containing an amount of 100 .mu.g of drug per dose,
subcutaneously three times per week; and (c) administering a dosage
of a TNF antagonist selected from (i) etanercept in an amount of 25
mg subcutaneously twice per week, (ii) infliximab in an amount of 3
mg of drug per kilogram of body weight intravenously at weeks 0, 2
and 6, and every 8 weeks thereafter or (iii) adalimumab in an
amount of 40 mg subcutaneously once weekly or once every other
week; for the desired treatment duration with an NS3 inhibitor
compound.
[0409] As non-limiting examples, any of the above-described methods
featuring an IFN-.alpha. and TNF antagonist combination regimen can
be modified to replace the subject IFN-.alpha. and TNF antagonist
combination regimen with an IFN-.alpha. and TNF antagonist
combination regimen comprising: (a) administering a dosage of
monoPEG (30 kD, linear)-ylated consensus IFN-.alpha. containing an
amount of 100 .mu.g of drug per dose, subcutaneously once weekly,
once every 8 days, or once every 10 days; and (b) administering a
dosage of a TNF antagonist selected from (i) etanercept in an
amount of 25 mg subcutaneously twice per week, (ii) infliximab in
an amount of 3 mg of drug per kilogram of body weight intravenously
at weeks 0, 2 and 6, and every 8 weeks thereafter or (iii)
adalimumab in an amount of 40 mg subcutaneously once weekly or once
every other week; for the desired treatment duration with an NS3
inhibitor compound.
[0410] As non-limiting examples, any of the above-described methods
featuring an IFN-.alpha. and TNF antagonist combination regimen can
be modified to replace the subject IFN-.alpha. and TNF antagonist
combination regimen with an IFN-.alpha. and TNF antagonist
combination regimen comprising: (a) administering a dosage of
monoPEG (30 kD, linear)-ylated consensus IFN-.alpha. containing an
amount of 150 .mu.g of drug per dose, subcutaneously once weekly,
once every 8 days, or once every 10 days; and (b) administering a
dosage of a TNF antagonist selected from (i) etanercept in an
amount of 25 mg subcutaneously twice per week, (ii) infliximab in
an amount of 3 mg of drug per kilogram of body weight intravenously
at weeks 0, 2 and 6, and every 8 weeks thereafter or (iii)
adalimumab in an amount of 40 mg subcutaneously once weekly or once
every other week; for the desired treatment duration with an NS3
inhibitor compound.
[0411] As non-limiting examples, any of the above-described methods
featuring an IFN-.alpha. and TNF antagonist combination regimen can
be modified to replace the subject IFN-.alpha. and TNF antagonist
combination regimen with an IFN-.alpha. and TNF antagonist
combination regimen comprising: (a) administering a dosage of
monoPEG (30 kD, linear)-ylated consensus IFN-.alpha. containing an
amount of 200 .mu.g of drug per dose, subcutaneously once weekly,
once every 8 days, or once every 10 days; and (b) administering a
dosage of a TNF antagonist selected from (i) etanercept in an
amount of 25 mg subcutaneously twice per week, (ii) infliximab in
an amount of 3 mg of drug per kilogram of body weight intravenously
at weeks 0, 2 and 6, and every 8 weeks thereafter or (iii)
adalimumab in an amount of 40 mg subcutaneously once weekly or once
every other week; for the desired treatment duration with an NS3
inhibitor compound.
[0412] As non-limiting examples, any of the above-described methods
featuring an IFN-.alpha. and TNF antagonist combination regimen can
be modified to replace the subject IFN-.alpha. and TNF antagonist
combination regimen with an IFN-.alpha. and TNF antagonist
combination regimen comprising: (a) administering a dosage of
INFERGEN.RTM. interferon alfacon-1 containing an amount of 9 .mu.g
of drug per dose, subcutaneously once daily or three times per
week; and (b) administering a dosage of a TNF antagonist selected
from (i) etanercept in an amount of 25 mg subcutaneously twice per
week, (ii) infliximab in an amount of 3 mg of drug per kilogram of
body weight intravenously at weeks 0, 2 and 6, and every 8 weeks
thereafter or (iii) adalimumab in an amount of 40 mg subcutaneously
once weekly or once every other week; for the desired treatment
duration with an NS3 inhibitor compound.
[0413] As non-limiting examples, any of the above-described methods
featuring an IFN-.alpha. and TNF antagonist combination regimen can
be modified to replace the subject IFN-.alpha. and TNF antagonist
combination regimen with an IFN-.alpha. and TNF antagonist
combination regimen comprising: (a) administering a dosage of
INFERGEN.RTM. interferon alfacon-1 containing an amount of 15 .mu.g
of drug per dose, subcutaneously once daily or three times per
week; and (b) administering a dosage of a TNF antagonist selected
from (i) etanercept in an amount of 25 mg subcutaneously twice per
week, (ii) infliximab in an amount of 3 mg of drug per kilogram of
body weight intravenously at weeks 0, 2 and 6, and every 8 weeks
thereafter or (iii) adalimumab in an amount of 40 mg subcutaneously
once weekly or once every other week; for the desired treatment
duration with an NS3 inhibitor compound.
[0414] As non-limiting examples, any of the above-described methods
featuring an IFN-.gamma. and TNF antagonist combination regimen can
be modified to replace the subject IFN-.gamma. and TNF antagonist
combination regimen with an IFN-.gamma. and TNF antagonist
combination regimen comprising: (a) administering a dosage of
IFN-.gamma. containing an amount of 25 .mu.g of drug per dose,
subcutaneously three times per week; and (b) administering a dosage
of a TNF antagonist selected from (i) etanercept in an amount of 25
mg subcutaneously twice per week, (ii) infliximab in an amount of 3
mg of drug per kilogram of body weight intravenously at weeks 0, 2
and 6, and every 8 weeks thereafter or (iii) adalimumab in an
amount of 40 mg subcutaneously once weekly or once every other
week; for the desired treatment duration with an NS3 inhibitor
compound.
[0415] As non-limiting examples, any of the above-described methods
featuring an IFN-.gamma. and TNF antagonist combination regimen can
be modified to replace the subject IFN-.gamma. and TNF antagonist
combination regimen with an IFN-.gamma. and TNF antagonist
combination regimen comprising: (a) administering a dosage of
IFN-.gamma. containing an amount of 50 .mu.g of drug per dose,
subcutaneously three times per week; and (b) administering a dosage
of a TNF antagonist selected from (i) etanercept in an amount of 25
mg subcutaneously twice per week, (ii) infliximab in an amount of 3
mg of drug per kilogram of body weight intravenously at weeks 0, 2
and 6, and every 8 weeks thereafter or (iii) adalimumab in an
amount of 40 mg subcutaneously once weekly or once every other
week; for the desired treatment duration with an NS3 inhibitor
compound.
[0416] As non-limiting examples, any of the above-described methods
featuring an IFN-.gamma. and TNF antagonist combination regimen can
be modified to replace the subject IFN-.gamma. and TNF antagonist
combination regimen with an IFN-.gamma. and TNF antagonist
combination regimen comprising: (a) administering a dosage of
IFN-.gamma. containing an amount of 100 .mu.g of drug per dose,
subcutaneously three times per week; and (b) administering a dosage
of a TNF antagonist selected from (i) etanercept in an amount of 25
mg subcutaneously twice per week, (ii) infliximab in an amount of 3
mg of drug per kilogram of body weight intravenously at weeks 0, 2
and 6, and every 8 weeks thereafter or (iii) adalimumab in an
amount of 40 mg subcutaneously once weekly or once every other
week; for the desired treatment duration with an NS3 inhibitor
compound.
[0417] As non-limiting examples, any of the above-described methods
that includes a regimen of monoPEG (30 kD, linear)-ylated consensus
IFN-.alpha. can be modified to replace the regimen of monoPEG (30
kD, linear)-ylated consensus IFN-.alpha. with a regimen of
peginterferon alfa-2a comprising administering a dosage of
peginterferon alfa-2a containing an amount of 180 .mu.g of drug per
dose, subcutaneously once weekly for the desired treatment duration
with an NS3 inhibitor compound.
[0418] As non-limiting examples, any of the above-described methods
that includes a regimen of monoPEG (30 kD, linear)-ylated consensus
IFN-.alpha. can be modified to replace the regimen of monoPEG (30
kD, linear)-ylated consensus IFN-.alpha. with a regimen of
peginterferon alfa-2b comprising administering a dosage of
peginterferon alfa-2b containing an amount of 1.0 .mu.g to 1.5
.mu.g of drug per kilogram of body weight per dose, subcutaneously
once or twice weekly for the desired treatment duration with an NS3
inhibitor compound.
[0419] As non-limiting examples, any of the above-described methods
can be modified to include administering a dosage of ribavirin
containing an amount of 400 mg, 800 mg, 1000 mg or 1200 mg of drug
orally per day, optionally in two or more divided doses per day,
for the desired treatment duration with an NS3 inhibitor
compound.
[0420] As non-limiting examples, any of the above-described methods
can be modified to include administering a dosage of ribavirin
containing (i) an amount of 1000 mg of drug orally per day for
patients having a body weight of less than 75 kg or (ii) an amount
of 1200 mg of drug orally per day for patients having a body weight
of greater than or equal to 75 kg, optionally in two or more
divided doses per day, for the desired treatment duration with an
NS3 inhibitor compound.
[0421] As non-limiting examples, any of the above-described methods
can be modified to replace the subject NS3 inhibitor regimen with
an NS3 inhibitor regimen comprising administering a dosage of 0.01
mg to 0.1 mg of drug per kilogram of body weight orally daily,
optionally in two or more divided doses per day, for the desired
treatment duration with the NS3 inhibitor compound.
[0422] As non-limiting examples, any of the above-described methods
can be modified to replace the subject NS3 inhibitor regimen with
an NS3 inhibitor regimen comprising administering a dosage of 0.1
mg to 1 mg of drug per kilogram of body weight orally daily,
optionally in two or more divided doses per day, for the desired
treatment duration with the NS3 inhibitor compound.
[0423] As non-limiting examples, any of the above-described methods
can be modified to replace the subject NS3 inhibitor regimen with
an NS3 inhibitor regimen comprising administering a dosage of 1 mg
to 10 mg of drug per kilogram of body weight orally daily,
optionally in two or more divided doses per day, for the desired
treatment duration with the NS3 inhibitor compound.
[0424] As non-limiting examples, any of the above-described methods
can be modified to replace the subject NS3 inhibitor regimen with
an NS3 inhibitor regimen comprising administering a dosage of 10 mg
to 100 mg of drug per kilogram of body weight orally daily,
optionally in two or more divided doses per day, for the desired
treatment duration with the NS3 inhibitor compound.
[0425] As non-limiting examples, any of the above-described methods
featuring an NS5B inhibitor regimen can be modified to replace the
subject NS5B inhibitor regimen with an NS5B inhibitor regimen
comprising administering a dosage of 0.01 mg to 0.1 mg of drug per
kilogram of body weight orally daily, optionally in two or more
divided doses per day, for the desired treatment duration with an
NS3 inhibitor compound.
[0426] As non-limiting examples, any of the above-described methods
featuring an NS5B inhibitor regimen can be modified to replace the
subject NS5B inhibitor regimen with an NS5B inhibitor regimen
comprising administering a dosage of 0.1 mg to 1 mg of drug per
kilogram of body weight orally daily, optionally in two or more
divided doses per day, for the desired treatment duration with an
NS3 inhibitor compound.
[0427] As non-limiting examples, any of the above-described methods
featuring an NS5B inhibitor regimen can be modified to replace the
subject NS5B inhibitor regimen with an NS5B inhibitor regimen
comprising administering a dosage of 1 mg to 10 mg of drug per
kilogram of body weight orally daily, optionally in two or more
divided doses per day, for the desired treatment duration with an
NS3 inhibitor compound.
[0428] As non-limiting examples, any of the above-described methods
featuring an NS5B inhibitor regimen can be modified to replace the
subject NS5B inhibitor regimen with an NS5B inhibitor regimen
comprising administering a dosage of 10 mg to 100 mg of drug per
kilogram of body weight orally daily, optionally in two or more
divided doses per day, for the desired treatment duration with an
NS3 inhibitor compound.
Patient Identification
[0429] In certain embodiments, the specific regimen of drug therapy
used in treatment of the HCV patient is selected according to
certain disease parameters exhibited by the patient, such as the
initial viral load, genotype of the HCV infection in the patient,
liver histology and/or stage of liver fibrosis in the patient.
[0430] Thus, some embodiments provide any of the above-described
methods for the treatment of HCV infection in which the subject
method is modified to treat a treatment failure patient for a
duration of 48 weeks.
[0431] Other embodiments provide any of the above-described methods
for HCV in which the subject method is modified to treat a
non-responder patient, where the patient receives a 48 week course
of therapy.
[0432] Other embodiments provide any of the above-described methods
for the treatment of HCV infection in which the subject method is
modified to treat a relapser patient, where the patient receives a
48 week course of therapy.
[0433] Other embodiments provide any of the above-described methods
for the treatment of HCV infection in which the subject method is
modified to treat a naive patient infected with HCV genotype 1,
where the patient receives a 48 week course of therapy.
[0434] Other embodiments provide any of the above-described methods
for the treatment of HCV infection in which the subject method is
modified to treat a naive patient infected with HCV genotype 4,
where the patient receives a 48 week course of therapy.
[0435] Other embodiments provide any of the above-described methods
for the treatment of HCV infection in which the subject method is
modified to treat a naive patient infected with HCV genotype 1,
where the patient has a high viral load (HVL), where "HVL" refers
to an HCV viral load of greater than 2.times.10.sup.6 HCV genome
copies per mL serum, and where the patient receives a 48 week
course of therapy.
[0436] One embodiment provides any of the above-described methods
for the treatment of an HCV infection, where the subject method is
modified to include the steps of (1) identifying a patient having
advanced or severe stage liver fibrosis as measured by a Knodell
score of 3 or 4 and then (2) administering to the patient the drug
therapy of the subject method for a time period of about 24 weeks
to about 60 weeks, or about 30 weeks to about one year, or about 36
weeks to about 50 weeks, or about 40 weeks to about 48 weeks, or at
least about 24 weeks, or at least about 30 weeks, or at least about
36 weeks, or at least about 40 weeks, or at least about 48 weeks,
or at least about 60 weeks.
[0437] Another embodiment provides any of the above-described
methods for the treatment of an HCV infection, where the subject
method is modified to include the steps of (1) identifying a
patient having advanced or severe stage liver fibrosis as measured
by a Knodell score of 3 or 4 and then (2) administering to the
patient the drug therapy of the subject method for a time period of
about 40 weeks to about 50 weeks, or about 48 weeks.
[0438] Another embodiment provides any of the above-described
methods for the treatment of an HCV infection, where the subject
method is modified to include the steps of (1) identifying a
patient having an HCV genotype 1 infection and an initial viral
load of greater than 2 million viral genome copies per ml of
patient serum and then (2) administering to the patient the drug
therapy of the subject method for a time period of about 24 weeks
to about 60 weeks, or about 30 weeks to about one year, or about 36
weeks to about 50 weeks, or about 40 weeks to about 48 weeks, or at
least about 24 weeks, or at least about 30 weeks, or at least about
36 weeks, or at least about 40 weeks, or at least about 48 weeks,
or at least about 60 weeks.
[0439] Another embodiment provides any of the above-described
methods for the treatment of an HCV infection, where the subject
method is modified to include the steps of (1) identifying a
patient having an HCV genotype 1 infection and an initial viral
load of greater than 2 million viral genome copies per ml of
patient serum and then (2) administering to the patient the drug
therapy of the subject method for a time period of about 40 weeks
to about 50 weeks, or about 48 weeks.
[0440] Another embodiment provides any of the above-described
methods for the treatment of an HCV infection, where the subject
method is modified to include the steps of (1) identifying a
patient having an HCV genotype 1 infection and an initial viral
load of greater than 2 million viral genome copies per ml of
patient serum and no or early stage liver fibrosis as measured by a
Knodell score of 0, 1, or 2 and then (2) administering to the
patient the drug therapy of the subject method for a time period of
about 24 weeks to about 60 weeks, or about 30 weeks to about one
year, or about 36 weeks to about 50 weeks, or about 40 weeks to
about 48 weeks, or at least about 24 weeks, or at least about 30
weeks, or at least about 36 weeks, or at least about 40 weeks, or
at least about 48 weeks, or at least about 60 weeks.
[0441] Another embodiment provides any of the above-described
methods for the treatment of an HCV infection, where the subject
method is modified to include the steps of (1) identifying a
patient having an HCV genotype 1 infection and an initial viral
load of greater than 2 million viral genome copies per ml of
patient serum and no or early stage liver fibrosis as measured by a
Knodell score of 0, 1, or 2 and then (2) administering to the
patient the drug therapy of the subject method for a time period of
about 40 weeks to about 50 weeks, or about 48 weeks.
[0442] Another embodiment provides any of the above-described
methods for the treatment of an HCV infection, where the subject
method is modified to include the steps of (1) identifying a
patient having an HCV genotype 1 infection and an initial viral
load of less than or equal to 2 million viral genome copies per ml
of patient serum and then (2) administering to the patient the drug
therapy of the subject method for a time period of about 20 weeks
to about 50 weeks, or about 24 weeks to about 48 weeks, or about 30
weeks to about 40 weeks, or up to about 20 weeks, or up to about 24
weeks, or up to about 30 weeks, or up to about 36 weeks, or up to
about 48 weeks.
[0443] Another embodiment provides any of the above-described
methods for the treatment of an HCV infection, where the subject
method is modified to include the steps of (1) identifying a
patient having an HCV genotype 1 infection and an initial viral
load of less than or equal to 2 million viral genome copies per ml
of patient serum and then (2) administering to the patient the drug
therapy of the subject method for a time period of about 20 weeks
to about 24 weeks.
[0444] Another embodiment provides any of the above-described
methods for the treatment of an HCV infection, where the subject
method is modified to include the steps of (1) identifying a
patient having an HCV genotype 1 infection and an initial viral
load of less than or equal to 2 million viral genome copies per ml
of patient serum and then (2) administering to the patient the drug
therapy of the subject method for a time period of about 24 weeks
to about 48 weeks.
[0445] Another embodiment provides any of the above-described
methods for the treatment of an HCV infection, where the subject
method is modified to include the steps of (1) identifying a
patient having an HCV genotype 2 or 3 infection and then (2)
administering to the patient the drug therapy of the subject method
for a time period of about 24 weeks to about 60 weeks, or about 30
weeks to about one year, or about 36 weeks to about 50 weeks, or
about 40 weeks to about 48 weeks, or at least about 24 weeks, or at
least about 30 weeks, or at least about 36 weeks, or at least about
40 weeks, or at least about 48 weeks, or at least about 60
weeks.
[0446] Another embodiment provides any of the above-described
methods for the treatment of an HCV infection, where the subject
method is modified to include the steps of (1) identifying a
patient having an HCV genotype 2 or 3 infection and then (2)
administering to the patient the drug therapy of the subject method
for a time period of about 20 weeks to about 50 weeks, or about 24
weeks to about 48 weeks, or about 30 weeks to about 40 weeks, or up
to about 20 weeks, or up to about 24 weeks, or up to about 30
weeks, or up to about 36 weeks, or up to about 48 weeks.
[0447] Another embodiment provides any of the above-described
methods for the treatment of an HCV infection, where the subject
method is modified to include the steps of (1) identifying a
patient having an HCV genotype 2 or 3 infection and then (2)
administering to the patient the drug therapy of the subject method
for a time period of about 20 weeks to about 24 weeks.
[0448] Another embodiment provides any of the above-described
methods for the treatment of an HCV infection, where the subject
method is modified to include the steps of (1) identifying a
patient having an HCV genotype 2 or 3 infection and then (2)
administering to the patient the drug therapy of the subject method
for a time period of at least about 24 weeks.
[0449] Another embodiment provides any of the above-described
methods for the treatment of an HCV infection, where the subject
method is modified to include the steps of (1) identifying a
patient having an HCV genotype 1 or 4 infection and then (2)
administering to the patient the drug therapy of the subject method
for a time period of about 24 weeks to about 60 weeks, or about 30
weeks to about one year, or about 36 weeks to about 50 weeks, or
about 40 weeks to about 48 weeks, or at least about 24 weeks, or at
least about 30 weeks, or at least about 36 weeks, or at least about
40 weeks, or at least about 48 weeks, or at least about 60
weeks.
[0450] Another embodiment provides any of the above-described
methods for the treatment of an HCV infection, where the subject
method is modified to include the steps of (1) identifying a
patient having an HCV infection characterized by any of HCV
genotypes 5, 6, 7, 8 and 9 and then (2) administering to the
patient the drug therapy of the subject method for a time period of
about 20 weeks to about 50 weeks.
[0451] Another embodiment provides any of the above-described
methods for the treatment of an HCV infection, where the subject
method is modified to include the steps of (1) identifying a
patient having an HCV infection characterized by any of HCV
genotypes 5, 6, 7, 8 and 9 and then (2) administering to the
patient the drug therapy of the subject method for a time period of
at least about 24 weeks and up to about 48 weeks.
Subjects Suitable for Treatment
[0452] Any of the above treatment regimens can be administered to
individuals who have been diagnosed with an HCV infection. Any of
the above treatment regimens can be administered to individuals who
have failed previous treatment for HCV infection ("treatment
failure patients," including non-responders and relapsers).
[0453] Individuals who have been clinically diagnosed as infected
with HCV are of particular interest in many embodiments.
Individuals who are infected with HCV are identified as having HCV
RNA in their blood, and/or having anti-HCV antibody in their serum.
Such individuals include anti-HCV ELISA-positive individuals, and
individuals with a positive recombinant immunoblot assay (MBA).
Such individuals may also, but need not, have elevated serum ALT
levels.
[0454] Individuals who are clinically diagnosed as infected with
HCV include naive individuals (e.g., individuals not previously
treated for HCV, particularly those who have not previously
received IFN-.alpha.-based and/or ribavirin-based therapy) and
individuals who have failed prior treatment for HCV ("treatment
failure" patients). Treatment failure patients include
non-responders (i.e., individuals in whom the HCV titer was not
significantly or sufficiently reduced by a previous treatment for
HCV, e.g., a previous IFN-.alpha. monotherapy, a previous
IFN-.alpha. and ribavirin combination therapy, or a previous
pegylated IFN-.alpha. and ribavirin combination therapy); and
relapsers (i.e., individuals who were previously treated for HCV,
e.g., who received a previous IFN-.alpha. monotherapy, a previous
IFN-.alpha. and ribavirin combination therapy, or a previous
pegylated IFN-.alpha. and ribavirin combination therapy, whose HCV
titer decreased, and subsequently increased).
[0455] In particular embodiments of interest, individuals have an
HCV titer of at least about 10.sup.5, at least about
5.times.10.sup.5, or at least about 10.sup.6, or at least about
2.times.10.sup.6, genome copies of HCV per milliliter of serum. The
patient may be infected with any HCV genotype (genotype 1,
including 1a and 1b, 2, 3, 4, 6, etc. and subtypes (e.g., 2a, 2b,
3a, etc.)), particularly a difficult to treat genotype such as HCV
genotype 1 and particular HCV subtypes and quasispecies.
[0456] Also of interest are HCV-positive individuals (as described
above) who exhibit severe fibrosis or early cirrhosis
(non-decompensated, Child's-Pugh class A or less), or more advanced
cirrhosis (decompensated, Child's-Pugh class B or C) due to chronic
HCV infection and who are viremic despite prior anti-viral
treatment with IFN-.alpha.-based therapies or who cannot tolerate
IFN-.alpha.-based therapies, or who have a contraindication to such
therapies.
[0457] In particular embodiments of interest, HCV-positive
individuals with stage 3 or 4 liver fibrosis according to the
METAVIR scoring system are suitable for treatment with the methods
described herein. In other embodiments, individuals suitable for
treatment with the methods of the embodiments are patients with
decompensated cirrhosis with clinical manifestations, including
patients with far-advanced liver cirrhosis, including those
awaiting liver transplantation. In still other embodiments,
individuals suitable for treatment with the methods described
herein include patients with milder degrees of fibrosis including
those with early fibrosis (stages 1 and 2 in the METAVIR, Ludwig,
and Scheuer scoring systems; or stages 1, 2, or 3 in the Ishak
scoring system.).
Preparation of NS3 Inhibitors
Methodology
[0458] The HCV protease inhibitors in the following sections can be
prepared according to the procedures and schemes shown in each
section. Certain compounds and intermediates used in the syntheses
have been described elsewhere. For instance, in Scheme 1 of Section
I below, the syntheses of intermediate
1(R)-tert-butoxycarbonylamino-2(S)-vinyl-cyclopropanecarboxylic
acid ethyl ester (1a) was carried out in a manner similar to that
described in International Application PCT/US2004/033970
(International Publication No. WO 2005/037214) and PCT/CA00/00353
(Publication No. WO 00/59929). The numberings in each of the
following Preparation of NS3 Inhibitor sections are meant for that
specific section only, and should not be construed or confused with
the same numberings in other sections.
Preparation of NS3 Inhibitors: Section I
[0459] A synthetic scheme for the preparation of NS3 inhibitors
described in this section is illustrated in Scheme 1 below and
exemplified by the following description of the synthesis of
compound 90:
##STR00009## ##STR00010##
Synthesis of Compound 90:
A. Step 1: Synthesis of
2S-(1-Ethoxycarbonyl-2-vinyl-cyclopropylcarbamoyl)-4R-hydroxy-pyrrolidine-
-1-carboxylic acid tert-butyl ester (3)
##STR00011##
[0461] To a flask charged with
ethyl-(1R,2S)/(1S,2R)-1-amino-2-vinylcyclopropyl carboxylate (1a,
1.0 g, 5.2 mmol), trans-N-(tent-Butoxycarbonyl)-4-hydroxy-L-proline
(2, 1.3 g, 1.1 equiv), and HATU (2.7 g, 1.1 equiv) were added 30 mL
DMF to make a solution. It was cooled to 0.degree. C. in an
ice-water bath, followed by slow addition of a solution of DIEA
(4.4 mL, 4 equiv) in DMF (15 mL) while stirring. The reaction was
allowed to warm up to rt and stirred overnight.
[0462] After 16 h, the reaction was complete as monitored by HPLC.
It was diluted with EtOAc (100 mL), washed with water (3.times.40
mL), sat. NaHCO.sub.3 (2.times.40 mL), and brine (2.times.40 mL),
then dried over Na.sub.2SO.sub.4 and concentrated down to give a
dark copper colored oil. The crude was purified on silica gel
(eluent:acetone/hexanes 3:7), giving pure 3 as tan foamy powder
(770 mg, 32%).
Step 2: (1R,2S)-ethyl
1-((2S,4R)-1-acetyl-4-hydroxypyrrolidine-2-carboxamido)-2-vinylcyclopropa-
necarboxylate
##STR00012##
[0464] Compound 3 (134 mg, 0.33 mmol) was dissolved in 2 mL 4N HCl
(dioxane) and left at rt for 90 min to remove the Boc protective
group. It was then concentrated down, taken up in acetonitrile and
concentrated down again twice. To this light brownish residue was
1.6 mL of DCE followed by addition of DIEA (174 .mu.L , 1 mmol).
The reaction stirred at rt for 1 h. Next, acetic anhydride (31
.mu.L, 0.33 mmol) was added dropwise and the reaction stirred for
another hour at room temperature.
[0465] LC/MS showed reaction to be complete at this time. The
reaction was loaded onto a Biotage 25+C-18 samplet and purified
using reverse phase chromatography eluting with a gradient from 0
to 50% acetonitrile/water to give 5 (30 mg, 29%) in fractions 16-20
using 13 mm test tubes and collecting fractions of 6 mL volume.
Step 3:
(3R,55)-1-acetyl-5-((1R,2S)-1-(ethoxycarbonyl)-2-vinylcyclopropylc-
arbamoyl)pyrrolidin-3-yl 4-fluoroisoindoline-2 carboxylate
##STR00013##
[0467] Intermediate 5 (30 mg, 0.1 mmol) was dissolved in THF (0.5
mL), followed by addition of CDI (24 mg, 0.15 mmol) in one portion.
The reaction was stirred at rt overnight. After 15 h, the reaction
was complete as monitored by TLC (DCM/MeOH 9:1).
4-fluoroisoindoline hydrochloride (25 mg, 0.15 mmol) was added to
the reaction in one portion followed by triethyl amine (30 .mu.L,
0.2 mmol), and the reaction was stirred at rt for overnight. After
22 h, TLC showed reaction complete. The reaction was loaded onto a
Biotage 12+C-18 samplet and purified using reverse phase
chromatography eluting with a gradient from 0 to 50%
acetonitrile/water to give 6 (32 mg, 69%) in fractions 21 and 22
using 13 mm test tubes and collecting fractions of 6 mL volume.
Step 4:
(1R,25)-1-((2S,4R)-1-acetyl-4-(4-fluoroisoindoline-2-carbonyloxy)p-
yrrolidine-2-(carboxamido)-2-vinylcyclopropane carboxylic acid
##STR00014##
[0469] Intermediate 6 (32 mg, 0.07 mmol) was dissolved in 0.4 mL of
a mixed solvent (THF/H.sub.2O 3:1), followed by addition of
LiOH--H.sub.2O (18 mg, 6 equiv). The mixture was stirred at rt for
overnight. After 18 h, TLC (DCM/MeOH 9:1) showed a clean new spot
with a lower Rf. The reaction was loaded onto a Biotage 12+C-18
samplet and purified using reverse phase chromatography eluting
with a gradient from 0 to 75% acetonitrile/water to give 7 (18 mg,
60%) in fractions 13-16 using 13 mm test tubes and collecting
fractions of 6 mL volume. MS m/e 444.2 (M.sup.--1).
Step 5:
(3R,55)-1-acetyl-5-((1R,2S)-1-(cyclopropylsulfonylcarbamoyl)-2-vin-
ylcyclopropylcarbamoyl)pyrrolidin-3-yl 4-fluoroisoindoline-2
carboxylate
##STR00015##
[0471] The macrocyclic acid (18 mg, 0.04 mmol) was dissolved in 0.2
mL DriSolve DCM, followed by addition of CDI (7.1 mg, 1.1 equiv).
The mixture was stirred at rt for 1 h, and TLC showed reaction
complete. Then cyclopropylsulfonamide (5 mg, 1.0 equiv) was added
to the reaction, followed by DBU (6 .mu.L, 1.1 equiv) at rt. The
reaction was stirred at rt overnight, and LCMS showed reaction
complete. The crude was directly loaded onto a Biotage 12+C-18
column, and purified by reverse phase chromatography
(eluent=gradient from 0 to 60% acetonitrile/water over 40-6 mL
fractions), giving the desired final product as a white solid (8
mg, 38%). MS m/z 547.2 (M-1, APCI-).
[0472] The NS3 inhibitors claimed can alternatively be prepared
using the general procedure described in Scheme 2, where R.sup.1,
R.sup.2, R.sup.3, R.sup.4, and R.sup.5 are as defined above for
Formula (I) and R is R.sup.1a as defined above for Formula (I).
##STR00016##
TABLE-US-00001 TABLE 1 Compound Structure .sup.1H-NMR/LCMS 90
##STR00017## 547 (M - 1, APCI neg) 91 ##STR00018## 662 (M - 1, APCI
neg)
Preparation of NS3 Inhibitors: Section II
[0473] The NS3 inhibitors described herein can be prepared
according to the procedures and schemes shown below. The synthesis
of Compound 104 outlined in Scheme 3 is exemplary of the methods
that may be used to synthesis other compounds disclosed herein.
##STR00019## ##STR00020##
Synthesis of 1-tert-butyl 3-ethyl 4-oxopiperidine-1,3-dicarboxylate
(2b)
##STR00021##
[0475] To a biphasic mixture of ethyl 4-oxopiperidine-3-carboxylate
hydrochloride (5.35 g, 25.0 mmol) in 1M Na.sub.2CO.sub.3 (75 mL)
and CH.sub.2Cl.sub.2 (100 mL) was added Boc.sub.2O (5.73 g, 26.3
mmol) in one portion. The mixture was stirred vigorously at rt for
6.5 h and treated with 2M HCl to pH=2. The organic layer removed
and the aqueous portion extracted with CH.sub.2Cl.sub.2 (2.times.).
The combined CH.sub.2Cl.sub.2 fractions were dried over
Na.sub.2SO.sub.4 and filtered through a packed Celite plug capped
with MgSO.sub.4. The solution was concentrated to give a viscous
oil which was dissolved in Et.sub.2O. The solution was concentrated
to provide the title compound 2b as a granular white solid; 6.70 g,
99%, .sup.1H NMR (400 MHz, DMSO) .delta. 1.29 (t, 3H), 1.38 (s,
9H), 2.25-2.60 (m, 2H), 3.40-3.62 (m, 2H), 3.66-3.72 (m, 1H),
3.81-3.90 (m, 1H) 4.15-4.19 (m, 1H), 4.22 (q, 2H).
1-tert-butyl 3-ethyl
5-((dimethylamino)methylene)-4-oxopiperidine-1,3-dicarboxylate
(3b)
##STR00022##
[0477] To a solution of 2b (272 mg, 1.00 mmol) in dry toluene (4.0
mL) was added Bredereck's reagent (183 mg, 1.05 mmol) dropwise over
2 minutes. The mixture stirred at rt for 1 h and heated to
60.degree. C. for 24 h. The mixture was concentratred and the
residue purified on a SiO.sub.2 column (CH.sub.2Cl.sub.2, 50%
EtOAc-hexanes then EtOAc for elution) to give a viscous oil. The
oil was dissolved in 50% Et.sub.2O-hexanes and concentrated to give
the title compound 3b as a waxy white solid; 243 mg, 74%. This
material was used immediately without further purification.
5-tert-butyl 7-ethyl
6,7-dihydro-2H-pyrazolo[4,3-c]pyridine-5,7(4H)-dicarboxylate
(4b)
##STR00023##
[0479] A solution of enaminoketone 3b (327 mg, 1.00 mmol) in abs.
EtOH (10 mL) was cooled to 0.degree. C. and hydrazine monohydrogen
chloride was added in one portion. The mixture was sitrred for 18 h
during which time the temperature reached rt after 2 h. The mixture
was concentrated and the residue partitioned with deionized
H.sub.2O and EtOAc. The organic layer was removed and the aqueous
portion extracted with EtOAc (2.times.). The combined EtOAc
portions were washed with brine, dried over MgSO.sub.4 and filtered
through a SiO.sub.2 plug capped with a MgSO.sub.4 layer (EtOAc for
elution). The solution was concentrated give the title compound 4b
as a brittle white foam crushed to a white solid; 253 mg, 87%, MS
m/z 240.0, 194.0 (ESI +, M-.sup.tBu, M-Boc).
5-(tert-butoxycarbonyl)-4,5,6,7-tetrahydro-2H-pyrazolo[4,3-c]pyridine-7-ca-
rboxylic acid (5b)
##STR00024##
[0481] A solution of ethyl ester 4b (250 mg, .846 mmol) in THF (5
mL) was cooled to 0.degree. C. and 1 M LiOH (2.12 mL, 2,12 mmol)
was added. The mixture stirred at 0.degree. C. for 30 min followed
by stirring at rt for 2 h. The THF was removed in vacuo and the
remaining aqueous solution diluted with deionized H.sub.2O to a
total volumn of 8 mL. The aqueous mixture was extracted with
Et.sub.2O (3.times.) and cooled to 0.degree. C. 2 M HCl was added
to obtain pH=3 and the mixture extracted with EtOAc (3.times.). The
combined EtOAc extracts were washed with brine, dried over
MgSO.sub.4 and filtered through a Celite plug capped with a layer
of MgSO.sub.4. The solution was concentrated to give the title
compound 5b as brittle ivory foam crushed to an ivory solid; 136
mg, 60%, MS m/z 266.0 (ESI -, M-1).
Synthesis of tert-butyl
74(1R,2S)-1-(ethoxycarbonyl)-2-vinylcyclopropylcarbamoyl)-6,7-dihydro-2H--
pyrazolo[4,3-c]pyridine-5(4H)-carboxylate (7b)
##STR00025##
[0483] A solution of acid 5b (93.0 mg, 0.348 mmol), amine
hydrochloride 6b (80.0 mg, 0.418 mmol) and HATU (139 mg, 0.365
mmol) in dry DMF (2 mL) was cooled to 0.degree. C. and DIEA (0.182
mL, 1.04 mmol) was added dropwise over 5 minutes. The mixture was
allowed to reach rt over 2 h and stirred at rt for 20 h. The
mixture was poured into deionized H.sub.2O (10 mL) and extracted
with EtOAc (3.times.). The combined extracts were washed
sequentially with 1M Na.sub.2CO.sub.3, deionized H.sub.2O, 0.5 M
HCl (2.times.) and brine. The EtOAc solution was dried over
MgSO.sub.4 and filtered through a SiO.sub.2 plug capped with a
layer of MgSO.sub.4. The solution was concentrated to give the
title compound 7b as a bronze glass which was scraped to a tan
solid; 81 mg, 58%, MS m/z 403.1 (ESI -, M-1).
(1R,2S)-1-(5-(tert-butoxycarbonyl)-4,5,6,7-tetrahydro-2H-pyrazolo[4,3-c]py-
ridine-7-carboxamido)-2-vinylcyclopropanecarboxylic acid (8b)
##STR00026##
[0485] A solution of ethyl ester 7b (80.0 mg, 0.198 mmol) in THF
(1.5 mL) was cooled to 0.degree. C. and 1 M LiOH (1.00 mL, 1.00
mmol) was added. The mixture was stirred for 20 h during which time
the temperature reached rt after 1.5 h. The THF was removed in
vacuo and the remaining aqueous solution was diluted with deionized
H.sub.2O to a final volumn of 3 mL. The aqueous mixture was
extracted with Et.sub.2O (3.times.) and cooled to 0.degree. C. 2 M
HCl was added obtain pH=3. The mixture was extracted with EtOAc
(3.times.) and the combined EtOAc portions were washed with brine,
dried over MgSO.sub.4 and filtered through a Celite plug capped
with a layer of MgSO.sub.4. The EtOAc solution was concentrated to
give the title acid 8b as bronze foam scraped to beige solid; 62
mg, 83%, MS m/z 375.1 (ESI -, M-1).
Tert-butyl
7-((1R,2S)-1-(cyclopropylsulfonylcarbamoyl)-2-vinylcyclopropylc-
arbamoyl)-6,7-dihydro-2H-pyrazolo[4,3-c]pyridine-5(4H)-carboxylate
(104)
##STR00027##
[0487] A solution of acid 8b (47.0 mg, 0.125 mmol) and CDI (22.3
mg, 0.150 mmol) in dry DCE (1.0 mL) was stirred at rt for 8 h. The
cyclopropyl sulfonamide 9b (18.2 mg, 0.150 mmol) and DBU (22.8 mg,
0.150 mmol) were sequentially added and the mixture stirred at rt
for 48 h. The solvent was evpaorated and the residue diluted with
EtOAc (2 mL). The mixture was washed sequentially with 0.5 M HCl
(2.times.), deionized H.sub.2O and brine. The EtOAc solution was
dried over MgSO.sub.4, filtered through a Celite plug capped with a
layer of MgSO.sub.4 and concentrated. The crude product was
purified via a SiO.sub.2 column (CH.sub.2Cl.sub.2, 25%
EtOAc/hexanes then 50% EtOAc/hexanes) to give compound 104 as an
ivory solid; 3:2 mixture of diastereomers, 27 mg, 45% (3:2 mixture
of diastereomers), MS m/z 478.1 (APCI -, M-1).
N-((1R,2S)-1-(cyclopropylsulfonylcarbamoyl)-2-vinylcyclopropyl)-4,5,6,7-te-
trahydro-2H-pyrazolo[4,3-c]pyridine-7-carboxamide hydrochloride
(111)
##STR00028##
[0489] A solution of Boc protected compound 104 in EtOAc (2 mL) was
treated with 4 M HCl-dioxane (1 mL) and the mixture stirred at rt
for 20 h. The reaction mixture was concentrated and the residue
dried in vacuum to give amine hydrochloride 111 as a white solid,
17 mg, 98%, MS m/z 380.0 (APCI +, M+1).
N-((1R,2S)-1-(cyclopropylsulfonylcarbamoyl)-2-vinylcyclopropyl)-5-(2-pheny-
lacetyl)-4,5,6,7-tetrahydro-2H-pyrazolo[4,3-c]pyridine-7-carboxamide
(103)
##STR00029##
[0491] A 3-mL resin tube was charged with phenylacetic acid loaded
onto polystyrene tetrafluorophenol resin (50 mg, .0385 mmol, 1.3
mmol/g load) and amine HCl salt 111 (7.00 mg, 0.0168 mmol). Dry
CH.sub.2Cl.sub.2 (1.0 mL) and DIEA (0.0586 mL, 0.0337 mmol) were
sequentially added and the tube sealed. The reaction mixture was
agitated on platform shaker at rt for 19 h and the solution was
drained followed by washes of the resin with dry CH.sub.2Cl.sub.2.
The CH.sub.2Cl.sub.2 solution was concentrated and the residue was
dissolved in EtOAc, washed with 0.5 M HCl (2.times.), H.sub.2O and
brine. The EtOAc solution was dried over MgSO.sub.4, filtered
through Celite and concentrated.
[0492] The crude residue was dissolved in CH.sub.2Cl.sub.2 and the
solution treated with excess SiO.sub.2-Triamine (10 equiv). The
mixture was stirred at rt for 18 h after which the mixture was
loaded onto a pipette containing a Celite plug. The resin-column
was eluted with 5% HOAc/EtOAc to release the product. The solution
was concentrated to give the title product as an ivory solid; 1:1
mix of diastereomers, MS m/z 496.0 (APCI -, M-1).
[0493] Most of the NS3 inhibitors shown in Table 2 below were
prepared in a manner similar to that described for Compounds 104,
111 and 103.
TABLE-US-00002 TABLE 2 Compound Structure .sup.1H-NMR/LCMS 101
##STR00030## MS m/z 222.1 ESI (-).sub. 102 ##STR00031## MS m/z
325.2 ESI (-).sub. 103 ##STR00032## MS m/z 496.0 ESI (-).sub. 104
##STR00033## MS m/z 478.1 APCI (-) 105 ##STR00034## MS m/z 411.1
APCI (+) 106 ##STR00035## MS m/z 504.8 APCI (-) 107 ##STR00036## MS
m/z 386.9 APCI (-) 108 ##STR00037## MS m/z 341.2 APCI (-) 109
##STR00038## MS m/z 344.7 APCI (-) 110 ##STR00039## MS m/z 168.0
APCI (+) 111 ##STR00040## MS m/z 380.0 APCI (+) 112 ##STR00041## MS
m/z 368.1 APCI (+)
Example A
NS3-NS4 Protease Assay
[0494] NS3 Complex Formation with NS4A-2.
[0495] Recombinant E. coli or Baculovirus full-length NS3 was
diluted to 3.33 .mu.M with assay buffer and transfered material to
an eppendorf tube and place in water bath in 4.degree. C.
refrigerator. The appropriate amount of NS4A-2 to 8.3 mM in assay
buffer was added to equal the volume of NS3 in step 2.1.1
(conversion factor--3.8 mg/272 .mu.L assay buffer). The material
was transferred to an eppendorf tube and place in water bath in
4.degree. C. refrigerator.
[0496] After equilibration to 4.degree. C., equal volumes of NS3
and NS4A-2 solutions were combined in an eppendorf tube, mix gently
with a manual pipettor, and incubate mixture for 15 minutes in the
4.degree. C. water bath. Final concentrations in the mixture are
1.67 .mu.M NS3, 4.15 mM NS4A-2 (2485 foldmolar excess NS4A-2).
[0497] After 15 minutes at 4.degree. C., the NS3/NS4A-2 eppendorf
tube was removed and place it in a room temperature water bath for
10 minutes. NS3/NS4A-2 was alliquoted at appropriate volumes and
store at -80.degree. C. (E. coli NS3 run at 2nM in assay, aliquot
at 25 .mu.L. BV NS3 run at 3 nM in assay, aliquot at 30 .mu.L).
Example B
NS3 Inhibition Assay
[0498] Sample compounds were dissolved to 10 mM in DMSO then
diluted to 2.5 mM (1:4) in DMSO. Typically, compounds were added to
an assay plate at 2.5 mM concentration, yielding upon dilution a
starting concentration of 50 microM in the assay inhibition curve.
Compounds were serial diluted in assay buffer to provide test
solutions at lower concentrations.
[0499] The E. coll. NS3/NS4A-2 was diluted to 4 nM NS3 (1:417.5 of
1.67 .mu.M stock-18 .mu.L 1.67 .mu.M stock+7497 .mu.L assay
buffer). The BV NS3/NS4A-2 was diluted to 6 nM NS3 (1:278.3 of 1.67
.mu.M stock-24 .mu.L 1.67 .mu.M stock+6655 .mu.L assay buffer).
Using the manual multichannel pipettor, careful not to introduce
bubbles into the plate, add 50 .mu.L assay buffer to wells A01-H01
of a black Costar 96-well polypropylene storage plate.
[0500] Using the manual multichannel pipettor, careful not to
introduce bubbles into the plate, add 50 .mu.L of diluted
NS3/NS4A-2 from step 2.2.6 to wells A02-H12 of plate in step 2.2.7.
Using the manual multichannel pipettor, careful not to introduce
bubbles into the plate, transfer 25 .mu.L of the wells in drug
dilution plate in step 2.2.5 to corresponding wells in assay plate
in step 2.2.8. Change tips on multichannel pipettor for each row of
compounds transferred. Using the manual multichannel pipettor,
careful not to introduce bubbles into the plate, mix the wells from
the assay plate in step 2.2.9 by aspirating and dispensing 35 .mu.L
of the 75 .mu.L in each well five times. Change tips on
multichannel pipettor for each row of wells mixed. Cover plate with
a polystyrene plate lid and pre-incubate the plate from step 2.2.10
containing NS3 protease and sample compounds 10 minutes at room
temperature. While plate from step 2.2.11 is pre-incubating, dilute
RETS1 substrate in a 15 mL polypropylene centrifuge tube. Dilute
RETS1 substrate to 8 .mu.M (1:80.75 of 646 .mu.M stock -65 .mu.L
646 .mu.M stock +5184 .mu.L assay buffer).
[0501] After the plate in step is done pre-incubating, and using
the manual multichannel, add 25 .mu.L of substrate to all wells on
the plate. Quickly mix the plate as in step 2.2.10, mixing 65 .mu.L
of the 100 .mu.L in the wells.
[0502] Read the plate in kinetic mode on the Molecular Devices
SpectraMax Gemini XS plate reader. Reader settings: Read time: 30
minutes, Interval: 36 seconds, Reads: 51, Excitation .lamda.:
335nm, Emission .lamda.: 495 nm, cutoff: 475 nm, Automix: off,
Calibrate: once, PMT: high, Reads/well: 6, Vmax pts: 21 or 28/51
depending on length of linearity of reaction
[0503] IC.sub.50s are determined using a four parameter curve fit
equation, and converted to Ki's using the following Km's:
[0504] Full-length E. coli NS3--2.03 .mu.M
[0505] Full-length BV NS3--1.74 .mu.M
[0506] where Ki=IC.sub.50/(1+[S]/Km))
[0507] Quantitation by ELISA of the Selectable Marker Protein,
Neomycin Phosphotransferase II (NPTII) in the HCV Sub-Genomic
Replicon, GS4.3
[0508] The HCV sub-genomic replicon (I377/NS3-3', accession No.
AJ242652), stably maintained in HuH-7 hepatoma cells, was created
by Lohmann et al. Science 285: 110-113 (1999). The
replicon-containing cell culture, designated GS4.3, was obtained
from Dr. Christoph Seeger of the Institute for Cancer Research, Fox
Chase Cancer Center, Philadelphia, Pa.
[0509] GS4.3 cells were maintained at 37.degree. C., 5% CO.sub.2,
in DMEM (Gibco 11965-092) supplemented with L-glutamine 200 mM
(100.times.) (Gibco25030-081), non-essential amino acids (NEAA)
(Biowhittaker 13-114E), heat-inactivated (HI) Fetal Bovine
Serum(FBS) (Hyclone SH3007.03) and 750 m/ml geneticin (G418) (Gibco
10131-035). Cells were sub-divided 1:3 or 4 every 2-3 days.
[0510] 24 h prior to the assay, GS4.3 cells were collected,
counted, and plated in 96-well plates (Costar 3585) at 7500
cells/well in 100 .mu.l standard maintenance medium (above) and
incubated in the conditions above. To initiate the assay, culture
medium was removed, cells were washed once with PBS (Gibco
10010-023) and 90 .mu.l Assay Medium (DMEM, L-glutamine, NEAA, 10%
HI FBS, no G418) was added. Inhibitors were made as a 10.times.
stock in Assay Medium, (3-fold dilutions from 10 .mu.M to 56 pM
final concentration, final DMSO concentration 1%), 10 .mu.l were
added to duplicate wells, plates were rocked to mix, and incubated
as above for 72 h.
[0511] An NPTII Elisa kit was obtained from AGDIA, Inc. (Compound
direct ELISA test system for Neomycin Phosphotransferase II, PSP
73000/4800). Manufacturer's instructions were followed, with some
modifications. 10.times. PEB-1 lysis buffer was made up to include
500 .mu.M PMSF (Sigma P7626, 50 mM stock in isopropanol). After 72
h incubation, cells were washed once with PBS and 150 .mu.l PEB-1
with PMSF was added per well. Plates were agitated vigorously for
15 minutes, room temperature, then frozen at -70.degree. C. Plates
were thawed, lysates were mixed thoroughly, and 100 .mu.l were
applied to an NPTII Elisa plate. A standard curve was made. Lysate
from DMSO-treated control cells was pooled, serially diluted with
PEB-1 with PMSF, and applied to duplicate wells of the ELISA plate,
in a range of initial lysate amount of 150 ul-2.5 ul. In addition,
100 .mu.l buffer alone was applied in duplicate as a blank. Plates
were sealed and gently agitated at room temperature for 2 h.
Following capture incubation, the plates were washed 5.times.300
.mu.l with PBS-T (0.5% Tween-20, PBS-T was supplied in the ELISA
kit). For detection, a 1.times. dilution of enzyme conjugate
diluent MRS-2 (5.times.) was made in PBS-T, into which 1:100
dilutions of enzyme conjugates A and B were added, as per
instructions. Plates were resealed, and incubated with agitation,
covered, room temperature, for 2 h. The washing was then repeated
and 100 .mu.l of room temperature TMB substrate was added. After
approximately 30 minutes incubation (room temperature, agitation,
covered), the reaction was stopped with 50 .mu.l 3M sulfuric acid.
Plates were read at 450 nm on a Molecular Devices Versamax plate
reader.
[0512] Inhibitor effect was expressed as a percentage of
DMSO-treated control signal, and inhibition curves were calculated
using a 4-parameter equation: y=A+((B-A)/(1+((C/x) D))), where C is
half-maximal activity or EC.sub.50.
Examples of Activity
TABLE-US-00003 [0513] TABLE 3 Compound NS3-NS4 IC.sub.50 90 D 91 C
101 A 102 B 103 B 104 A 105 A 106 A 107 A 108 B 109 A 110 B 111 A
112 B
where A indicates an IC.sub.50 between 10 and 50 .mu.M, B indicates
an IC.sub.50 between 1 and 10 .mu.M, C indicates an IC.sub.50
between 0.1 and 1 .mu.M, and D indicates an IC.sub.50 of less the
0.1 .mu.M.
Conclusion
[0514] Potent small molecule inhibitors of the HCV NS3 protease
have been developed.
[0515] While the present invention has been described with
reference to the specific embodiments thereof, it should be
understood by those skilled in the art that various changes may be
made and equivalents may be substituted without departing from the
true spirit and scope of the invention. In addition, many
modifications may be made to adapt a particular situation,
material, composition of matter, process, process step or steps, to
the objective, spirit and scope of the present invention. All such
modifications are intended to be within the scope of the claims
appended hereto.
* * * * *