In large randomized controlled trials, serum enzymes elevations were uncommon in patients treated with sofosbuvir despite the fact that the patients being treated had chronic liver disease. In most situations, serum aminotransferase levels improved rapidly upon initiating sofosbuvir therapy, and de novo, late elevations of ALT above 3 times the upper limit of normal (ULN) were uncommon and less frequent than with placebo or no therapy. In multiple, large clinical trials sofosbuvir has not been linked to instances of clinically apparent liver injury with jaundice. Because sofosbuvir is always used with other antiviral agents, it is not always possible to separate the relative role of sofosbuvir from other drugs in causing adverse reactions.
Two rare and unusual forms of liver injury of uncertain relationship to sofosbuvir have been described in patients with receiving antiviral therapy for hepatitis C: sudden hepatic decompensation in patients with preexisting cirrhosis and reactivation of hepatitis B in patients with preexisting evidence of HBV infection.
A rare, but striking liver injury associated with sofosbuvir (and perhaps other potent agents active against HCV) is hepatic decompensation occurring in patients with preexisting cirrhosis. In several instances, decompensation occurred within 2 to 6 weeks of starting therapy (Case 1), while in others it occurred late during therapy or in the immediate posttreatment period. The typical pattern of onset was a progressive rise in bilirubin with signs of hepatic failure such as prolongation of the prothrombin time, decrease in serum albumin and appearance of ascites and hepatic encephalopathy. In many (but not all) instances, serum enzyme levels did not change or increased only slightly in comparison to pretreatment values. In all instances, sofosbuvir was being used in combination with other antiviral agents, such as peginterferon, simeprevir, daclatasvir or ledipasvir, and the specific role of sofosbuvir has been difficult to define. The decompensation usually coincided with rapid viral clearance and patients who survived the episode often had a sustained virological response. The cause of this decompensation is not clear, but it may represent a response to HCV viral eradication (on-target effect) rather than toxicity of the administered antiviral agents (off-target effect on the liver). Alternatively, the injury may be coincidental and unrelated to therapy.
A second form of liver injury that can occur with sofosbuvir therapy and perhaps other potent anti-HCV agents is reactivation of hepatitis B. Instances of clinically apparent hepatitis with rises in serum HBV DNA levels have been reported in patients with chronic hepatitis C who were HBsAg positive and had low levels of HBV DNA which were not thought to be the cause of the chronic liver disease (Case 2). Reactivation has also been described in patients who have anti-HBc without HBsAg in serum, a pattern that suggests previous recovery from hepatitis B. HBV reactivation typically arises within 2 to 8 weeks of starting therapy for hepatitis C and it can be clinically manifest with symptoms of acute hepatitis and marked elevations in serum aminotransferase levels and bilirubin. Instances of death from HBV reactivation have been reported with sofosbuvir therapy. The cause of reactivation is unclear, but it may reflect the eradication of HCV replication which has a nonspecific suppressive effect on HBV replication. Alternatively, the change in immune reactivity with sudden clearance of HCV or as a result of a direct activity of the antiviral agents may alter the replicative status of HBV.
Likelihood score: E* (unproven but suspected cause of clinically apparent liver injury in susceptible individuals).
来源:LiverTox
毒理性
蛋白质结合
伏西拉普韦（Voxilaprevir）与人类血浆蛋白的结合率超过99%。
Voxilaprevir is more than 99% bound to human plasma proteins.
When provided as the fixed dose combination product Vosevi with [DB08934] and [DB11613], voxilaprevir reaches a maximum concentration (Cmax) of 192 ng/mL at a maximum time (Tmax) of 4 hours post-dose.
来源:DrugBank
吸收、分配和排泄
消除途径
伏西拉普韦主要通过胆汁排泄消除。
Voxilaprevir is primarily eliminated via biliary excretion.
The present disclosure relates generally to toll like receptor modulator compounds, such as diamino pyrido[3,2 D]pyrimidine compounds and pharmaceutical compositions which, among other things, modulate toll-like receptors (e.g. TLR-8), and methods of making and using them.
The disclosure is related to anti-viral compounds, compositions containing such compounds, and therapeutic methods that include the administration of such compounds, as well as to processes and intermediates useful for preparing such compounds.
[EN] 4,6-DIAMINO-PYRIDO[3,2-D]PYRIMIDINE DERIVATIES AS TOLL LIKE RECEPTOR MODULATORS<br/>[FR] DÉRIVÉS DE 4,6-DIAMINO-PYRIDO [3,2-D] PYRIMIDINE EN TANT QUE MODULATEURS DU RÉCEPTEUR DE TYPE TOLL
申请人：GILEAD SCIENCES INC
公开号：WO2018045150A1
公开（公告）日：2018-03-08
This application relates generally to toll like receptor modulator compounds as defined below and pharmaceutical compositions which, among other things, modulate toll-like receptors (e.g. TLR8), and methods of making and using them.
Discovery of the pan-genotypic hepatitis C virus NS3/4A protease inhibitor voxilaprevir (GS-9857): A component of Vosevi®
作者：James G. Taylor、Sheila Zipfel、Kyla Ramey、Randy Vivian、Adam Schrier、Kapil K. Karki、Ashley Katana、Darryl Kato、Tetsuya Kobayashi、Ruben Martinez、Michael Sangi、Dustin Siegel、Chinh V. Tran、Zheng-Yu Yang、Jeff Zablocki、Cheng Y. Yang、Yujin Wang、Kelly Wang、Katie Chan、Ona Barauskas、Guofeng Cheng、Debi Jin、Brian E. Schultz、Todd Appleby、Armando G. Villaseñor、John O. Link
DOI：10.1016/j.bmcl.2019.03.037
日期：2019.8
therapeutic class. Our discovery efforts were focused on identifying an NS3/4Aproteaseinhibitor with pan-genotypic antiviral activity, improved coverage of resistance associated substitutions, and a decreased risk of hepatotoxicity. Towards this goal, distinct interactions with the conserved catalytic triad of the NS3/4Aprotease were identified that improved genotype 3 antiviral activity. We further
The present disclosure provides processes for the preparation of a compound of formula I:
which is useful as an antiviral agent. The disclosure also provides compounds and processes for the preparation of the compounds that are synthetic intermediates to the compound of formula I.
