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Financial disclosures for Dr Hicks

Explore the pooled 24-week results of the DUET-1 and DUET-2 studies on the efficacy of TMC125 in HIV-1-infected treatment-experienced patients. The study compared TMC125 with placebo alongside background regimens. Findings include viral load reduction, CD4 cell count increase, and responder rates, with subgroup analyses based on baseline characteristics. Discover insights on viral load suppression based on enfuvirtide use, darunavir fold change, number of active background ARVs, and baseline viral load/CD4 counts.

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Financial disclosures for Dr Hicks

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  1. Financial disclosures for Dr Hicks • Grant support, honoraria and/or advisory board from Abbott, Bristol-Myers Squibb, Boehringer-Ingelheim, Glaxo SmithKline, Merck, Pfizer, Tibotec, Monogram Biosciences, Gilead, Koronis

  2. Pooled 24-week results of DUET-1 and -2: efficacy of TMC125 in treatment-experienced HIV-1-infected patients (Abstract 1316) C Hicks, P Cahn, J Leider, G Pialoux, M Peeters, J Vingerhoets and B Woodfall on behalf of the DUET-1 and DUET-2 study groups

  3. Abstract 1316 Screening 6 weeks Follow up 4 weeks 600 patients target per trial DUET study design and major inclusion criteria • DUET-1 and -2 differed only in geographical location; pooled analysis was pre-specified • Major inclusion criteria: • Plasma viral load >5,000 HIV-1 RNA copies/mL and stable therapy for ≥8 weeks • ≥1 NNRTI mutation,* at screening or in documented historical genotype • ≥3 primary PI mutations at screening • Patients recruited from Thailand, Australia, Europe and the Americas 48-week treatment period with optional 48-week extension 24-week primary analysis TMC125 + BR* Placebo + BR* *BR = darunavir/ritonavir with optimized NRTIs and optional enfuvirtide *From extended list of NNRTI mutations (Tambuyzer et al. Abstract 67 EHDRW 2007); BR = background regimen

  4. Abstract 1316 Baseline characteristics and background ARVs *From extended list of NNRTI mutations used in inclusion criteria; §assessed by phenotypic sensitivity score (PSS); BR = background regimen;

  5. Abstract 1316 TMC125 + BR (n=599) Placebo + BR (n=604) Patients with viral load <50 copies/mL at Week 24 (primary endpoint; ITT TLOVR) 100 90 80 70 60 50 40 30 20 10 0 p<0.0001 59% Responders (%) ± 95% CIs 41% 0 4 8 12 16 20 24 Time (weeks) TMC125 + BR: 558 553 545 541 Patients remaining on study (n) for: 577 568 559 Placebo + BR: 562 BR = background regimen; CI = confidence interval; ITT = intent-to-treat population; TLOVR = time to loss of virologic response analysis

  6. Abstract 1316 TMC125 + BR (n=599) Placebo + BR (n=604) Mean viral load reduction from baseline (ITT NC=F) 0.0 –0.5 –1.0 –1.5 –2.0 –2.5 –3.0 –3.5 p<0.0001 Mean change in viral load from baseline (log10 copies/mL) ± SE –1.7 –2.4 0 4 8 12 16 20 24 Time (weeks) BR = background regimen; SE = standard error; ITT = intent-to-treat population; NC=F = noncompleter equals failure analysis; changes below detection limit (<50 copies/mL) were imputed as 49 copies/mL

  7. Abstract 1316 TMC125 + BR (n=599) Placebo + BR (n=604) Mean change in CD4 cell count from baseline (ITT NC=F) 100 75 50 25 0 +86 +67 p<0.0001 Mean change in CD4 cell count from baseline (cells/mm3) ± SE 0 4 8 12 16 20 24 Time (weeks) BR = background regimen; SE = standard error; ITT = intent-to-treat population; NC=F = noncompleter equals failureanalysis

  8. Abstract 1316 TMC125 + BR (n=213) Placebo + BR (n=209) CD4 cell count increase to 50 cells/mm3 or above • At baseline, 36% and 35% of patients in the TMC125 and placebo groups respectively had a CD4 cell count below 50 cells/mm3 (n=422 in total) • At Week 24 in the TMC125 group 74% of these patients had moved above the 50 cells/mm3 threshold (n=157), compared with 55% in the placebo group (n=115) 74% 55% Patients with CD4 cell count increased to above 50 cells/mm3 at Week 24 Baseline CD4 cell count <50 cells/mm3 BR = background regimen

  9. Placebo + BR TMC125 + BR Response (<50 copies/mL) according to enfuvirtide use 67% 62% 56% Patients with viral load <50 copies/mL at Week 24 (%) 34% 102/153 251/446 99/160 149/444 Re-using or not using enfuvirtide Using de-novo enfuvirtide p<0.0001 p=0.427 The primary analysis divided patients according to ENF use

  10. Abstract 1316 Placebo + BR TMC125 + BR Response (<50 copies/mL) according to baseline darunavir fold change 100 75 50 25 0 71% 57% 56% Patients with viral load <50 copies/mL at Week 24 (%) 44% 30% 2% 39/132 200/358 73/129 1/67 246/345 31/71 DRV FC>40 DRV FC<10 DRV FC 10–40 Analysis excludes patients who discontinued except for virologic failure; BR = background regimen; DRV = darunavir; FC = baseline fold change

  11. Abstract 1316 Placebo + BR TMC125 + BR Response (<50 copies/mL) according to number of active background ARVs 45% 40/88 8%a 7/91 60% 120/199 Number of fully active background ARVs (PSS) 30% 63/211 74% 191/258 ≥ 67% 171/257 Patients with viral load <50 copies/mL at Week 24 (%) Analysis excludes patients who discontinued except for virologic failure; PSS = phenotypic sensitivity score; darunavir and enfuvirtide are counted as fully active if FC<10 or used de novo, respectively

  12. Abstract 1316 Placebo + BR TMC125 + BR Response (<50 copies/mL) according to baseline viral load and CD4 cell count 76% 73% 67% 62% 61% 55% 47% 44% 39% 39% Patients with viral load <50 copies/mL at Week 24 (%) 26% 23% 126/ 165 56/ 217 130/ 177 102/ 186 108/ 174 84/ 213 83/ 213 49/ 209 139/ 208 97/ 208 126/ 206 101/ 228 <50 50–199 <30,000 ≥100,000 ≥200 30,000–99,999 Baseline CD4 cell count Baseline viral load BR = background regimen; ITT = intent-to-treat population; TLOVR = time to loss of virologic response analysis

  13. Mutations associated with a decreased response to TMC125 • Using the data from these trials, 13 baseline mutations were found to be associated with a decreased response to TMC125 (TMC125 RAMs)*: V90I A98G L100I K101E/P V106I V179D/F Y181C/I/V G190A/S • These TMC125 RAMs occurred mainly in the presence of other NNRTI mutations • K103N is not associated with resistance to TMC125 *A decreased response was defined as ≤75% of the response for patients with zero NNRTI mutations at baseline from the extended NNRTI mutation list; RAM = resistance-associated mutation

  14. TMC125 + BR (n=406) Placebo + BR (n=414) Response (<50 copies/mL) according to number of TMC125 RAMS • The greatest added benefit in the TMC125 versus placebo group was seen in patients with <3 TMC125 RAMs • 86% of patients had <3 TMC125 RAMs 75% 121/161 64/147 44% 60% 73/121 38% 59/157 Number of TMC125 RAMs present at baseline 58% 37/64 25% 17/68 41% 13/32 25% 6/24 25% 7/28 ≥ 3/18 17% 0 20 40 60 80 Patients with viral load <50 copies/mL at Week 24 (%) Analysis excludes patients who used de-novo enfuvirtide or discontinued except for virologic failure BR = background regimen; RAM = resistance-associated mutation;

  15. Abstract 1316 Conclusions • In treatment-experienced patients, including those with NNRTI resistant virus, TMC125 was superior to placebo • 59% of patients achieved confirmed undetectable viral load (<50 copies/mL) with TMC125 + BR at Week 24 • Even in the absence of any other fully active background agents (PSS = 0), with TMC125, 45% of patients achieved undetectable (<50 copies/mL) viral load • response rates increased as more active agents were used in the BR • Better responses were achieved in patients with higher CD4 cell counts and lower viral loads for both treatment arms • higher responses were apparent with TMC125 compared with placebo, for all categories of baseline viral load or CD4 cell count • 13 TMC125 RAMs were identified • an increasing number of TMC125 RAMs was associated a decreasing response in both treatment arms • in the TMC125 group, the greatest added benefit was seen with <3 TMC125 RAMs • 86% of patients had <3 TMC125 RAMs • TMC125 demonstrated significant activity and provides a new treatment option for patients with resistance to other NNRTIs BR = background regimen; RAM = resistance-associated mutation;

  16. Abstract 1316 Acknowledgements • We express our gratitude to the patients that participated in the study, as well as the study centre staff, DSMB, clinical event adjudication panel, Tibotec personnel and following principal investigators: Argentina: H Ariza, J Benetucci, L Calanni, L Cassetti, J Corral, D David, A Krolewiecki, M Losso, P Patterson, R Teijeiro; Brazil: C A da Cunha, E Kallas, E Netto, J H Pilotto, M Schechter, J Suleiman, A Timerman; Chile: J Ballesteros, R Northland; Costa Rica: A Alvilés Montoya, G Herrera Martinez, A Solano Chinchilla; France: M Dupon, C Katlama, J M Livrozet, P Morlat, C Piketty, I Poizot-Martin; Mexico: J Andrade-Villanueva, G Reyes-Terán, J Sierra-Madero; Panama: A Canton, A Rodriguez, N Sosa; Puerto Rico: J O Morales Ramirez, J L Santana Bagur, R Soto-Malave; Thailand: T Anekthananon, P Mootsikapun, K Ruxrungtham; USA: M Albrecht, N Bellos, R Bolan, P Brachman, C Brinson, F Cruickshank, R Elion, W J Fessel, T Hawkins, S Hodder, T Jefferson, H Katner, C Kinder, M Kozal, D McDonough, K Mounzer, D Norris, W O’Brien, G Pierone, K Raben, B Rashbaum, M Rawlings, B Rodwick, P Ruane, J Sampson, S Schrader, A Scribner, M Sension, D Sweet, B Wade, D Wheeler, A Wilkin, T Wills, M Wohlfeiler, K Workowski. DUET-2 DUET-1 Australia: J Chuah, D Cooper, B Eu, J Hoy, C Workman; Belgium: N Clumeck, R Colebunders, M Moutschen; Canada: J Gill, K Gough, P Junod, D Kilby, J Montaner, A Rachlis, C M Tsoukas, S L Walmsley; France:C Arvieux, L Cotte, J F Delfraissy, P M Girard, B Marchou, J M Molina, D Vittecoq, Y Yazdanpanah, P Yeni; Germany: S Esser, G Fätkenheuer, H Gellermann, K Göbels, F D Goebel, H Jäger, A Moll, J K Rockstroh, D Schuster, S Staszewski, A Stoehr; Italy: A Antinori, G Carosi, G Di Perri, R Esposito, F Mazzotta, G Pagano, E Raise, S Rusconi, L Sighinolfi, F Suter; Netherlands: P H J Frissen, J M Prins, B J A Rijnders; Poland: A Horban; Portugal: F Antunes, M Miranda, J Vera; Spain: P Domingo, G Garcia, J M Gatell, J González-Lahoz, J López-Aldeguer, D Podzamczer; UK: P Easterbrook, M Fisher, C Orkin, E Wilkins; USA:B Barnett, J Baxter, G Beatty, D Berger, C Borkert, C Cohen, M Conant, J Ernst, C Farthing, T File, M Frank, J E Gallant, A E Greenberg, C Hicks, D T Jayaweera, S Kerkar, N Markowitz, C Martorell, C McDonald, D McMahon, M Mogyoros, R A Myers Jr, G Richmond, K Sathasivam, S Schneider, H Schrager, P Shalit, F P Siegal, L Sloan, K Smith, S Smith, P Tebas, L S Tkatch.

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