Skip to main content

Development of ZEPATIER®

  • Chapter
  • First Online:

Part of the book series: Topics in Medicinal Chemistry ((TMC,volume 32))

Abstract

ZEPATIER® (MK-5172A; elbasvir and grazoprevir, Merck & Co., Inc.) is a fixed-dose combination treatment for individuals with chronic hepatitis C virus (HCV) infection. This novel direct-acting antiviral (DAA) regimen combines elbasvir, a selective inhibitor of the HCV nonstructural protein 5A, and grazoprevir, a reversible competitive inhibitor of the HCV nonstructural protein 3/4A protease. After extensive preclinical testing and evaluation of safety and pharmacokinetics (PK) in healthy volunteers, the efficacy of these agents was evaluated in a systematic and comprehensive clinical development program culminating in phase 3 clinical trials in a broad population of participants with HCV infection, including treatment-naive and treatment-experienced participants, those with chronic kidney disease or inherited blood disorders, and those receiving opioid agonist therapy. These studies led to the approval of the elbasvir/grazoprevir combination therapy for the treatment of people with HCV genotype 1 or genotype 4 infection in the United States, Europe, Canada, and many other countries worldwide.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   349.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   449.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   449.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Coburn C (2018) Discovery of elbasvir. Top Med Chem. https://doi.org/10.1007/7355_2018_44

    Google Scholar 

  2. McCauley J, Rudd M (2018) The invention of grazoprevir: an HCV NS3/4a protease inhibitor. Top Med Chem. https://doi.org/10.1007/7355_2018_41

    Google Scholar 

  3. Lahser FC, Bystol K, Curry S, McMonagle P, Xia E, Ingravallo P et al (2016) The combination of grazoprevir, a hepatitis C virus (HCV) NS3/4A protease inhibitor, and elbasvir, an HCV NS5A inhibitor, demonstrates a high genetic barrier to resistance in HCV genotype 1a replicons. Antimicrob Agents Chemother 60(5):2954–2964

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Harper S, McCauley JA, Rudd MT, Ferrara M, DiFilippo M, Crescenzi B et al (2012) Discovery of MK-5172, a macrocyclic hepatitis C virus NS3/4a protease inhibitor. ACS Med Chem Lett 3(4):332–336

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Summa V, Ludmerer SW, McCauley JA, Fandozzi C, Burlein C, Claudio G et al (2012) MK-5172, a selective inhibitor of hepatitis C virus NS3/4a protease with broad activity across genotypes and resistant variants. Antimicrob Agents Chemother 56(8):4161–4167

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Liu R, Curry S, McMonagle P, Yeh WW, Ludmerer SW, Jumes PA et al (2015) Susceptibilities of genotype 1a, 1b, and 3 hepatitis C virus variants to the NS5A inhibitor elbasvir. Antimicrob Agents Chemother 59(11):6922–6929

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Coburn CA, Meinke PT, Chang W, Fandozzi CM, Graham DJ, Hu B et al (2013) Discovery of MK-8742: an HCV NS5A inhibitor with broad genotype activity. ChemMedChem 8(12):1930–1940

    Article  CAS  PubMed  Google Scholar 

  8. Manns MP, Vierling JM, Bacon BR, Bruno S, Shibolet O, Baruch Y et al (2014) The combination of MK-5172, peginterferon, and ribavirin is effective in treatment-naive patients with hepatitis C virus genotype 1 infection without cirrhosis. Gastroenterology 147(2):366–376

    Article  CAS  PubMed  Google Scholar 

  9. Lagging M, Brown A, Mantry PS, Ramji A, Weilert F, Vierling JM et al (2016) Grazoprevir plus peginterferon and ribavirin in treatment-naive patients with hepatitis C virus genotype 1 infection: a randomized trial. J Viral Hepat 23(2):80–88

    Article  CAS  PubMed  Google Scholar 

  10. Lawitz E, Gane E, Pearlman B, Tam E, Ghesquiere W, Guyader D et al (2015) Efficacy and safety of 12 weeks versus 18 weeks of treatment with grazoprevir (MK-5172) and elbasvir (MK-8742) with or without ribavirin for hepatitis C virus genotype 1 infection in previously untreated patients with cirrhosis and patients with previous null response with or without cirrhosis (C-WORTHY): a randomised, open-label phase 2 trial. Lancet 385:1075–1086

    Article  CAS  PubMed  Google Scholar 

  11. Sulkowski M, Hezode C, Gerstoft J, Vierling JM, Mallolas J, Pol S et al (2015) Efficacy and safety of 8 weeks versus 12 weeks of treatment with grazoprevir (MK-5172) and elbasvir (MK-8742) with or without ribavirin in patients with hepatitis C virus genotype 1 mono-infection and HIV/hepatitis C virus co-infection (C-WORTHY): a randomised, open-label phase 2 trial. Lancet 385(9973):1087–1097

    Article  CAS  PubMed  Google Scholar 

  12. Brown A, Hezode C, Zuckerman E, Foster GR, Zekry A, Roberts SK et al (2018) Efficacy and safety of 12 weeks of elbasvir +/− grazoprevir +/− ribavirin in participants with HCV genotype 2, 4, 5, or 6 infection: the C-SCAPE study. J Viral Hepat 25(5):457–464

    Article  CAS  PubMed  Google Scholar 

  13. Forns X, Gordon SC, Zuckerman E, Lawitz E, Calleja JL, Hofer H et al (2015) Grazoprevir and elbasvir plus ribavirin for chronic HCV genotype-1 infection after failure of combination therapy containing a direct-acting antiviral agent. J Hepatol 63(3):564–572

    Article  CAS  PubMed  Google Scholar 

  14. Buti M, Gordon SC, Zuckerman E, Lawitz E, Calleja JL, Hofer H et al (2016) Grazoprevir, elbasvir, and ribavirin for chronic hepatitis C virus genotype 1 infection after failure of pegylated interferon and ribavirin with an earlier-generation protease inhibitor: final 24-week results from C-SALVAGE. Clin Infect Dis 62(1):32–36

    Article  CAS  PubMed  Google Scholar 

  15. Lawitz E, Poordad F, Gutierrez JA, Wells JT, Landaverde CE, Evans B et al (2017) Short-duration treatment with elbasvir/grazoprevir and sofosbuvir for hepatitis C: a randomized trial. Hepatology 65(2):439–450

    Article  CAS  PubMed  Google Scholar 

  16. Zeuzem S, Ghalib R, Reddy KR, Pockros PJ, Ben AZ, Zhao Y et al (2015) Grazoprevir-elbasvir combination therapy for treatment-naive cirrhotic and noncirrhotic patients with chronic HCV genotype 1, 4, or 6 infection: a randomized trial. Ann Intern Med 163(1):1–13

    Article  PubMed  Google Scholar 

  17. Kwo P, Gane E, Peng CY, Pearlman B, Vierling JM, Serfaty L et al (2017) Effectiveness of elbasvir and grazoprevir combination, with or without ribavirin, for treatment-experienced patients with chronic hepatitis C infection. Gastroenterology 152(1):164–175

    Article  CAS  PubMed  Google Scholar 

  18. Roth D, Nelson DR, Bruchfeld A, Liapakis A, Silva M, Monsour Jr H et al (2015) Grazoprevir plus elbasvir in treatment-naive and treatment-experienced patients with hepatitis C virus genotype 1 infection and stage 4-5 chronic kidney disease (the C-SURFER study): a combination phase 3 study. Lancet 386(10003):1537–1545

    Article  CAS  PubMed  Google Scholar 

  19. Bruchfeld A, Roth D, Martin P, Nelson DR, Pol S, Londono MC et al (2017) Elbasvir plus grazoprevir in patients with hepatitis C virus infection and stage 4-5 chronic kidney disease: clinical, virological, and health-related quality-of-life outcomes from a phase 3, multicentre, randomised, double-blind, placebo-controlled trial. Lancet Gastroenterol Hepatol 2(8):585–594

    Article  PubMed  Google Scholar 

  20. Rockstroh JK, Nelson M, Katlama C, Lalezari J, Mallolas J, Bloch M et al (2015) Efficacy and safety of grazoprevir (MK-5172) and elbasvir (MK-8742) in patients with hepatitis C virus and HIV co-infection (C-EDGE CO-INFECTION): a non-randomised, open-label trial. Lancet HIV 2(8):e319–e327

    Article  PubMed  Google Scholar 

  21. Dore GJ, Altice F, Litwin AH, Dalgard O, Gane EJ, Shibolet O et al (2016) Elbasvir-grazoprevir to treat hepatitis C virus infection in persons receiving opioid agonist therapy: a randomized trial. Ann Intern Med 165(9):625–634

    Article  PubMed  Google Scholar 

  22. Hezode C, Colombo M, Bourliere M, Spengler U, Ben-Ari Z, Strasser SI et al (2017) Elbasvir/grazoprevir for patients with hepatitis C virus infection and inherited blood disorders: a phase III study. Hepatology 66(3):736–745

    Article  CAS  PubMed  Google Scholar 

  23. Sperl J, Horvath G, Halota W, Ruiz-Tapiador JA, Streinu-Cercel A, Jancoriene L et al (2016) Efficacy and safety of elbasvir/grazoprevir and sofosbuvir/pegylated interferon/ribavirin: a phase III randomized controlled trial. J Hepatol 65(6):1112–1119

    Article  CAS  PubMed  Google Scholar 

  24. George J, Burnevich E, Sheen IS et al (2018) Elbasvir/grazoprevir in Asia/Pacific/Russian participants with chronic hepatitis C virus genotype 1, 4, or 6 infection. Hepatol Comm 2:595–606. https://doi.org/10.1002/hep4.1177/full

    Article  CAS  Google Scholar 

  25. Kumada H, Suzuki Y, Karino Y, Chayama K, Kawada N, Okanoue T et al (2017) The combination of elbasvir and grazoprevir for the treatment of chronic HCV infection in Japanese patients: a randomized phase II/III study. J Gastroenterol 52(4):520–533

    Article  CAS  PubMed  Google Scholar 

  26. Foster GR, Agarwal K, Cramp ME, Moreea S, Barclay S, Collier J et al (2018) Elbasvir/grazoprevir and sofosbuvir for HCV genotype 3 infection with compensated cirrhosis: a randomized trial. Hepatology 67:2113. https://doi.org/10.1002/hep.29852

    Article  CAS  PubMed  Google Scholar 

  27. Yeh WW, Fraser IP, Jumes P et al (2018) Antiviral activity, safety, and tolerability of multiple ascending doses of elbasvir or grazoprevir in participants with hepatitis C virus genotype-1 or -3. Clin Ther 40:704–718. https://doi.org/10.1016/j.clinthera.2018.03.002

    Article  CAS  PubMed  Google Scholar 

  28. Jacobson IM, Lawitz E, Kwo PY, Hezode C, Peng CY, Howe AY et al (2017) Safety and efficacy of elbasvir/grazoprevir in patients with hepatitis C virus infection and compensated cirrhosis: an integrated analysis. Gastroenterology 152(6):1372–1382

    Article  CAS  PubMed  Google Scholar 

  29. Boyd SD, Tracy L, Komatsu TE, Harrington PR, Viswanathan P, Murray J et al (2017) US FDA perspective on elbasvir/grazoprevir treatment for patients with chronic hepatitis c virus genotype 1 or 4 infection. Clin Drug Investig 37(4):317–326

    Article  CAS  PubMed  Google Scholar 

  30. Zepatier [package insert] (2018) Merck, Kenilworth

    Google Scholar 

  31. Komatsu TE, Boyd S, Sherwat A, Tracy L, Naeger LK, O’Rear JJ et al (2017) Regulatory analysis of effects of hepatitis C virus NS5A polymorphisms on efficacy of elbasvir and grazoprevir. Gastroenterology 152(3):586–597

    Article  CAS  PubMed  Google Scholar 

  32. European Association for the Study of the Liver (2017) EASL recommendations on treatment of hepatitis C 2016. J Hepatol 66(1):153–194

    Article  Google Scholar 

  33. European Medicines Agency (2016) Zepatier EMA CHMP assessment report. Contract No.: EMA/419807/2016, European Medicines Agency, London. http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Public_assessment_report/human/004126/WC500211237.pdf

  34. Zeuzem S, Serfaty L, Vierling J, Cheng W, George J, Sperl J et al (2018) The safety and efficacy of elbasvir and grazoprevir in participants with hepatitis C virus genotype 1b infection. J Gastroenterol 53:679. https://doi.org/10.1007/s00535-018-1429-3

    Article  CAS  PubMed  Google Scholar 

  35. Asselah T, Reesink H, Gerstoft J, de Ledinghen V, Pockros PJ, Robertson M et al (2018) Efficacy of elbasvir and grazoprevir in participants with hepatitis C virus genotype 4 infection: a pooled analysis. Liver Int. https://doi.org/10.1111/liv.13727

    Article  CAS  PubMed  Google Scholar 

  36. Dusheiko GM, Manns MP, Vierling JM, Reddy KR, Sulkowski MS, Kwo PY (2015) Safety and tolerability of grazoprevir/elbasvir in patients with chronic hepatitis C: integrated analysis of phase 2–3 trials [Abstract 712]. Hepatology 62(Suppl S1):562A

    Google Scholar 

Download references

Acknowledgments

We extend our gratitude to the participants, their families, investigators, and site personnel who participated in the elbasvir/grazoprevir clinical trials. Medical writing and editorial assistance were provided by Tim Ibbotson, PhD, of ApotheCom, Yardley, PA, and funded by Merck & Co., Inc., Kenilworth, NJ, USA.

Compliance with Ethical Standards

Funding Funding for the studies described in this book chapter was provided by Merck & Co., Inc., Kenilworth, NJ, USA.

Conflict of Interest Drs Robertson and Barr are employees of, and hold stock in, Merck & Co., Inc., Kenilworth, NJ, USA.

Ethical Approval

All studies were carried out in accordance with the Declaration of Helsinki, current guidelines on Good Clinical Practices and local ethical and legal requirements. For each study, independent institutional review boards or ethics committees reviewed and approved the protocol and applicable amendments.

Informed Consent

In all studies, all participants gave written informed consent.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Michael N. Robertson .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Robertson, M.N., Barr, E. (2019). Development of ZEPATIER® . In: Sofia, M. (eds) HCV: The Journey from Discovery to a Cure. Topics in Medicinal Chemistry, vol 32. Springer, Cham. https://doi.org/10.1007/7355_2018_54

Download citation

Publish with us

Policies and ethics