Protease inhibitor (pharmacology)
Protease inhibitors are a class of antiviral drugs that are widely used to treat HIV/AIDS and hepatitis C. Protease inhibitors prevent viral replication by selectively binding to viral proteases and blocking proteolytic cleavage of protein precursors that are necessary for the production of infectious viral particles.
Protease inhibitors that have been developed and are currently used in clinical practice include:
- Antiretroviral HIV-1 protease inhibitors — class stem –navir
- * Amprenavir
- * Atazanavir
- * Darunavir
- * Fosamprenavir
- * Indinavir
- * Lopinavir
- * Nelfinavir
- * Ritonavir
- * Saquinavir
- * Tipranavir
- Hepatitis C virus NS3/4A protease inhibitors — class stem –previr
- * Asunaprevir
- * Boceprevir
- * Grazoprevir
- * Glecaprevir
- * Paritaprevir
- * Simeprevir
- * Telaprevir
Antiretrovirals
Protease inhibitors were the second class of antiretroviral drugs developed. The first members of this class, saquinavir, ritonavir and indinavir were approved in late 1995–1996. Within 2 years, annual deaths from AIDS in the United States fell from over 50,000 to approximately 18,000 Prior to this the annual death rate had been increasing by approximately 20% each year.Name | Trade name | Company | Patent | FDA approval date | Notes |
Saquinavir | Invirase, Fortovase | Hoffmann–La Roche | December 6, 1995 | The first protease inhibitor approved by the U.S. Food and Drug Administration. | |
Ritonavir | Norvir | AbbVie | March 1, 1996 | AbbVie was part of Abbott Laboratories when patent was granted. | |
Indinavir | Crixivan | Merck & Co. | March 13, 1996 | — | |
Nelfinavir | Viracept | Hoffmann–La Roche | March 14, 1997 | — | |
Amprenavir | Agenerase | GlaxoSmithKline | April 15, 1999 | The sixteenth FDA-approved antiretroviral. It was the first protease inhibitor approved for twice-a-day dosing instead of needing to be taken every eight hours. The convenient dosing came at a price, as the dose required is 1,200 mg, delivered in 8 very large gel capsules. Production was discontinued by the manufacturer December 31, 2004, as it has been superseded by fosamprenavir. | |
Lopinavir | Kaletra | AbbVie | September 15, 2000 | Is only marketed as a fixed-dose combination with ritonavir. AbbVie was part of Abbott Laboratories when patent was granted. | |
Atazanavir | Reyataz | Bristol-Myers Squibb | June 20, 2003 | Atazanavir was the first PI approved for once-daily dosing. It appears to be less likely to cause lipodystrophy and elevated cholesterol as side effects. It may also not be cross-resistant with other PIs. | |
Fosamprenavir | Lexiva, Telzir | GlaxoSmithKline | — | October 20, 2003 | A prodrug of amprenavir. The human body metabolizes fosamprenavir in order to form amprenavir, which is the active ingredient. That metabolization increases the duration that amprenavir is available, making fosamprenavir a slow release version of amprenavir and thus reduces the number of pills required versus standard amprenavir. |
Tipranavir | Aptivus | Boehringer Ingelheim | — | June 22, 2005 | Also known as tipranavir disodium. |
Darunavir | Prezista | Janssen Therapeutics | June 23, 2006 | As of 2016, darunavir is an OARAC recommended treatment option for treatment-naïve and treatment-experienced adults and adolescents. Several ongoing phase III trials are showing a high efficiency for the darunavir/ritonavir combination being superior to the lopinavir/ritonavir combination for first-line therapy. Darunavir is the first drug in a long time that didn't come with a price increase. It leapfrogged two other approved drugs of its type, and is matching the price of a third. |
Other activities
Antiprotozoal activity
Researchers are investigating the use of protease inhibitors developed for HIV treatment as anti-protozoals for use against malaria and gastrointestinal protozoal infections:- A combination of ritonavir and lopinavir was found to have some effectiveness against Giardia infection.
- The drugs saquinavir, ritonavir, and lopinavir have been found to have anti-malarial properties.
- A cysteine protease inhibitor drug was found to cure Chagas disease in mice.
Anticancer activity
Inhibitors of the proteasome, such as bortezomib are now front-line drugs for the treatment of multiple myeloma.
Tanomastat is one of the matrix metalloproteinase inhibitors that can be used to treat cancer. Batimastat was also well-known from Lednicer book.