Drug Database: Tucidinostat

Pharmacology

Pharmacology

Mechanism of Action: Latency-reversing agent, specifically a histone deacetylase inhibitor (HDACi).³ Tucidinostat, a benzamide derivative, is an HDACi that selectively targets the class I HDAC enzymes HDAC-1, -2, and -3, which are important in the disruption of HIV latency. Additionally, tucidinostat is active against the class II HDAC-10 enzyme.^4,5 Tucidinostat has also been shown to reactivate latent HIV via the NF-κB signaling pathway.⁶ Currently, tucidinostat is approved for use in China and Japan for the treatment of certain types of cancer.⁷

In HIV-1 latency, HDACs are recruited to the proviral 5' long terminal repeat (LTR), where they catalyze deacetylation of lysine residues on histones, resulting in chromatin condensation on nucleosome 1 (nuc-1) and preventing HIV transcription. Inhibition of HDAC activity promotes histone acetylation (hyperacetylation) of lysine residues by histone acetyltransferases (HATs), leading to chromatin relaxation and transcriptional activation.^5,8 Some research suggests that the activity of HDACis in inducing HIV transcription may not be caused by direct effects on histone acetylation, but may be caused by effects on other non-histone proteins.^9,10

Half-life (T_1/2): In a Phase 1b/2a trial (NCT02513901) of tucidinostat in adults with HIV, the elimination half-life of tucidinostat after a single oral 10-mg dose was approximately 11.5 hours. After multiple oral 10-mg doses of tucidinostat, the half-life was approximately 15.5 hours.¹¹

Select Clinical Trials

Select Clinical Trials

Study Identifiers: CHARTER; NCT02513901
Sponsor: Tang-Du Hospital
Phase: 1b/2a
Status: This study has been completed.
Study Purpose: The purpose of this open-label trial was to evaluate the safety of tucidinostat plus ART and the efficacy of tucidinostat plus ART in reactivating HIV transcription in latently infected cells and reducing latent HIV reservoir size.
Study Population:

• Participants were adults with HIV who were on ART and who had been receiving ART for at least 18 months.
• Participants had HIV RNA <50 copies/mL for at least 1 year and had CD4 counts >350 cells/mm³.^11,12

Selected Study Results:

• AIDS, 2018: Chidamide disrupts and reduces HIV-1 latency in patients on suppressive antiretroviral therapy
• HIV Med article, 2020: The histone deacetylase inhibitor chidamide induces intermittent viraemia in HIV-infected patients on suppressive antiretroviral therapy

Study Identifier: NCT02902185
Sponsor: Tang-Du Hospital
Phase: 2/3
Status: This study has been completed.
Study Purpose: The purpose of this study was to confirm the efficacy of tucidinostat plus ART in reactivating HIV transcription in latently infected cells and reducing latent HIV reservoir size.
Study Population:

• Participants were adults with HIV who were on ART and who had been receiving ART for at least 24 months.
• Participants had HIV RNA <20 copies/mL for at least 1.5 years and had CD4 counts >350 cells/mm³.^3,13

Study Identifier: NCT04985890
Sponsor: UBP Greater China (Shanghai) Co., Ltd
Phase: 2
Status: See the ClinicalTrials.gov record for this study's status.
Study Purpose: The purpose of this open-label study is to evaluate the safety of tucidinostat plus the attachment inhibitor UB-421 and the ability of this regimen in reducing the HIV reservoir in participants undergoing a treatment interruption of ART.
Study Population:

• Participants are adults with HIV who have been receiving ART for more than 1 year and who have more than two different alternative optimized ART regimens available.
• Participants have HIV RNA <50 copies/mL at screening and have had HIV RNA <50 copies/mL for at least 12 months prior to screening.
• Participants have CD4 counts ≥350 cells/mm3 at screening and have had CD4 counts ≥350 cells/mm3 within the 12 months prior to screening.
• Participants have total HIV DNA levels ≥300 copies per million CD4+ T cells.¹⁴

Study Identifier: NCT05056974
Sponsor: United BioPharma
Phase: 2
Status: See the ClinicalTrials.gov record for this study’s status.
Study Purpose: The purpose of this open-label study is to assess the safety and efficacy of tucidinostat plus UB-421 monotherapy in changing the latent HIV reservoir in participants undergoing a treatment interruption of ART.
Study Population:

• Participants are adults with HIV who have been receiving ART for more than 3 years.
• Participants have stable viral suppression.¹⁵

In addition, a Phase 1 study (NCT03980691) evaluated whether tucidinostat used in combination with chimeric antigen receptor (CAR)-T or T cell receptor (TCR)-T cell therapy could reduce the size of the latent HIV reservoir in participants on suppressive ART. This study has been completed.¹⁶

Adverse Events

Adverse Events

CHARTER (NCT02513901):

In this Phase 1b/2a trial, seven participants completed treatment with eight oral doses of tucidinostat. No significant adverse events (AEs) occurred, and all AEs were of Grade 1 severity. Rash and fatigue/somnolence were each reported in one participant. A small decrease in complete blood cell counts, most notably red blood cell counts and hemoglobin values, were seen with tucidinostat treatment, but these cases were all below Grade 1 and returned to baseline levels by Day 56. CD4 counts remained unchanged throughout the study.^11,17

Drug Interactions

Drug Interactions

Information about drug-drug interactions between tucidinostat and HIV-related drugs is currently unavailable.

References

References

1. United States National Library of Medicine. ChemIDplus Advanced: tucidinostat. https://chem.nlm.nih.gov/chemidplus/rn/1616493-44-7. Accessed November 19, 2021
2. Huya Bioscience International: Press Release, dated March 6, 2007. HUYA Bioscience licenses chidamide cancer compound from Chipscreen Biosciences. https://www.huyabio.com/huya-bioscience-licenses-chidamide-cancer-compound-chipscreen-biosciences/. Accessed November 19, 2021
3. Treatment Action Group website. Research toward a cure trials. http://www.treatmentactiongroup.org/cure/trials. Accessed November 19, 2021
4. Lu X, Ning Z, Li Z, Cao H, Wang X. Development of chidamide for peripheral T-cell lymphoma, the first orphan drug approved in China. Intractable Rare Dis Res. 2016;5(3):185-191. doi:10.5582/irdr.2016.01024
5. Matalon S, Rasmussen TA, Dinarello CA. Histone deacetylase inhibitors for purging HIV-1 from the latent reservoir. Mol Med. 2011;17(5-6):466-472. doi:10.2119/molmed.2011.00076
6. Yang W, Sun Z, Hua C, et al. Chidamide, a histone deacetylase inhibitor-based anticancer drug, effectively reactivates latent HIV-1 provirus. Microbes Infect. 2018;20(9-10):626-634. doi:10.1016/j.micinf.2017.10.003
7. Chipscreen Biosciences. Chidamide. https://www.chipscreen.com/en/products/712.html. Accessed November 19, 2021
8. Rasmussen TA, Tolstrup M, Winckelmann A, Østergaard L, Søgaard OS. Eliminating the latent HIV reservoir by reactivation strategies. Hum Vaccin Immunother. 2013;9(4):790-799.
9. Shirakawa K, Chavez L, Hakre S, Calvanese V, Verdin E. Reactivation of latent HIV by histone deacetylase inhibitors. Trends Microbiol. 2013;21(6):277-285. doi:10.1016/j.tim.2013.02.005
10. Elliott JH, Wightman F, Solomon A, et al. Activation of HIV transcription with short-course vorinostat in HIV-infected patients on suppressive antiretroviral therapy. PLoS Pathog. 2014;10(11). doi:10.1371/journal.ppat.1004473
11. Sun Y, Li J, Ma C. Chidamide disrupts and reduces HIV-1 latency in patients on suppressive antiretroviral therapy. Slides presented at: International AIDS Conference; July 23-27, 2018; Amsterdam, Netherlands. https://programme.aids2018.org/PAGMaterial/PPT/3643_2431/2018-IAS-Chidamide.pptx. Accessed November 19, 2021
12. Tang-Du Hospital. Safety and efficacy of the histone deacetylase inhibitor chidamide in combination with antiretroviral therapy for eradication of the latent HIV-1 reservoir (CHARTER). In: ClinicalTrials.gov. Bethesda (MD): National Library of Medicine (US). Registered on July 30, 2015. NLM Identifier: NCT02513901. https://clinicaltrials.gov/ct2/show/NCT02513901. Accessed November 19, 2021
13. Tang-Du Hospital. Efficacy of the histone deacetylase inhibitor chidamide in combination with antiretroviral therapy for reactivation of the latent HIV-1 reservoir: a randomized controlled clinical trial. In: ClinicalTrials.gov. Bethesda (MD): National Library of Medicine (US). Registered on September 6, 2016. NLM Identifier: NCT02902185. https://clinicaltrials.gov/ct2/show/NCT02902185. Accessed November 19, 2021
14. UBP Greater China (Shanghai) Co., Ltd. A proof of concept study to evaluate the safety and efficacy of UB-421 in combination with Chidamide for reduction of HIV reservoir as compared to UB-421 alone in ART stabilized HIV-1 patients who undergo ART interruption. In: ClinicalTrials.gov. Bethesda (MD): National Library of Medicine (US). Registered on July 8, 2021. NLM Identifier: NCT04985890. https://clinicaltrials.gov/ct2/show/NCT04985890. Accessed November 19, 2021
15. United BioPharma. A Phase II proof-of-concept trial to evaluate the safety and efficacy of UB-421 plus Chidamide for the shock-block-kill mechanism in changing HIV reservoirs among ART stabilized HIV-1 patients who undergo ART interruption. In: ClinicalTrials.gov. Bethesda (MD): National Library of Medicine (US). Registered on August 18, 2021. NLM Identifier: NCT05056974. https://clinicaltrials.gov/ct2/show/NCT05056974. Accessed November 19, 2021
16. Guangzhou 8th People’s Hospital. Effect of chidamide combined with CAT-T or TCR-T cell therapy on HIV-1 latent reservoir. In: ClinicalTrials.gov. Bethesda (MD): National Library of Medicine (US). Registered on June 7, 2019. NLM Identifier: NCT03980691. https://clinicaltrials.gov/ct2/show/NCT03980691. Accessed November 19, 2021
17. Sun Y, Li J, Ma J. Chidamide reactivates and diminishes latent HIV-1 DNA in patients on suppressive antiretroviral therapy. Abstract presented at: International AIDS Conference; July 23-27, 2018; Amsterdam, Netherlands. Abstract WEAA0101. http://programme.aids2018.org/Abstract/Abstract/9294. Accessed November 19, 2021

Last Reviewed: November 19, 2021