The optimization of the 4-methoxy-6-azaindole series of HIV-1 attachment inhibitors (AIs) that originated with 1 to deliver temsavir (3, BMS-626529) is described. The most beneficial increases in potency and pharmacokinetic (PK) properties were attained by incorporating N-linked, sp²-hybridized heteroaryl rings at the 7-position of the heterocyclic nucleus. Compounds that adhered to a coplanarity model afforded targeted antiviral potency, leading to the identification of 3 with characteristics that provided for targeted exposure and PK properties in three preclinical species. However, the physical properties of 3 limited plasma exposure at higher doses, both in preclinical studies and in clinical trials as the result of dissolution- and/or solubility-limited absorption, a deficiency addressed by the preparation of the phosphonooxymethyl prodrug 4 (BMS-663068, fostemsavir). An extended-release formulation of 4 is currently in phase III clinical trials where it has shown promise as part of a drug combination therapy in highly treatment-experienced HIV-1 infected patients.

中文翻译：

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发现人类免疫缺陷病毒1型（HIV-1）附着抑制剂替莫沙韦及其膦酰氧甲基前药氟替沙韦

描述了从1开始递送替米沙韦（3，BMS-626529）的HIV-1附着抑制剂（AIs）的4-甲氧基-6-氮杂吲哚系列的优化。通过将N-连接的，sp ^2-杂化的杂芳基环并入杂环核的7位，可获得最有效的药效和药代动力学（PK）性能提高。遵守共面性模型的化合物可提供靶向的抗病毒效力，从而鉴定出3种具有为三种临床前物种提供靶向暴露和PK特性的特征。但是3的物理性质在临床前研究和临床试验中，由于溶解和/或溶解度受限的吸收而限制了较高剂量的血浆暴露，这是膦酰氧甲基前药4（BMS-663068，fostemsavir）的制备所解决的缺陷。4的缓释制剂目前正处于III期临床试验中，已显示出有望在高度治疗经验丰富的HIV-1感染患者中作为药物联合疗法的一部分。