James S H, Larson K B, Acosta E P, Prichard M N
Division of Infectious Diseases, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Clin Pharmacol Ther. 2015 Jan;97(1):66-78. doi: 10.1002/cpt.3. Epub 2014 Nov 18.
The seminal discovery of acyclovir 40 years ago heralded the modern era of truly selective antiviral therapies and this drug remains the therapy of choice for herpes simplex virus infections. Yet by modern standards, its antiviral activity is modest and new drugs against novel molecular targets such as the helicase-primase have the potential to improve clinical outcome, particularly in high-risk patients. A brief synopsis of current therapies for these infections and clinical need is provided to help provide an initial perspective. The function of the helicase-primase complex is then summarized and the development of new inhibitors of the helicase-primase complex, such as pritelivir and amenamevir, is discussed. We review their mechanism of action, propensity for drug resistance, and pharmacokinetic characteristics and discuss their potential to advance current therapeutic options. Strategies that include combinations of these inhibitors with acyclovir are also considered, as they will likely maximize clinical efficacy.
40年前阿昔洛韦的重大发现开创了真正选择性抗病毒疗法的现代时代,这种药物仍然是单纯疱疹病毒感染的首选治疗药物。然而,按照现代标准,其抗病毒活性一般,针对诸如解旋酶-引发酶等新分子靶点的新药有可能改善临床疗效,尤其是在高危患者中。本文简要概述了这些感染的当前治疗方法及临床需求,以帮助提供初步观点。接着总结了解旋酶-引发酶复合物的功能,并讨论了解旋酶-引发酶复合物新抑制剂(如普瑞替韦和阿昔美韦)的研发情况。我们综述了它们的作用机制、耐药倾向和药代动力学特征,并讨论了它们推进当前治疗选择的潜力。还考虑了将这些抑制剂与阿昔洛韦联合使用的策略,因为它们可能会使临床疗效最大化。