Antiretroviral Drug Interaction Study in Volunteers With HIV
|First Received Date ICMJE||November 22, 2011|
|Last Updated Date||November 27, 2013|
|Start Date ICMJE||October 2011|
|Primary Completion Date||Not Provided|
|Current Primary Outcome Measures ICMJE
||The primary objective of this study is to determine the steady state pharmacokinetics of 2 doses of atovaquone oral suspension in the presence of ATV/r, EFV, or no ARVs in HIV-infected patients.|
|Original Primary Outcome Measures ICMJE||Same as current|
|Change History||Complete list of historical versions of study NCT01479361 on ClinicalTrials.gov Archive Site|
|Current Secondary Outcome Measures ICMJE
||To compare our PK results with the recently reported interaction between a single dose of atovaquone+proguanil and ATV/r and EFV, and the comparator group which consists of HIV-infected subjects, as opposed to a comparator group of healthy subje...|
|Original Secondary Outcome Measures ICMJE||Same as current|
|Current Other Outcome Measures ICMJE||Not Provided|
|Original Other Outcome Measures ICMJE||Not Provided|
|Brief Title ICMJE||Antiretroviral Drug Interaction Study in Volunteers With HIV|
|Official Title ICMJE||The Influence of Atazanavir-ritonavir and Efavirenz on Atovaquone Pharmacokinetics in HIV-infected Volunteers|
- People who are infected with the human immunodeficiency virus (HIV) are at risk of getting certain diseases. Two of these diseases are a type of pneumonia known as PCP and a brain infection called toxoplasmosis. Most people with HIV take antiretroviral (ARV) drugs to treat HIV and lower the risk of infections. However, some ARV drugs may make other drugs used to treat PCP and toxoplasmosis less effective. Researchers want to test specific ARV drugs to see if they affect atovaquone, a drug used to treat PCP and toxoplasmosis.
- To see if ARV drugs atazanavir-ritonavir or efavirenz lower the blood levels of atovaquone.
The incidence of opportunistic infections such as Pneumocystis jirovecii pneumonia (PCP) and Toxoplasma gondii have substantially declined in patients with HIV infection due to potent combination antiretroviral (ARV) therapy and effective prophylaxis. The drug of choice for prophylaxis and treatment of PCP and toxoplasmosis is trimethoprim-sulfamethoxazole (TMP-SMX) and sulfadiazine, respectively. In patients who cannot tolerate these first line therapies, atovaquone is a common alternative. While generally considered safe and effective, a recent drug interaction study involving a single dose of combination tablet of atovaquone/proguanil (Malarone ) in HIV-infected patients showed that atovaquone plasma concentrations were significantly lowered (compared to healthy volunteers) by 75%, 74%, and 46% in patients taking the ARV medications efavirenz (EFV), lopinavir-ritonavir (LPV/r), and atazanavir-ritonavir (ATV/r), respectively. The mechanism of this drug interaction is unknown but is presumably due to induction of uridine diphosphate glucuronsosyltransferase (UGT) enzymes responsible for the metabolism of atovaquone. The magnitude of this interaction is such that it strongly suggests a clinically relevant drug interaction between atovaquone and the aforementioned ARVs. The purpose of this study is to determine whether HIV-infected subjects receiving ATV/r or EFV-containing ARV regimens, experience reductions in atovaquone exposure under steady state conditions compared to HIV-infected patients not receiving ARV therapy.
In this open-label study, 30 HIV-infected subjects will participate in 1 of 3 groups of 10 (Groups A, B, and C). Group A will consist of 10 subjects who are already receiving combination ARV therapy containing ATV/r; Group B will consist of 10 subjects already receiving combination ARV therapy containing EFV; and Group C will consist of 10 subjects who are not currently receiving ARV therapy. All subjects in Groups A, B, and C will be randomly assigned to either receive atovaquone 750 mg twice daily for 14 days (Phase 1) followed by a 2-6 week washout period, followed by atovaquone 1500 mg twice daily for 14 days (Phase 2), or vice versa. Pharmacokinetic (PK) sampling for atovaquone will occur on Day 14 of Phase 1 and 2.
Atovaquone PK parameters will be determined using non-compartmental methods with the WinNonlin professional computer program (version 5.2; Pharsight Corporation, Mountain View, CA). The following PK parameters will be compared among the groups: area under the concentration vs. time curve (AUC ?), maximum concentration (Cmax), apparent oral clearance (Cl/F), time to reach maximum concentration (Tmax), and half-life (T (Omega)). Data from this investigation will determine whether ATV/r and/or EFV alter the steady state PK of atovaquone in HIV-infected subjects. This information will assist clinicians in choosing appropriate alternative therapies for the treatment of PCP and toxoplasmosis in patients who are not candidates for first line therapies.
|Study Type ICMJE||Interventional|
|Study Phase||Phase 1|
|Study Design ICMJE||Allocation: Randomized
Endpoint Classification: Pharmacokinetics Study
Intervention Model: Crossover Assignment
Masking: Open Label
Primary Purpose: Treatment
|Study Arm (s)||Not Provided|
* Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
|Recruitment Status ICMJE||Recruiting|
|Estimated Enrollment ICMJE||100|
|Completion Date||Not Provided|
|Primary Completion Date||Not Provided|
|Eligibility Criteria ICMJE||
A subject will be considered eligible for this study only if all of the following criteria are met:
A subject will be ineligible for this study if 1 or more of the following criteria are met:
|Ages||18 Years to 70 Years|
|Accepts Healthy Volunteers||No|
|Location Countries ICMJE||United States|
|NCT Number ICMJE||NCT01479361|
|Other Study ID Numbers ICMJE||120017, 12-CC-0017|
|Has Data Monitoring Committee||Not Provided|
|Responsible Party||National Institutes of Health Clinical Center (CC)|
|Study Sponsor ICMJE||National Institutes of Health Clinical Center (CC)|
|Collaborators ICMJE||Not Provided|
|Information Provided By||National Institutes of Health Clinical Center (CC)|
|Verification Date||July 2013|
ICMJE Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP