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A Drug-drug Interaction Study Between Daclatasvir and Atazanavir/Ritonavir or Atazanavir/Cobicistat (DATE-4)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT02565888
Recruitment Status : Completed
First Posted : October 1, 2015
Last Update Posted : January 26, 2016
Sponsor:
Information provided by (Responsible Party):
Radboud University

Brief Summary:
This study aims to provide the evidence that 150mg of cobicistat will have the same effect on the pharmacokinetics of daclatasvir 30mg QD as 100mg of ritonavir, when given together with atazanavir 300mg.

Condition or disease Intervention/treatment Phase
Hepatitis C HIV Drug: Daclatasvir Drug: Atazanavir Drug: Ritonavir Drug: Cobicistat Phase 1

Detailed Description:

Approximately 20-25% of the total number of HIV-infected patients is co-infected with HCV which translates to 6-8 million persons worldwide. Combined treatment of HIV and HCV is complicated by the risk of drug-drug interactions as both the direct acting antiviral agents (DAAs) for HCV as the antiretroviral agents for HIV are substrates of cytochrome P450 (CYP450) or various membrane transporters, and also have the capacity to influence these systems. A careful selection of the appropriate regimens and if needed adjusted doses is key for optimal treatment of both viral infections.

Daclatasvir is a recently approved anti-HCV agent that is a CYP3A4 substrate but does not affect CYP450 itself. It is also a moderate inhibitor of various membrane transporters such as organic anion-transporting polypeptide (OATP1B1), P-glycoprotein (P-gP), and organic cation transporters (OCT2).

Atazanavir/ritonavir is one of the preferred antiretroviral agents in all international guidelines. Ritonavir is used as a boosting agents based on its inhibitory effects on CYP3A. This also inhibits CYP3A-mediated metabolism of daclatasvir and when atazanavir/ritonavir is combined with daclatasvir, it is recommended to reduce the dose of daclatasvir from 60mg QD to 30mg QD.

Cobicistat has recently been approved as an alternative booster of atazanavir at a dose of 150mg QD. It is expected that cobicistat will inhibit CYP3A mediated metabolism of daclatasvir in a similar manner as ritonavir does, but there are no clinical data to support this. As cobicistat lacks some of the adverse events associated with ritonavir use, the use of cobicistat, including as a booster of atazanavir, is likely to increase.

This study aims to provide the evidence that 150mg of cobicistat will have the same effect on the pharmacokinetics of daclatasvir 30mg QD as 100mg of ritonavir, when given together with atazanavir 300mg.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 16 participants
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: None (Open Label)
Official Title: A Drug-drug Interaction Study Between the Novel Anti-HCV Agent Daclatasvir and the Antiretroviral Agents Atazanavir/Ritonavir or Atazanavir/Cobicistat in Healthy Volunteers
Study Start Date : November 2015
Actual Primary Completion Date : January 2016
Actual Study Completion Date : January 2016

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Drug Reactions

Arm Intervention/treatment
Active Comparator: Treatment A
Daclatasvir 30 mg QD film-coated tablet + atazanavir 300mg QD hard capsule + ritonavir 100mg QD from film-coated tablet for 10 days.
Drug: Daclatasvir
Other Name: Daklinza

Drug: Atazanavir
Other Name: Reyataz

Drug: Ritonavir
Other Name: Norvir

Experimental: Treatment B
Daclatasvir 30 mg QD film-coated tablet + atazanavir 300mg QD hard capsule + cobicistat 150mg QD from film-coated tablet for 10 days.
Drug: Daclatasvir
Other Name: Daklinza

Drug: Atazanavir
Other Name: Reyataz

Drug: Cobicistat
Other Name: Tybost




Primary Outcome Measures :
  1. AUC [ Time Frame: up to 24 hours after administration ]

Secondary Outcome Measures :
  1. Adverse events [ Time Frame: 4 weeks ]
    adverse events will be collected up to 4 weeks in total (entire study)



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 55 Years   (Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

  1. Subject is at least 18 and not older than 55 years at screening.
  2. Subject does not smoke more than 10 cigarettes, 2 cigars, or 2 pipes per day for at least 3 months prior to Day 1.
  3. Subject has a Quetelet Index (Body Mass Index) of 18 to 30 kg/m2, extremes included.
  4. Subject is able and willing to sign the Informed Consent Form prior to screening evaluations.
  5. Subject is in good age-appropriate health condition as established by medical history, physical examination, and electrocardiography, results of biochemistry, hematology and urinalysis testing within 4 weeks prior to day 1. Results of biochemistry, hematology and urinalysis testing should be within the laboratory's reference ranges (see Appendix A). If laboratory results are not within the reference ranges, the subject is included on condition that the Investigator judges that the deviations are not clinically relevant. This should be clearly recorded.
  6. Subject has a normal blood pressure and pulse rate, according to the Investigator's judgment.

Exclusion Criteria:

  1. Creatinine clearance below 60mL/min.
  2. Documented history of sensitivity/idiosyncrasy to medicinal products or excipients.
  3. Positive HIV test.
  4. Positive hepatitis B or C test.
  5. Pregnant female (as confirmed by an hCG test performed less than 4 weeks before day 1) or breast-feeding female. Female subjects of childbearing potential without adequate contraception, e.g. hysterectomy, bilateral tubal ligation, (non-hormonal) intrauterine device, total abstinence, double barrier methods, or two years post-menopausal. They must agree to take precautions in order to prevent a pregnancy throughout the entire conduct of the study.
  6. Therapy with any drug (for two weeks preceding Day 1), except for acetaminophen (max 2 gram/day).
  7. Relevant history or presence of pulmonary disorders (especially COPD), cardiovascular disorders, neurological disorders (especially seizures and migraine), psychiatric disorders, gastro-intestinal disorders, renal and hepatic disorders (clinically relevant increased ALAT/ASAT or hyperbilirubinemia) hormonal disorders (especially diabetes mellitus), coagulation disorders.
  8. Relevant history or current condition that might interfere with drug absorption, distribution, metabolism or excretion.
  9. History of or current abuse of drugs, alcohol or solvents.
  10. Inability to understand the nature and extent of the study and the procedures required.
  11. Participation in a drug study within 60 days prior to Day 1.
  12. Donation of blood within 60 days prior to Day 1.
  13. Febrile illness within 3 days before Day 1.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02565888


Locations
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Netherlands
CRCN, Radboud University Medical Center
Nijmegen, Netherlands
Sponsors and Collaborators
Radboud University
Investigators
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Principal Investigator: David Burger, PharmD, PhD Radboud University
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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Responsible Party: Radboud University
ClinicalTrials.gov Identifier: NCT02565888    
Other Study ID Numbers: UMCN-AKF 14.12
First Posted: October 1, 2015    Key Record Dates
Last Update Posted: January 26, 2016
Last Verified: January 2016
Keywords provided by Radboud University:
Hepatitis C
HIV
atazanavir
ritonavir
daclatasvir
cobicistat
Additional relevant MeSH terms:
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Hepatitis C
Hepatitis
Liver Diseases
Digestive System Diseases
Hepatitis, Viral, Human
Virus Diseases
RNA Virus Infections
Flaviviridae Infections
Ritonavir
Atazanavir Sulfate
Cobicistat
HIV Protease Inhibitors
Protease Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Anti-HIV Agents
Anti-Retroviral Agents
Antiviral Agents
Anti-Infective Agents
Cytochrome P-450 CYP3A Inhibitors
Cytochrome P-450 Enzyme Inhibitors