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Arısoy M, Saydam M, Dolaksız YE, Demirbaş Ö, Talay Ç, Sağlam O, Demiray G, Kurtoğlu ED, Oktay AN. Evaluation of Pharmacokinetics of a BCS Class III Drug with Two Different Study Designs: Tenofovir Alafenamide Monofumarate Film-coated Tablet. AAPS PharmSciTech 2024; 25:123. [PMID: 38816624 DOI: 10.1208/s12249-024-02835-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/08/2024] [Indexed: 06/01/2024] Open
Abstract
Tenofovir alafenamide (TAF) is a BCS Class III compound and an oral pro-drug of Tenofovir (TFV) with limited oral bioavailability. The bioavailability of the oral intake increases with food as a result of the low stability of the active substance in the stomach. The reference drug is "Vemlidy® 25 mg Film Tablet", which contains 25 mg of TAF in "hemifumarate" form, is under patent protection until 15.08.2032 by Gilead, and so the "monofumarate" form was used in the present study. At first, a pilot study was conducted involving 12 subjects under fed conditions. The results of the pilot study revealed the test and reference products were not bioequivalent, as a result of insufficient statistical power and high inter-subject variability. Secondly, a physiologically based pharmacokinetic (PBPK) simulation was performed based on the pilot study results and literature data. Finally, the power of the design was increased and the pivotal study design was optimized into a four-period, full-replicated, cross-over study with 34 subjects under fed conditions and it was concluded that the test and reference products were bioequivalent. In conclusion, the present study proved the importance of a correct study design with higher statistical power for a BCS Class III compound with high variability, to present the pharmacokinetics.
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Affiliation(s)
- Mustafa Arısoy
- Drogsan Pharmaceuticals, 1370 St. No:7, Oğuzlar District, Balgat, Ankara, 06520, Türkiye
| | - Mehtap Saydam
- Drogsan Pharmaceuticals, 1370 St. No:7, Oğuzlar District, Balgat, Ankara, 06520, Türkiye.
| | - Yasemin Ekin Dolaksız
- Drogsan Pharmaceuticals, 1370 St. No:7, Oğuzlar District, Balgat, Ankara, 06520, Türkiye
| | - Özge Demirbaş
- Drogsan Pharmaceuticals, 1370 St. No:7, Oğuzlar District, Balgat, Ankara, 06520, Türkiye
| | - Çağrı Talay
- Drogsan Pharmaceuticals, 1370 St. No:7, Oğuzlar District, Balgat, Ankara, 06520, Türkiye
| | - Onursal Sağlam
- Novagenix Bioanalytical Drug R&D Centre, Balıkhisar, Özal Av. No:664, Akyurt, Ankara, 06970, Türkiye
| | - Gökçe Demiray
- Novagenix Bioanalytical Drug R&D Centre, Balıkhisar, Özal Av. No:664, Akyurt, Ankara, 06970, Türkiye
| | - Emel Doğan Kurtoğlu
- Novagenix Bioanalytical Drug R&D Centre, Balıkhisar, Özal Av. No:664, Akyurt, Ankara, 06970, Türkiye
| | - Ayşe Nur Oktay
- University of Heath Science, Faculty of Pharmacy, EmrahEtlik, Keçiören, Ankara, 06018, Türkiye
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Ngongondo M, Ritz J, Hughes MD, Matoga M, Hosseinipour MC. Discontinuation of tenofovir disoproxil fumarate from initial ART regimens because of renal adverse events: An analysis of data from four multi-country clinical trials. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002648. [PMID: 38175824 PMCID: PMC10766173 DOI: 10.1371/journal.pgph.0002648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/02/2023] [Indexed: 01/06/2024]
Abstract
Tenofovir disoproxil fumarate (TDF), a potent and commonly used antiretroviral drug, is associated with renal tubular dysfunction and renal adverse events. We evaluated the frequency of, time to, and baseline risk factors for discontinuing TDF from initial antiretroviral therapy (ART) regimens because of renal adverse events from presumed tenofovir renal toxicity. We conducted an observational cohort study as a secondary analysis of data from four clinical trials conducted mainly in low- and middle-income countries. We included ART naïve participants living with HIV who started TDF-containing ART regimens in the trials. Participants had to have estimated creatinine clearance (eCrCl) equal to or greater than 60ml/min before starting ART. The primary outcome was the first instance of discontinuing TDF because of renal adverse events attributed to tenofovir renal toxicity during the first 48 weeks after starting ART. We evaluated the cumulative incidence of discontinuing TDF and associated risk factors using Fine and Gray competing risk regression models with a backward elimination variable selection strategy. There were 2802 ART-naïve participants who started TDF-containing ART from the four clinical trials were included in the analysis. Fifty-eight percent were female, the median age was 34 years, and 87% had CD4 cell counts less than 200 cells/μl. Sixty-four participants (2.4%, 95% CI 1.7%-2.8%) discontinued TDF due to renal adverse events. Among the 64 participants, the median time to discontinue TDF was 9.4 weeks (IQR: 3.4-20.7 weeks). From multivariable Fine and Gray regression models, risk factors for discontinuing TDF were older age, CD4 cell count <200 cells/μl, presence and severity of anemia, and eCrCl <90 ml/min. The risk of discontinuing TDF because of renal adverse events was low in participants initiating TDF-containing ART with advanced HIV and normal renal function, attesting to the tolerability of TDF in ART in low- and middle-income countries.
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Affiliation(s)
| | - Justin Ritz
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | - Michael D. Hughes
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | | | - Mina C. Hosseinipour
- UNC Project Malawi, Lilongwe, Malawi
- The University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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Phuphuakrat A, Pasomsub E, Chantratita W, Mahasirimongkol S, Disthabanchong S, Sungkanuparph S, Kiertiburanakul S. Risk Factors of Renal Tubular Dysfunction in Thai People Living with HIV Receiving Tenofovir Disoproxil Fumarate. J Int Assoc Provid AIDS Care 2022; 21:23259582221134751. [PMID: 36314476 PMCID: PMC9623366 DOI: 10.1177/23259582221134751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Tenofovir disoproxil fumarate (TDF) associates with renal tubular dysfunction (RTD) in some people living with HIV (PLWH). We studied clinical and genetic factors associated with RTD in Thai PLWH receiving TDF. RTD was diagnosed in 13 of 65 (20%) patients. The median (interquartile range) age and CD4 cell counts were 43.8 (40.4-50.9) years and 554 (437-716) cells/mm3, respectively. The median duration of TDF use was 46.9 (31.5-54.1) months. Univariate logistic regression demonstrated body mass index (BMI), concomitant use of protease inhibitor (PI), hyperlipidemia, and homozygous C/C SNP rs1059751 of ABCC4 gene as predisposing factors of RTD. In multivariate model, concomitant use of PI [adjusted odds ratio (aOR) 11.39; 95% confidence interval (CI), 1.59- 81.56; P = 0.015], hyperlipidemia (aOR 8.59; 95% CI, 1.46-50.40; P = 0.017), and BMI (aOR 0.76; 95% CI, 0.59-0.98; P = 0.037) remained associated with RTD in patients receiving TDF. PLWH receiving TDF with the presence of these factors should be closely monitored for RTD.
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Affiliation(s)
- Angsana Phuphuakrat
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital,
Bangkok, Thailand,Sasisopin Kiertiburanakul, Division of
Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi
Hospital, Mahidol University, Bangkok, 10400, Thailand.
| | - Ekawat Pasomsub
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital,
Bangkok, Thailand
| | - Wasun Chantratita
- Center for Medical Genomics, Faculty of Medicine Ramathibodi
Hospital, Mahidol University, Bangkok, Thailand
| | - Surakameth Mahasirimongkol
- Division of Genomic Medicine and Innovation Support, Department of
Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand
| | - Sinee Disthabanchong
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital,
Bangkok, Thailand
| | - Somnuek Sungkanuparph
- Chakri Naruebodindra Medical Institute, Faculty of Medicine
Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand
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Role of plasmatic and urinary concentration of tenofovir disoproxil fumarate in a cohort of patients affected by chronic hepatitis B. Arch Virol 2022; 167:1669-1674. [DOI: 10.1007/s00705-022-05466-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 03/26/2022] [Indexed: 11/25/2022]
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Tenofovir plasma trough concentrations in people with HIV treated with doravirine versus other antiretroviral regimens. AIDS 2021; 35:2551-2553. [PMID: 34870935 DOI: 10.1097/qad.0000000000003045] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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ABCC4 single-nucleotide polymorphisms as markers of tenofovir disoproxil fumarate-induced kidney impairment. THE PHARMACOGENOMICS JOURNAL 2021; 21:586-593. [PMID: 33850298 DOI: 10.1038/s41397-021-00235-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 03/16/2021] [Accepted: 03/23/2021] [Indexed: 02/02/2023]
Abstract
Recently, the use of antiretroviral drug tenofovir disoproxil fumarate (TDF) is increased, thanks to the new co-formulation with doravirine, the availability of booster-free regimens, and its advantageous lipid-lowering effect. The aim of our study was to identify genetic markers that contribute to assess the risk of TDF-related renal toxicity. We have retrospectively investigated, in 179 HIV positive patients treated with TDF, the association between the main variants in ABCC2, ABCC4, and ABCC10 genes and four safety endpoints, three clinically relevant as renal outcomes and a higher tenofovir plasma concentration. In patients with an annual eGFR decline >5 mL/min/1.73 m2 a difference in genotype frequencies was observed for ABCC10 c.1875 + 526 G>A (3 subjects AA vs. 44 GG + GA, p = 0.045). In patients with an eGFR decrement >25%, plus a decline in GFR category and TDF discontinuation, a difference was observed for ABCC4 c.*38T>G (35 subjects TG + GG vs. 18 TT, p = 0.052). At univariate analysis OR was 1.39 [(95% CI 1.00-1.96) p = 0.054] and at multivariate analysis OR was 1.49 [(95% CI 1.00-2.22) p = 0.049]. The stronger associations were found between the tenofovir accumulation and ABCC4 c.*38T>G and c.3348G>A: the percentage of these patients was higher in the TG + GG (p = 0.011) and in the AA (p = 0.004) genotype, respectively. The logistic regression analysis confirmed these significant relationships. No significant association was observed in patients with eGFR < 60 mL/min/1.73m2 and with the studied ABCC2 polymorphisms. Our results show a major role for a combined determination of ABCC4/ABCC10 variants as an indicator of tenofovir toxicity in the clinical practice.
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