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Belkhir L, Elens L, Zech F, Panin N, Vincent A, Yombi JC, Vandercam B, Haufroid V. Interaction between Darunavir and Etravirine Is Partly Mediated by CYP3A5 Polymorphism. PLoS One 2016; 11:e0165631. [PMID: 27788239 PMCID: PMC5082792 DOI: 10.1371/journal.pone.0165631] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 10/15/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To assess the impact of the loss-of-function CYP3A5*3 allele (rs776746, 6986A>G SNP) on darunavir (DRV) plasma concentrations. METHODS 135 HIV-1 infected patients treated with DRV-based therapy were included in the study and plasma samples were obtained immediately before drug intake in order to determine DRV trough concentrations using an ultra performance liquid chromatography method (UPLC) with diode-array detection (DAD). Noteworthy is the fact that in 16 (11.9%) patients, etravirine (ETR) was combined with DRV. CYP3A5 genotypes were determined using real time PCR method (TaqMan® genotyping assay). The patients were then classified into CYP3A5 expressors (CYP3A5*1 allele carriers) and non-expressors (CYP3A5*3 homozygous). Subsequently, the association between DRV plasma trough concentration ([DRV]plasma) and CYP3A5 genotype-based expression status was analyzed. RESULTS 45% of the patients were classified as CYP3A5 expressors. In the whole cohort, mean [DRV]plasma was not different between CYP3A5 expressors and non-expressors (1894ng/ml [CI95%: 1566-2290] versus 1737ng/ml [CI95%: 1468-2057], p = 0.43). However, in the subgroup of the 16 patients receiving DRV combined with ETR, a significantly lower [DRV]plasma was observed for CYP3A5 expressors when compared to non-expressors (1385ng/ml [CI95%:886.3-2165] versus 3141ng/ml [CI95%:2042-4831], p = 0.007). CONCLUSIONS Interaction between DRV and ETR is partly mediated by CYP3A5 polymorphism with lower DRV plasma trough concentrations in CYP3A5 expressors suggesting a specific ETR-driven CYP3A5 activation only in CYP3A5 expressors. Consequently, these patients might be more at risk of infra-therapeutic [DRV]plasma. This potentially important observation is a good illustration of a genotype-based drug interaction, which could also have considerable consequences if translated to other CYP3A5-metabolized drugs. Further investigations are thus needed to confirm this association and to explore its clinical impact, mainly in the African population among whom CYP3A5 expressors are more frequent, before recommending systematic CYP3A5 pre-emptive genotyping for DRV-ETR co-administration.
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Affiliation(s)
- Leïla Belkhir
- AIDS Reference Center, Department of Internal Medicine, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
- Louvain centre for Toxicology and Applied Pharmacology, Institut de recherche expérimentale et clinique, Université catholique de Louvain, Brussels, Belgium
- * E-mail:
| | - Laure Elens
- Louvain centre for Toxicology and Applied Pharmacology, Institut de recherche expérimentale et clinique, Université catholique de Louvain, Brussels, Belgium
- Integrated PharmacoMetrics, PharmacoGenomics and PharmacoKinetics, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Francis Zech
- AIDS Reference Center, Department of Internal Medicine, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Nadtha Panin
- Louvain centre for Toxicology and Applied Pharmacology, Institut de recherche expérimentale et clinique, Université catholique de Louvain, Brussels, Belgium
| | - Anne Vincent
- AIDS Reference Center, Department of Internal Medicine, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Jean Cyr Yombi
- AIDS Reference Center, Department of Internal Medicine, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Bernard Vandercam
- AIDS Reference Center, Department of Internal Medicine, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Vincent Haufroid
- Louvain centre for Toxicology and Applied Pharmacology, Institut de recherche expérimentale et clinique, Université catholique de Louvain, Brussels, Belgium
- Department of Clinical Chemistry, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
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Raltegravir Pharmacokinetics in Patients on Asunaprevir-Daclatasvir. Antimicrob Agents Chemother 2015; 59:7903-5. [PMID: 26438504 DOI: 10.1128/aac.01603-15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 10/01/2015] [Indexed: 12/28/2022] Open
Abstract
Raltegravir pharmacokinetics was studied in 20 patients included in the ANRS HC30 QUADRIH Study before and after addition of anti-hepatitis C virus (anti-HCV) quadritherapy, including pegylated-interferon-ribavirin and asunaprevir plus daclatasvir. Raltegravir pharmacokinetic parameters remained unchanged whether administered on or off anti-HCV therapy. In addition, concentrations of raltegravir, asunaprevir, and daclatasvir were not affected by liver cirrhosis. These data suggest that in human immunodeficiency virus (HIV)-HCV-coinfected patients, whether cirrhotic or not, asunaprevir and daclatasvir could be administered safely with raltegravir.
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Taburet AM, Sauvageon H, Grinsztejn B, Assuied A, Veloso V, Pilotto JH, De Castro N, Grondin C, Fagard C, Molina JM. Pharmacokinetics of Raltegravir in HIV-Infected Patients on Rifampicin-Based Antitubercular Therapy. Clin Infect Dis 2015; 61:1328-35. [PMID: 26105170 DOI: 10.1093/cid/civ477] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 06/08/2015] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Rifampicin (RIF) induces UGT1A1, an enzyme involved in raltegravir (RAL) elimination, thereby potentially lowering RAL exposure. We examined the pharmacokinetics of RAL in human immunodeficiency virus (HIV)-infected patients on RIF-based antitubercular therapy in the French National Agency for HIV/AIDS and Viral Hepatitis Research 12 180 Reflate Tuberculosis trial. METHODS Patients started RAL in combination with tenofovir disoproxil fumarate and lamivudine after initiation of RIF (10 mg/kg/day). In arm 1 (n = 21), they received 400 mg RAL twice daily; in arm 2 (n = 16), they received RAL 800 mg twice daily initially then 400 mg twice daily 4 weeks after RIF discontinuation. Pharmacokinetic sampling was performed over 12-hour periods, 4 weeks after initiation of RAL together with RIF (period 1), 4 weeks after RIF discontinuation (period 2), and after the RAL dose reduction in arm 2 (period 3). RESULTS In arm 1, the geometric mean ratio (GMR) between period 1 and period 2 was 0.94 (90% confidence interval [CI], .64-1.37) for the 12-hour area under the time-concentration curve (AUC0-12), and 0.69 (90% CI, .42-1.13) for the concentration at 12 hours (C12). In arm 2, the corresponding GMRs were 0.75 (90% CI, .48-1.17) and 1.10 (90% CI, .61-2.00) for period 1 vs period 2, and 1.10 (90% CI, .78-1.55) and 1.68 (90% CI, .88-3.23) for period 1 vs period 3. CONCLUSIONS The double dose of RAL overcompensated for RIF induction, but the standard dose was associated with only small decreases in AUC0-12 and C12 during RIF coadministration, warranting further evaluation in patients with HIV/tuberculosis coinfection. CLINICAL TRIALS REGISTRATION NCT0082231.
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Affiliation(s)
- Anne-Marie Taburet
- Hospital Bicetre, Assistance Publique-Hôpitaux de Paris, DHU Hepatinov; INSERM U1184, Center for Immunology of Viral Infections and Autoimmune Diseases, Université Paris-Sud, Kremlin Bicêtre
| | - Hélène Sauvageon
- Hospital Saint-Louis, Assistance Publique-Hôpitaux de Paris, France
| | - Beatriz Grinsztejn
- Instituto de Pesquisa Clinica Evandro Chagas, Fundaçao Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Alex Assuied
- Centre INSERM U897-Epidémiologie-Biostatistiques, Université de Bordeaux, Bordeaux, France
| | - Valdilea Veloso
- Instituto de Pesquisa Clinica Evandro Chagas, Fundaçao Oswaldo Cruz, Rio de Janeiro, Brazil
| | - José Henrique Pilotto
- Hospital General de Nova Iguaçu and Laboratório de AIDS e Imunologia Molecular, Rio de Janeiro, Brazil
| | | | - Carine Grondin
- Centre INSERM U897-Epidémiologie-Biostatistiques, Université de Bordeaux, Bordeaux, France
| | - Catherine Fagard
- Centre INSERM U897-Epidémiologie-Biostatistiques, Université de Bordeaux, Bordeaux, France
| | - Jean-Michel Molina
- Hospital Saint-Louis, Assistance Publique-Hôpitaux de Paris, France University Paris Diderot INSERM U941, Paris, France
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Kwon OK, Kim SS, Rhee JE, Kee MK, Park M, Oh HR, Choi JY. Drug susceptibility to etravirine and darunavir among Human Immunodeficiency Virus Type 1-derived pseudoviruses in treatment-experienced patients with HIV/AIDS in South Korea. Virol J 2015; 12:53. [PMID: 25879840 PMCID: PMC4404133 DOI: 10.1186/s12985-015-0283-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 03/19/2015] [Indexed: 11/25/2022] Open
Abstract
Background In South Korea, about 20 types of antiretroviral drugs are used in the treatment of patients with human immunodeficiency virus/acquired immune deficiency syndrome. Since 2010, raltegravir, etravirine, and darunavir have been spotlighted as new drugs for highly active antiretroviral therapy (HAART)-experienced adults with resistant HIV-1 in South Korea. In this study, we investigated potential susceptibility of pseudoviruses derived from treatment-experienced Korean patients to etravirine vs efavirenz and to darunavir vs amprenavir and indinavir using a modified single-round assay. Methods Pseudoviruses derived from nine treatment-experienced patients infected with HIV-1 were investigated by comparison with the wild-type strain pNL4-3. The 50% inhibitory concentration (IC50) values were calculated and drug susceptibility was compared. The intensity of genotypic drug resistance was classified based on the ‘SIR’ interpretation of the Stanford data base. Results Drug susceptibility was generally higher for etravirine and darunavir compared with efavirenz, amprenavir, and indinavir in pseudoviruses derived from treatment-experienced patients. Pseudoviruses derived from patients KRB4025 and KRB8014, who exhibited long-term use of protease inhibitors, showed an outside of tested drug concentration, especially for amprenavir and indinavir. However, they exhibited a lower fold-change in resistance to darunavir. Conclusions Etravirine and darunavir have been used in HAART since 2010 in South Korea. Therefore, these antiretroviral drugs together with other newly introduced antiretroviral drugs are interesting for the optimal treatment of patients with treatment failure. This study may help to find a more effective HAART in the case of HIV-1 infected patients that have difficulty being treated.
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Affiliation(s)
- Oh-Kyung Kwon
- Department of Immunology and Pathology, Division of AIDS, Korea National Institute of Health, Osong, Republic of Korea.
| | - Sung Soon Kim
- Department of Immunology and Pathology, Division of AIDS, Korea National Institute of Health, Osong, Republic of Korea.
| | - Jee Eun Rhee
- Department of Immunology and Pathology, Division of AIDS, Korea National Institute of Health, Osong, Republic of Korea.
| | - Mee-Kyung Kee
- Department of Immunology and Pathology, Division of AIDS, Korea National Institute of Health, Osong, Republic of Korea.
| | - Mina Park
- Department of Immunology and Pathology, Division of AIDS, Korea National Institute of Health, Osong, Republic of Korea.
| | - Hye-Ri Oh
- Department of Immunology and Pathology, Division of AIDS, Korea National Institute of Health, Osong, Republic of Korea.
| | - Ju-Yeon Choi
- Department of Immunology and Pathology, Division of AIDS, Korea National Institute of Health, Osong, Republic of Korea.
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Barau C, Braun J, Vincent C, Haim-Boukobza S, Molina JM, Miailhes P, Fournier I, Aboulker JP, Vittecoq D, Duclos-Vallée JC, Taburet AM, Teicher E, Teicher E, Duclos-Vallée JC, Aboulker JP, Braun J, Fournier I, Vincent C, Arulananthan A, Eliette V, Euphrasie F, Guillon B, Ralaimazava P, Haïm-Boukobza S, Roque-Afonso AM, Bonhomme-Faivre L, Rudant E, Taburet AM, Aboulker J, Bonhomme-Faivre L, Braun J, Couffin-Cadiergues S, Delaugerre C, Durand F, Vittecoq D, Flandre P, Garraffo R, Ghosn J, Marraud A, Pageaux G, Derradji O, Bolliot C, Churaqui F, Antonini T, Coilly A, Ichai P, Ogier O, Belnard M, Molina JM, De Lastours V, Gazaignes S, Ponscarme D, Sauvageon H, Miailhes P, Koffi J, Radenne S, Brochier C. Pharmacokinetic Study of Raltegravir in HIV-Infected Patients With End-Stage Liver Disease: The LIVERAL-ANRS 148 Study. Clin Infect Dis 2014; 59:1177-84. [DOI: 10.1093/cid/ciu515] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Interindividual and Intra-Individual Variabilities of Darunavir and Ritonavir Plasma Trough Concentrations in Multidrug Experienced HIV Patients Receiving Salvage Regimens. Ther Drug Monit 2013; 35:785-90. [DOI: 10.1097/ftd.0b013e31829ad690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Furtado J, Madruga JV, Bicudo EL, da Eira M, Lopes MI, Netto EM, Santini-Oliveira M, Leite OH, Machado AA, Tupinambas U, de Andrade Neto JL, Lima MP, de Jesus Pedro R, Miranda AF, Lewi DS, Santos BR, Portsmouth S, Wajsbrot DB, Cassoli LM. Safety and immunovirologic outcomes with maraviroc combination regimens in patients with a history of past treatment failures and virologic resistance in Brazil: an open-label, multicenter phase 3b study. AIDS Res Hum Retroviruses 2013; 29:1203-10. [PMID: 23731330 DOI: 10.1089/aid.2012.0330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Maraviroc is a first-in-class chemokine coreceptor type-5 (CCR5) antagonist with demonstrated immunovirologic activity in treatment-experienced (TE) patients with CCR5 (R5)-tropic HIV-1; however, experience in regimens containing newer antiretroviral agents is limited. The primary objective of this 96-week open-label, noncomparative, multicenter Phase 3b study (NCT00478231) was to assess the safety of maraviroc in combination with optimized background therapy (OBT), which could include recently introduced agents such as darunavir and raltegravir in TE patients in Brazil with R5 HIV-1 and limited therapeutic options. Immunovirologic activity was a secondary endpoint. Of 638 patients screened, 206 were treated and 125 completed the study. Approximately 70% were male; the mean age was 43.2 years. Most patients (65.0%) received an OBT combination of protease inhibitor plus nucleoside reverse transcriptase inhibitor. Adverse event (AE) and treatment-related AE incidence was 91.3% and 36.9%, respectively. The most common AEs were diarrhea, nasopharyngitis, and headache. Serious AEs and treatment-related serious AEs occurred in 16.5% and 4.4% of patients. Only eight patients (3.9%) discontinued due to AEs. Few AIDS-defining events were observed (4.9%). The proportion of patients with viral load <400 copies/ml increased from 2.4% at baseline to 43.9% at week 8, remaining >40% until week 48. At the end of treatment, 26.7% of patients had a viral load <400 copies/ml. Median CD4(+) cell count increased throughout the study; the mean change from baseline to end of treatment was 174.1 cells/μl. In conclusion, maraviroc, combined with different agents from multiple classes, was well tolerated in highly TE patients. Maraviroc plus OBT was associated with an immunovirologic response in this population.
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Affiliation(s)
- Juvencio Furtado
- Faculdade de Medicina do ABC and Hospital Heliópolis, São Paulo, Brazil
| | - José V. Madruga
- Centro de Referência e Treinamento DST/AIDS, São Paulo, Brazil
| | - Eliana L. Bicudo
- Mixed Unit no. 1–Reference Center no. 1, STD AIDS (Day Hospital), Brasilia/DF, Brazil
| | | | - Max I.B.F. Lopes
- Casa da AIDS, Divisão de Moléstias Infecciosas e Parasitárias do HC, FMUSP, São Paulo, Brazil
| | - Eduardo M. Netto
- UFBA, Hospital Universitário Prof. Edgard Santos, Salvador, Brazil
| | | | | | - Alcyone A. Machado
- Faculdade de Medicina de Ribeirão Preto, Clinical Hospital, Special Unit of Infectious Diseases, Ribeirão Preto, Brazil
| | - Unaí Tupinambas
- Federal University of Minas Gerais School of Medicine, Minas Gerais, Brazil
| | | | - Maria P.J.S. Lima
- Hospital e Maternidade Celso Pierro da Pontifícia Universidade Católica de Campinas, Campinas, Brazil
| | | | | | - David S. Lewi
- Universidade Federal de São Paulo, Hospital São Paulo, São Paulo, Brazil
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Characterization of binding of raltegravir to plasma proteins. Antimicrob Agents Chemother 2013; 57:5147-50. [PMID: 23856784 DOI: 10.1128/aac.00625-13] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
The objective of this study was to characterize raltegravir (RAL) binding to albumin and alpha-1-acid glycoprotein (AAG). Unbound and bound RAL were separated by ultrafiltration. The association constant (Ka) was estimated by a graphical method. In HIV-infected patients, the average plasma protein binding is 76%. RAL did not bind to AAG but bound to nonsaturable, low-affinity albumin sites with an n (number of sites) · Ka product of 9.8 × 10(2) liters/mol. A pH increase of 0.2 U led to a 2% increase in the bound fraction.
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Dailly E, Allavena C, Bouquié R, Deslandes G, Raffi F, Jolliet P. Effect of efavirenz, nevirapine, etravirine, and raltegravir administration on the pharmacokinetics of ritonavir-boosted darunavir in a population of HIV-infected patients. AIDS Res Hum Retroviruses 2013; 29:42-6. [PMID: 23148588 DOI: 10.1089/aid.2012.0188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract The influence of efavirenz, etravirine, raltegravir, and nevirapine administration on the pharmacokinetics of ritonavir-boosted darunavir was investigated using population pharmacokinetics analysis. The population was composed of 142 patients infected with HIV: darunavir plus nucleoside/nucleotide reverse transcriptase inhibitors (NRTI), 54 patients (group A); darunavir plus efavirenz±NRTI, 4 patients (group B); darunavir plus etravirine±NRTI, 5 patients (group C); darunavir plus nevirapine±NRTI, 21 patients (group D); darunavir plus raltegravir±NRTI, 38 patients (group E); and darunavir plus raltegravir and etravirine±NRTI, 20 patients (group F). A significant increase in darunavir clearance in combination with nevirapine (+66%) and efavirenz (+235%) was observed. A significant decrease (p<0.05) in trough plasma concentration was observed in groups B and D compared with the other groups. Our study indicates that the combination of ritonavir-boosted darunavir and etravirine or raltegravir has no significant influence on the pharmacokinetics of darunavir in contrast to the combination of ritonavir-boosted darunavir and nevirapine or efavirenz, which involves an increase in darunavir clearance and a decrease in the plasma concentration of darunavir.
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Affiliation(s)
- Eric Dailly
- Clinical Pharmacology Department, CHU de Nantes, Nantes, France
- EA 4275 Biostatistique, Pharmacoépidémiologie et Mesures Subjectives en Santé, Faculté de Médecine–Pharmacie, Université de Nantes, Nantes, France
| | - Clotilde Allavena
- Infectious Diseases Department, CHU de Nantes, Nantes, France
- EA 4271 Immunovirologie et Polymorphisme Génétique, Faculté de Médecine-Pharmacie, Université de Nantes, Nantes, France
| | - Regis Bouquié
- Clinical Pharmacology Department, CHU de Nantes, Nantes, France
- EA 4275 Biostatistique, Pharmacoépidémiologie et Mesures Subjectives en Santé, Faculté de Médecine–Pharmacie, Université de Nantes, Nantes, France
| | | | - François Raffi
- Infectious Diseases Department, CHU de Nantes, Nantes, France
- EA 4271 Immunovirologie et Polymorphisme Génétique, Faculté de Médecine-Pharmacie, Université de Nantes, Nantes, France
| | - Pascale Jolliet
- Clinical Pharmacology Department, CHU de Nantes, Nantes, France
- EA 4275 Biostatistique, Pharmacoépidémiologie et Mesures Subjectives en Santé, Faculté de Médecine–Pharmacie, Université de Nantes, Nantes, France
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Calin R, Paris L, Simon A, Peytavin G, Wirden M, Schneider L, Valantin MA, Tubiana R, Agher R, Katlama C. Dual raltegravir/etravirine combination in virologically suppressed HIV-1-infected patients on antiretroviral therapy. Antivir Ther 2012; 17:1601-4. [PMID: 22941896 DOI: 10.3851/imp2344] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND The combination of raltegravir (RAL) and etravirine (ETR) represents a novel antiretroviral treatment option in patients with toxicity or long-term exposure to standard therapies including protease inhibitors (PI) and nucleoside reverse transcriptase inhibitors (NRTI). The objective of this study was to evaluate the capacity of dual RAL/ETR therapy to maintain virological suppression in HIV-1 patients under effective antiretroviral therapy (ART). METHODS Using the Nadis database we retrospectively identified all patients in our centre who were switched from different ART regimens to ETR 200 mg twice daily plus RAL 400 mg twice daily prior to February 2010, having a suppressed HIV-1 plasma viral load (pVL<200 copies/ml) at the moment of switch. Patients already on RAL or ETR at baseline were not excluded from the study. Treatment failure was defined as two consecutive pVL>50 copies/ml or discontinuation of RAL/ETR for any reason. RESULTS A total of 18 patients were included. Median baseline characteristics were: age 48 years (IQR 45-56), duration of ART 14 years (IQR 13-16), duration of viral suppression 6 years (IQR 5-9), duration of NRTI exposure 11 years (IQR 8-14) and PI exposure 6 years (IQR 3-9). In intent-to-treat analysis, the efficacy at 6 months of follow-up was 94.4% (n=17/18, 95% CI 74.2, 99%) and 83.3% (n=15/18, 95% CI 60.7, 94.1%) at 12 months. In per-protocol analysis, the efficacy at 12 months was 100% (n=15/15, 95% CI 80.6, 100%). No tolerability-related treatment discontinuation was recorded. CONCLUSIONS This study, although on a limited number of patients, suggests that raltegravir plus etravirine represents a potential option of NRTI/PI-sparing strategy, deserving further investigation in randomized studies.
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Affiliation(s)
- Ruxandra Calin
- Infectious Diseases Department, Hôpital Pitié-Salpêtrière, Paris, France
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11
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Do VT, Higginson RT, Fulco PP. Raltegravir dosage adjustment in HIV-infected patients receiving etravirine. Am J Health Syst Pharm 2011; 68:2049-54. [DOI: 10.2146/ajhp110083] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- Vi T. Do
- Internal Medicine, The Johns Hopkins Hospital, Baltimore, MD
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12
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In vitro activity of antiretroviral drugs against Plasmodium falciparum. Antimicrob Agents Chemother 2011; 55:5073-7. [PMID: 21876053 DOI: 10.1128/aac.05130-11] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Malaria and HIV infection are both very common in many developing countries. With the increasing availability of therapy for HIV infection, it was of interest to determine whether antiretroviral drugs exert antimalarial effects. We therefore tested the in vitro activity of 19 antiretroviral drugs against the W2 and 3D7 strains of Plasmodium falciparum at concentrations up to 50 μM. None of 5 tested nucleoside reverse transcriptase inhibitors demonstrated activity. Two nonnucleoside reverse transcriptase inhibitors, efavirenz (mean 50% inhibitory concentration [IC(50)] of 22 to 30 μM against the two strains) and etravirine (3.1 to 3.4 μM), were active; nevirapine was not active. Also active were the fusion inhibitor enfuvirtide (6.2 to 7.9 μM) and the entry inhibitor maraviroc (15 to 21 μM). Raltegravir was not active. However, for all active drugs mentioned above, the IC(50)s were considerably greater than the concentrations achieved with standard dosing. The effects most likely to be clinically relevant were with HIV protease inhibitors. Of the tested compounds, activity was seen with lopinavir (2.7 to 2.9 μM), atazanavir (3.3 to 13.0 μM), saquinavir (5.0 to 12.1 μM), nelfinavir (6.5 to 12.1 μM), ritonavir (9.5 to 10.9 μM), tipranavir (15.5 to 22.3 μM), and amprenavir (28.1 to 40.8) but not darunavir. Lopinavir was active at levels well below those achieved with standard dosing of coformulated lopinavir-ritonavir. Lopinavir also demonstrated modest synergy with the antimalarial lumefantrine (mean fractional inhibitory concentration index of 0.66 for W2 and 0.53 for 3D7). Prior data showed that lopinavir-ritonavir also extends the pharmacokinetic exposure of lumefantrine. Thus, when used to treat HIV infection, lopinavir-ritonavir may have clinically relevant antimalarial activity and also enhance the activity of antimalarials.
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Abstract
The development of multiple agents with potent antiretroviral activity against HIV has ushered in a new age of optimism in the management of patients infected with the virus. However, the viruses' dynamic ability to develop resistance against these agents necessitates the investigation of novel targets for viral suppression. Raltegravir represents a first-in-class agent targeting the HIV integrase enzyme, which is responsible for integration of virally encoded DNA into the host genome. Over the last 5 years, clinical trials data has demonstrated an increasing role for raltegravir in the management of both treatment-experienced and treatment-naïve HIV-1-infected patients. This review focuses on the evidence supporting raltegravir's efficacy in an array of clinical settings. Other HIV-1 integrase inhibitors in development are also briefly discussed.
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Affiliation(s)
- N Lance Okeke
- Duke University Medical Center, Department of Hospital Medicine, Durham Regional Hospital, Durham, North Carolina, USA
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Switch from enfuvirtide to raltegravir lowers plasma concentrations of darunavir and tipranavir: a pharmacokinetic substudy of the EASIER-ANRS 138 trial. Antimicrob Agents Chemother 2011; 55:3613-5. [PMID: 21576452 DOI: 10.1128/aac.01827-10] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
We compared tipranavir and darunavir concentrations measured at steady state in 20 human immunodeficiency virus (HIV)-infected patients enrolled in the EASIER-ANRS 138 clinical trial who switched from enfuvirtide to raltegravir while maintaining the same background regimen. The geometric mean ratios of the observed predose concentration (C(trough)), maximum concentration of drug observed in plasma (C(max)), and area under the plasma concentration-time curve (AUC) before (day 0) and after (week 24) the switch were 0.49, 0.76, and 0.67 and 0.82, 0.68, and 0.64 for tipranavir and darunavir, respectively. The virologic consequences of these drug interactions have yet to be determined.
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Reply to comment on ‘pharmacokinetics of etravirine, raltegravir and darunavir/ritonavir in treatment experienced patients’. AIDS 2011. [DOI: 10.1097/qad.0b013e328345ee4b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Reply to 'Pharmacokinetics of etravirine, raltegravir and darunavir/ritonavir in treatment experienced patients'. AIDS 2011; 25:1012-3; author reply 1011-2. [PMID: 21412129 DOI: 10.1097/qad.0b013e3283463c84] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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