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Jucker BM, Fuchs EJ, Lee S, Damian V, Galette P, Janiczek R, Macura KJ, Jacobs MA, Weld ED, Solaiyappan M, D'Amico R, Shaik JS, Bakshi K, Han K, Ford S, Margolis D, Spreen W, Gupta MK, Hendrix CW, Patel P. Multiparametric magnetic resonance imaging to characterize cabotegravir long-acting formulation depot kinetics in healthy adult volunteers. Br J Clin Pharmacol 2021; 88:1655-1666. [PMID: 34240449 PMCID: PMC9290983 DOI: 10.1111/bcp.14977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/20/2021] [Accepted: 05/01/2021] [Indexed: 12/26/2022] Open
Abstract
AIM Cabotegravir long-acting (LA) intramuscular (IM) injection is being investigated for HIV preexposure prophylaxis due to its potent antiretroviral activity and infrequent dosing requirement. A subset of healthy adult volunteers participating in a Phase I study assessing cabotegravir tissue pharmacokinetics underwent serial magnetic resonance imaging (MRI) to assess drug depot localization and kinetics following a single cabotegravir LA IM targeted injection. METHODS Eight participants (four men, four women) were administered cabotegravir LA 600 mg under ultrasonographic-guided injection targeting the gluteal muscles. MRI was performed to determine injection-site location in gluteal muscle (IM), subcutaneous (SC) adipose tissue and combined IM/SC compartments, and to quantify drug depot characteristics, including volume and surface area, on Days 1 (≤2 hours postinjection), 3 and 8. Linear regression analysis examined correlations between MRI-derived parameters and plasma cabotegravir exposure metrics, including maximum observed concentration (Cmax ) and partial area under the concentration-time curve (AUC) through Weeks 4 and 8. RESULTS Cabotegravir LA depot locations varied by participant and were identified in the IM compartment (n = 2), combined IM/SC compartments (n = 4), SC compartment (n = 1) and retroperitoneal cavity (n = 1). Although several MRI parameter and exposure metric correlations were determined, total depot surface area on Day 1 strongly correlated with plasma cabotegravir concentration at Days 3 and 8, Cmax and partial AUC through Weeks 4 and 8. CONCLUSION MRI clearly delineated cabotegravir LA injection-site location and depot kinetics in healthy adults. Although injection-site variability was observed, drug depot surface area correlated with both plasma Cmax and partial AUC independently of anatomical distribution.
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Affiliation(s)
| | - Edward J Fuchs
- Departments of Internal Medicine and Radiology, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | | | | | | | - Katarzyna J Macura
- Departments of Internal Medicine and Radiology, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Michael A Jacobs
- Departments of Internal Medicine and Radiology, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ethel D Weld
- Departments of Internal Medicine and Radiology, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Meiyappan Solaiyappan
- Departments of Internal Medicine and Radiology, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | | | | | | | - Susan Ford
- GlaxoSmithKline, Research Triangle Park, NC, USA
| | | | | | | | - Craig W Hendrix
- Departments of Internal Medicine and Radiology, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Parul Patel
- ViiV Healthcare, Research Triangle Park, NC, USA
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